Psychological First Aid

1
Psychological First Aid

• Kathy Berlin, RN
• MRC Coordinator
• Elizabeth McClure, MD, MPH
• Medical Director
• Academic Health Center
• Office of Emergency Response

2
Training Objectives

• Understand key points of Psychological First Aid
  (PFA)
• Increase awareness of the signs and symptoms of
  stress
• Identify strategies to limit distress and
  negative health behaviors
• Identify strategies to support resilience among
  responders

3
Psychological First Aid Key Points

• Parallel to medical first aid
• Uses skills you probably already have
• Designed for use in the immediate aftermath of a
  disaster
• Offers practical assistance information

4
Psychological First Aid Key Points

• Appropriate for all ages
• Culturally informed
• Consistent with research evidence on risk and
  resilience following trauma

5
Psychological First AidWho, Where, When?

• Who delivers PFA?
• First responder teams, Medical Reserve Corps
  (MRC), Community Emergency Response Teams (CERT)
  and others
• Where is PFA used?
• Family assistance centers, mass triage facilities
  , mass dispensing sites, special needs shelters
• When is PFA used?
• As an integral part of the immediate disaster
  response

6
Endorsed by

• American Psychological Association
• WHO, CDC, MDH
• National Institute for Mental Health
• National Center for PTSD
• Metro Disaster Behavioral Health Work Group
• SAMHSA

7

8
(No Transcript)
9
Psychosocial Consequences of Disasters
Fear and Distress Response
Impact of Disaster Event
Behavior Change
Psychiatric Illness
Source Butler AS, Panzer AM, Goldfrank LR,
Institute of Medicine Committee on Responding to
the Psychological Consequences of Terrorism Board
of on Neuroscience and Behavioral Health.
Preparing for the psychological consequences of
terrorism A public health approach.
Washington, D.C. National Academies Press, 2003.
10
Reactions to Stress Adults

• Physical
• Behavioral
• Emotional
• Cognitive
• Spiritual

11
Reactions to StressChildren

• Physical
• Behavioral
• Emotional
• Cognitive
• Spiritual

12
(No Transcript)
13
Events are More Stressful or Traumatic When

• Event is unexpected
• Many people die, especially children
• Event lasts a long time
• The cause is unknown
• The event is poignant or meaningful
• Event impacts a large area

14
Minimize negative emotional impact of a disaster
through..

• Rapid intervention
• Identification, labeling, and expression of
  emotions
• Regaining a sense of mastery and control over
  life

15
PFA Big PictureTarget Outcomes

• Restore Safety
• Safeguard
• Sustain through basic needs
• Facilitate Function
• Comfort
• Connect
• Empower Action
• Education
• Resilience

16
Psychological First Aid Help Card

• Goal
• Promote Safety
• Calm and Comfort
• Connectedness
• Self-empowerment

17
Psychological First Aid Help Card

• Responder Resilience
• Prevention Strategies
• Self care
• When in Doubt- CONSULT!

18
PROMOTE SAFETY

• Meet basic survival needs
• Offer practical assistance and information
• Shield survivors from onlookers/ media
• Repeat information as often as needed
• Assist in finding resources

Safeguarding survivors and sustaining their basic
needs
19
CALM AND COMFORT

• Compassionate presence
• Active listening
• Dont push for information
• Use stress management techniques
• Be flexible and supportive
• Comfort, console, soothe

Facilitate psychological function through calming
and connection
20
What People Need

• To talk to about their experience
• Someone to care
• Someone to really listen
• Someone to lean on or cry with

21
Active Listening

• Body language
• eye contact
• facial expression
• tone of voice
• Gentle prompts
• Label, summarize, and mirror
• Compassionate presence

22
Active Understanding

• Try not to interrupt until story ended
• Do ask questions to clarify
• Occasionally restate part of the story in your
  own words to make sure you understand

23
Active Understanding

• Avoid Why/Why not?
• Dont judge
• Avoid I know how you feel.
• Avoid evaluation of their experience and their
  reactions
• Silence is O.K.

24
It is NOT OK to say.

• Lets talk about something else
• You should work toward getting over this
• You are strong enough to deal with this
• Youll feel better soon
• You did everything you could
• You need to relax
• Its good that you are alive

25
Stress reactions are normal

• Basic information on ways of coping
• Psychological reactions are common and expected
• Simple relaxation techniques

26
Agitation

• Refusal to follow directions
• Loss of control, becoming verbally agitated
• Becoming threatening
• It is not personal
• This is their reaction to an UNCOMMON situation,
  it has nothing to do with you

27
When to Refer

• Harm to self or others
• Inability to make simple decisions
• Significant withdrawal
• Ritualistic behavior
• Hallucinations/paranoia
• Disorientation to time and place
• Unable to care for self

28
How to Refer

• Ask about reaction to referral
• Make referral with individual present
• Dont push referral unless person appears to be
  at imminent risk to self or others
• Cold referrals are generally not successful

29
CONNECTEDNESS

• Help connect with friends and loved ones
• Keep survivor families intact
• Reunite children with family
• Connect survivors to available support services

Facilitate psychological function through calming
and connection
30
SELF EMPOWERMENT

• Clarify Disaster information
• Engage towards meeting own needs
• Work toward normal life activities
• Guide towards what to expect, teach resilience

Reestablish hope and action through education and
empowerment
31
Resiliency

• Ability to accommodate and bounce back after a
  setback disappointment crisis or major distress.

32
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 PFA support resilience in ourselves
  and others

33
Personal Resiliency Plan

• Know your unique stressors and red flags
• Know unique stressors of the event extent of
  damage, death, and current suffering
• Monitor on-going internal stress
• Emotional pain and anxiety are contagious

34
Responder Resiliency Tools

• Help Card
• Prevention Strategies
• Self Care
• Resiliency
• Pre-event
• During event
• Post-event

35
Building Responder Resilience Pre-event

• Educate and train
• Build social support systems
• Instill sense of mission purpose
• Create family communications plan
• Learn coping strategies

36
Building Responder ResilienceDuring event

• If possible, use the buddy system
• Focus on immediate tasks at hand
• Monitor health, safety, and psychological
  well-being
• Know your limits
• Activate family communications plan

37
Compassion Fatigue

• There is a cost to caring. We professionals who
  are paid to listen to the stories of fear, pain,
  and suffering of others may feel, ourselves,
  similar fear, pain and suffering because we care.
• Compassion fatigue is the emotional residue of
  exposure to working with the suffering,
  particularly those suffering from the
  consequences of traumatic events.
• Charles R. Figley, Ph.D.

37
38
Building Responder ResiliencePost-event

• Delayed reactions seen among general public and
  emergency responders
• Monitor health and well-being
• Take time to recover
• Seek support when needed

39
Self Care Post-event

• Expect a reintegration period upon returning to
  your usual routine.
• Pay attention to cues from your family that you
  are becoming too involved.

40
GROUP PARTICIPATION
41

• Q Effective communication during times of trauma
  may include repeating information often.
• Q Which of the following describes possible
  symptoms of stress in children?
• a. Fear of being alone
• b. Difficulty sleeping
• c. Sense of guilt or responsibility for event
• d. Regression
• e. All of the above

42

• Q Physical symptoms of stress, such as elevated
  heart rate breathing can sometimes improve with
  calm, soothing verbal intervention.
• Q Children may feel more secure in a structured
  environment (such as school) after a traumatic
  event.

43

• Q During a traumatic event, it is helpful to
  provide immediate psychotherapy.
• Q During the crisis response, it is important to
  do which of the following?
• a. Work in partners or teams
• b. Take brief stress breaks
• c. Check in with others
• d. Talk about your feelings at the end of the day
• e. All of the above

44

• Q There is an adjustment period after returning
  from a crisis.
• True or False

45
Learn More

• On-line Courses
• Psychological Issues Following a Disaster, U of
  M Center for Public Health Preparedness
• http//cpheo.sph.edu (I ½ hours)
• Mental Health Consequences of Disasters,
• Johns Hopkins Center for Public Health
  Preparedness
• http//nccphp.sph.unc.edu/training (I hour)
• Other Resources
• DEEP PREP All Hazards Disaster Behavioral Health
  Training
• SAMHSA Website
• http//mentalhealth.samhsa.gov/publications/Public
  ations_browse.asp?ID181TopicDisaster2fTrauma
• American Academy of Child and Adolescent
  Psychiatry Website
• http//mentalhealth.samhsa.gov/_scripts/redirect.a
  sp?ID775

46
(No Transcript)