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Psychological First Aid A Community Support Model Course Objectives: Enhance immediate and on-going safety by providing emotional support. Offer practical assistance, and coping skills to help deal with the emotional impact of a traumatic event.

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psychological first aid

Psychological First Aid

A Community Support Model

course objectives
Course Objectives:
  • Enhance immediate and on-going safety

by providing emotional support.

  • Offer practical assistance, and coping skills to help deal with the emotional impact of a traumatic event.
  • Recognize common stress responses in children/adults, and provide basic triage skills to know when to refer to professional Behavioral Health services.
  • Recognize the signs and symptoms of personal stress and learn self care strategies to increase resilience in yourself and others.
psychological first aid3
Psychological First Aid
  • Recommended as the Standard Acute Behavioral Health Intervention by:
  • National Child Traumatic Stress Network (NCTSN)
  • American Psychological Association (APA)
  • Centers for Disease Control (CDC)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)
  • National Institute for Mental Health (NIMH)
  • National Center for PTSD, Terrorism & Disaster Branch
  • World health Organization (WHO)
  • Minnesota Department of Health (MDH)
psychological first aid pfa
Psychological First Aid (PFA)
  • Principles and techniques of PFA meet four basic standards:
    • 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
mn psychological first aid
MN Psychological First Aid

A model that:

  • Integrates public health, community health, and individual psychology.
  • Includes preparedness for communities, work places, healthcare systems, schools, faith communities, and families.
  • Does not rely on direct services by mental health professionals.
  • Uses skills you probably already have…
slide6

Individual Level:

What are we trying to do?

Get people to do

what is in their best interest

AND

Prevent people from doing

what is not in their best interest

slide7

Health Care SystemLevel:

  • What are we trying to do?
    • Provide care for disaster survivors
    • Maintain care for current patients
    • Safeguard staff
    • Support responders
    • Lead effectively in crisis
slide8

Community Level:

  • What are we trying to do?
    • Promote community health
    • Reduce exposure, illness, injury
    • Promote pro-social behavior
    • Reduce fear-driven behavior
    • Safeguard the health care system
psychological first aid basics
Psychological First Aid Basics
  • Expect normal recovery
  • Assume survivors are competent
  • Recognize survivor strengths
  • Promote resilience
psychosocial consequences of disasters
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.

what is stress
What is Stress?

The International Federation of the Red Cross defines stress as “A very broad term referring to the effect of anything in life to which people must adjust.”

  • For instance, anything we consider challenging causes stress, even if it is something we willingly choose to do.
  • The key is that stress requires us to adjust our attention and behavior and makes demands upon our energy.
what scares us
What scares us?
  • Than things that are…
  • In our control
  • Easily & quickly diagnosable & treatable
  • Natural
  • Survivable
  • Managed by a trusted person or organization
  • Familiar and routine
  • Things frighten us more if they are…
  • Imposed or Controlled by others
  • Hard to treat or rationing required
  • Manmade
  • Catastrophic or deadly
  • Caused by someone or something we don’t trust
  • Exotic or unusual
event is more stressful or traumatic when
Event is 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
what assists our emotional adjustment
What assists our Emotional Adjustment?
  • Acceptance of the disaster and losses
  • Identification, labeling, and expression of emotions, an
  • Regaining a sense of mastery and control.
common physical reactions adults
Common Physical Reactions - Adults
  • Sleep difficulties
  • Gastrointestinal problems (Diarrhea, cramps)
  • Stomach upset, nausea
  • Elevated heart rate
  • Elevated blood pressure
  • Elevated blood sugar
  • With extended stress, suppression of immune

system functioning

common physical reactions children youth
Common Physical Reactions- Children/Youth
  • Headaches
  • Stomachaches
  • Nausea
  • Eating Problems
  • Speech Difficulties
  • Skin eruptions
common emotional reactions adults
Common Emotional Reactions - Adults
  • Fear and Anxiety
  • Sadness and Depression
  • Anger and Irritability
  • Numb, withdrawn, or

disconnected

  • Feeling a lack of involvement

or enjoyment in favorite activities

  • Feeling a sense of emptiness or hopelessness about the future
common emotional reactions children youth
Common Emotional Reactions – Children/Youth
  • Anxiety & Vulnerability
  • Fear of reoccurrence
  • Fear of being left alone
    • Particularly if separated from family
  • Loss of “Sense of Safety”
  • Depression
  • Anger
  • Guilt
common behavioral reactions adults
Common Behavioral Reactions - Adults
  • Family difficulties

(physical, emotional abuse)

  • Substance abuse
  • Being overprotective of family
  • Keeping excessively busy
  • Isolating oneself from others
  • Being very alert at times, startling easily
  • Avoiding places, activities, or people that bring back memories
common behavioral reactions children youth
Common Behavioral Reactions- Children/Youth
  • “Childish” or regressive behavior
    • May not be deliberate acting out
  • Bedtime problems
    • Sleep onset insomnia
    • Mid-night awakening
    • Fear of dark
    • Fear of event reoccurrence during night
common cognitive reactions adults
Common Cognitive Reactions - Adults
  • Difficulty concentrating
  • Difficulty with memory
  • Intrusive Memories
  • Recurring dreams or

nightmares

  • Flashbacks
  • Difficulty communicating
  • Difficulty following complicated instructions
common cognitive reactions
Common Cognitive Reactions
  • Confusion, memory loss, and disorientation
  • Difficulty in concentrating
    • May appear as behavioral

problems in classroom

  • School may be where child functions best
    • Continuing Structure, sense of control
    • Social group
common faith spirituality reactions adults children
Common Faith & Spirituality Reactions– Adults & Children
  • Reliance upon faith
  • Questioning values

and beliefs

  • Loss of meaning
  • Directing anger

toward God

  • Cynicism
common sensory reactions adults children
Common Sensory Reactions– Adults & Children
  • Sight
  • Sound
  • Smell
  • Taste
  • Touch
slide25

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

PFA: TARGET OUTCOMES

Physical health:

Restore SAFETY

Psychological health:

Facilitate FUNCTION

Behavioral health:

Empower ACTION

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

slide26

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

OUTCOMES

SAFETY

FUNCTION

ACTION

Restoring

physical safety

and diminishing

the physiological

stress

response.

Facilitating

psychological

function

and perceived

sense of safety

and control.

Initiating

action toward

disaster

recovery

and return to

normal activity.

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

slide27

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

STRATEGIES

SAFETY

FUNCTION

ACTION

SAFEGUARD

COMFORT

EDUCATE

SUSTAIN

CONNECT

EMPOWER

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

slide28

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

SAFETY

Safety

Security

Shelter

What Survivors Need:

SAFETY

SAFEGUARD

Remove 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.

psychological exposure risk zones

DIRECT EXPOSURE (eye witness)

ON SITE (eye witness)

IN NEIGHBORHOOD

OUT OF VICINITY

PSYCHOLOGICAL EXPOSURE RISK ZONES
traumatic stress risk factors
Traumatic Stress Risk Factors
  • Involving a child
  • Human caused disasters
  • Loss of life or threat to loss of life
  • Extensive widespread damage
  • Personal involvement
  • Previous history of mental health problems
  • Previous significant loss (such as a parent or close friend)
  • Social isolation (as can be the case with older adults)
  • Adverse life circumstances such as poverty
  • Involvement in rescue and response efforts
  • Identification with victims

National Mental Health Association. (2003). Blueprint for responding to public mental health needs in times of crisis. PP. 10-11.

slide31

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

SAFETY

Basic survival needs

What Survivors Need:

SAFETY

Provide food, water, ice.

Provide medical care, alleviate pain.

Provide clothing.

Provide power, light, heat, air conditioning.

Provide sanitation.

What To Do:

SUSTAIN

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

slide33

Sarin Attack on Tokyo Subways

Examined & discharged

4023

Hospitalized

984

Severely injured

62

Norwood AE, 2002

Killed 12

medical casualties think behaviorally
Medical Casualties? Think Behaviorally
  • Some disasters provide warning periods

during which distressed persons surge upon healthcare prior to impact.

  • For every person who is physically injured or directly impacted by a disaster, there are 4 - 10 secondary victims who experience a significant impact on their behavioral health.
  • Plan for the accompanying or arriving family.
slide35

Hospital Triage Point

Initial Hospital Triage

Medical Casualties

Psychological Casualties

Searching Family Members

Red

Yellow

Green

Support Center

Family Center

Behavioral Triage

Community

Behavioral Health

resources

Emergency

Medical

Treatment

Area

Medical/

Surgical

Units/ICUs

Distress

Patients needing

Psychiatric evaluation

D/C

Community

Behavioral Health

resources

Behavioral

Health

Source: Shaw, Shultz, Espinel 2005

slide36

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

FUNCTION

Soothing human contact

Validation that reactions are “normal”.

What Survivors Need:

FUNCTION

COMFORT

Establish compassionate “presence.”

Listen actively.

Comfort, console, soothe, and reassure.

Apply stress management techniques.

Reassure survivors that their reactions are

“normal” and expectable

What To Do:

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

trust determination factors in high concern situations
Trust Determination Factors In High Concern Situations

Assessed First 30 Seconds

Listening/Caring/

Empathy

50%

Listening/Caring/

Empathy

50%

Assessed First 30 Seconds

Competence/Expertise 15-20%

Competence/Expertise 15-20%

Dedication/

Commitment

15-20%

Dedication/

Commitment

15-20%

Honesty/ Openness 15-20%

Honesty/ Openness 15-20%

active listening
Active Listening
  • Make it clear that you are listening

Body Language

      • Eye contact
      • Distance
      • Body orientation
      • Facial Expression
      • Physical Tension
ways of responding
Ways of Responding
  • Ask mostly open-ended questions

- Closed: “Are you feeling better?”

- Open-ended: “How are you feeling?”

  • Paraphrase & Reflect Feelings
  • Avoid giving outright advice

- Assist with formal problem solving

- “Lets look at all your options.”

  • Remember your role as supportive helper
teach about normal symptoms and how to cope
Teach About Normal Symptoms and How to Cope
  • Acknowledge the common changes that can occur in people who grieve
    • Physical Changes
    • Emotional Changes
    • Cognitive Changes
    • Changes in Spiritual Beliefs
information on coping
Information on Coping
  • 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
  • Provide basic information on ways of coping
  • Teach simple relaxation techniques (3x3x3)
  • Employ “Grounding”
slide42

Adrenaline, Friend or Foe?

  • Increase in speed and strength
  • Decrease in reaction time
  • Increase in sensory acuity
  • Freezing and unable to react
  • Overreacting
  • May act in a way that seems inappropriate for the situation (e.g. giggle, yell)
slide43

Agitation

  • Sometimes, despite our best attempts at active listening, people still become agitated
  • Refusal to follow directions
  • Loss of control, becoming verbally agitated
  • Becoming threatening
  • It is usually not personal
  • This is their reaction to an UNCOMMON situation, and

it has nothing to do with you

slide44

Alarm Bells/When to Refer

  • Harm to self

Saying they want to:

“End it all”

“Go to sleep and never wake up again”

    • Excessive use of substances
      • Driving under influence
      • In some cases working under influence
  • Harm to others
    • Child abuse
    • Spouse abuse
slide45

Alarm Bells/When to Refer

  • Loss of control
  • Significant withdrawal (as change in behavior)
  • Behavior is unusually (for that individual) confused or bizarre
  • Unable to care for self (cannot eat, bathe etc. - Vulnerable)
slide46

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

FUNCTION

Social supports/keeping family together

Reuniting separated loved ones

Connection to disaster recovery services,

medical care, work, school, vital services

What Survivors Need:

FUNCTION

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

connect with support system
Connect with Support System
  • Connect with community support services
  • Attend to children who are separated from their parents/caregivers
  • Connect with pets
hospital behavioral health casualties
Hospital Behavioral Health Casualties

EMS

Processed

Medical

Casualties

Self Transported

Medical Casualties

Bystanders or

Family

Members,

Friends,

Co workers

of Incoming

Casualties

Family Members

Searching

for Missing

Loved Ones

Injured,

Exposed,

Distressed

Disaster/

Emergency

Workers

Psychological

Casualties

Media

Volunteers

Onlookers

Distressed Inpatients

Family Members

of Inpatients

Distressed Staff

slide50

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

ACTION

Information about the disaster

Information about what to do

Information about resources

Reduction of uncertainty

What Survivors Need:

ACTION

EDUCATE

  • Clarify disaster information:
  • what happened
  • what will happen
  • Provide 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.

practical assistance
Practical Assistance
  • Offer practical assistance and information to address students’ immediate needs and concerns.
  • Identify the most immediate need(s)
  • Clarify the need(s)
  • Discuss an action response
  • Act to address the need
slide52

It is OK to…

  • Recommend substitute precautions that are:
    • more useful,
    • less burdensome or
    • less likely to backfire
  • If you don’t know an answer, say “I don’t know but I might be able to help you find out.”
  • Or, “I’m not sure what to do, but I will be happy to help you find someone who does.”
slide53

Not OK to suggest that…

  • Let’s talk about something else.
  • You should work toward getting over this.
  • You are strong enough to deal with this.
  • I know how you feel.
  • You’ll feel better soon.
  • You did everything you could.
  • You need to relax.
  • It’s good that you are alive.
slide55

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

ACTION

Planning for recovery

Practical first steps and “do-able” tasks

Support to resume normal activities

Opportunities to help others

What Survivors Need:

ACTION

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:

EMPOWER

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

promoting resilience
Promoting Resilience
  • 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 Psychological First Aid: support resilience in ourselves and others
compassion fatigue

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.

slide58
INCREASE YOUR RESILENCY

How we perceive, label and

Interpret our experiences, how we think about the events in our lives, and what we predict for the futureeffects our current functioning!

When we anticipate negative

or painful outcomes, we increase

the probability of a stressful

response.

personal resiliency plan
Personal Resiliency Plan
  • Focus beyond short term
  • Know your unique stressors and Red Flags for further assistance
  • Know unique stressors of the event: extent of damage, death, and current suffering
  • Demystify/de-stigmatize common reactions
  • Select from menu of coping responses
  • Monitor on-going internal stress
developing disaster resilience
Developing Disaster Resilience

Personal & Family Preparation

  • Recognize pre-existing stress
  • Develop healthy coping skills
  • Participate in preparedness exercises & drills
  • Educate yourself on your school, city, and county response plans and your response role in a crisis situation
  • Make pre-emergency individual and family response plans
slide61

SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors

SAFETY

FUNCTION

ACTION

SAFEGUARD

Goal: SAFEGUARD

survivors from

harm and

offer protection.

COMFORT

Goal: COMFORT

support, validate,

and orient

distressed survivors.

EDUCATE

Goal: EDUCATE and inform

survivors about the disaster,

available options for action,

and resources for support.

EMPOWER

Goal: EMPOWER survivors

to take first steps toward

disaster recovery and foster

self-efficacy and resilience.

CONNECT

Goal: CONNECT

survivors to

family, friends, and

social supports,

SUSTAIN

Goal: SUSTAIN

survivors

by providing

basic needs.

Source: Shultz, Cohen, Watson, Flynn, Espinel, Smith. SAFETY, FUNCTION, ACTION:

Psychological First Aid for Disaster Survivors. Miami FL: DEEP Center 2006.

slide62
Nancy Carlson

Behavioral Health Preparedness Coordinator

Minnesota Department of Health

Office of Emergency Preparedness

625 Robert Street North

St. Paul, MN 55155- 0975

Phone 651-201-5707

Cell: 651-247-7398

Fax: 651-201-5720

Nancy.J.Carlson@health.state.mn.us

MDH Behavioral Health Web Sites:

www.health.state.mn.us/oep/planning/mhimpact.html

www.health.state.mn.us/mentalhealth/mhep.html

www.health.state.mn.us/emergency/