Psychological First Aid

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Psychological First Aid

• Connie L. Best, Ph. D.Professor, and Director of
  Adult ServicesNational Crime Victims Research
  and Treatment CenterMedical University of South
  Carolina

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Acknowledgements

• South Carolina Area Health Education Consortium
  (AHEC)
• Funded by the Health Resources and Services
  Administration
• Grant number T01HP01418
• Principal Investigator David Garr, MD, Director
  SC AHEC
• Project Director Beth Kennedy, MS, Associate
  Program Director SC AHEC
• Core Team
• Co-director Ralph Shealy, MD
• Project Manager Deborah Stier Carson, PharmD
• CME Director William Simpson, MD
• Database Manager Frances Wickham Lee, DBA
• Public Relations Ragan DuBose, MA
• Web Master Mary Mauldin, EdD
• Mental Health Consultant Connie Best, PhD
• Public Health Consultant Harold Gabel, MD, MPh
• Infectious Disease Consultant Michael Schmidt,
  PhD

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Psychological First AidField Operations Guide

• Terrorism and Disaster Branch National Child
  Traumatic Stress Network
• National Center for PTSD

Funded by The Substance Abuse and Mental Health
Services Administration (SAMHSA)
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What is Psychological First Aid?

• Psychological First Aid is an evidence-informed
  modular approach for assisting children,
  adolescents, adults, and families in the
  immediate aftermath of disaster and terrorism.
  PFA is designed to reduce the initial distress
  caused by traumatic events, and to foster short-
  and long-term adaptive functioning.

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What is Psychological First Aid?

• Principles and techniques of Psychological First
  Aid meet four basic standards.
• They are
• consistent with research evidence on risk and
  resilience following trauma
• applicable and practical in field settings
• appropriate to developmental level across the
  lifespan
• culturally informed and adaptable.

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Who Delivers PFA?

• It is designed for delivery by mental health
  specialists who provide acute assistance to those
  affected as part of an organized response effort.
  
• These specialists may be imbedded in a variety of
  response groups (e.g., primary and emergency
  health care providers, response teams, community
  and school crisis response teams, disaster
  response team, first responder).
• It may also be used by mental health providers in
  more traditional settings in the event of large
  scale disasters.

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When Should PFA Be Used?

• In the immediate wake of disasters.

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Where Should PFA Be Used?

• It is designed for delivery in diverse settings,
  including staging areas, hospitals, schools,
  assistance centers, shelters, and other community
  settings.
• Following weapons of mass destruction (WMD)
  events, PFA may be delivered at mass casualty
  collection points, hospitals, and in field
  decontamination locations.

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Strengths of Psychological First Aid?

• Includes basic information-gathering techniques
  to help mental health professionals make rapid
  assessments of immediate concerns and needs and
  to tailor interventions in a flexible manner
• Relies on field-tested, evidence-informed
  strategies that can be used in a variety of
  settings.
• Emphasizes developmentally and culturally
  appropriate interventions
• Includes handouts that provide important
  information for use over the course of recovery

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Basic Objectives of Psychological First Aid

• Establish a human connection in a non-intrusive,
  compassionate manner
• Enhance immediate and on-going safety
• Calm and orient distressed and overwhelmed
  survivors
• Offer practical assistance and information
• Connect survivors to social support networks,
  including family members
• Support positive coping and empower survivors
• Provide information to help survivors cope
  effectively with the psychological impact
• Facilitate continuity in response efforts and
  link survivors with indigenous recovery systems

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Guidelines for Delivering Psychological First Aid

• Politely observe first, dont intrude. Then ask
  simple respectful questions, so as to be able to
  discuss how you may be of help.
• Initiate contact only after you have observed the
  situation and the person or family, and have
  determined that contact is not likely to be an
  intrusion or disruptive.

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Guidelines Cont.

• Be prepared to be either avoided or flooded with
  contact by affected persons, and make brief but
  respectful contact with each person who
  approaches you.
• Adapt the information you provide to directly
  address the persons immediate goals and clarify
  answers repeatedly as needed.

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Guidelines Cont.

• Give information that is accurate and
  age-appropriate for your audience, and correct
  inaccurate beliefs. If you dont know, tell them
  this and offer to find out.
• Remember that the goal of Psychological First Aid
  is to reduce distress, assist with current needs,
  and promote adaptive functioning, not to elicit
  details of traumatic experiences and losses.

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Some Behaviors to Avoid

• Do not make assumptions about what the person is
  experiencing or what they have been through.
• Do not assume that everyone exposed to a disaster
  will be traumatized.
• Do not pathologize.
• Most acute reactions are understandable and
  expectable given what people exposed to the
  disaster have personally experienced.
• Do not label reactions as symptoms, or speak in
  terms of diagnoses, conditions, pathologies, or
  disorders.

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Behaviors to Avoid Cont.

• Do not assume that all survivors want to talk or
  need to talk to you. Often, being physically
  present in a supportive and calm way helps
  affected people to feel safer and more able to
  cope.
• Do not debrief by asking for details of what
  happened.
• Do not suggest fad interventions or present
  uninformed opinion as fact.

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Be Aware of At-Risk Populations

• Individuals that are at special risk after a
  disaster include
• Children (especially children whose parents have
  died or are missing)
• Those who have had multiple relocations and
  displacements
• Medically frail adults
• The elderly
• Those with serious mental illness
• Those with physical disabilities or illness
• Those with current or prior history of substance
  abuse

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At-Risk Populations Cont.

• Adolescents who may be risk-takers
• Adolescents and adults with substance abuse
  problems
• Pregnant women
• Mothers with babies and small children
• Professionals or volunteers who participated in
  disaster response and recovery efforts
• Whose who have experienced significant loss
• Those exposed first hand to grotesque scenes or
  extreme life threat

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Psychological First Aid Core Actions

• Contact and Engagement
• Safety and Comfort
• Stabilization
• Information Gathering Current needs and Concerns
• Practical Assistance
• Connection with Social Supports
• Information on Coping
• Linkage with Collaborative Services

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1 Contact and Engagement

• Goal To respond to contact initiated by affected
  persons, or initiate contacts in a non-intrusive,
  compassionate, and helpful manner.

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1 Contact and Engagement

• Introduce yourself with name, title, role
• Ask permission to talk to them
• Explain your objective, to determine whether
  there is anything you can do to make things
  easier
• Find out if there is anything that needs
  immediate attention

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2 Safety and Comfort

• Goal Enhance immediate and ongoing safety, and
  provide physical and emotional comfort.

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2 Safety and Comfort

• Make sure the survivors are physically safe, to
  the extent possible
• Re-organize the immediate environment if
  necessary
• If there are medical concerns, contact
  appropriate medical support
• Attend to physical comfort
• Promote social engagement
• Attend to children who are separated from their
  parents, and to those acutely bereaved

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3 Stabilization (if needed)

• Goal To calm and orient emotionally-overwhelmed/d
  istraught survivors.

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3 Stabilization (if needed)

• Stabilize emotionallyoverwhelmed survivors
• Respect privacy and give them a few minutes
• Remain present and offer a drink or chair
• Help them focus on specific manageable thoughts
  or goals
• If none of your efforts work, consider
  consultation and possible medication

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4 Information Gathering Current needs and
Concerns

• Goal To identify immediate needs and concerns,
  gather additional information, and tailor
  Psychological First Aid interventions.

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4 Information Gathering Current needs and
Concerns

• Although a formal assessment is not appropriate,
  the provider may ask pertinent questions to
  obtain and clarify a variety of issues that can
  inform decisions about
• Need for immediate referral
• Need for additional services
• Offering a follow-up meeting
• Using components of PFA that may be helpful

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4 Information Gathering Current needs and
Concerns

• It may be useful for the provider to ask some
  questions to clarify the following(depending
  on the context, providers qualifications
  specific role)
• Nature and severity of experiences during the
  disaster
• Death of family member or close friend
• Concerns about immediate post-disaster
  circumstances / threat
• Separation from / concerns about loved ones

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4 Information Gathering Current needs and
Concerns

• Physical illness and need for medication
• Losses incurred as a result of the disaster
• Extreme feelings of guilt or shame
• Thoughts about causing harm to self or others
• Lack of adequate supportive social network
• Prior alcohol or drug use
• Prior exposure to trauma and loss
• Prior psychological problems
• Specific youth, adult and family concerns over
  developmental impact

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5 Practical Assistance

• Goal To offer practical help to the survivor in
  addressing immediate needs and concerns.

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5 Practical Assistance

• Identify the most immediate needs
• Clarify the need
• Discuss an action plan
• Act to address the need

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6 Connection with Social Supports

• Goal To help establish brief or ongoing
  contacts with primary support persons or other
  sources of support, including family members,
  friends, and community helping resources.

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6 Connection with Social Supports

• Enhance access to primary support persons
• Encourage use of immediate available support
  persons
• Discuss support-seeking and giving
• If appropriate, give handouts

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7 Information on Coping

• Goal To provide information (about stress
  reactions and coping) to reduce distress and
  promote adaptive functioning

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7 Information on Coping

• Provide basic information about stress reactions
• Review common psychological reactions to
  traumatic experiences
• (intrusive reactions, avoidance, physical
  arousal, grief, depression and others)
• Provide basic information on ways of coping
• Demonstrate basic relaxation techniques
• Assist with anger management sleep problems and
  substance use

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8 Linkage with Collaborative Services

• Goal To link survivors with needed services, and
  inform them about available services that may be
  needed in the future.

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8 Linkage with Collaborative Services

• Provide direct links to additional services
• Promote continuity in helping relationships

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Questions and Answers?