Providing Problem Management Plus (PM+) Through Volunteers

Well into the second phase of the project, the organisations who participated in the problem management plus (PM+) training are busy disseminating PM+ across the globe by training staff, supervising role-plays, and starting to provide PM+ sessions to clients. This month we want to highlight the work of the International Federation of Red Cross and Red Crescent Societies Reference Centre for Psychosocial Support (IFRC PS Centre), as one of the nine organisations that attended the PM+ Training of Trainers in Cairo.

With nearly 14 million volunteers and presence in 191 countries, the Red Cross Red Crescent Movement makes up the world’s largest humanitarian network. Volunteers are at the core of all work in the Movement. The IFRC PS Centre is specifically interested in determining the feasibility of employing a mostly volunteer workforce to deliver scalable psychological interventions, such as PM+. A study is now being conducted in Colombia with Venezuelan migrants and Colombian internally displaced persons, led by the IFRC PS Centre and the Colombian Red Cross, with support from Trinity College Dublin. The study will highlight the specific strengths and challenges of working with a network of volunteers to provide mental health and psychosocial support services.

The study started in June 2018 and first looked at adapting the generic PM+ manual, to fit the specific context. In order to do this, the team sat down and reviewed the generic Spanish translated manual available on the World Health Organisation (WHO) website. Their aim was to determine if the illustrations were representative of the community members, if local idioms of distress were included, and if the case studies represented the population that they’d be working with. One of the items that stood out was the illustrations in the manual didn’t fully represent the community they were serving. To mend this, they added illustrations of men and people with disabilities to ensure that the PM+ handouts resembled the community members and to avoid distractions during PM+ sessions.*

After adaptation, they trained Colombian Red Cross volunteers and one staff member to serve as PM+ supervisors, over the course of four days. The four days were packed but each trainee had studied the manual beforehand, allowing them to jump right in and focus on practicing the supervision skills through role-plays and observation after they understood the intervention in depth.

PM+ supervisors from the Colombian Red Cross will co-train Colombian Red Cross PM+ helpers with support from the IFRC PS Centre and they are also looking into the possibility of conducting a refresher training in the future. Following the PM+ helpers training, Colombian Red Cross volunteers will start by practicing role-plays to rehearse the strategies in each session followed by seeing clients who meet the PM+ inclusion criteria.

When asked what strengths have been recognised in the study thus far, Camila Perera from the IFRC PS Centre responded, “the Colombian Red Cross has a very rigorous process for volunteer recruitment and sustained volunteer work. Volunteers are very well established within the organisation and have worked together on numerous humanitarian projects, from psychosocial activities to cash transfers and food distribution. They are very well respected by the community in which they work.”

She continued by talking about the sensitive nature of discussing taboo topics that arise during the screening process, such as suicidality, as being a possible challenge for volunteers. In addition, she stressed that the set-up for training is different to one with a paid workforce. Since they are training volunteers, it is not possible to have consecutive full days of training, only on weekends and public holidays, and most of the training has to be conducted after working hours. Furthermore, she recognised that addressing unconscious judgement and discrimination towards Venezuelan participants will be extremely important during the training and throughout supervision.

The IFRC PS Centre is interested to learn from this experience and gain knowledge that will support them in the implementation of PM+ and other scalable psychological interventions in the future. They plan is to develop an evidence-based protocol indicating, step-by-step, how volunteers with staff support can proceed to implement this type of intervention in the context of the International Red Cross and Red Crescent Movement.

Written by Ashley Nemiro (project consultant) with support from Camila Perera

*WHO encourages anyone using the PM+ intervention to make necessary adaptions for your context and share your feedback. You can find the adaptation information in the manual, available on WHO's website.