Pengertian Assesment dan Model Intervensi ACT Penyintas Bencana

Pengertian Assesment dan Model Intervensi ACT Penyintas Bencana - Dari materi pembelajaran Universitas Psikologi kali ini adalah mengenai assesment dan model intervensi pada penyintas bencans. Dalam memahami assesmen terhadap korban bencana sebelumnya harus mengenal terlebih dahulu assesment sehingga mudah dalam menentukan intervensi yang layak dan tepat terhadap penyintas bencana.

Assesment dalam intervensi klinis dan model treatment untuk trauma (ACT) merupakan sekuential dari satu paket assessment dan treatment. Model ACT ini mengintegrasikan 3 protokol dari strategi intervensi pada saat krisis yaitu: seven-stage crisis intervention model, critical incident stress management (CISM) dan the 10-step acute traumatic stress management protocol.

Model intervensi ACT untuk krisis akut dan treatment trauma, yang akan di bahas berikut ini:

• Assessment protocol 
• Komponen yang harus di ases selama krisis 
• Review dimensi biopsikososial dan assessment budaya 
• Skala yang biasa digunakan untuk melakukan assessment krisis, trauma dan kesehatan mental

image source: www(dot)hi-re(dot)nl

Baca juga: Penjelasan Psikologi Industri Organisasi (PIO) Lengkap Hakikat dan Pengertian

Apa itu Assesment?

Tim respon krisis atau crisis response team atau tim garis depan harus melakukan wawancara secara langsung dalam situasi yang belum begitu stabil dan terkadang harus menunda sampai keadaan menjadi stabil dan adanya support atau dukungan. Idealnya sesudah dilakukan asesmen maka akan dilakukan intervensi (tapi tidak selamanya hal tersebut berjalan di lapangan).

Alat untuk melakukan assesment harus memasukan informasi demografik (nama, alamat, nomor telpon, e-mail, dll), persepsi tentang kekuatan dari kejadian traumatis , metode coping, permasalah yang dihadapi sekarang ini, isu keamanan, pengalaman traumatis sebelumnya, dukungan sosial, penggunaan obat-obatan terlarang, kondisi psikiater yang sudah ada sebelumnya, kecenderungan bunuh diri.

Asesment psikologis ataupun psikiatris menrujuk pada proses pengambilan keputusan segera dimana pekerja kesehatan mental menentukan dan melakukan refereal dengan alternative di bawah ini:

• Kasus pasien rawat inap yang emergency 
• Kasus pasien yang rawat jalan 
• Dukungan sosial dan agen sosial service 
• Tidak dibutuhkan referral (rujukan) ke pihak lainnya

Huruf A dalam ACT mencakup assessment krisis dan trauma dan rujukan kepada sumberdaya yang ada dan tepat yang tersedia di dalam komunitas. Untuk kasus psikiatrik biasanya ada akumulasi dari kejadian traumatis sebelumnya (Burgess & Roberts, 2000), biasanya pasien ini memerlukan perawatan secara medis dan obat-obatan (farmakologi), atau kasus gangguan mental, atau pun kecenderungan bunuh diri.

Peranan dari konselor krisis ataupun staf klinis lainnya adalah mengumpulkan informasi yang dibutuhkan untuk menyelesaikan krisis yang dihadapi oleh penyintas. Hasil asesmen akan membantu konselor kesehatan mental untuk mengambil keputusan treatment apa yang akan dilakukan dan dalam jangka waktu berapa lama.

Assessment biopsikososial dan budaya Vandiver & Corcoran (2002)

• Status kesehatan sekarang, sebelumnya, penggunaan obat-obatan farmasi, gaya hidup. 
• Status psikologis penyintas, kondisi kesehatan mental, penampilan dan perilaku, bahasa dan bicara, proses berpikir dan isi pikiran, mood dan perasaan, fungsi kognisi, konsentrasi, memori dan intelegensi secara umum. Assessment tambahan untuk melihat kecenderungan untuk bunuh diri dan harus segera di rujuk ke pihak lainnya. 
• Pengalaman sosiokultur dan budaya dari penyintas, termasuk: etnis, bahasa, asimilasi, akulturasi, keyakinan spiritaual, konseksi lingkungan, dukungan sosial

Proses assessment harus mempersiapkan metode bertahap dalam mengeksplorasi, mengidentifikasi, menggambarkan, mengukur, mengklasifikasi, mendiagnosa kondisi kesehatan mental, kondisi lingkungan, resilientsi, protektif faktor, gaya hidup sehat/positif, dan level keberfungsian seseorang.

Asesment Biospsikososial menurut Austrian (2002):

• Data demografis 
• Nomor yang bisa dihubungi dari agen/psikiater/psikolog sekarang atau sebelumnya 
• Kondisi medis, psikiatris, dan penyalahgunaan obat-obatan 
• Resume kondisi penyintas 
• Permintaan dari penyintas 
• Permasalahan yang dihadapi berdasarkan penuturan penyintas ataupun konselor 
• Kontrak kesepakatan

Sumber assessment (Sophie Woo: Professor, Dept of Psychology AU)

Laporan penyintas dan hasil interview: keuntungan menggunakan assessment ini adalah ketersediaan data di lapangan, tidak memerlukan peralatan yang khusus dan tidak perlu melakukan training mengenai alat test tesebut, ada format interview dan laporan penyintas yang terstandard dan valid, banyak informasi yang tersedia dan bisa diinterpretasikan.

Tes Psikologi:

• a. Test neuropsikologi
• b. Test intelegensi
• c. Tes kepribadian
• d. Test Rosarch 

Pengukuran psikologis: pengukuruan kondisi fisiologis seperti tekanan darah, detak jantung, respon elektrik dari otak, hormone stress dll

• Rekam data pribadi, medis ataupun psikologis yang resmi 

Yang harus diassesment adalah kondisi fisik, psikologis, emosi dan perilaku:

Rencana dan melakukan assessment terhadap kondisi kritis: Asesment kondisi yang bersifat letal

• Membangun raport: mendengarkan secara aktif, paraphrase, menggunakan pertanyaan terbuka dan tertutup. 
• Identifikasi permasalahn 
• Deal dengan perasaan penyintas. Para relawan harus mendengarkan dan memvalidasi perasaan dan emosi dari penyintas, mulai mengeksplore coping yang tepat dlaam menghadapi permasalahannya. 
• Mendiskusikan alternative pemecahan permasalahan dengan klien 
• Mengembangkan rencana tindakan atau “action plan” 
• Follow up tentang kondisi penyintas

APPENDIX E. Assessment Tools (sumber: NSW health)

Acute stress disorder measures

Clinician-Administered Measures

Two clinician-administered measures of ASD have been proposed. These measures have the advantage of using clinician’s experience in the assessment of ASD rather than relying on trauma survivors’ self-reports. They share the limitation however, of relating to diagnostic criteria that have not yet been strongly validated (Bryant & Harvey, 2000).

1. Acute Stress Disorder Interview (ASDI)

The ASDI (Bryant, Harvey, Dang & Sackville, 1998) is the only structured clinical interview that is validated against DSM-IV criteria. The ASDI satisfies standard criteria for internal consistency, construct validity, and test-retest reliability. The identification of 91% of trauma survivors who were clinically diagnosed with ASD and 93% of those who had not been diagnosed with ASD, suggests that it is a sound measure to identify those individuals who meet criteria for this disorder. The main advantage of the ASDI is that it is user-friendly and can be administered quickly. These qualities are often necessary when conducting an assessment in the acute trauma setting. The main disadvantage of the ASDI is that it lacks ordinal ratings of each symptom. Accordingly it does not provide ratings of severity or frequency of each symptom.

2. Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)

The SCID-D (Steinberg, 1993) has been offered as a structured interview for ASD. This interview was developed to diagnose dissociative disorders, and it has been subjected to extensive evaluation in this context. However, although the SCID-D is a valuable tool for assessing dissociative disorders, its heavy emphasis on dissociative pathology is offset by a relative neglect of reexperiencing, avoidance, and arousal symptoms. More importantly there are currently no data concerning the utility of the SCID-D in identifying people who meet criteria for ASD.

Self-Report Measures

Self-report measures are descriptive indices of ASD symptoms that individuals complete. It should be understood that self-report measures are NOT diagnostic. Their advantages are that they are simple and time-efficient to administer, and often permit severity ratings. Accordingly, they can be useful to index symptom severity pre- and post-treatment. There are currently two self-report measures available for the assessment of ASD however both need further validation with a wide range of trauma populations (Bryant & Harvey, 2000).

1. Stanford Acute Stress Reaction Questionnaire (SARCQ)

The original SARCQ (Cardena et al, 1991) was a 70-item self-report inventory that indexed all of the ASD symptoms. More recently the SARCQ was refined to a 30-item questionnaire that indexes specific ASD symptoms (Stam, 1996). The major disadvantage of the SARCQ is that it has not been validated against clinician diagnoses of ASD. Accordingly, it is uncertain at this stage how accurately this measure can identify those people who meet criteria for ASD.

2. Acute Stress Disorder Scale (ASDS)

The ASDS (Bryant, Moulds & Guthrie, 2000) is a self-report measure that is based on the same 19 ASD symptoms contained in the ASDI. Each item is scored on a 5-point Likert scale (1=not at all, 5=extremely) and describes the extent to which the respondent is currently experiencing ASD symptoms. This instrument possesses sound psychometric properties and has reasonable predictive ability in identifying trauma survivors who subsequently develop PTSD (ie. 91% sensitivity).

Posttraumatic stress disorder measures
Some of the most commonly used measures to assess PTSD are briefly described below.
For a more comprehensive review see Wilson & Keane (1997).

Clinician-Administered Measures

1. Structured Interview for DSM-IV (SCID-IV)

The PTSD module of the SCID (Spitzer et al, 1996) is the most widely used clinical interview across a range of traumatized populations. One of its advantages is that it provides a comprehensive assessment of the comorbid disorders that can be present in traumatised populations. The SCID-IV has good reliability across clinicians and possesses sound sensitivity and specificity for diagnostic decisions (Kulka et al, 1990). The SCID-IV is limited however, because it indexes the presence, absence, or sub threshold presence of each symptom. Accordingly, it does not permit measurement of changing severity of PTSD. This limits the utility of the SCID-IV in measuring trauma adjustment after treatment.

2. Clinician Administered PTSD Scale (CAPS)

The CAPS (Blake et al, 1990) was designed to index the frequency and severity of each symptom and was intended to be used by clinicians and non-clinicians. It indexes both the 17 primary symptoms of PTSD as well as 8 additional items that index associated features (including guilt, depression and hopelessness). Each scale has clear anchors for both the frequency and severity ratings. The CAPS has credible psychometric properties (Weathers et al, 1992). The CAPS has a very good reputation among clinicians and researchers. Its main flaws are that is has yet to be strongly validated in civilian populations and that it requires considerable time to administer.

3. PTSD Symptom Scale Interview (PSS-I)

The PSS-I was developed to assess the severity of PTSD symptoms over the preceding two weeks (Foa et al, 1993). The items are based on the symptoms listed in DSM-III-R criteria. Its psychometric properties are acceptable and it has good inter-rater reliability for diagnosis and symptom severity. The disadvantages of this scale include its validation being limited to female assault victims, the absence of clear anchors, and the unavailability of lifetime diagnoses (Newman, Kaloupek & Keane, 1996).

4. Diagnostic Interview Schedule (DIS)

The PTSD section of the DIS (Robins et al, 1981) has been primarily used in epidemiological studies. A subsequent version of the DIS also included a Disaster Supplement (DIS/DS) which has been used in a number of community studies (Robins & Smith, 1983). The DIS was developed to be administered by trained technicians as opposed to mental health professionals. Accordingly, it is simple to administer. The main disadvantages of the DIS are that it uses a dichotomous scoring system, requires the respondent to link each symptom to a specific traumatic event, and has questionable psychometric properties.

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