Families need to be assessed multi-dimensionally, which includes their general and specific culture, group contexts, lifestyle, value base and developmental stage. Information about families may be obtained from their local networks and community services. Families include parents, children and grandparents. Other members in the same household including relatives and friends, extended households and even close family members who were not in the disaster area at the time may form parts of assessments. Pets and toys should also be included whenever practicable. Assessments must balance the family as a unit and its members as individuals. Special importance of family assessments rest with the information which they supply about children. A critical aspect of the assessment process is to identify and support a family's normal recovery processes and identifying ways in which they can identify their own needs, recognise need for specialist assistance and be aided and supported. Assessment may be used to guide families in their own recovery and to prevent future difficulty. The following points should be noted in family assessments: • It is critical to ensure that all members of the family and other residents in the household are included in assessments from infants to the older generations. • Families may ‘protect’ vulnerable members from scrutiny or use them as projections of their own distress. • Wider family networks, which suffer secondary stress, should be assessed in their own right.
24 • The same ethics, such as of privacy and confidentiality (Appendix C), apply to family assessments as for those of individuals. Adults
While adults are assessed as parts of communities and families, who may give information about individuals, adults should be assessed individually as well. Similarly, adults’ subjective assessments and self-assessments depend both on their perceived roles and execution of their responsibilities within them, as well as on highly subjective experiences and responses. These will be influenced by age, family status and specific capacities and vulnerabilities.
Losses of social support and networks may influence individual responses adversely, while their presence may ameliorate severe responses. During assessment the following points should be noted: • Affected individuals do not always recognise or report their difficulties and may need encouragement to do so. For instance being given information about common stress reactions may lead to people realising that they too are experiencing them. • Assessment must be undertaken in a manner space and setting congenial to the person. Privacy, confidentiality, dignity and rights as well as special needs of the person should be respected at all times (Appendix C). • Individuals may fluctuate in their functioning at different times in different roles and in different circumstances. For instance, an individual may help others at one point in time but at another focus on themselves. • Assessments should include adaptive and maladaptive biological, psychological and social responses. Diagnosis of these responses may be attempted by tracing them back to their origins in specific situations in the disaster (Appendix B). • Past strengths and vulnerabilities, especially in similar past situations may help predicting future coping and planning for special needs. • Continued unabated distress or total cutting off of feelings (dissociation) for more than a week may be predictive of longer-term adjustment difficulties.