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Psychological First-Aid

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Presentation on theme: "Psychological First-Aid"— Presentation transcript:

1 Psychological First-Aid
A Community Support Model No one who experiences a disaster is untouched by it.

2 Psychological First-Aid
A set of skills that helps community residents care for their families, friends, neighbors, and themselves by providing basic psychological support in the aftermath of traumatic events.

3 Psychological First-Aid
A model that: Integrates public health, community, and individual psychology. Includes preparedness for communities, work places, schools, faith communities, and families. Does not rely on direct services by mental health professionals. Uses skills you probably already have. Integrates….in times of disaster or critical incidents that have an impact on the community, public health and community psychology are called upon to respond. Your supervisors (people available to you for questions, support and referral sources) are community psychologists, social workers, counselors and ministers. They are part of an expanding response network. The specific organization of this response will be reviewed later in the training. Includes…. Does not rely….but mental health professionals are available for support. Individual resilience and community resilience are anchored to the ind and comm psychology.

4 Psychological First-Aid Resources
American Red Cross American Psychological Association Centers for Disease Control & Prevention (CDC) Substance Abuse and Mental Health Services Administration (SAMHSA) National Institute for Mental Health (NIMH) Minnesota Department of Health (MDH) Minnesota Department of Human Services Minnesota Hospital Association (MHA) National Center for PTSD, Terrorism & Disaster Branch This is a list of agencies who have been instrumental in the development and promotion of psychological first aid training for behavioral health and other healthcare professionals. For more information, each agency has a website. All agencies listed did develop training specific to Hurricane Katrina responders. This training does not require previous knowledge of psychological principles. It is an entry level training on understanding disaster and critical event response. Minnesota Department of Health is the initiative. Minnesota Department of Human Services is responsible for deploying resources in the event of a disaster.

5 Guidelines A normal reaction to an abnormal situation
Expect and promote normal recovery Assume survivors are competent Recognize survivor strengths Promote resiliency Support survivors to master the disaster experience All Rights Reserved © 2005 DEEP Center / University of Miami School of Medicine

6 All Disasters Begin Locally. Get Prepared Locally!
What is a Disaster? A disaster is an occurrence that causes human suffering or creates human needs that the victim cannot alleviate without assistance. Ask the audience for definitions of Disaster while title is on screen. After definition is shown, ask for local examples of “disasters” i.e.: straight-line winds in BWCA, Benzene Spill, Blizzard of 1990 (Halloween), Blizzard of 1977 (had to dig a tunnel to get to Park Point), others? Local incident in summer 2005 – tanker with 15 metric tons of ammonium nitrate, iranian stowaway aboard and captain committed suicide. In metric tons blew out windows 20 miles away…(ammonium nitrate used for iron mine explosive). Resilience building is anchored in understanding individual difference. All Disasters Begin Locally. Get Prepared Locally!

7 What is a Critical Incident?
A natural or man-made event or situation that has the potential to temporarily overwhelm the ability to maintain psychosocial equilibrium. An event may not qualify as a disaster, but has an impact on the community. Such as suicides or serious accidents. The focus of this slide is on the words “temporary” and “equilibrium”. Symptoms may last longer, or may not emerge immediately, and even if additional help is needed, that is not necessarily an indication that negative effects of the event are permanent. For extreme cases, such as PTSD, negative symptoms can be managed with appropriate support and professional intervention.

8 To the Trainer: The number of people affected psychologically is larger than the number sustaining personal harm, damage to home, or loss of possessions. The size of the “psychological footprint” is larger than the medical footprint. Ex: During the Sept. 11, 2001 terrorist attack, 3,000 people were killed and 7,500 sought medical attention- in fact people all over the world were affected. The term widespread refers to not only larger numbers, but larger geographical area. 8

9 Psychological First-Aid
The Model Skills

10 OUTCOMES SAFETY FUNCTION ACTION SAFETY, FUNCTION, ACTION: Restoring
Psychological First Aid for Disaster Survivors OUTCOMES SAFETY FUNCTION ACTION Restoring physical safety and diminishing the physiological stress response. Facilitating psychological function and perceived sense of safety and control. Initiating action toward disaster recovery and return to normal activity. Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

11 SAFETY SAFETY SAFEGUARD SAFETY, FUNCTION, ACTION: Safety Security
Psychological First Aid for Disaster Survivors SAFETY Safety Security Shelter SAFETY What Survivors Need: SAFEGUARD Remove from harm’s way. Remove from the scene. Provide safety and security. Provide shelter. Reduce stressors. What To Do: Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

12 SAFETY SAFETY SUSTAIN SAFETY, FUNCTION, ACTION: Basic survival needs
Psychological First Aid for Disaster Survivors SAFETY Basic survival needs SAFETY What Survivors Need: Provide food, water, ice. Provide medical care, alleviate pain. Provide clothing. Provide power, light, heat, air conditioning. Provide sanitation. What To Do: SUSTAIN Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

13 FUNCTION FUNCTION COMFORT SAFETY, FUNCTION, ACTION:
Psychological First Aid for Disaster Survivors FUNCTION Soothing human contact Validation that reactions are “normal”. FUNCTION What Survivors Need: COMFORT Establish a compassionate “presence.” Listen actively. Comfort, console, soothe, and reassure. Apply stress management techniques. Reassure survivors that their reactions are “normal” and expected What To Do: Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

14 FUNCTION FUNCTION CONNECT SAFETY, FUNCTION, ACTION:
Psychological First Aid for Disaster Survivors FUNCTION Social supports/keeping family together Reuniting separated loved ones Connection to disaster recovery services, medical care, work, school, vital services FUNCTION What Survivors Need: Keep survivor families intact. Reunite separated loved ones. Reunite parents with children. Connect survivors to available supports. Connect to disaster relief services, medical care. What To Do: CONNECT

15 ACTION ACTION EDUCATE SAFETY, FUNCTION, ACTION:
Psychological First Aid for Disaster Survivors ACTION Information about the disaster Information about what to do Information about resources Reduction of uncertainty ACTION What Survivors Need: EDUCATE Clarify disaster information: what happened what will happen Provide guidance about what to do. Identify available resources. What To Do: Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

16 ACTION SAFETY, FUNCTION, ACTION: ACTION EMPOWER
Psychological First Aid for Disaster Survivors ACTION Planning for recovery Practical first steps and “do-able” tasks Support to resume normal activities Opportunities to help others ACTION What Survivors Need: Set realistic disaster recovery goals. Problem solve to meet goals. Define simple, concrete tasks. Identify steps for resuming normal activities. Engage able survivors in helping tasks. What To Do: EMPOWER Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

17 General Guidelines Tell the truth as it is known, when it is known.
Explain what is being done to deal with the problem. Avoid withholding bad news or disturbing information. Be forthright about what is not known. Provide practical guidance for citizen protection. Use very direct language such as “Dead or die” not “loss or pass” Start slow add details as ready Sources: Glass et al. 2002; Pilch, 2004

18 SAFETY FUNCTION ACTION
Psychological First Aid for Disaster Survivors SAFETY FUNCTION ACTION SAFEGUARD Goal: SAFEGUARD survivors from harm and offer protection. COMFORT Goal: COMFORT support, validate, and orient distressed survivors. EDUCATE Goal: EDUCATE and inform survivors about the disaster, available options for action, and resources for support. SUSTAIN Goal: SUSTAIN survivors by providing basic needs. CONNECT Goal: CONNECT survivors to family, friends, and social supports, EMPOWER Goal: EMPOWER survivors to take first steps toward disaster recovery and foster self-efficacy and resilience. Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION: Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

19 SKILLS: Stress Stress is: Normal Productive or destructive
Acute or chronic Cumulative over time Preventable Manageable

20 Life is inherently stressful

21 Stressors Events or situations that produce physical or psychological reactions Stressors can be: Real or imagined Internal or external Absolute or perceived

22 The Stress Response Physical – Body Reactions Emotional – Feelings
Cognitive – Thinking and decision making Behavioral – Actions Spiritual – Beliefs and values

23 Common Physical Reactions to Traumatic Stress in Adults
Elevated heart rate Elevated blood pressure Elevated blood sugar Stomach upset, nausea Gastrointestinal problems (diarrhea, cramps) Sleep difficulties With extended stress, suppression of immune system functioning

24 Common Physical Reactions to Traumatic Stress in Children
Headaches Stomachaches Nausea Eating problems Other physical reactions

25 Common Emotional Reactions to Traumatic Stress in Adults
Fear and anxiety Sadness and depression Anger and irritability Feeling numb, withdrawn, or disconnected Feeling a lack of involvement or enjoyment in favorite activities Feeling a sense of emptiness or hopelessness about the future This is the first of 8 slides that will list common symptoms of stress in adults and children. Give examples of emotional reactions for: Ice storm Car accident with serious injury Hunting accident School violence Suicide of adolescent in neighborhood or school

26 Common Emotional Reactions to Traumatic Stress in Children
Anxiety, fear, vulnerability Fear of reoccurrence Fear of being left alone Especially if separated from family during event May seem like an exaggerated reaction to adults Loss of “Sense of Safety” Depression Anger Guilt Give examples of emotional reactions for: Ice storm Car accident with serious injury Hunting accident School violence Suicide of adolescent in neighborhood or school

27 Common Cognitive Reactions to Traumatic Stress in Adults
Difficulty concentrating Difficulty with memory Intrusive memories Recurring dreams or nightmares Flashbacks Difficulty communicating Difficulty following complicated instructions

28 Common Cognitive Reactions to Traumatic Stress in Children
Confusion and disorientation Particularly difficult symptom for school-age children Difficulty concentrating May appear as behavioral problems in classroom *Note that school may be place where child functions best: Continuing structure, predictability Child may retain a sense of control

29 Common Behavioral Reactions to Traumatic Stress in Adults
Family challenges (physical, emotional abuse) Substance abuse Being overprotective of family Keeping excessively busy Isolating self from others Being very alert at times, startling easily Problems getting to sleep or staying asleep Avoiding places, activities, or people that bring back memories

30 Common Behavioral Reactions to Traumatic Stress in Children
“Childish” or regressive behavior May not be deliberate acting out Bedtime problems Sleep onset insomnia Midnight awakening Fear of dark Fear of event reoccurrence during night

31 Common Reactions to Traumatic Stress – Faith & Spirituality in Adults & Children
Reliance upon faith Questioning values and beliefs Loss of meaning Directing anger toward God Cynicism Senses have the power to diminish or intensify stress responses. Under stress, sensory responses are compromised. Also can trigger memories.

32 Event is more traumatic when…
Event is unexpected Many people die, especially children Event lasts a long time The cause is unknown Event is poignant or meaningful Event impacts a large area Good slide to ask for real life examples of when situations were made more stressful by these things.

33 Factors that make traumatic events less stressful…
Preparation Training Teamwork, cooperation, camaraderie This slide reinforces the need for training.

34 SKILLS: Active Listening
Eye contact Facial expression Tone of voice Head movement

35 Active Listening Verbal Support Physical Contact Tone of voice
Not too loud Encouraging prompts/head movement Support personal pacing Physical Contact Pat on back Hug Follow lead of person

36 Active Understanding Try not to interrupt Ask questions to clarify
Occasionally restate a part of the story in your own words to make sure you understand Establish sequence Avoid “Why?” and “Why not?” Avoid “I know how you feel” Avoid evaluation of their experience and their reactions in the event Silence is OK

37 Agitation Some may become agitated Refusal to follow directions
Loss of control Become threatening This is a reaction to an UNCOMMON situation, and has nothing to do with you Seek help from security To the Trainer: Denial defenses are primary in all catastrophic situations. Sometimes an innocent word expressed by you may produce an unexpected violent reaction. You have to be sensitive to the fact that most survivors need to defend themselves FOR A TIME from the reality of their situation. *Carefully support them into accepting reality and help them process the sense of loss by using comforting skills. Emotional/Behavioral Escalation: Answer their questions Repeat your request in a neutral tone of voice Elements of De-escalation: 1) Introduce yourself if they do not know you Ask the person what they would like to be called Don't shorten their name or use their first name without their permission With some cultures, it is important to always address them as "Mr." or "Mrs.", especially if they are older than you 2) Use concrete questions to help the person focus Use closed ended questions If the person is not too agitated, briefly explain why you are asking the question For example: I'd like to get some basic information from you so that I can help you better. Where do you live? 3. Come to an agreement on something Establishing a point of agreement will help solidify your relationship and help gain their trust Positive language has more influence than negative language Active listening will assist you in finding a point of agreement 4. Speak to the person with respect This is communicated with: Words Para-verbal Communication Non-verbal behavior Use of words like please and thank you Don't make global statements about the person's character Use “I” statements Lavish praise is not believable 37

38 Basic principles… Privacy Respect Non-judging Impartial
Equal care for all Gender, age,ethnicity, religion, political perspective, and culture

39 A Compassionate Presence
Your Role A Compassionate Presence

40 Basic Principle of Helping:
WHEN IN DOUBT… REFER TO A PROFESSIONAL!

41 Specific reactions that MAY indicate additional needs
Difficultly thinking clearly or acting logically Bizarre behavior Lacking awareness of reality Extreme stress reactions or grief Confusion Inability to concentrate or make decisions Haunted by images or memories of the event Complaining of physical symptoms after reassurance that there are none Alarm Bells list verbal or non-verbal indicators that more help is needed than psychological first aid. These would be signs that a supervisor should be called, or that someone be encouraged to contact a professional. Take time to explore how this might be handled with the most sensitivity for the community.

42 Referrals for Additional Care and Support (IMMEDIATE)
Disorientation Psychotic behavior Inability to care for self Suicidal/homicidal thoughts, talk, or plans Inappropriate anger or reactions to triggers Excessively “flat” emotions Regression Problematic alcohol or drug use Flashbacks, excessive nightmares, or crying Brainstorm what this would look like.

43 Self-Care: Are You Ready…Really?
Evaluate your level of readiness to respond Do not assume that because you are experienced you must be ready to respond Give consideration to your physical and emotional health If you have recently encountered a major life stressor it may be better for you and those who need assistance for you to NOT to respond

44 What is Resilience? Positive adaptation in the face of adversity
Ordinary--not extraordinary People commonly demonstrate resilience The “rule” not the exception

45 Promote Resiliency Everyone who experiences a disaster is touched by it We have the ability to “bounce back” after a disaster to a “New Normal” Resilience can be fostered One goal of Psychological First-Aid: support resiliency in ourselves and others To the trainer: Resilience is the ability to accommodate and bounce back after a setback, disappointment, crisis or major distress. Following a disaster the ability to bounce back can be supported and nurtured. Psychological First Aid can nurture resilience. 45

46 Personal Resiliency Plan
Focus beyond short-term Know your unique stressors and Red Flags Know unique stressors of the event: extent of damage, death, current suffering Demystify/de-stigmatize common reactions Select from menu of coping responses Monitor on-going internal stress To the Trainer: Understand how you react to stress. Do you feel it as: Shoulder pain, Headaches, Stomach problems? Learn to recognize when you reach your stress limit. Remember what are the common reactions to stress. Use healthy coping skills – what has worked for you in the past? Assisting others in physical or emotional pain may start to affect you so you should be constantly aware of your own reactions. Emotional pain and anxiety are “contagious” and will affect you so continue to monitor yourself for stress reactions. 46

47 Building Responder Resilience Building Responder Resilience Pre-event
Educate and train Build social support systems Instill sense of mission and purpose Create family communications plan To The Trainer: Pre-event – create a family communications plan ( you will not be able to effectively respond if you are worried about your won loved ones) Response – Use the buddy system and monitor your own and your co-workers emotional well-being 47

48 Response If possible deploy as a team or use the buddy system
Focus on immediate tasks at hand Monitor occupational safety, personal health, and psychological well-being Know your limits Activate family communication plans

49 Post-event (Recovery)
Monitor health and well-being Delayed reactions with increased demand for services seen in general public and emergency responders (onset >5 wks later) Give yourself time to recover Seek support when needed To The Trainer: Post-event- realize that your emotional reactions to the event may be delayed up to 5 weeks after the event so give yourself time to recover and seek help from a professional if needed. 49

50 Self Care After Support Work
Expect a reintegration period upon returning to your usual routine Pay attention to cues from your family that you are becoming too involved Because people who are drawn to be helpers are motivated to relieve distress, the rewards can be somewhat intoxicating, making the work of everyday relationships appear humdrum and unimportant. The opposite is true! Family members will let us know that we’ve lost touch with our role in the family. What would this look like? Take a moment to discuss symptoms of over involvement on the part of helpers. Talk about what family members would say. Brainstorm positive and negative responses. 50


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