Copy of Psychological First Aid Week 1.pptx

Psychological First Aid What is Psychological First Aid? ● Psychological First Aid is an evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. Psychological First Aid is designed to reduce the initial distress c...

Psychological First Aid What is Psychological First Aid? ● Psychological First Aid is an evidence-informed modular approach to help children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism. Psychological First Aid is designed to reduce the initial distress caused by traumatic events and to foster short- and long-term adaptive functioning and coping. Principles and techniques of Psychological First Aid meet four basic standards. They are: 1. Consistent with research evidence on risk and resilience following trauma 2. Applicable and practical in field settings 3. Appropriate for developmental levels across the lifespan 4. Culturally informed and delivered in a flexible manner What is Psychological First Aid cont. ● Psychological First Aid does not assume that all survivors will develop severe mental health problems or long-term difficulties in recovery. Instead, it is based on an understanding that disaster survivors and others affected by such events will experience a broad range of early reactions (for example, physical, psychological, behavioral, spiritual). Some of these reactions will cause enough distress to interfere with adaptive coping, and recovery may be helped by support from compassionate and caring disaster responders. Who is Psychological First Aid for? ● Psychological First Aid intervention strategies are intended for use with children, adolescents, parents/caretakers, families, and adults exposed to disaster or terrorism. Psychological First Aid can also be provided to first responders and other disaster relief workers. Who Delivers Psychological First Aid? ● Psychological First Aid is designed for delivery by mental health and other disaster response workers who provide early assistance to affected children, families, and adults as part of an organized disaster response effort. These providers may be imbedded in a variety of response units, including first responder teams, incident command systems, primary and emergency health care, school crisis response teams, faith-based organizations, Community Emergency Response Teams (CERT), Medical Reserve Corps, the Citizens Corps, and other disaster relief organizations. Where Should Psychological First Aid Be Used? ● Psychological First Aid is a supportive intervention for use in the immediate aftermath of disasters and terrorism. ● Psychological First Aid is designed for delivery in diverse settings. Mental health and other disaster response workers may be called upon to provide Psychological First Aid in general population shelters, special needs shelters, field hospitals and medical triage areas, acute care facilities (for example, Emergency Departments), staging areas or respite centers for first responders or other relief workers, emergency operations centers, crisis hotlines or phone banks, feeding locations, disaster assistance service centers, family reception and assistance centers, homes, businesses, and other community settings. Strengths of Psychological First Aid ● Psychological First Aid includes basic information-gathering techniques to help providers make rapid assessments of survivors’ immediate concerns and needs, and to implement supportive activities in a flexible manner. ● Psychological First Aid relies on field-tested, evidence-informed strategies that can be provided in a variety of disaster settings. ● Psychological First Aid emphasizes developmentally and culturally appropriate interventions for survivors of various ages and backgrounds. ● Psychological First Aid includes handouts that provide important information for youth, adults, and families for their use over the course of recovery. Basic Objectives of Psychological First Aid ● ● ● ● ● ● ● ● ● Establish a human connection in a non-intrusive, compassionate manner. Enhance immediate and ongoing safety, and provide physical and emotional comfort. Calm and orient emotionally overwhelmed or distraught survivors. Help survivors to tell you specifically what their immediate needs and concerns are, and gather additional information as appropriate. Offer practical assistance and information to help survivors address their immediate needs and concerns. Connect survivors as soon as possible to social support networks, including family members, friends, neighbors, and community helping resources. Support adaptive coping, acknowledge coping efforts and strengths, and empower survivors; encourage adults, children, and families to take an active role in their recovery. Provide information that may help survivors cope effectively with the psychological impact of disasters. Be clear about your availability, and (when appropriate) link the survivor to another member of a disaster response team or to local recovery systems, mental health services, public-sector services, and organizations. Delivering Psychological First Aid ● Professional Behavior ○ ○ ○ ○ ○ ○ Operate only within the framework of an authorized disaster response system. Model healthy responses; be calm, courteous, organized, and helpful. Be visible and available. Maintain confidentiality as appropriate Remain within the scope of your expertise and your designated role. Make appropriate referrals when additional expertise is needed or requested by the survivor. ○ Be knowledgeable and sensitive to issues of culture and diversity ○ Pay attention to your own emotional and physical reactions, and practice self-care. Delivering Psychological First Aid ● Guidelines for Delivering Psychological First Aid ○ Politely observe first; don’t intrude. Then ask simple respectful questions to determine how you may help. ○ Often, the best way to make contact is to provide practical assistance (food, water, blankets). ○ Initiate contact only after you have observed the situation and the person or family, and have determined that contact is not likely to be intrusive or disruptive. ○ Be prepared that survivors will either avoid you or flood you with contact. ○ Speak calmly. Be patient, responsive, and sensitive. ○ Speak slowly, in simple concrete terms; don’t use acronyms or jargon. ○ If survivors want to talk, be prepared to listen. When you listen, focus on hearing what they want to tell you, and how you can be of help. Delivering Psychological First Aid ● Guidelines for Delivering Psychological First Aid - cont. ○ Acknowledge the positive features of what the survivor has done to keep safe. ○ Give information that directly addresses the survivor’s immediate goals and clarify answers repeatedly as needed. ○ Give information that is accurate and age-appropriate for your audience. ○ When communicating through a translator or interpreter, look at and talk to the person you are addressing, not at the translator or interpreter. ○ Remember that the goal of Psychological First Aid is to reduce distress, assist with current needs, and promote adaptive functioning, not to elicit details of traumatic experiences and losses. Some Behaviors to Avoid ● Do not make assumptions about what survivors are experiencing or what they have been through. ● Do not assume that everyone exposed to a disaster will be traumatized. ● Do not pathologize. Most acute reactions are understandable and expected given what people exposed to the disaster have experienced. Do not label reactions as “symptoms,” or speak in terms of “diagnoses,” “conditions,” “pathologies,” or “disorders.” ● Do not talk down to or patronize the survivor, or focus on his/her helplessness, weaknesses, mistakes, or disability. Focus instead on what the person has done that is effective or may have contributed to helping others in need, both during the disaster and in the present setting. Some Behaviors to Avoid cont. ● Do not assume that all survivors want to talk or need to talk to you. Often, being physically present in a supportive and calm way helps affected people feel safer and more able to cope. ● Do not “debrief” by asking for details of what happened. ● Do not speculate or offer possibly inaccurate information. If you cannot answer a survivor’s question, do your best to learn the facts. Working With Children and Adolescents ● For young children, sit or crouch at the child’s eye level. ● Help school-age children verbalize their feelings, concerns and questions; provide simple labels for common emotional reactions (for example, mad, sad, scared, worried). Do not use extreme words like “terrified” or “horrified” because this may increase their distress. ● Listen carefully and check in with the child to make sure you understand him/her. ● Be aware that children may show developmental regression in their behavior and use of language. Working With Children and Adolescents cont. ● Match your language to the child’s developmental level. Younger children typically have less understanding of abstract concepts like “death.” Use direct and simple language as much as possible. ● Talk to adolescents “adult-to-adult,” so you give the message that you respect their feelings, concerns, and questions. ● Reinforce these techniques with the child’s parents/caregivers to help them provide appropriate emotional support to their child. Working With Older Adults ● Older adults have strengths as well as vulnerabilities. Many older adults have acquired effective coping skills over a lifetime of dealing with adversities. ● For those who may have a hearing difficulty, speak clearly and in a low pitch. ● Don’t make assumptions based only on physical appearance or age, for example, that a confused elder has irreversible problems with memory, reasoning, or judgment. Reasons for apparent confusion may include: disaster-related disorientation due to change in surroundings; poor vision or hearing; poor nutrition or dehydration; sleep deprivation; a medical condition or problems with medications; social isolation; and feeling helpless or vulnerable. ● An older adult with a mental health disability may be more upset or confused in unfamiliar surroundings. If you identify such an individual, help to make arrangements for a mental health consultation or referral. Working With Survivors with Disabilities ● When needed, try to provide assistance in an area with little noise or other stimulation. ● Address the person directly, rather than the caretaker, unless direct communication is difficult. ● If communication (hearing, memory, speech) seems impaired, speak simply and slowly. ● Take the word of a person who claims to have a disability–even if the disability is not obvious or familiar to you. Working With Survivors with Disabilities - cont. ● When you are unsure of how to help, ask, “What can I do to help?” and trust what the person tells you. ● When possible, enable the person to be self-sufficient. ● Offer a blind or visually impaired person your arm to help him/her move about in unfamiliar surroundings. ● If needed, offer to write down information and make arrangements for the person to receive written announcements. ● Keep essential aids (such as medications, oxygen tank, respiratory equipment, and wheelchair) with the person. Preparing to Deliver Psychological First Aid ● In order to be of assistance to disaster-affected communities, the Psychological First Aid provider must be knowledgeable about the nature of the event, current circumstances, and the type and availability of relief and support services ● Planning and preparation are important when working as a Psychological First Aid provider. Up-to-date training in disaster mental health and knowledge of your incident command structure are critical components in undertaking disaster relief work. You may also be working with children, older adults and special populations, all of which require additional in-depth knowledge. In deciding whether to participate in disaster response, you should consider your comfort level with this type of work, your current health, your family and work circumstances, and be prepared to engage in appropriate self-care. See Appendix C for more guidance in regard to these topics Entering the Setting ● Psychological First Aid begins when a disaster response worker enters an emergency management setting in the aftermath of a disaster (See Appendix B for descriptions of various service delivery sites). Successful entry involves working within the framework of an authorized Incident Command System (ICS) in which roles and decision-making are clearly defined. It is essential to establish communication and coordinate all activities with authorized personnel or organizations that are managing the setting. Effective entry also includes learning as much as you can about the setting, for example, leadership, organization, policies and procedures, security, and available support services. You need to have accurate information about what is going to happen, what services are available, and where they can be found. This information needs to be gathered as soon as possible, given that providing such information is often critical to reducing distress and promoting adaptive coping. Providing Services ● In some settings, Psychological First Aid may be provided in designated areas. In other settings, providers may circulate around the facility to identify those who might need assistance. Focus your attention on how people are reacting and interacting in the setting. Individuals who may need assistance include those showing signs of acute distress, including individuals who are: ○ ○ ○ ○ ○ ○ ○ Disoriented Confused Frantic or agitated Panicky Extremely withdrawn, apathetic, or “shut down” Extremely irritable or angry Exceedingly worried Group Settings ● While Psychological First Aid is primarily designed for working with individuals and families, many components can be used in group settings, such as when families gather together for information about loved ones and for security briefings. The components of providing information, support, comfort, and safety can be applied to these spontaneous group situations. For groups of children and adolescents, offering games for distraction can reduce anxiety and concern after hours and days in a shelter setting. Group Settings cont. ● When meeting with groups, keep the following in mind: ○ Tailor the discussion to the group’s shared needs and concerns. ○ Focus the discussion on problem-solving and applying coping strategies to immediate issues. ○ Do not let discussion about concerns lapse into complaints. ○ If an individual needs further support, offer to meet with him/her after the group discussion. Maintain a Calm Presence ● People take their cue from how others are reacting. By demonstrating calmness and clear thinking, you can help survivors feel that they can rely on you. Others may follow your lead in remaining focused, even if they do not feel calm, safe, effective, or hopeful. Psychological First Aid providers often model the sense of hope that survivors cannot always feel while they are still attempting to deal with what happened and current pressing concerns. Be Sensitive to Culture and Diversity ● Providers of Psychological First Aid must be sensitive to culture, ethnic, religious, racial, and language diversity. Whether providing outreach or services, you should be aware of your own values and prejudices, and how these may agree with or differ from those of the community being served. Training in cultural competence can facilitate this awareness. Helping to maintain or re-establish customs, traditions, rituals, family structure, gender roles, and social bonds is important in helping survivors cope with the impact of a disaster. Information about the community being served, including how emotions and other psychological reactions are expressed, attitudes toward government agencies, and receptivity to counseling, should be gathered with the assistance of community cultural leaders who represent and best understand local cultural groups. Be Aware of At-Risk Populations ● Individuals that are at special risk after a disaster include: ● Children, especially those: ○ ○ ○ ○ ● ● ● ● ● Separated from parents/caregivers Whose parents/caregivers, family members, or friends have died Whose parents/caregivers were significantly injured or are missing Involved in the foster care system Those who have been injured Those who have had multiple relocations and displacements Medically frail children and adults Those with serious mental illness Those with physical disability, illness, or sensory deficit Be Aware of At-Risk Populations cont. ● ● ● ● ● ● Adolescents who may be risk-takers Adolescents and adults with substance abuse problems Pregnant women Mothers with babies and small children Disaster response personnel Those with significant loss of possessions (for example, home, pets, family memorabilia) ● Those exposed first hand to grotesque scenes or extreme life threat Be Aware of At-Risk Populations cont. ● Especially in economically disadvantaged groups, a high percentage of survivors may have experienced prior traumatic events (for example, death of a loved one, assault, disaster). As a consequence, minority and marginalized communities may have higher rates of preexisting trauma-related mental health problems, and are at greater risk for developing problems following disaster. Mistrust, stigma, fear (for example, of deportation), and lack of knowledge about disaster relief services are important barriers to seeking, providing, and receiving services for these populations. Those living in disaster-prone regions are more likely to have had prior disaster experiences. Psychological First Aid Core Actions 1. Contact and Engagement Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner. 2. Safety and Comfort Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort. 3. Stabilization (if needed) Goal: To calm and orient emotionally overwhelmed or disoriented survivors. 4. Information Gathering: Current Needs and Concerns Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions. These core actions of Psychological First Aid constitute the basic objectives of providing early assistance within days or weeks following an event. Providers should be flexible, and base the amount of time they spend on each core action on the survivors’ specific needs and concerns. Psychological First Aid Core Actions 5. Practical Assistance Goal: To offer practical help to survivors in addressing immediate needs and concerns. 6. Connection with Social Supports Goal: To help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources. 7. Information on Coping Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning. 8. Linkage with Collaborative Services Goal: To link survivors with available services needed at the time or in the future. 1.Contact and Engagement ● Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner. ● Your first contact with a survivor is important. If managed in a respectful and compassionate way, you can establish an effective helping relationship and increase the person’s receptiveness to further help. Your first priority should be to respond to survivors who seek you out. If a number of people approach you simultaneously, make contact with as many individuals as you can. Even a brief look of interest and calm concern can be grounding and helpful to people who are feeling overwhelmed or confused. Contact and Engagement: Culture Alert ● The type of physical or personal contact considered appropriate may vary from person to person and across cultures and social groups, for example, how close to stand to someone, how much eye contact to make or whether or not to touch someone, especially someone of the opposite sex. Unless you are familiar with the culture of the survivor, you should not approach too closely, make prolonged eye contact, or touch. You should look for clues to a survivor’s need for “personal space,” and seek guidance about cultural norms from community cultural leaders who best understand local customs. In working with family members, find out who is the spokesperson for the family and initially address this person. Contact and Engagement ● Some survivors may not seek your help, but may benefit from assistance. When you identify such persons, timing is important. Do not interrupt conversations. Do not assume that people will respond to your outreach with immediate positive reactions. It may take time for some survivors or bereaved persons to feel some degree of safety, confidence, and trust. If an individual declines your offer of help, respect his/her decision and indicate when and where to locate a Psychological First Aid provider later on. Introduce Yourself/Ask about Immediate Needs ● Introduce yourself with your name, title, and describe your role. Ask for permission to talk to him/her, and explain that you are there to see if you can be of help. Unless given permission to do otherwise, address adult survivors using last names. Invite the person to sit, try to ensure some level of privacy for the conversation, and give the person your full attention. Speak softly and calmly. Refrain from looking around or being distracted. Find out whether there is any pressing problem that needs immediate attention. Immediate medical concerns have the utmost priority. ● When making contact with children or adolescents, it is good practice to first make a connection with a parent or accompanying adult to explain your role and seek permission. If you speak with a child in distress when no adult is present, find a parent or caregiver as soon as possible to let him/her know about your conversation. Introduce Yourself/Ask about Immediate Needs Adult/Caregiver Hello. My name is ___________. I work with __________. I’m checking in with people to see how they are doing, and to see if I can help in any way. Is it okay if I talk to you for a few minutes? May I ask your name? Mrs. Williams, before we talk, is there something right now that you need, like some water or fruit juice? Adolescent/Child And is this your daughter? (Get on child’s eye level, smile and greet the child, using her/his name and speaking softly.) Hi Lisa, I’m ___________ and I’m here to try to help you and your family. Is there anything you need right now? There is some water and juice over there, and we have a few blankets and toys in those boxes. Confidentiality ● Protecting the confidentiality of your interactions with children, adults, and families after a disaster can be challenging, especially given the lack of privacy in some postdisaster settings. However, maintaining the highest level of confidentiality possible in any conversation you have with survivors or disaster responders is extremely important. If you are a professional who belongs to a category of mandated reporters, you should abide by state abuse and neglect reporting laws. You should also be aware of the Health Insurance Portability and Accountability Act (HIPAA) and the provisions related to disaster and terrorism. If you have questions about releasing information, discuss this with a supervisor or an official in charge. Talking to co-workers about the challenges of working in the post-disaster environment can be helpful, but any discussions organized for this purpose also need to preserve strict confidentiality. 2. Safety and Comfort ● Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort. ● Restoration of a sense of safety is an important goal in the immediate aftermath of disaster and terrorism. Promoting safety and comfort can reduce distress and worry. Assisting survivors in circumstances of missing loved ones, death of loved ones, death notification and body identification is a critical component of providing emotional comfort and support. Safety and Comfort Comfort and safety can be supported in a number of ways, including helping survivors: ● Do things that are active (rather than passive waiting), practical (using available resources), and familiar (drawing on past experience). ● Get current, accurate and up-to-date information, while avoiding survivors’ exposure to information that is inaccurate or excessively upsetting. ● Get connected with available practical resources. ● Get information about how responders are making the situation safer. ● Get connected with others who have shared similar experiences. Ensure Immediate Physical Safety ● Make sure that individuals and families are physically safe to the extent possible. If necessary, reorganize the immediate environment to increase physical and emotional safety. For example: ○ Find the appropriate officials who can resolve safety concerns that are beyond your control, such as threats, weapons, etc. ○ Remove broken glass, sharp objects, furniture, spilled liquids, and other objects that could cause people to trip and fall. ○ Make sure that children have a safe area in which to play and that they are adequately supervised. ○ Be aware and ensure the safety of survivors in a particular subgroup that may be targeted for persecution based on their ethnicity, religion, or other affiliations. To promote safety and comfort for survivors who are elderly or disabled, you can: ● Help make the physical environment safer (for example, try to ensure adequate lighting, and protect against slipping, tripping, and falling). ● Ask specifically about his/her needs for eyeglasses, hearing aids, wheelchairs, walkers, canes, or other devices. Try to ensure that all essential aids are kept with the person. ● Ask whether the survivor needs help with health-related issues or daily activities (for example, assistance with dressing, use of bathroom, daily grooming, and meals). Ensure Immediate Physical Safety ● Inquire about current need for medication. Ask if he/she has a list of current medications or where this information can be obtained, and make sure he/she has a readable copy of this information to keep during the post-disaster period. ● Consider keeping a list of survivors with special needs so that they can be checked on more frequently. ● Contact relatives, if they are available, to further ensure safety, nutrition, medication, and rest. Make sure that the authorities are aware of any daily needs that are not being met. Ensure Immediate Physical Safety ● If there are medical concerns requiring urgent attention or immediate need for medication, contact the appropriate unit leader or medical professional immediately. Remain with the affected person or find someone to stay with him/her until you can obtain help. Other safety concerns involve: ● Threat of harm to self or others–Look for signs that persons may hurt themselves or others (for example, the person expresses intense anger towards self or others, exhibits extreme agitation). If so, seek immediate support for containment and management by medical, EMT assistance, or a security team. ● Shock–If an individual is showing signs of shock (pale, clammy skin; weak or rapid pulse; dizzy; irregular breathing; dull or glassy eyes; unresponsive to communication; lack of bladder or bowel control; restless, agitated, or confused), seek immediate medical support. Providing Information about Disaster Response Activities and Services ● ● ● ● ● ● ● To help reorient and comfort survivors, provide information about: What to do next What is being done to assist them What is currently known about the unfolding event Available services Common stress reactions Self-care, family care, and coping In providing information ● Use your judgment as to whether and when to present information. Does the individual appear able to comprehend what is being said, and is he/she ready to hear the content of the messages? ● Address immediate needs and concerns to reduce fears, answer pressing questions, and support adaptive coping. ● Use clear and concise language, while avoiding technical jargon. Providing Information about Disaster Response Activities and Services Ask survivors if they have any questions about what is going to happen, and give simple accurate information about what they can expect. Also, ask whether he/she has any special needs that the authorities should know about in order to decide on the best placement. Be sure to ask about concerns regarding current danger and safety in their new situation. Try to connect survivors with information that addresses these concerns. If you do not have specific information, do not guess or invent information in order to provide reassurance. Instead, develop a plan with the person for ways you and he/she can gather the needed information. Examples of what you might say include: Adult/Caregiver/Adolescent From what I understand, we will start transporting people to the Adolescent shelter at West High School in about an hour. There will be food, clean clothing, and a place to rest. Please stay in this area. A member of the team will look for you here when we are ready to go. Child Here’s what’s going to happen next. You and your mom are going together soon to a place called a shelter, which really is just a safe building with food, clean clothing, and a place to rest. Stay here close to your mom until it’s time to go. Providing Information about Disaster Response Activities and Services Do not reassure people that they are safe unless you have definite factual information that this is the case. Also do not reassure people of the availability of goods or services (for example, toys, food, medicines) unless you have definite information that such goods and services will be available. However, do address safety concerns based on your understanding of the current situation. For example, you may say: Adult/Caregiver Mrs. Williams, I want to assure you that the authorities are responding as well as they can right now. I am not sure that the fire has been completely contained, but you and your family are not in danger here. Do you have any concerns about your family’s safety right now? Adolescent We’re working hard to make you and your family safe. Do you have any questions about what happened, or what is being done to keep everyone safe? Child Your mom and dad are here, and many people are all working hard together so that you and your family will be safe. Do you have any questions about what we’re doing to keep you safe? Attend to Physical Comfort ● Look for simple ways to make the physical environment more comfortable. If possible, consider things like temperature, lighting, air quality, access to furniture, and how the furniture is arranged. In order to reduce feelings of helplessness or dependency, encourage survivors to participate in getting things needed for comfort (for example, offer to walk over to the supply area with the person rather than retrieving supplies for him/her). Help survivors to soothe and comfort themselves and others around them. For children, toys like soft teddy bears that they can hold and take care of can help them to soothe themselves. However, avoid offering such toys if there are not enough to go around to all children who may request them. You can help children learn how to take care of themselves by explaining how they can “care” for their toy (for example, “Remember that she needs to drink lots of water and eat three meals a day–and you can do that, too”). Attend to Physical Comfort When working with the elderly or people with disabilities, pay attention to factors that may increase their vulnerability to stress or worsen medical conditions. When attending to the physical needs of these survivors, be mindful of: ● Health problems, such as physical illness, problems with blood pressure, fluid and electrolyte balance, respiratory issues (supplemental oxygen dependency), frailty (increased susceptibility to falls, minor injuries, bruising, and temperature extremes) ● Age-related sensory loss: ○ Visual loss, which can limit awareness of surroundings and add to confusion ○ Hearing loss, resulting in gaps in understanding of what others are saying Attend to Physical Comfort ● Cognitive problems, such as difficulty with attention, concentration, and memory ● Lack of mobility ● Unfamiliar or over-stimulating surroundings ● Limited access to bathroom facilities or mass eating areas, or having to wait in long lines (A person who has not needed a wheelchair before the event may need one now.) ● Noise that can limit hearing and interfere with hearing devices ● Concern for the safety of a service animal