Presentation on theme: "Psychological First-Aid"— Presentation transcript:
1 Psychological First-Aid A Community Support ModelNo 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 CrossAmerican Psychological AssociationCenters 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 ServicesMinnesota Hospital Association (MHA)National Center for PTSD, Terrorism & Disaster BranchThis 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.
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
10 OUTCOMES SAFETY FUNCTION ACTION SAFETY, FUNCTION, ACTION: Restoring Psychological First Aid for Disaster SurvivorsOUTCOMESSAFETYFUNCTIONACTIONRestoringphysical safetyand diminishingthe physiologicalstressresponse.Facilitatingpsychologicalfunctionand perceivedsense of safetyand control.Initiatingaction towarddisasterrecoveryand return tonormal 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 SurvivorsSAFETYSafetySecurityShelterSAFETYWhat Survivors Need:SAFEGUARDRemove 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 SurvivorsSAFETYBasic survival needsSAFETYWhat Survivors Need:Provide food, water, ice.Provide medical care, alleviate pain.Provide clothing.Provide power, light, heat, air conditioning.Provide sanitation.What To Do:SUSTAINSource: 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 SurvivorsFUNCTIONSoothing human contactValidation that reactions are “normal”.FUNCTIONWhat Survivors Need:COMFORTEstablish a compassionate “presence.”Listen actively.Comfort, console, soothe, and reassure.Apply stress management techniques.Reassure survivors that their reactions are“normal” and expectedWhat 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 SurvivorsFUNCTIONSocial supports/keeping family togetherReuniting separated loved onesConnection to disaster recovery services,medical care, work, school, vital servicesFUNCTIONWhat 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 SurvivorsACTIONInformation about the disasterInformation about what to doInformation about resourcesReduction of uncertaintyACTIONWhat Survivors Need:EDUCATEClarify disaster information:what happenedwhat will happenProvide 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 SurvivorsACTIONPlanning for recoveryPractical first steps and “do-able” tasksSupport to resume normal activitiesOpportunities to help othersACTIONWhat 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:EMPOWERSource: 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 readySources: Glass et al. 2002; Pilch, 2004
18 SAFETY FUNCTION ACTION Psychological First Aid for Disaster SurvivorsSAFETYFUNCTIONACTIONSAFEGUARDGoal: SAFEGUARDsurvivors fromharm andoffer protection.COMFORTGoal: COMFORTsupport, validate,and orientdistressed survivors.EDUCATEGoal: EDUCATE and informsurvivors about the disaster,available options for action,and resources for support.SUSTAINGoal: SUSTAINsurvivorsby providingbasic needs.CONNECTGoal: CONNECTsurvivors tofamily, friends, andsocial supports,EMPOWERGoal: EMPOWER survivorsto take first steps towarddisaster recovery and fosterself-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 chronicCumulative over timePreventableManageable
21 StressorsEvents or situations that produce physical or psychological reactionsStressors can be:Real or imaginedInternal or externalAbsolute or perceived
22 The Stress Response Physical – Body Reactions Emotional – Feelings Cognitive – Thinking and decision makingBehavioral – ActionsSpiritual – Beliefs and values
23 Common Physical Reactions to Traumatic Stress in Adults Elevated heart rateElevated blood pressureElevated blood sugarStomach upset, nauseaGastrointestinal problems (diarrhea, cramps)Sleep difficultiesWith extended stress, suppression of immune system functioning
24 Common Physical Reactions to Traumatic Stress in Children HeadachesStomachachesNauseaEating problemsOther physical reactions
25 Common Emotional Reactions to Traumatic Stress in Adults Fear and anxietySadness and depressionAnger and irritabilityFeeling numb, withdrawn, or disconnectedFeeling a lack of involvement or enjoyment in favorite activitiesFeeling a sense of emptiness or hopelessness about the futureThis is the first of 8 slides that will list common symptoms of stress in adults and children.Give examples of emotional reactions for:Ice stormCar accident with serious injuryHunting accidentSchool violenceSuicide of adolescent in neighborhood or school
26 Common Emotional Reactions to Traumatic Stress in Children Anxiety, fear, vulnerabilityFear of reoccurrenceFear of being left aloneEspecially if separated from family during eventMay seem like an exaggerated reaction to adultsLoss of “Sense of Safety”DepressionAngerGuiltGive examples of emotional reactions for:Ice stormCar accident with serious injuryHunting accidentSchool violenceSuicide of adolescent in neighborhood or school
27 Common Cognitive Reactions to Traumatic Stress in Adults Difficulty concentratingDifficulty with memoryIntrusive memoriesRecurring dreams or nightmaresFlashbacksDifficulty communicatingDifficulty following complicated instructions
28 Common Cognitive Reactions to Traumatic Stress in Children Confusion and disorientationParticularly difficult symptom for school-age childrenDifficulty concentratingMay appear as behavioral problems in classroom*Note that school may be place where child functions best:Continuing structure, predictabilityChild may retain a sense of control
29 Common Behavioral Reactions to Traumatic Stress in Adults Family challenges (physical, emotional abuse)Substance abuseBeing overprotective of familyKeeping excessively busyIsolating self from othersBeing very alert at times, startling easilyProblems getting to sleep or staying asleepAvoiding places, activities, or people that bring back memories
30 Common Behavioral Reactions to Traumatic Stress in Children “Childish” or regressive behaviorMay not be deliberate acting outBedtime problemsSleep onset insomniaMidnight awakeningFear of darkFear of event reoccurrence during night
31 Common Reactions to Traumatic Stress – Faith & Spirituality in Adults & Children Reliance upon faithQuestioning values and beliefsLoss of meaningDirecting anger toward GodCynicismSenses 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 unexpectedMany people die, especially childrenEvent lasts a long timeThe cause is unknownEvent is poignant or meaningfulEvent impacts a large areaGood 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… PreparationTrainingTeamwork, cooperation, camaraderieThis slide reinforces the need for training.
34 SKILLS: Active Listening Eye contactFacial expressionTone of voiceHead movement
35 Active Listening Verbal Support Physical Contact Tone of voice Not too loudEncouraging prompts/head movementSupport personal pacingPhysical ContactPat on backHugFollow 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 understandEstablish sequenceAvoid “Why?” and “Why not?”Avoid “I know how you feel”Avoid evaluation of their experience and their reactions in the eventSilence is OK
37 Agitation Some may become agitated Refusal to follow directions Loss of controlBecome threateningThis is a reaction to an UNCOMMON situation, and has nothing to do with youSeek help from securityTo 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 questionsRepeat your request in a neutral tone of voiceElements of De-escalation:1) Introduce yourself if they do not know youAsk the person what they would like to be calledDon't shorten their name or use their first name without their permissionWith some cultures, it is important to always address them as "Mr." or "Mrs.", especially if they are older than you2) Use concrete questions to help the person focusUse closed ended questionsIf the person is not too agitated, briefly explain why you are asking the questionFor 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 somethingEstablishing a point of agreement will help solidify your relationship and help gain their trustPositive language has more influence than negative languageActive listening will assist you in finding a point of agreement4. Speak to the person with respectThis is communicated with:WordsPara-verbal CommunicationNon-verbal behaviorUse of words like please and thank youDon't make global statements about the person's characterUse “I” statementsLavish praise is not believable37
38 Basic principles… Privacy Respect Non-judging Impartial Equal care for allGender, age,ethnicity, religion, political perspective, and culture
39 A Compassionate Presence Your RoleA CompassionatePresence
40 Basic Principle of Helping: WHEN IN DOUBT…REFER TO APROFESSIONAL!
41 Specific reactions that MAY indicate additional needs Difficultly thinking clearly or acting logicallyBizarre behaviorLacking awareness of realityExtreme stress reactions or griefConfusionInability to concentrate or make decisionsHaunted by images or memories of the eventComplaining of physical symptoms after reassurance that there are noneAlarm 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) DisorientationPsychotic behaviorInability to care for selfSuicidal/homicidal thoughts, talk, or plansInappropriate anger or reactions to triggersExcessively “flat” emotionsRegressionProblematic alcohol or drug useFlashbacks, excessive nightmares, or cryingBrainstorm what this would look like.
43 Self-Care: Are You Ready…Really? Evaluate your level of readiness to respondDo not assume that because you are experienced you must be ready to respondGive consideration to your physical and emotional healthIf 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 extraordinaryPeople commonly demonstrate resilienceThe “rule” not the exception
45 Promote ResiliencyEveryone who experiences a disaster is touched by itWe have the ability to “bounce back” after a disaster to a “New Normal”Resilience can be fosteredOne goal of Psychological First-Aid: support resiliency in ourselves and othersTo 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-termKnow your unique stressors and Red FlagsKnow unique stressors of the event: extent of damage, death, current sufferingDemystify/de-stigmatize common reactionsSelect from menu of coping responsesMonitor on-going internal stressTo 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 trainBuild social support systemsInstill sense of mission and purposeCreate family communications planTo 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-being47
48 Response If possible deploy as a team or use the buddy system Focus on immediate tasks at handMonitor occupational safety, personal health, and psychological well-beingKnow your limitsActivate family communication plans
49 Post-event (Recovery) Monitor health and well-beingDelayed reactions with increased demand for services seen in general public and emergency responders (onset >5 wks later)Give yourself time to recoverSeek support when neededTo 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 routinePay attention to cues from your family that you are becoming too involvedBecause 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