ABC OF CARE FOR VICTIMSWhat is the aim of Law 1448 of 2011? (Enacting comprehensive measures of care, assistance and reparation to the victims of the internal armed conflict and other provisions)The purpose of Law 1448 of 2011 is to “establish a group of judicial, administrative, social and economic measures, individual and collective, to benefit the victims of the violations referred to in Article 3 of this Law, within a framework of transitional justice, that will allow the enjoyment of their rights to truth, justice and reparation with guarantee of non-repetition, for them to be recognized as victims and to be dignified through the realization of their constitutional rights.” Article 3 of Law 1448 of 2011 defined the victims as “those persons who individually or collectively have suffered damage from events occurring from January 1, 1985, as a result of violations of international humanitarian law or serious and flagrant violations of international standards of human rights that occurred because of the armed conflict.” What is the Program for Psychosocial Care and Comprehensive Health for Victims of Armed Conflict?The Program for Psychosocial Care and Comprehensive Health for Victims of Armed Conflict, hereinafter PAPSIVI, which is in the following document, is part of the relief and rehabilitation measures enshrined in Law 1448 of 2011, which seek to restore the physical conditions.What is the Program for Psychosocial Care and Comprehensive Health for Victims of Armed Conflict (PAPSIVI) about?The Program provides guidelines, strategies and actions designed by the Ministry of Health and Social Protection to comply with regulations regarding reparations for victims, specifically in regard to relief and rehabilitation measures established in Law 1448 of 2011. Therefore, the Ministry of Health and Social Protection establishes and coordinates the number of new measures articulated with other stakeholders of the National System for Care and Reparation for Victims, SNARIV, and with the actors of the General Social Security System (SGSS) in accordance with the competencies defined in Laws 100 of 1993, 715 of 2001, 1122 of 2007, 1438 of 2011 and the principles of subsidiarity, complementarity and competition. The program is founded on regulatory and conceptual bases and it consists of two (2) large specific components: psychosocial care and comprehensive health for victims of armed conflict, which are articulated through simultaneous and cross-cutting coordination strategies between different local governments, joint construction with all actors responsible for implementation and the victims and their organizations, human talent training and tracking, monitoring and feedback.What is the intent of the Program for Psychosocial Care and Comprehensive Health for Victims of Armed Conflict?In this sense the spirit of the Program for Psychosocial Care and Comprehensive Health for Victims of Armed Conflict is to contribute to the effectiveness and enjoyment of the right to life, health, equality, liberty, honor, participation and peace among other fundamental rights in our Constitution and updated by the political and social will to recognize the direct damage and effects the internal armed conflict in a large segment of the population.Likewise, the incorporation of this approach in the PAPSIVI actions means understanding the victims as subjects of rights, who seek to overcome the victimization events with access to truth, justice and reparation as established in Law 975 of 2005 ; the right to the truth about the circumstances and reasons of the acts of victimization, and the whereabouts of their dead or missing loved ones; the investigation of crimes and the subsequent trial and conviction of those responsible and; measures of reparation, including restitution, rehabilitation, compensation, measures of satisfaction and guarantees of non-repetition and which thus represent “damage mitigation, the recognition of the dignity of victims, compensation for losses, aid for the reconstruction of life and the implementation of measures to avoid repetition of violations.” What are the objectives of the Program for Psychosocial Care and Comprehensive Health for Victims?GENERAL PURPOSEEnsure psychosocial care and comprehensive care in physical and mental health with a psychosocial approach to victims of Gross Violations of Human Rights and International Humanitarian Law Violations in the context of the Colombian armed conflict.SPECIFIC OBJECTIVES1. To mitigate the impact and damage to the psychological and moral integrity, the life project and life in relationship, in relation to the violence to victims by the armed conflict, from psychosocial care processes for individuals, families, groups and the community.2. To establish mechanisms that will enable local authorities the assurance of comprehensive health care with psychosocial approach to victims of armed conflict, under the framework of the Social Security System in Health.3. To contribute to the restoration of the physical, mental and psychosocial conditions of the victims.How has the Program for Psychosocial Care and Comprehensive Health for Victims been developed?In this context, the PAPSIVI (the Program for Psychosocial Care and Comprehensive Health for Victims) is the result of the first phase of a joint construction process within the Ministry of Health and Social Protection, that although complying with the mandate of Article 137 of the Victims Law, it also includes the learnings and development of this Ministry’s mission response to victims of forced displacement in relation to the discussion on mental health policy for the country and especially in the qualification that has been required for compliance with the judgments, rulings and orders by the Constitutional Court to safeguard the rights of the victims of the armed conflict in Colombia.In this regard, the PAPSIVI will continue the construction and joint consultation process, and it is considered a binding technical tool for officials in public and private institutions of the Social Security System in Health SGSSS , while serving as a reference for other entities or organizations involved in repair processes to victims of armed conflict.What is the scope of the Program for Psychosocial Care and Comprehensive Health for Victims?As part of the rehabilitation measure in the framework of the comprehensive reparations specified in Regulatory Decree 4800 of 2011, PAPSIVI is the technical line that allows the different stakeholders to address the psychosocial impact and damage to the physical and mental health of victims caused by or in connection with the armed conflict, at the individual, family and community levels (including the subjects of collective repair), in order to alleviate their emotional suffering, contribute to their physical and mental recovery and reconstruction the social fabric of their communities. This technical line will be developed under the provisions of the strategy of Primary Health Care, APS, which shall be implemented through the Public Health Ten Year Plan.As an inter-sector coordination strategy, Primary Health Care, APS, allows comprehensive and integrated care, from public health, health promotion, disease prevention, diagnosis, treatment, rehabilitation of victims at all levels of complexity in order to guarantee a higher level of welfare. This strategy, to be regulated in the Ministry of Health and Social Protection, shall consist of three integrated and interrelated components: i) health services, ii) inter-sector/trans-sector care for health, and iii) social, community and citizen participation.What is comprehensive health care?Comprehensive health care is understood as “the essential activities to meet the health needs of the target population and that are provided by the institutions providing health services (IPS) and it includes all activities, interventions and procedures in its promotion, prevention, treatment and rehabilitation components, which will enable the affected population to recover its physical, emotional and psychological integrity.”Comprehensive health care to victims should adhere to the principles of the General System of Social Security in Health under Article 3 of Law 1438 of 2011 and the principles of care for victims identified in this Program.What is involved in health care?Do no harm: Avoid promoting new situations where victims feel attacked, stigmatized, marked or ignored because this would lead to exacerbation of the damage and re-victimization. Even if the contact is short and it is only part of a larger chain of care, each contact is unique and irreplaceable as an opportunity to make a difference compared to the history of relations that have victimized them and to contribute to building a new relationship with the State.A relationship with the victims, their families and communities must be built based on trust and empathy. Therefore, it is important that professionals build empathetic bonds, seeking to dignify the contact and attention processes where the victims, their families and communities feel that they are recognized, heard, considered and respected. Attitudes, behaviors, beliefs and knowledge by the professionals are also important to be in line with what the person needs and with what the person has experienced, showing concern for the people, but also for their stories and accounts.Dignity: The axiological foundation of the right to truth, justice and reparation is to respect the integrity and honor of the victims. The victims will be treated with consideration and respect, they will be involved in decisions that affect them, for which they will have the information, advice and support needed and they will obtain the effective protection of their rights under the constitutional mandate, positive duty and principle of dignity.The State undertakes to conduct mainly actions aimed at strengthening the autonomy of victims so that the care, assistance and repair measures provided for in this law contribute to their recovery as citizens in full exercise of their rights and duties. Principle of Good FaithThe State will presume the good faith of the victims covered by this law. The victim can prove the damage suffered, by any legally accepted means. Consequently, it will suffice that the victim summarily demonstrate the damage to the administrative authority, for it to proceed to relieve the victim of the burden of proof. Joint participationTo overcome the manifest vulnerability of victims involves performing a series of actions as are: the duty of the State to implement the care, assistance and repair measures to the victims. The duty of solidarity and respect by the civil society and the private sector with the victims, and support to the authorities in the repair processes; and the active participation of victims. “Law 1448 of 2011, known as the “Victims Law,” is advancing in the recognition of the rights of victims of human rights violations and breaches of international humanitarian law to actively participate in all phases of implementation of the public policy in care and repair. The Law not only recognizes participation as a right in itself, but it also provides some mechanisms to guarantee it. Mutual RespectThe actions of officials and the requests raised by victims in proceedings under this law shall be governed always by mutual respect and cordiality. The State shall remove administrative barriers that prevent the real and effective access of victims to care, service and repair measures. ProgressivenessThe progressive principle implies a commitment to initiate processes that lead to the effective enjoyment of human rights, an obligation that is combined to the recognition of a few minimum or essential contents of satisfaction of those rights which the State must guarantee to all persons, and must gradually increase them. GradualismThe principle of gradualism involves State responsibility for designing operational tools with defined scope in time, space and budget resources to allow the phased implementation of programs, plans and projects of care, assistance and repair, while recognizing the obligation to implement them throughout the country in a given period, respecting the constitutional principle of equality. Complementarity principleAll care, assistance and repair measures should be established in harmony and must strive for the protection of the rights of victims.Individual reparations, whether administrative or judicial, together with collective reparations or to collective groups, should be complementary to achieve comprehensiveness. Harmonious Collaboration State institutions must work in harmony and coordinately to fulfill the purposes of this law, without prejudice to their autonomy. These principles are a reference for setting up a differential form of care for victims from a psychosocial approach within the framework of the repair. These principles should guide the work of care teams and officials responsible for the implementation of this program, so that the processes are tailored to the needs of individuals, families and communities who have been victims of political violence and armed conflict in Colombia.National Incidence Area. May 2012. “Observations and recommendations to ensure the effective participation of victims in the design, monitoring and evaluation of public policy for assistance and repair of Law 1448 of 2011.”Who is responsible for the implementation of comprehensive health care?To implement care actions, different stakeholders will concur (Local Health Offices, DTS, Health Promoting Companies, EPS, Health Service Provision Institutions, IPS, etc.) who, working in coordination, will establish tasks for care of the damage and the effects caused by the armed conflict, as yet another determinant in health, with emphasis on:− Health Promotion and Disease Prevention− Inter-sector actions to impact the determinants− Culture of self-care− Individual, family and community guidance− Inter-culturalism (other cultural alternatives for health care)− Human talent organized in qualified multidisciplinary teamsEach local authority, in accordance with existing regulations regarding health and care for victims, and administrative, financial and management capacity, will ensure the creation of comprehensive and suitable basic health care teams covered by the Primary Health Care strategy. This will enable complete, adequate and special promotion and prevention of all events of interest in public health as well as the detection of cases which, in the context of armed conflict, are unapparent for various personal, cultural or social factors that hinder it, as in the case of gender and sexual violence.What is psychosocial care?The term psychosocial care is understood as “the articulated service processes that aim to mitigate, overcome and prevent damage and impact to the psychological and moral integrity, to the life project and life in relationship, to the victims, their families and communities due to serious human rights violations and breaches of international humanitarian law.”What is psychosocial approach?In the PAPSIVI development, the psychosocial approach should be transversal to all actions taken on behalf of mental health in the terms raised by the Constitutional Court decision T -045: “mental health care that allows the victims’ recovery, which should include the need to break the isolation, acknowledge their experience of fear, identify their diseases, allow them to talk about their feelings of shame and guilt, and break the taboos that fuel them. And, most importantly, allow them to talk about what they experienced and facilitate community reflection, combating stigma and promoting positive attitudes that allow recognition of victims” WHO (2004) cited in (Judgment T-045, 2010).What is mental health?When referring to mental health, the focus is not the mental illness or disorder. What is at the center of the debate and of the psychosocial care of victims is the impact of the serious violations of human rights and breaches of international humanitarian law. To that extent, the care of these victims involves different forms of action or psychosocial care, because although it is important to continue with the strategy of comprehensive health care and mental health, it is also necessary to give this action a different connotation.What is a differential approach?Under Law 1448 of 2011, the differential approach is considered one of the general principles governing the same and it is stated in Article 13: The principle of differential approach recognizes that there are populations with particular characteristics because of their age, gender, sexual orientation and disability. For this reason, measures of comprehensive reparation, humanitarian aid, care and assistance established in this law will have such an approach. “The state will offer special guarantees and protection measures for groups at higher risk of violations referred to in Article 3 of this Law, such as women, youth, children, seniors, people with disabilities, farmers, social leaders, members of trade unions, human rights defenders and victims of forced displacement.To this end, in the implementation and adoption by the National Government of repair and assistance policies in developing this law, differential criteria shall be adopted to meet the characteristics and vulnerability of each of these population groups.Similarly, the State will make efforts to ensure that the care, assistance and repair arrangements contained herein will contribute to the elimination of discrimination and marginalization schemes that could have triggered the victimizing events.” Are there measures for each population group in the application of measures of comprehensive reparation, care and assistance to the victims?Yes, there are policy measures for women in restitution processes, which are set out in Articles 114 to 118 and a specific chapter on the comprehensive protection of children and adolescent victims. And Article 205 orders the issue of decrees with the force of law for the regulation of the rights and grantees of victims that are indigenous peoples and communities, Roma and black, Afro Colombian, from the Archipelago and from Palenque, that have already been developed and are current. Who is considered a victim?According to Law 1448 of 2011, Article 3 states that the victims are:• Those persons who individually or collectively have suffered harm for events occurring as of January 1, 1985, as a result of violations of international humanitarian law or of serious and manifest breaches to international standards of human rights that occurred due to the internal armed conflict.• The spouse, permanent partner, same-sex couples and relatives in the first-degree of kinship, first degree of direct kinship by adoption of the victim, when the latter has been killed or is missing. In the absence of these, they are those who are in the second degree of kinship upward.• Likewise, people who have suffered harm in intervening to assist victims in distress or to prevent victimization.• The condition of victim is acquired independently from the perpetrator of the offense being individualized, apprehended, prosecuted or convicted and the relationship that may exist between perpetrator and victim.Paragraph 4 of Article 3 states that people who have been victims for acts occurring before January 1, 1985 are entitled to the truth, symbolic reparation measures and guarantees of non-repetition.What are the components of the health care program?The program consists of two major components:• Psychosocial care. This includes individual, family and community actions, which are based on characterization and/or psychosocial diagnosis of damage suffered by the victims.• Comprehensive health care. It provides continuity to health care initiated in the assistance measure and it develops rehabilitation actions in physical and mental health.Is there special care for abused women?Yes, particularly in the case of women victims of sexual abuse in the context of armed conflict, such as rape, abuse and sexual slavery, sexual exploitation, trafficking for sexual exploitation, forced pregnancy and forced sterilization (see Annex 1). Law 1164 of 2007 establishes that comprehensive care will be provided following the principles and parameters of humanity, dignity, responsibility, prudence and secrecy. Humanity involves basing the act of health care in the biological, psychological, social and even spiritual needs of women victims.According to Law 1257 of 2008, victims of sexual violence are entitled to receive comprehensive care through services with sufficient coverage, accessibility and quality, to receive clear, complete, accurate and timely information regarding their rights, to give informed consent for medical and legal examinations, to choose the sex of the authorized person to practice them within the possibilities offered by the service, to receive clear, complete, accurate and timely information in relation to sexual and reproductive health, to be treated with reservation of identity when receiving medical, legal, or social assistance regarding personal data, those of their descendants or those of any other person under the person’s care or custody, to receive specialized and comprehensive medical, psychological, psychiatric and forensic care in the terms and conditions set forth in the legal system for themselves and their children.Therefore comprehensive care processes for these persons should include:a) Emotional Supportb) Addressing of all health conditions related to sexual violence as are: medical/psychological - trauma emergency, poisoning, general health care, etc., as well as specific medical care, such as emergency contraception, STI and HIV prophylaxis, hepatitis B, Voluntary Termination of Pregnancy, VTOP, etc.c) Performance of forensic evidence collection when necessaryd) Implementing of all protective measures for victimse) Performance of treatment and rehabilitation on the victim for mental healthf) Guidance at the family level g) Performance of the complaint, reporting and documentation of sexual violenceh) Activation of the various institutional, community and family support networks to facilitate the victim’s comprehensive care.i) By institutions, assurance that victims of sexual violence are NOT violated again during the care process.How will the psychosocial care be implemented?Psychosocial care will be conducted by interdisciplinary teams of professionals with training and experience in psychosocial and community care with victims or vulnerable population. To ensure psychosocial care, these teams need to develop skills in listening, empathy and integration and appreciation of differences and the capabilities and potentialities of population, because in community settings, it is important for them to maintain respect for such differences, since these constitute the starting point for social and cultural appropriateness of the strategies or tools to be used.How is psychosocial care operational?Psychosocial care is implemented through individual, family and community care. In whatever form, this care, in all its modalities, will be developed from guidelines or protocols developed by the Ministry of Health and Social Protection for this purpose, taking into account the action plans built together with the victims.The different modalities of care will be implemented in four phases, with the following activities:a. Individual psychosocial carePHASES OBJECTIVE ACTIVITIES RESPONSIBLE ACTIONS/ACTIVITIESPHASE I TARGETING AND CONTACT WITH THE VICTIM Establish the first contact with the victim Home visit Psychosocial promoter Presents PAPSIVI. Identifies need for physical or mental health. Performs emotional first aid as appropriate, and refers to psychosocial team. Welcome interview in case of remission Psychology or social work Welcomes and gives information about PAPSIVI. Evaluates needs for physical or mental health and psychosocial care. Refers to Comprehensive Health for Victims protocol and/or to PAPSIVI psychosocial care pathway PHASE II CHARACTERIZATION Individual characterization Interview Psychology Applies individual characterization tool. Evaluates need for health care. Prepares psychosocial care plan. Provides therapeutic support. Refers to comprehensive health protocol accordingly.PHASE III PSYCHOSOCIAL CARE Develop Individual psychosocial Plan Interview Psychosocial team members according to the case 1) Provides contextual information about the SNARIV repair programs and plans. 2) Performs psychosocial support to repair programs and projects as appropriate. 3) Performs tracking of victim’s individual repair process.PHASE IV CLOSING Close Individual care process Interview Psychology or social work Assessment of care process with victim participationb. Family psychosocial carePHASES OBJECTIVE ACTIVITIES RESPONSIBLE ACTIONSPHASE I TARGETING AND CONTACT WITH THE VICTIM FAMILY Establish the first contact with the victim family Home visit Psychosocial promoter Presents PAPSIVI. Identifies need for physical or mental health. Performs emotional first aid as appropriate, and refers to psychosocial team. Welcome interview in case of remission Psychology or social work Welcomes and gives information about PAPSIVI. Evaluates needs for physical or mental health and psychosocial care of family. Refers to Comprehensive Health for Victims protocol and/or to PAPSIVI psychosocial care pathway PHASE II CHARACTERIZATION Family characterization Interview Psychology Applies PAPSIVI family characterization tool. Evaluates family need for health care. Prepares family psychosocial care plan. Provides therapeutic support to family taking into account a differential approach. Refers to comprehensive health protocol accordingly.PHASE III PSYCHOSOCIAL CARE Develop Family psychosocial Plan Family meetings Psychosocial team members according to the case 1) Provides contextual information about the SNARIV repair programs and plans. 2) Performs psychosocial support to repair programs and projects as appropriate. 3) Performs tracking of repair process of victim family.PHASE IV CLOSING Close family care process Interview Psychology or social work Assessment of care process with victim family participationc. Community psychosocial care:PHASES OBJECTIVE ACTIVITIES RESPONSIBLE ACTIONSPHASE I TARGETING AND CONTACT WITH THE VICTIM COMMUNITY Establish the first contact with the target community Targeting upon review of secondary information about the community Psychosocial team (psychology, social work, nurse, sociology, anthropology, psychosocial promoters) Review and analysis of secondary information about the community Visit to the community 1) Identifies: victim population; natural leaders of the community; organizations and organizational processes of the victims in the community; organizations and organizational processes of the community; SNARIV programs; authorities, government agencies and resources; and social and ecclesial actors present in the community. 2) Establishes contact with the victim population, identified organizations and social and government actors. 3) Presents PAPSIVI.PHASE II CHARACTERIZATION Community characterization Meetings. Gatherings Psychosocial team 1) Conducts victimizing context analysis with the victims and their organizations. 2) Performs community characterization according to PAPSIVI tools. 3) Identifies psychosocial care needs in the victim community. 4) Identifies individual or family care needs of a victim and refers to welcome professional in the psychosocial team. 5) Establishes working bonds with the victims, their organizations and other identified community and government stakeholders. 6) Coordinates psychosocial action plans with the victims and their organizations, according to the findings of the community characterization performed.PHASE III COMMUNITY PSYCHOSOCIAL CARE Develop community psychosocial Plan Meetings, gatherings, community events as psychosocial care plan Psychosocial team members according to the case 1) Provides contextual information about SNARIV repair programs and plans. 2) Performs psychosocial support to repair programs and projects as appropriate. 3) Provides information and training to victim community about its rights, the exercise of citizenship, self-care and community mechanisms to overcome the harm suffered. 4) Supports community initiatives that contribute to its repair process. 5) Performs monitoring of reparation process of the victims in the community.PHASE IV CLOSING Close community care process Meeting with the community Psychosocial team Assessment of psychosocial care process with victim participation, organizations and the community at large.How to make use of the health services?Comprehensive health care pathway. The victims may access health services in three ways:1. Spontaneous demand for outpatient services2. Demand for emergency care and3. Referral by local interdisciplinary specialist teams. In all three cases it is important to ensure that the care received by those affected meets the standards of quality, timeliness and relevance agreed with them. They also must involve the basic principles of psychosocial care. Who is responsible for the operation of the PAPSIVI program?The national operation of the program for psychosocial care and holistic health will be the responsibility of the Ministry of Health and Social Protection.The operation of the program will be decentralized, as part of the Strategies of Primary Health Care and Integrated Health Networks adopted by Law 1438 of 2011, reforming the General System of Social Security in Health.Thus, the following are also responsible for the operation of the program:Responsible at the administrative level• The Governors’ Offices• Province and Municipal Health Offices • The municipal Mayors’ OfficesResponsible at the care level:The multidisciplinary psychosocial care teams The Social Companies of the State, ESEThe Institutions Providing Health Services, IPSThe Health - Promoting Companies, EPSThe ICBF partners and strategic alliesCommunities, victims’ organizations, organizations supporting victims, civil society, international cooperation and community psychosocial promotersWhat measures have been undertaken by the Ministry of Health and Social Protection?In response to said Orders and in an attempt to take the necessary measures for the Effective Enjoyment of Rights of the victims of forced displacement, the Ministry of Health and Social Protection has developed eight programs and nine strategies:Order 092 of 2008 and Order 237 of 2008. Promotion of membership and comprehensive health care; psychosocial approach and mental health; Prevention of sexual violence, domestic and community violence; and support for displaced women heads of household to facilitate access to employment and production opportunities and prevention of domestic and employment exploitation.Order 251 of 2008. My rights first: rapid monitoring of vaccination coverage, institutions friendly to women and children, comprehensive care of childhood illnesses, psychosocial approach, mental health promotion, inter-sector approach to sexual and reproductive health and prevention of violence, user-friendly services for adolescents and youth, healthy environments, prevention and eradication of the worst forms of child labor and youth worker protection.Order 004 of 2009, Order 382 of 2010, Order 005 of 2009, Order 384 of 2010 and Order 174 of 2011. Programs of the Assistance Plan for the Displaced outlined in Orders 092 of 2008, 251 of 2008, 006 of 2009, and related, for the comprehensive care to the displaced population, while Safeguard Plans for indigenous peoples and Specific Plans for the Protection of Afro-Colombian communities are formulated.Order 006 of 2009. Design, adoption and implementation of a program for differential protection of people with disabilities and their families regarding forced displacement, Order 052 of 2008, Order 007 of 2009, Order 008 of 2009, Order 314 of 2009, Order 383 of 2009. Programs of the Policy of Assistance for the Displaced on Social Protection stated in Orders 092 of 2008 and related, 251 of 2008, 004 and 005 of 2009 and related, and 006 of 2009, to provide comprehensive care to the displaced population, victim of the armed conflict.Order 116 of 2009. Process and outcome indicators associated with enjoyment indicators for each of Social Protection Programs under the Plan of Assistance for the Displaced: Orders 092 of 2008 and related, 251 of 2008, 004 and 005 of 2009 and related, and 006 of 2009.