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Psychological First Aid

Psychological First Aid. Kathy Berlin, RN MRC Coordinator Elizabeth McClure, MD, MPH Medical Director Academic Health Center Office of Emergency Response. Training Objectives. Understand key points of Psychological First Aid (PFA) Increase awareness of the signs and symptoms of stress

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Psychological First Aid

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  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 Aid:Who, 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. 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.

  8. Reactions to Stress Adults • Physical • Behavioral • Emotional • Cognitive • Spiritual

  9. Reactions to StressChildren • Physical • Behavioral • Emotional • Cognitive • Spiritual

  10. 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

  11. 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

  12. PFA Big Picture:Target Outcomes • Restore Safety • Safeguard • Sustain through basic needs • Facilitate Function • Comfort • Connect • Empower Action • Education • Resilience

  13. Psychological First Aid Help Card • Goal: • Promote Safety • Calm and Comfort • Connectedness • Self-empowerment

  14. Psychological First Aid Help Card • Responder Resilience • Prevention Strategies • Self care • When in Doubt- CONSULT!

  15. 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

  16. CALM AND COMFORT • Compassionate presence • Active listening • Don’t push for information • Use stress management techniques • Be flexible and supportive • Comfort, console, soothe Facilitate psychological function through calming and connection

  17. What People Need • To talk to about their experience • Someone to care • Someone to really listen • Someone to lean on or cry with

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

  19. 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

  20. Active Understanding • Avoid Why/Why not? • Don’t judge • Avoid “I know how you feel.” • Avoid evaluation of their experience and their reactions • Silence is O.K.

  21. It is NOT OK to say…. • Let’s talk about something else • You should work toward getting over this • You are strong enough to deal with this • You’ll feel better soon • You did everything you could • You need to relax • It’s good that you are alive

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

  23. 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

  24. 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

  25. How to Refer Ask about reaction to referral Make referral with individual present Don’t push referral unless person appears to be at imminent risk to self or others Cold referrals are generally not successful

  26. 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

  27. 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

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

  29. 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

  30. 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

  31. Responder Resiliency Tools • Help Card • Prevention Strategies • Self Care • Resiliency • Pre-event • During event • Post-event

  32. Building Responder Resilience Pre-event Educate and train Build social support systems Instill sense of mission & purpose Create family communications plan Learn coping strategies

  33. 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

  34. 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. Compassion Fatigue 37

  35. 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

  36. Expect a reintegration period upon returning to your usual routine. Pay attention to cues from your family that you are becoming too involved. Self Care Post-event

  37. GROUP PARTICIPATION

  38. 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

  39. 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.

  40. 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

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

  42. 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/Publications_browse.asp?ID=181&Topic=Disaster%2fTrauma • American Academy of Child and Adolescent Psychiatry Website • http://mentalhealth.samhsa.gov/_scripts/redirect.asp?ID=775

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