Educational tool about trauma, war and PTSD – European Federation of Psychiatric Trainees

Introduction

The Psychiatry Across Borders (PAB) Working Group – part of the European Federation of Psychiatric Trainees (EFPT) – was founded during the EFPT Forum 2016 that took place in Belgium. We aim to improve awareness and knowledge about mental health of forcibly displaced people, asylum seekers and refugees, and transcultural competences for European residents in psychiatry and child and adolescent psychiatry.

Since the beginning of the terrible war in Ukraine, members of the PAB Working Group decided to create a leaflet containing trauma-specific information for health care providers and those affected. With this in mind, we gathered educational material and self-help/informative material. This list is not intended to be exhaustive. The purpose of this leaflet is to provide an overview of the resources we found interesting and useful, specifically focusing on the current war in Ukraine and its consequences on mental health, as well as general material about transcultural psychiatry, trauma, and refugee experiences.

If you have any suggestions to improve this leaflet, please contact us via pab-wg@efpt.eu.

EDUCATIONAL MATERIAL FOR HEALTH CARE PROVIDERS

MAIN SOCIETIES AND ORGANIZATIONS DEDICATED TO TRAUMA

GUIDELINES

RESOURCES ADDRESSING WAR/DISTASTER TRAUMA

CSTS (Center for the Study of Traumatic Stress) provides some evidence-based actions and other resources to protect mental health for those working with refugees and people directly impacted in Ukraine, in different languages:
- War in Ukraine Mental Health Resources
- Information for first responders and healthcare providers on emotional reactions to human bodies in mass death
- Sustaining the psychological Well-Being of caregivers while caring for disaster victims
CSTS (Center for the Study of Traumatic Stress) other resources:
- Helping people after a loss
- Helping students after a disaster
IACS (InterAgency Standing Committee) resource package on mental health and psychosocial support for the humanitarian response in Ukraine and neighbouring countries
- Ukrainian version
ISTSS (International Society for Traumatic Stress Studies) Electronic Pamphlets: pamphlets and fact sheets about trauma-related issues
ISTSS (International Society for Traumatic Stress Studies): webinar “Opportunities and Challenges for the Traumatic Stress Community to Assist those Affected by the War in Ukraine” (29/03/2022):
Mental Health & Psychosocial Support Network (MHPSS.net) Emergency Briefing Kit Ukraine – Russia Conflict (2022): a document in which many tools, guidelines and manuals are provided in different languages
Mental Health and Psychosocial Support Materials from The International Trauma Consortium
Psychosocial support to people in Ukraine and impacted countries – developed by the Psychosocial Support Centre of the IFRC
The Vicarious Trauma Toolkit: Compendium of resources from Office for Victims of Crime (OVC): over 500 tools that organizations can use to became more vicarious trauma-informed, such as procedures, research literature, new tools, links, podcast and videos that can be searched by topic, category, organizational strategy, discipline and CDC code
Phoenix Australia – Disaster Recovery Toolkits: a group of toolkits, each containing information and resources that health practitioners can utilize in their work with disaster-impacted individuals. Some toolkits are arranged by topics that reflect common psychosocial difficulties, others focus on helpful strategies to support recovery. Each toolkit contains brief videos in which experts highlight key, as well as a range of written materials and resources.

SUPPORT FOR CHILDREN AND FAMILIES

RESOURCES FOCUSING ON REFUGEES

Boston Children’s Hospital Refugee and immigrant core stressor toolkit: a toolkit with information about four core stressors that refugees and immigrants may face and sample question to guide the assessment
EthnoMed: A website develops for clinicians and health care providers working whit immigrant and refugee. A source for social and cultural details relevant to clinical care.
Medecins Sans Frontieres (MSF) Low-threshold psychosocial support for refugees and asylum seekers
Understanding refugee trauma in children and families from The National Child Traumatic Stress Network (NCTSN):

VIDEO RESOURCES

ECNP (European College of Neuropsychopharmacology) traumatic stress network – The ECNP Traumatic Stress Network is composed of a group of experts from basic and clinical neuroscience, that will focus on the need to use translational and interdisciplinary approaches to come up with new concepts to target traumatic memories and provide opportunities for secondary prevention. In this site you can find many virtual meetings about “hot topics” in the field.
IACAPAP (International Association for Child and Adolescent Psychiatry and the Allied Professions) – Transcultural psychiatry: challenges with immigrant families and their children (Dr. Marie-Rose Moro)
ISTSS (International Society for Traumatic Stress Studies) Webinar: War in Ukraine – This webinar highlights opportunities and challenges for traumatic stress professionals assisting those affected by the war in Ukraine. Dr. Frankova discusses the current needs of forcibly displaced people and digital interventions developed for people under stress. Next, Dr. Sijbrandij focuses on scalable psychological strategies to prevent or address common mental health problems of people affected by the war in Ukraine. Finally, Dr. Ventevogel presents an overview of how mental health and psychosocial support is integrated into the humanitarian response for Ukrainian refugees.
ISTSS (International Society for Traumatic Stress Studies): Advanced in the Use of Telehealth for the treatment of traumatic stress (Leslie Morland, PsyD)

National Center for PTSD – The PTSD Consultation Program: The PTSD Consultation Program offers consultation, continuing education, and other resources to healthcare providers who treat Veterans with PTSD in the community or in VA. Among the lecture series, all interesting, we recommend:

RC-Psych (Royal College of Psychiatrists):
- WHO mhGAP humanitarian intervention guide – Drs. Peter Hughes FRCPsych and Vitalii Klymchuk, Community Mental Health Services Coordinator at MH4U, presented an overview of the WHO’s mhGAP (Mental Health Gap Action Programme) Humanitarian Intervention Guide, which is a mental health toolkit designed for emergency settings.
- Psychological Firs Aid (PFA) webinar – a webinar on the principles and practice of Psychological First Aid, focusing on the devastating effect of COVID-19 in India and the wider South Asian region. Professor Mohammed Al-Uzri, Professor Richard Williams, Dr Peter Hughes, Dr Anis Ahmed, Dr Sophie Thomson, Dr Bhavana Chawda.
- General principles of Pychological First Aid – Peter Hughes FRCPsych and Vitalii Klymchuk, Community Mental Health Services Coordinator at MH4U, presented an overview of the principles of PFA and its application in crisis settings.

The Schwartz Center for Compassionate Healthcare: Caring with compassion: supporting patients and families in a crisis: Drs. Patricia Watson and Richard Westphal discuss specific strategies healthcare professionals can use to address the essential human needs that support recovery from adversity and stress for patients and families. They also explain how to use the Stress First Aid framework to assess for stress injury, discuss patient needs, and make referral to other supports.

SCREENING AND ASSESSMENT TOOLS

Adult Self-Report Measures from National Center for PTSD:
Adult Trauma Assessment from ISTSS (Clinical Administered PTSD Scale – CAPS-5; Global Psychotrauma Screen – GPS; Primary Care PTSD Screen for DSM-5 – PC-PTSD-5; PTSD Checklist for DSM-5 – PCL-5; Postraumatic Symptom Scale-Interview Version for DSM-5, PSS-I-5):
Assessment Instruments from American Psychological Association:
- Interviews (Clinical Administered PTSD Scale – CAPS-5, PTSD Symptom Scale Interview – PSS-I and PSS-I-5, Structured Clinical Interview PTSD Module – SCID PTSD Module, Structured Interview for PTSD – SIP or SI-PTSD, Treatment-Outcome Posttraumatic Stress Disorder Scale – TOP-8)
- Self-report instruments (Davidson Trauma Scale – DTS, Impact of Event Scale – Revised – IES-R, Mississippi Scale for Combat-related PTSD – MISS or M-PTSD, Modified PTSD Symptom Scale – MPSS-SR, PTSD Checklist for DSM-5 – PCL-5, PTSD Symptom Scale Self-Report Version – PSS-SR, Short PTSD Rating Interview – SPRINT):
Assessment Instruments from CSTS:
- First responders and public health emergency workers
- Addressing alcohol misuse through brief screening and counselling in the military
Assessment Instruments from The International Trauma Consortium
- Mental Health Assessment Materials (demographic questions, questionnaires about depression, anxiety, trauma exposure, PTSD, somatic problems, impairments in living)
- International trauma Questionnaire (ITQ)
- International Trauma Exposure Measure (ITEM)
- International Adjustment Disorder Questionnaire (IADQ)
- International Prolonged Grief Disorder Scale (IPGDS)

Assessment Instruments for Trauma and Mental Health in Refugee from Refugee Health Technical Assistance Center: Harvard Trauma Questionnaire (HTQ), Post Migration Living Difficulties Scale (PMLD), 32-item Resettlement Stressor Scale (RSS), War Trauma Scale (WTS), Comprehensive Trauma Inventory – 104 (CTI-104), Vietnamese Depression Scale (VDS), New Mexico Refugee Symptom Checklist – 121 (NMRSCL-121), Hopkins Symptom Checklist-25 (HSCL-25), Impact of Events Scale (IES), Symptoms Checklist-90 (SCL-90), Posttraumatic Symptom Scale – Self Report (PSS-SR)
Alcohol Screen (AUDIT-C)
Dimensions of Anger Reaction (DAR-5)
Initial primary care screening for severe psychiatric illness after disasters from CSTS
Refugee Health Screener – 15 (RHS – 15)

Child and adolescent trauma assessment

Assessment Instruments from International Trauma Consortium:
- International Trauma Questionnaire – Child and Adolescent Version, ITQ-CA
- Child and Adolescend Trauma Screen, Parent Report Version for 3-6 and 7-17 years old in Ukrainian
Child/Adolescent Trauma Assessment from ISTSS (Acute Stress Checklist for Children, ASC-Kids; Clinician Administered PTSD Scale for DSM-5, CAPS-CA-5; Child and Adolescent Trauma Screen, CATS; Childhood Attachment and Relational Trauma Screen, CARTS; Child PTSD Symptom Scale for DSM-5, CPSS-DSM-5; Child Trauma Screen, CTS; UCLA Child/Adolescent PTSD Reaction Index for DMS-5; UCLA Brief COVID-19 Screen for Child/Adolescent PTSD)
The National Child Traumatic Stress Network (NCTSN) database:
- Reviews of tools that measure children’s experiences of trauma, their reactions to it, and other mental health and trauma-related issues
- Measures that are appropriate for refugee children and families

Complex trauma

National Child Traumatic Stress Network (NCTSN) proposes complex trauma standardized measures, specifying the domains studied by each tool, its format and the targeted age

PSYCHOLOGICAL INTERVENTIONS

ANGER AND IRRITABILITY MANAGEMENT SKILLS (AIMS): a method who provides a wide range of practical skills and tools to manage anger, irritability and develop self-control
COGNITIVE PROCESSING THERAPY (CPT) for PTSD: CPT is a specific cognitive-behavioral treatment that has been shown to be effective in reducing PTSD symptoms. CPT teaches how change the upsetting thoughts and feelings the patient has had since the trauma and is strongly recommended by most of the guidelines for the treatment of PTSD:
- https://www.ptsd.va.gov/understand_tx/cognitive_processing.asp
- https://www.ptsd.va.gov/professional/treat/txessentials/cpt_for_ptsd_pro.asp
- CPT Manual
- CPT resources
- A web-based learning course for CPT
- Knowledge-based CPT course
- CPT Coach (mobile app): A useful tool that helps patient and therapist during CPT:

EYE MOVEMENT DESENSITIZATION AND REPROCESSING (EMDR): EMDR helps processing and making sense of trauma while paying attention to back-and-fourth movement or sound
Mental health interventions for refugee children in resettlement from National Child Traumatic Stress Network (NCTSN)
MINDFULNESS
PRESENT-CENTERED THERAPY (PCT): A time-limited treatment focused on increasing adaptive responses to current life stressor and difficulties that are directly or indirectly related to trauma or PTSD
PROBLEM MANAGEMENT PLUS (PM+) (WHO): An individual psychological help for adults impaired by distress in communities exposed to adversity
PROLONGED EXPOSURE THERAPY (PE): PE teaches to gradually approach trauma-related memories, feelings and situations that subjects have been avoiding since trauma:
- https://www.ptsd.va.gov/understand_tx/prolonged_exposure.asp
- PE Coach (mobile app): It is a mobile app for patients to use with their therapists during PE treatment
PSYCHOLOGICAL FIRS AID (PFA): It is an evidence-informed modular approach to help individuals affected by a disaster or a traumatic incident in the immediate aftermath of the event with the goal to promote safety, stabilize survivors and connect individuals to help and resources.
- Psychological First Aid (PFA) field operation guide (VA)
- Psychological first aid: guide for field work (WHO):
  - Ukrainian version
- Psychological first aid: facilitator’s manual for orienting field workers
  - Ukrainian version
- Psychological First Aid for displaced children and families
- PFA Mobile app: An app that can assist responders who provide Psychological First Aid to adults, families and children:
  - Ukrainian version

Recommendations for dealing with people in crisis situation and following life events
- Ukrainian version
- Russian version
SKILLS FOR PSYCHOLOGICAL RECOVERY (SPR): an evidenced-informed modular interventions that aims to help survivor gain skills to manage distress and cope with post-disaster stress and adversity:
STRESS FIRST AID (SFA): a framework to improve recovery from stress reaction both in oneself and in coworkers:
- Manual
- Workbook
TRAUMA-FOCUSED COGNITIVE BEHAVIORAL THERAPY (TF-CBT): it is an evidence-based treatment for children and adolescent impacted by traumatic life events, that incorporates trauma-sensitive interventions with cognitive behavioral, family and humanistic principles and techniques:
- Course for TF-CBT
- Workbook

TRAUMA SYSTEM THERAPY FOR REFUGEES (TST-R): a comprehensive method for treating traumatic stress, adapted for refugee youth and families who had experienced war and violence prior to resettlement and continue to face ongoing acculturation and resettlement stress.
- Fact sheet
- Culture specific fact sheet
WRITTEN EXPOSURE THERAPY (WET): WET helps find new ways to think about your trauma and its meaning through writing assignments

SELF-HELP TOOLS and INFORMATIVE MATERIAL FOR PATIENTS

GENERAL INFORMATIVE MATERIAL/SELF-HELP TOOLS

SELF-HELP APPs

29k: Mental Health App: section “Coping with War Anxiety”: 29k is an open-source, co-created non-profit app making psychological tools for mental health. In response to the fast-deteriorating situation in Ukraine, they are launching digital tools for Ukrainians who are struggling with anxiety and worry as a result of the war. The tools are available in Ukrainian, Russian, English and Swedish.
ACT Coach: It was developed for people who are in Acceptance and Commitment Therapy in consultation with therapist.
AIMS: I t is designed to help manage anger and irritability.
CBT-i: a mobile app, based on the Cognitive Behavioral Therapy for insomnia, for helping people who experienced symptoms of insomnia or has wrong sleep habits.
Insomnia Coach: app created to help manage insomnia
Mindfulness Coach: an app that will help practice mindfulness meditation.
PTSD Coach: is an app that provides support to people struggling with the aftereffects of trauma by educating users about trauma and posttraumatic stress disorder (PTSD). It also provides tools to identify, track, and manage trauma symptoms, aimed at enhancing problem-solving skills.
- Desktop version
- Guide
PTSD Family Coach: app develop to support family members of those with PTSD.
STAIR Coach: it supplements psychotherapy using Skills Training in Affective & Interpersonal Regulation, that provides users with concrete skills for managing complex emotions and becoming more socially engaged
VetChange: it was created to help users with PTSD to build skills to reduce problem drinking.

TOOLS SPECIFICALLY ADDRESSING UKRAINIAN CONFLICT

Diamociunamano: A group of licensed psychologists and medical doctors provide free mental health counselling for international Ukrainians living abroad and impacted by the current Ukrainian war
ESTSS4Ukraine – Ask the expert: ESTSS offers, in specific dates, therapists and other professional workers to help colleague face with Ukraine war
FIND A CLINICIAN: ISTSS developed an online searchable database to find a clinician, counsellor or mental health professional based on ones location
Friend: this page gives quick and direct online access to the chatbot, which will help quickly cope with the consequences of a traumatic event. In Ukrainian.
It’s complicated: site in English and Ukrainian, aimed at finding a therapist that supports Ukraine with free counselling
Optum: a site full of useful resources (documents, webinars and tips), both in English and Ukrainian
Samopomi: A secured website that provides information and advice how to maintain your mental health, in time of distress in Ukrainian-language
Ukraine take shelter: an independent platform helping to connect Ukrainian refugees with potential hosts and housing

TOOLS FOR CHILDREN, PARENTS AND FAMILIES

Community trauma toolkit: contains resources to help and support adults and children before, during and after a disaster or traumatic event
Center for the Study of Traumatic Stress (CSTS):
- Help children cope during deployment
- Helping children understanding frightening events
- Managing the stress of children after crisis
- Post disaster stress management for parents
Child Protection Global Protection Cluster: How can you support your child during bomb?
- Ukrainian version
- Russian version
European Society for Child and Adolescent Psychiatry (ESCAP):
- A trauma-picture book about help for parents and their children who fled from war and home
- Helping children cope with the stresses of war: a manual for parents and teachers
Helping children cope with grief during war
How to help children during bombing
- In Ukrainian
- List of links with fairy tales to read, listen or watch in the Ukrainian language
- Mental Health and Psychosocial Support Materials from The International Trauma Consortium, therapeutic stories for children – developed by Professor Justyna Ziółkowska at SWPS University, Poland. Available in Ukrainian, Polish, and English.
Military Child Education Coalition (MCEC):
- Anxiety and depression in youth: a military parents’ guide through transition
- Community crises and disaster: a parent’s guide to talking with children of all ages
National Child Traumatic Stress Network (NCTSN) talking children about war
Psychological First Aid (PFA):
- Tips for helping infants and toddlers after disasters (Ukrainian)
- Parents tips for helping preschool-age children after disaster (Ukrainian)
- Parents tips for helping adolescents: Russian version: Ukrainian version:
Traumatic separation and refugee and immigrant children: tips for current caregivers from National Child Traumatic Stress Network (NCTSN)