the program was funded by the australian government department of health and aging , and developed and implemented by trauma , disaster and health promotion experts from the australian centre for posttraumatic mental health ( acpmh ) , the mater hospital brisbane and beyondblue as part of the victorian government s bushfire psychosocial recovery plan .
key activities of the program included : formation of expert advisory and reference groups comprised of key government and non - government stakeholders to provide oversight and advice on the development and implementation of the program , including integration with other initiatives and existing resources extensive consultation with disaster recovery experts and key personnel from government and non - government organizations to assist with developing the program the target audience was lay people from the general community including people with a high community profile such as those working in disaster support and recovery roles , and members of local sporting and community organizations .
the learning objectives for participants were : to improve their knowledge of different psychological responses , common mental health problems , and individual , family and community - level reactions following disaster to increase confidence in their abilities to detect clues that someone may be having difficulties coping , to ask questions and listen to that person , and to provide support to them to improve their knowledge of how and when to refer people to professional support and of local services and supports .
the face - to - face training sessions were educational and provided an opportunity for discussion , reflection , and skill development .
versions of the program that were available were of 90 , 120 , and 180 min duration .
the structure and duration of the program was designed to best meet the needs of community members , many of whom were dealing with demanding practical issues . following the training ,
participants were supported via newsletters and emails for a further three to six months to reinforce key competencies and information about available services .
the program materials developed included : a facilitator manual which included advice on preparing to run a session and engaging with local communities , session plans and schedules , and sample responses to frequently asked questions a participant manual which included useful information on disaster recovery and mental health supports participant handouts to provide advice on recovery from disaster audiovisual materials , including powerpoint slides and a dvd of interviews with survivors of previous bushfires posters and other promotional materials a webpage with training session dates and resources .
the promotion of the program within disaster - affected communities relied upon a community development approach that included proactive and sensitive engagement and collaboration with key community agencies such as local recovery committees , primary health services , and community and sporting clubs .
nine facilitators were recruited and formally trained and accredited in a single day to prepare them to run the training sessions .
facilitator prerequisites were a tertiary mental health qualification ; two years minimum experience as a mental health practitioner ; and previous experience of facilitating training sessions in community settings . prior to each training session ,
the project manager , facilitator and local host held a teleconference to brief the facilitator on local issues and the planned session .
a meal was often provided to create an opportunity for community members to meet others in an informal way . following each training session , the project manager contacted the facilitator to review proceedings and offer support and advice .
participants learnt about common psychological and relationship problems ( including risk and protective factors ) following disaster , with the aim of reducing stigma and improving understanding and empathy for others in the community . in order to develop greater confidence and better skills to listen to and assist others ,
the program encouraged participants to consider and rehearse what they would say and do when approaching someone .
the focus for participants was on assisting others , including active listening and encouraging them to seek professional help if necessary , rather than becoming experts in mental health diagnosis or treatment .
some simple tips discussed with participants to help them initiate and manage a conversation with another person included : start with practical questions such as  how is the clean - up coming along ?  try to normalize the person s distress to encourage them to talk , for example you could say 
how are you managing ?  choose a time to talk when you are less likely to be interrupted and when you are available to spend some time with the person there is no  right thing  to say , but try not to talk too much about yourself or use 
conversation stoppers such as  you should think yourself lucky , it could have been worse  if you identify that the person needs extra help , such as showing signs of a mental health problem , then the priority is to refer them to local services for assistance .
participants were given the opportunity to rehearse  opening lines  when approaching someone , and were encouraged to incorporate these simple tips when initiating conversations with fellow community members .
to evaluate the effectiveness of the program , participants were asked to complete an anonymous survey to obtain pre and post - training self - report ratings by participants on key competencies tied to the learning objectives of the training session , and post - training ratings on the quality of the session and materials .
ratings of key competencies were provided on a four - point scale : 1 = very little or none , 2 = a little , 3 = quite a bit , and 4 = a great deal .
paired samples t - tests were conducted to compare pre- and post - training participant ratings , and cohen s d was calculated as a measure of the standardized difference between rating means at the two time - points . in total , 51 training sessions were attended by 909 community members from april 2009 to december 2010 .
surveys were completed by 462 ( 80.1% ) of 577 eligible people who attended one of 39 sessions run between august 2009 and october 2010 .
the mean age of participants was 48.1 y ( sd = 12.9 ) and the majority ( 60.4% ) were women .
thirty - three ( 84.6% ) of the training sessions delivered were of 180 min duration .
comparisons between community members pre- and post - training ratings showed substantial and significant increases in knowledge of post - disaster reactions and mental health problems ; confidence in abilities to detect difficulties coping in others and to provide assistance ; and knowledge of available services and supports and how and when to refer someone ( see table 1 ) .
cohen s d values ranged from 0.55 to 0.75 which are indicative of moderate to large effect sizes .
the similarity of scores for all items at both respective time - points may be indicative of response bias , such as the general tendency to avoid extreme response options .
in addition , a typical pre - training mean score of 2.5 on a four - point scale may have inadvertently led to a ceiling effect on the post - training ratings . note .
sd , standard deviation ; scores for items 1 to 8 ranged from 1(very little or none ) to 4 ( a great deal ) .
the large majority of community members who attended the program rated the quality of the program and materials highly , with at least 98% indicating that they agreed or strongly agreed with the following : the session was interesting ; the information was clearly provided ; the discussion was useful ; there was enough time for questions ; the participant manual was user - friendly ; and a willingness to recommend the program to others .
the study findings provide support for the community support training program as a beneficial , acceptable and feasible community - level intervention as part of a coordinated and early mental health response to communities affected by the 2009 victorian bushfires .
reports from community members indicated that the program increased key competencies to help them recognize when others may be having difficulties coping and to provide them with care and assistance .
in addition , the quality of the program was rated very highly by the large number of people who attended local training sessions in the aftermath of a natural disaster .
the acceptability of the program is further supported by the finding that almost all participants reported that they would recommend the program to others .
a limitation of the study is the lack of follow - up data to determine whether or not the training resulted in sustained improvement of participants competencies , and whether or not the training program resulted in participants providing more or improved assistance to others at risk of mental health problems . to address this limitation
, we are seeking to undertake a more extensive evaluation of the program that incorporates more direct assessment of community members competencies and helping behaviors at follow - up .
ideally , more sophisticated testing of the effectiveness of the training program would include a control or comparison group using an experimental research design .
first , the program demonstrated that there are excellent opportunities for governments to partner with non - government agencies and local communities on disaster mental health training programs for community members .
second , the delivery of the program used a community development approach that relied upon collaboration with existing community networks and recovery systems in order to facilitate delivery of the program by local trainers . this type of approach is consistent with wider efforts to protect and develop the adaptive capacities of disaster - affected communities .
third , quality assurance measures for this program included governance arrangements to ensure coordination and integration with other disaster recovery initiatives and existing resources ; design of the training sessions and materials by an expert group comprised of trauma , disaster and health promotion experts ; and recruitment of trainers who met minimum prerequisite mental health and training qualifications .
fourth , the program met minimum standards of disaster mental health training programs by making explicit the objectives , target audience , training topic and focus , means of delivery , measurable outcomes , and evaluation procedures .
finally , the study used quantitative measures of participants competencies to make comparisons between the pre - and post - training time - points . since the implementation of the program as part of the psychosocial response to the 2009 victorian bushfires ,
the program has been modified for use in the aftermath of other types of natural disaster , and has subsequently been delivered in several other disaster - affected regions across australia with an expanded pool of facilitators .
the program was funded by the australian government department of health and aging , and implemented as part of the victorian government s bushfire psychosocial recovery plan .
 this study reports data on a disaster mental health training program to enhance the capacity of lay people from disaster - affected communities , to provide assistance to others following a bushfire disaster . 
 local facilitators conducted training sessions which were actively promoted within communities . 
 participants were asked to complete an anonymous pre- and post - training survey to obtain data on the impact and quality of the training program . 
 responses from 462 ( 80% ) of 577 people who attended 39 sessions showed substantial and significant increases in key competencies including confidence in their abilities to detect difficulties coping in others and to provide assistance . 
 the quality of the program and materials were rated highly . 
 the findings of the evaluation provide support for the program as a beneficial , acceptable and feasible community - level intervention following disaster . 
Design and development
Delivery
Evaluation
Acknowledgments