psychological first aid kathy berlin, rn mrc coordinator elizabeth mcclure, md, mph medical director...
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Psychological First Aid
Kathy Berlin, RNMRC Coordinator
Elizabeth McClure, MD, MPHMedical Director
Academic Health CenterOffice of Emergency Response
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
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
Psychological First Aid Key Points
Appropriate for all ages
Culturally informed
Consistent with research evidence on risk and resilience following trauma
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
Endorsed by……
American Psychological Association
WHO, CDC, MDH National Institute for Mental
Health National Center for PTSD Metro Disaster Behavioral Health
Work Group SAMHSA
Psychosocial Consequences of Disasters
Fear and Distress Response
Impact of Disaster Event Behavior
Change
PsychiatricIllness
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.
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
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
PFA Big Picture:Target Outcomes
Restore Safety– Safeguard– Sustain through basic needs
Facilitate Function– Comfort– Connect
Empower Action– Education– Resilience
Psychological First Aid Help Card
Goal: – Promote Safety– Calm and Comfort– Connectedness– Self-empowerment
Psychological First Aid Help Card
Responder Resilience – Prevention Strategies– Self care
When in Doubt- CONSULT!
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
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
What People Need
To talk to about their experience
Someone to care Someone to really
listen Someone to lean on
or cry with
Active Listening
Body language eye contact facial expression tone of voice
Gentle prompts Label, summarize, and mirror Compassionate presence
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
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.
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
Stress reactions are normal
Basic information on ways of coping
Psychological reactions are common and expected
Simple relaxation techniques
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
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
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
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
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
Resiliency
Ability to accommodate and bounce back after a setback disappointment crisis or major distress.
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
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
Responder Resiliency Tools
Help Card– Prevention Strategies– Self Care
Resiliency– Pre-event– During event– Post-event
Building Responder Resilience Pre-event
Educate and train Build social support systems Instill sense of mission &
purpose Create family communications
plan Learn coping strategies
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
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
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
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
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
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.
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
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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