NCTSN/NCPTSD Psychological First Aid (PFA)

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NCTSN/NCPTSDPsychological First Aid (PFA)

• Overview presented by
• Eric Vernberg, Ph.D.
• University of Kansas and the
• NCTSN Terrorism and Disaster Center

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PSYCHOLOGICAL FIRST AIDField Operations Guide

• Sponsors
• National Child Traumatic Stress Network
• National Center for PTSD
• Principal Authors (alphabetical order)
• Melissa Brymer, Anne Jacobs, Chris Layne,
  Robert Pynoos, Joseph Ruzek, Alan Steinberg, Eric
  Vernberg, and Patricia Watson
• Special consultants (alphabetical order)
• Steve Berkowitz, Dora Black, Carrie Epstein,
  Julian Ford, Laura Gibson, Robin Gurwitch, Jack
  Herrmann, Jessica Hamblen, Russell Jones, Robert
  Macy, William Saltzman, Janine Shelby, Merritt
  Schreiber, Betty Pfefferbaum, Rose Pfefferbaum,
  Margaret Samuels, Cynthia Whitham, Bonita Wirth,
  and Bruce Young.

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Basics of Psychological First Aid

• What establish safety and security, connect to
  restorative resources, reduce stress-related
  reactions, and foster adaptive short- and
  long-term coping
• For individuals experiencing acute stress
  reactions or who appear to be at risk for
  significant impairment in functioning
• By mental health professionals and others who
  provide crisis assistance after catastrophic
  events
• When Immediate and early phase post-event, in as
  little as 30 minutes and extended as needed
• Where in a broad range of emergency settings, in
  either single or multiple sessions, adapted for
  use in group settings

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PFA

• Principles and techniques of PFA meet four basic
  standards
• (1) consistent with research evidence on risk and
  resilience following trauma
• (2) applicable and practical in field settings
• (3) appropriate to developmental level across the
  lifespan
• (4) culturally informed

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Strengths of PFA

• Evidence-Informed
• Modular format
• Information-gathering
• Concrete examples
• Developmental Framework
• Attention to Cultural Factors
• Handouts

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Basic Requirements for Early Intervention
Providers

• Capacity to connect with wide range of
  individuals
• Tolerance for symptomatic behavior and strong
  expression of affect
• Capacity for rapid assessment of survivors
• Ability to provide care tailored to timing of
  intervention, context, culture
• Recognition and response to emotional numbing
  processes
• Knowledge of self capacities
• Ability to provide clear, concrete information
• Ability to shift from conventional clinical
  practice
• Capacity for self-care

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Some Basics

• Expect normal recovery
• Assume survivors are competent
• Recognize survivor strengths
• Promote resilience

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PFA Core Actions

• Contact and engagement
• Safety and comfort
• Stabilization (if needed)
• Information gathering current needs and concerns
• Practical assistance
• Connection with social supports
• Information on distress reactions and coping
• Linkage with collaborative services

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Contact and Engagement

• 1 Establish a connection with affected persons
  in a non-intrusive, compassionate manner.
• Introduce self and describe role
• Ask for permission to talk
• Explain objective
• Ask about immediate needs
• Be informed about cultural norms related to
  personal contact

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Safety and Comfort (1)

• 2 Enhance immediate and ongoing safety, and
  provide physical and emotional comfort.
• Ensure immediate physical safety
• Provide information about disaster response
  activities/services
• Offer physical comforts
• Offer social comforts
• Attend to children who are separated from their
  parents/caregivers
• Protect from additional trauma and potential
  trauma reminders

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Safety and Comfort (2)

• Help survivors who have a missing family member
• Help survivors when a family member or close
  friend has died
• Attend to grief and spiritual issues
• Provide information about casket and funeral
  issues
• Attend to issues related to traumatic grief
• Support survivors who receive death notification
• Support survivors involved In body identification
• Help caregivers confirm body identification to a
  child or adolescent

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Stabilization (1)

• 3 Calm and orient emotionally-overwhelmed/distrau
  ght survivors.
• Stabilize emotionally overwhelmed survivors
• Talking points for emotionally overwhelmed
  survivors
• Role of medications in stabilization

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Stabilization (2)

• Signs a Survivor is Disoriented or Overwhelmed
• Looking glassy eyed and vacant
• Unresponsive to verbal questions or commands
• Disoriented
• Exhibiting strong emotional and physical
  responses (uncontrollable crying,
  hyperventilating, rocking or regressive behavior,
  shaking, trembling)
• Exhibiting frantic searching behavior
• Feeling incapacitated by worry
• Engaging in risky activities

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Stabilization (3)

• If extremely agitated or losing touch with the
  surroundings
• Ask them to listen to and look at you
• Speak softly and calmly
• Orient to surroundings
• Talk about aspect of the situation that is under
  their control, hopeful, or positive

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Information Gathering Current Needs and Concerns
(1)

• 4 Identify immediate needs and concerns, and
  gather additional information as appropriate to
  the situation.
• Form and maintain an alliance with the survivor
• Remain sensitive to survivor needs and
  perceptions
• Identify individuals in need of immediate
  referral
• Identify components of PFA that may be especially
  helpful
• Integrate survivor education with informal
  assessment
• Identify need for additional services or referral

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Information Gathering Content Areas (2)

• Nature and severity of experiences
• Death of a loved one
• Concerns about the immediate post-disaster
  circumstances and ongoing threat
• Separation from or concerns about the safety of
  loved ones
• Physical illness and need for medications
• Losses incurred as a result of the disaster
• Feelings of guilt or shame
• Thoughts about causing harm to self or others
• Developmental Impact
• Lack of adequate supportive social network
• Prior alcohol or drug use or psychiatric problems
• Prior exposure to trauma and loss

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Practical Assistance

• 5 Offer practical assistance and information to
  address survivors immediate needs and concerns.
• Identify the most immediate need(s)
• Clarify the need
• Discuss an action response
• Act to address the need

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Connection with Social Supports

• 6 Connect survivors as soon as possible to
  social support providers, including family
  members, friends, and community helping
  resources.
• Enhance access to primary support persons (family
  and significant others)
• Encourage use of immediately-available support
  persons
• Discuss support-seeking
• Special considerations for children and
  adolescents
• Model supportive behavior

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Information on Coping (1)

• 7 Provide the individual with information that
  may help them cope with the event and its
  aftermath, including information about
• Provide basic information about common
  psychological reactions to traumatic experiences
  and losses
• Talk with children and body and emotional
  reactions
• Provide basic information on ways of coping
• Teach simple relaxation techniques

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Information on Coping (2)

• Assist with developmental issues
• Assist with anger management Address highly
  negative emotions
• Address highly negative emotions (e.g., guilt,
  shame)
• Help with sleep problems
• Address alcohol and substance use

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Linkage with Collaborative Services

• 8 Links survivors with needed services, and
  inform them about services that may be needed in
  the future.
• Provide direct links to additional needed
  services
• Promote continuity in helping relationships

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Next Steps Training

• Develop strategic plan for dissemination and
  training
• NCTSN Terrorism and Disaster Network Committee
• Partnerships and adaptations
• Medical Reserve Corps (MRC)
• Spiritual care providers
• Health care settings
• Schools
• Community Emergency Response Teams (CERT)
• Standardized training packages
• Videos
• Skills training
• Integration with drills
• Online training version

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Next Steps Evaluation

• Assessing effectiveness of PFA
• Does PFA facilitate decision-making
• Does PFA reduce immediate distress
• Does PFA help survivors avoid additional risk or
  risk-taking behavior?
• Does PFA help survivors connect to important
  services more quickly
• Assessing impact of PFA training on providers
• Confidence, attitudes, knowledge
• Behavior in post-disaster settings
• Analog studies (e.g., behavior in training
  exercises)