Psychological First Aid Week 2.pptx

Help Survivors When a Family Member or Close Friend has Died ● Children and adolescents sometimes feel guilty that they survived while other family members did not. They may believe that they caused the death in some way. Families need to help dispel children’s sense of responsibility and assure the...

Help Survivors When a Family Member or Close Friend has Died ● Children and adolescents sometimes feel guilty that they survived while other family members did not. They may believe that they caused the death in some way. Families need to help dispel children’s sense of responsibility and assure them that, in events like this, they are not to blame for what happened. For example, you may suggest that a caregiver say: Parent/Caregiver ● ● We all did what we could to try to save everybody. Daddy would be so happy that we are all okay. You did not do anything wrong. Note: Saying this once may not be enough; feelings of guilt may come up again and again, and a parent may need to provide constant assistance with a child’s ongoing worries and confusion about guilt. Attend to Grief and Spiritual Issues ● In order to assist survivors with spiritual needs after a death, you should become familiar with clergy who may be part of the disaster response team on-site, and with ways to obtain contact information for clergy of local religious groups to whom you can refer survivors. It is common for people to rely on religious and spiritual beliefs/practices as a way to cope with the death of a loved one. Survivors may use religious language to talk about what is happening or want to engage in prayer or other religious practices. It is not necessary for you to share these beliefs in order to be supportive. You are not required to do or say anything that violates your own beliefs. Often, simply listening and attending is all that is required. Things to keep in mind include: ● A good way to introduce this topic is to ask, “Do you have any religious or spiritual needs at this time?” This question is not meant to lead to a theological discussion or to your engaging in spiritual counseling. If requested, you can refer them to a clergy member of their choice. ● Do not contradict or try to “correct” what a person says about his/her religious beliefs, even if you disagree and think that it may be causing them distress. ● Do not try to answer religious questions like, “Why was this allowed to happen?” These questions generally represent expressions of emotion rather than real requests for an answer. Attend to Grief and Spiritual Issues ● If a person is clearly religious, ask if he/she wants to see a clergy member of his/her faith. ● Many people rely on religious objects such as prayer beads, statues, or sacred texts that they may have lost or left behind. Locating an object like this can help to increase their level of security and sense of control. A local clergy member can often be of help in providing these items. ● Survivors may want to pray alone or in a group. You may help by finding a suitable place for them to do so. For some people, facing in the proper direction while praying is important. You can help to orient them. Attend to Grief and Spiritual Issues ● You may also provide information to officials in charge regarding space and religious items needed for religious observances. ● If you are asked to join in prayer, you may decline if you feel uncomfortable. Keep in mind that joining may only involve standing in silence while they pray. If you are comfortable joining in at the end with an “Amen,” this can help your relationship with the person and the family. ● Many people routinely light candles or incense when they pray. If not allowed in the setting, explain this to survivors, and assist them in finding a nearby place where an open flame would be allowed. Attend to Grief and Spiritual Issues ● A survivor may voice hope for a miracle, even in the face of virtual certainty that their loved one has died. Do not take this as evidence that he/she has lost touch with reality or has not heard what has been said, but as the survivor’s way of continuing to function in devastating circumstances. It is important to neither encourage or discourage such hope. ● Every religion has specific practices around death, particularly in regard to the care of dead bodies. These issues may be especially complicated when the body is not recovered. Ask survivors about their religious needs in this area. They may want a clergy member to advise them. Attend to Grief and Spiritual Issues ● In some cultures, expressions of grief can be very loud and may seem out of control. It may be helpful to move families to a more private space to prevent them from upsetting others. If the behavior is upsetting to you, you should find someone else to assist the family. ● If a survivor expresses anger associated with his/her religious beliefs (a sign of spiritual distress), do not judge or argue with him/her. Most people are not looking for an “answer,” but a willing, non-judgmental listener. If spiritual concerns are contributing to significant distress, guilt, or functional impairment, you can ask if he/she would like a referral to a clergy member. Provider Alert: ● Many times during disaster situations, well-meaning religious people seek out survivors in order to proclaim their own religious beliefs. If you become aware of activities like this, do not try to intervene; instead notify security personnel or others in charge. Provide Information about Casket and Funeral Issues ● Local laws often govern the preparation of a body for burial and rules regarding caskets or internment. Sometimes exceptions are made for members of particular religious groups. In many jurisdictions, the law requires autopsies for any victim of a traumatic death or when the cause of death is not clear. This requirement may be upsetting, especially to members of religious groups that normally prohibit autopsies. In some jurisdictions, autopsy requirements can be waived by a Medical Examiner. Families who do not want an autopsy should be helped to find out about local laws. ● When a body has been significantly disfigured, you may suggest that–if it is in keeping with the religious tradition of the family–survivors place a photograph of the deceased on the casket in order to allow mourners to remember the person as he/she was alive and pay their respects. You can assist family members with their questions about children’s attendance at a funeral, memorial service, or gravesite. ● It can be helpful for a child to attend a funeral. Although emotionally challenging, funerals help children accept the physical reality of the death which is part of grieving. If not included, children can feel left out of something important to the family. Parents/caregivers should give children a choice whether or not to attend a funeral or other ritual. They may be encouraged, but should not be pressured. ● Before asking children to choose, tell them what to expect if they attend, including letting them know that adults may be upset and crying. Explain that there will be a special area for the family to sit together (if that is to be arranged). Let them know what will happen during the service. ● Give them an opportunity to choose the person that they will sit next to at the service. Make sure that this person can pay appropriate attention to them. ● Always provide a way for children to leave the service with that person, even temporarily, if they become overwhelmed. ● Tell children about alternative arrangements if they do not wish to attend, such as staying with a neighbor or friend of the family. ● If they choose not to attend, offer to say something or read something on their behalf, and explain how they can participate in memorial activities at a later time, including memorials of their own making. ● If possible, bring younger children to the location early so that they can explore the space. Describe the casket and, if they wish, join them in approaching it. Caution should be exercised in regard to allowing young children to view or touch the body. A young child can use a photograph of the person to help say goodbye. ● For younger children, reinforce that the deceased family member is not in distress. Provide Information about Casket and Funeral Issues ● You may be asked to attend funerals or other events. You may feel that this will help a family member or child. Attend funerals only with the permission and knowledge of the family. Attend to Issues Related to Traumatic Grief ● After traumatic death, some survivors may stay focused on the circumstances of the death, including being preoccupied with how the death could have been prevented, what the last moments were like, and who was at fault. These reactions may interfere with grieving, making it more difficult for survivors to adjust to the death. These reactions include: ○ Intrusive, disturbing images of the death that interfere with positive remembering and reminiscing ○ Retreat from close relationships with family and friends ○ Avoidance of usual activities because they are reminders of the traumatic death ○ For children, repetitive play that includes themes involving the traumatic circumstances of the death ● These reactions can change mourning, often putting individuals on a different time course than may be experienced by other family members. You may want to speak privately to a family member who was present at the time of the death in order to advise him/her about the extra burden of witnessing the death. Let him/her know that talking to a mental health professional or clergy member may be very helpful. For example, you might say: Adult/Adolescent It is awful to have been there when Joe died. Other family members may want to know details about what happened, but there may be some details that you think will be too upsetting for them. Discussing what you went through with a professional can help you decide what to share with your family and also help you with your grief. Support Survivors Who Receive Death Notification ● Although it is unlikely that you will be asked to notify a family member of a death, you may assist family members who have been informed of a death. You may be asked by police, FBI, hospital personnel or Disaster Mortuary Operational Response Team (DMORT) members to be present at the time of death notification. In some catastrophic situations, such as airline crashes, the news media may report that there were no survivors of the accident before family members have been officially notified. As incorrect information is sometimes circulated by the media or other survivors–caution family members to wait for official confirmation from the authorities. Support Survivors Who Receive Death Notification ● After learning of the death of a family member or close friend, people may have psychological and physiological reactions that vary from agitation to numbness. At the same time, they must cope with the continuing stress of still being in the disaster environment. In providing support, keep the following in mind: ○ Don’t rush. Family members need time to process the news and ask questions. ○ Allow for initial strong reactions: these will likely improve over time. ○ When talking about a person who is a confirmed fatality, use the word “died,” not “lost” or “passed away.” ○ Remember that family members do not want to know how YOU feel (sympathy); they want to know you are trying to understand how THEY feel (empathy). Active steps to help support survivors in dealing with death notification include: ● ● ● ● Seek assistance from medical support personnel if a medical need arises. Get help from the authorities if family members are at risk for hurting themselves or others. Make sure that social supports are available, such as family, friends, neighbors, or clergy. Try to work with individuals or family units. Even when officials are addressing large crowds, it is better to have family members assembled at their own tables with you present. Potentially traumatic activities–such as reviewing passenger manifests, ticket lists, or morgue photos–should be done in family groups, in a private location, with the appropriate authorities. Be careful that children and adolescents do not see morgue photos. ● If an unaccompanied child is told that his/her caregiver has died, stay with the child or ensure that another worker stays with the child until he/she is reunited with other family members or is attended to by an appropriate child protective service worker. ● Children may have a range of responses to being told of the death of a loved one. They may act as if they did not hear, they may cry or protest the news, or they may not speak for an extended period. They may be angry with the person who told them. You may suggest that the parent/ caretaker say something like: Parent/Caregiver It is awfully hard to hear that Aunt Julia is really dead. It’s okay if you want to cry or if you don’t want to cry. Anytime you want to talk about her and what happened, I’m going to be here for that. You’ll see me have lots of feelings too. We can all help each other. Support Survivors Who Receive Death Notification ● For adolescents, you can advise parents to caution teens about doing something risky, like storming off, driving while overwhelmed with such news, staying out late, engaging in high-risk sexual behavior, using alcohol or other drugs, or acting in some other reckless way. Parents/caretakers should also understand that an adolescent’s anger can turn to rage over the loss, and they should be prepared to tolerate some expressions of rage. However, they should also be firm in addressing any behavioral risks. Expression of any suicidal thought should be taken seriously, and appropriate additional assistance should be immediately sought. Expressions of revenge should also be taken seriously. Adolescents should be cautioned to think about the consequences of revenge, and be encouraged to consider constructive ways to respond to their feelings. ● Family members should address immediate questions from children and adolescents about their living circumstances and who will take care of them. You may suggest that separation of siblings be avoided, if at all possible. Support Survivors Involved in Body Identification ● Where identifiable bodies have been recovered and family members have been asked to assist in the identification process, authorities may take family members to the morgue or an alternative location to view and identify the body. The Psychological First Aid provider will typically not participate in these activities, but may be of assistance prior to and after body identification. Some individuals may feel that they must see the body before they can accept that the person is dead. Adolescents and older children might ask to be present when the body is identified; however, in most cases, children should be discouraged from participating in the process. Children may not understand the extent to which the body has deteriorated or changed, and may find seeing the body extremely disturbing. Parents can say to the child: Parent/Caregivers You know, Uncle Bobby wouldn’t want you to see him that way. I’m going to go and make sure that it’s him, but I don’t feel that you should go and see the body. Support Survivors Involved in Body Identification ● When the body is found, it is natural for families to want to know when and where it was found, and what the person experienced before dying. Family members may be more disturbed by unanswered questions, than by having those questions answered. You should expect a wide range of reactions after viewing the body, including shock, numbness, fainting, vomiting, trembling, screaming, or hitting something or someone. Help Caregivers Confirm Body Identification to a Child or Adolescent ● After a family member has identified the body of a loved one, a caregiver should convey this to children. You may sit in to provide support and assistance. Since young children do not understand that death is final, a family member should make it very clear that the lost loved one’s body has been found, and that he/she is dead. If the identification was made through forensic methods, it is important to explain the certainty of the identification in simple direct language. Parents should reassure children that the loved one is not suffering, that they were very loved by him/her, and that they will be taken care of. Allow children to ask questions, and–if an answer is not readily available–let them know that the parent or you will try to get additional information. You should caution parents/caretakers about giving disturbing details of the physical appearance of the body. If the child asks about the appearance, a parent can say: * Parent/Caregivers It was not easy to see Uncle Jack, and he would want us to remember him alive, and to think about the nice times we spent together. I remember going on hikes and going fishing. You can pick any memory of Uncle Jack that you want, too. Then we’ll both have good ways to think about him. Stabilization (if needed) Stabilization ● Goal: To calm and orient emotionally overwhelmed or disoriented survivors. ● Most individuals affected by disasters will not require stabilization. Expressions of strong emotions, even muted emotions (for example, numb, indifferent, spaced-out, or confused) are expectable reactions, and do not of themselves signal the need for additional intervention beyond ordinary supportive contact. While expression of strong emotions, numbing, and anxiety are normal and healthy responses to traumatic stress, extremely high arousal, numbing, or extreme anxiety can interfere with sleep, eating, decision making, parenting, and other life tasks. You should be concerned about those individuals whose reactions are so intense and persistent that they significantly interfere with a survivor’s ability to function. Stabilize Emotionally Overwhelmed Survivors Stabilize Emotionally Overwhelmed Survivors ● ● ● ● ● ● ● ● Unresponsiveness to verbal questions or commands Looking glassy eyed and vacant–unable to find direction Disorientation (for example, engaging in aimless disorganized behavior) Exhibiting strong emotional responses, uncontrollable crying, hyperventilating, rocking or regressive behavior Experiencing uncontrollable physical reactions (shaking, trembling) Exhibiting frantic searching behavior Feeling incapacitated by worry Engaging in risky activities If the person is too upset, agitated, withdrawn, or disoriented to talk, or shows extreme anxiety, fear, or panic, consider: ● Is the person with family and friends? If so, enlist them in comforting the distressed person. You may want to take a distressed individual to a quiet place, or speak quietly with that person while family/friends are nearby. ● What is the person experiencing? Is he/she crying, panicking, experiencing a “flashback,” or imagining that the event is taking place again? When intervening, address the person’s primary immediate concern or difficulty, rather than simply trying to convince the person to “calm down” or to “feel safe” (neither of which tends to be effective). Stabilize Emotionally Overwhelmed Survivors: For children or adolescents ● Is the child or adolescent with his/her parents? If so, briefly make sure that the adult is stable. Focus on empowering the parents in their role of calming their children. Do not take over for the parents, and avoid making any comments that may undermine their authority or ability to handle the situation. Let them know that you are available to assist in any way that they find helpful. ● If emotionally overwhelmed children or adolescents are separated from their parents, or if their parents are not coping well, refer below to the options for stabilizing distressed persons. In general, the following steps will help to stabilize the majority of distressed individuals: ● Respect the person’s privacy, and give him/her a few minutes before you intervene. Say you will be available if they need you or that you will check back with them in a few minutes to see how they are doing and if there is anything you can do to help at that time. ● Remain calm, quiet, and present, rather than trying to talk directly to the person, as this may contribute to cognitive/emotional overload. Just remain available, while giving him/her a few minutes to calm down. ● Stand close by as you talk to other survivors, do some paperwork, or other tasks while being available should the person need or wish to receive further help. ● Offer support and help him/her focus on specific manageable feelings, thoughts, and goals. ● Give information that orients him/her to the surroundings, such as how the setting is organized, what will be happening, and what steps he/she may consider. Orient Emotionally Overwhelmed Survivors: Adults Use these points to help survivors understand their reactions: ● Intense emotions may come and go in waves ● Shocking experiences may trigger strong, often upsetting, “alarm” reactions in the body, such as startle reactions. ● Sometimes the best way to recover is to take a few moments for calming routines (for example, go for a walk, breathe deeply, practice muscle relaxation techniques). ● Friends and family are very important sources of support to help calm down. Orient Emotionally Overwhelmed Survivors: Children & adolescents ● After bad things happen, your body may have strong feelings that come and go like waves in the ocean. When you feel really bad, that’s a good time to talk to your mom and dad to help you calm down. ● Even adults need help at times like this. ● Many adults are working together to help with what happened, and to help people recover. ● Staying busy can help you deal with your feelings and start to make things better. Caution adolescents about doing something risky or impulsive, without discussing it with a parent or trusted adult. For example, you might say: Adolescent/Child When something bad like this happens, it is really important to get support from adults that you trust. Is there anyone who helps you feel better when you talk to them? Maybe I can help you get in touch with them. If the person appears extremely agitated, shows a rush of speech, seems to be losing touch with the surroundings, or is experiencing ongoing intense crying, it may be helpful to: ● Ask the individual to listen to you and look at you. ● Find out if he/she knows who he/she is, where he/she is, and what is happening. ● Ask him/her to describe the surroundings, and say where both of you are. If none of these actions seems to help to stabilize an agitated individual, a technique called “grounding” may be helpful. You can introduce grounding by saying: “After a frightening experience, you can sometimes find yourself overwhelmed with emotions or unable to stop thinking about or imagining what happened. You can use a method called ‘grounding’ to feel less overwhelmed. Grounding works by turning your attention from your thoughts back to the outside world. Here’s what you do….” ● Sit in a comfortable position with your legs and arms uncrossed. ● Breathe in and out slowly and deeply. ● Look around you and name five non-distressing objects that you can see. For example you could say, “I see the floor, I see a shoe, I see a table, I see a chair, I see a person.” ● Breathe in and out slowly and deeply. Grounding cont. ● Next, name five non-distressing sounds you can hear. For example: “I hear a woman talking, I hear myself breathing, I hear a door close, I hear someone typing, I hear a cell phone ringing.” ● Breathe in and out slowly and deeply. ● Next, name five non-distressing things you can feel. For example: “I can feel this wooden armrest with my hands, I can feel my toes inside my shoes, I can feel my back pressing against my chair, I can feel the blanket in my hands, I can feel my lips pressed together.” ● Breathe in and out slowly and deeply. Grounding cont. ● You might have children name colors that they see around them. For example, say to the child, “Can you name five colors that you can see from where you are sitting. Can you see something blue? Something yellow? Something green?” ● If none of these interventions aids in emotional stabilization, consult with medical or mental health professionals, as medication may be needed. Modify these interventions for a person who has difficulty with vision, hearing, or expressive language. The Role of Medications in Stabilization ● In most cases, the above-described ways of stabilizing survivors will be adequate. Medication for acute traumatic stress reactions is not recommended as a routine way of meeting the goals of Psychological First Aid, and medication should be considered only if an individual has not responded to other ways of helping. Any use of medication in survivors should have a specific target (for example, sleep and control of panic attacks), and should be timelimited. Medications may be necessary when the survivor is experiencing extreme agitation, extreme anxiety and panic, psychosis, or is dangerous to self or others. You should be mindful of the following: ● Exposure to disaster may worsen pre-existing conditions (for example, schizophrenia, depression, anxiety, pre-existing PTSD). ● Some survivors may be without their medications, or face uncertainty about continued access to medications. ● Communication with their psychiatrists, physicians, or pharmacies may be disrupted. ● Monitoring of medication blood levels may be interrupted. Gather information that will be helpful when referring to a physician, including: * ● List of current medications ● Current medications that require ongoing monitoring by a physician ● Access to currently prescribed medications, doctors, and dispensing pharmacy ● The survivor’s compliance with medication ● Substance abuse/recovery issues ● Ongoing medical and mental health conditions You may obtain more information about current medications from family and friends if the survivor is too distressed or confused to give an accurate report. Information Gathering: Needs and Current Concerns Information Gathering: Needs and Current Concerns Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions. ● You should be flexible in providing Psychological First Aid, and should adapt interventions for specific individuals, and their identified needs and concerns. Gather enough information so that you can tailor and prioritize your interventions to meet these needs. Gathering and clarifying information begins immediately after contact and continues throughout Psychological First Aid. Information Gathering: Needs and Current Concerns ● Remember that in most Psychological First Aid settings, your ability to gather information will be limited by time, survivors’ needs and priorities, and other factors. Although a formal assessment is not appropriate, you may ask about: ○ ○ ○ ○ Need for immediate referral Need for additional services Offering a follow-up meeting Using components of Psychological First Aid that may be helpful Nature and Severity of Experiences during the Disaster ● Survivors who experienced direct life-threat to self or loved ones, injury to self, or those who witnessed injury or death are at increased risk for more severe and prolonged distress. Those who felt extremely terrified and helpless may also have more difficulty in recovering. For information about the survivor’s experiences, you may ask: ○ You’ve been through a lot of difficult things. May I ask you some questions about what you have been through? ○ Where were you during the disaster? ○ Did you get hurt? ○ Did you see anyone get hurt? ○ How afraid were you? Nature and Severity of Experiences during the Disaster ● Provider Alert: In clarifying disaster-related traumatic experiences, avoid asking for in-depth descriptions that may provoke additional distress. Follow the survivor’s lead in discussing what happened. Don’t press survivors to disclose details of any trauma or loss. On the other hand, if they are anxious to talk about their experiences, politely and respectfully tell them that what would be most helpful now is to get some basic information so that you can help with their current needs, and plan for future care. Let them know that the opportunity to discuss their experiences in a proper setting can be arranged for the future. ● For survivors with these kind of experiences, provide information about postdisaster reactions and coping (see Information on Coping), and offer a follow-up meeting. For those who were injured, arrange medical consultation as appropriate. Death of a Loved One ● The death of loved ones under traumatic circumstances is devastating, and over time can greatly complicate the grieving process. Ask about the death of loved ones with a question like: ○ Did someone close to you get hurt or die as a result of the disaster? Who got hurt or died? ● For those who experienced the death of a loved one, provide emotional comfort, information about coping, social support, and acute grief, and offer a follow-up meeting. Concerns about Immediate Post-Disaster Circumstances and Ongoing Threat ● Survivors may be highly concerned about immediate and ongoing danger. You may ask questions like: ○ Do you need any information to help you better understand what has happened? ○ Do you need information about what is being done to protect the public? ○ Do you need information about how to keep you and your family safe? ● For those with these concerns, help them obtain information about safety and protection. Separation from or Concern about the Safety of Loved Ones ● Separation from loved ones and concern about their safety is an additional source of distress. If not addressed earlier, get information with questions like these: ○ Are you worried about anyone close to you right now? ○ Do you know where they are? ○ Is there anyone especially important like a family member or friend who is missing? ● For survivors with these concerns, provide practical assistance in connecting them with available information sources and registries that can help locate and reunite family members. See Safety and Comfort and Connection with Social Supports. Physical Illness, Mental Health Conditions, and Need for Medications ● Pre-existing medical or mental health conditions and need for medications are additional sources of post-disaster distress. Those with a history of psychological problems may experience a worsening of these problems, as well as more severe and prolonged post disaster reactions. Give a high priority to immediate medical and mental health concerns. Ask questions like: ○ ○ ○ ○ Do you have any medical or mental health condition that needs attention? Do you need any medications that you don’t have? Do you need to have a prescription filled? Can you get in touch with your doctor? ● For those with medical or mental health conditions, provide practical assistance in obtaining medical or psychological care and medication. Losses (Home, School, Neighborhood, Business, Personal Property, and Pets) ● If survivors have extensive material losses and post-disaster adversities, their recovery may be complicated with feelings of depression, demoralization, and hopelessness. For information about such loss, ask questions like: ○ ○ ○ ○ Was your home badly damaged or destroyed? Did you lose other important personal property? Did a pet die or get lost? Was your business, school, or neighborhood badly damaged or destroyed? ● For those with losses, provide emotional comfort, practical assistance to help link them with available resources, and information about coping and social support. Extreme Feelings of Guilt or Shame ● Extreme negative emotions can be very painful, difficult, and challenging, especially for children and adolescents. Children and adults may be ashamed to discuss these feeling Listen carefully for signs of guilt or shame in their comments. To further clarify, you may say: ○ It sounds like you are being really hard on yourself about what happened. ○ It seems like you feel that you could have done more. ● For those experiencing guilt or shame, provide emotional comfort and information about coping with these emotions. Thoughts about Causing Harm to Self or Others ● It is a priority to get a sense of whether an individual is having thoughts about causing harm to self or others. To explore these thoughts and feelings, ask questions like: ○ Sometimes situations like these can be very overwhelming. Have you had any thoughts about harming yourself? ○ Have you had any thoughts about harming someone else? ● For those with these thoughts, get medical or mental health assistance immediately. If the survivor is at immediate risk of hurting themselves or others, stay with him/her until appropriate personnel arrive on the scene and assume management of the survivor. Availability of Social Support ● Family, friends, and community support can greatly enhance the ability to cope with distress and post-disaster adversity. Ask about social support as follows: ○ Are there family members, friends, or community agencies that you can rely on for help with problems that you are facing as a result of the disaster? ● For those lacking adequate social support, help them connect with available resources and services, provide information about coping and social support, and offer a follow-up meeting. ● Provider Alert: In clarifying prior history of substance use, prior trauma and loss, and prior mental health problems, you should be sensitive to the immediate needs of the survivor, avoid asking for a history if not appropriate, and avoid asking for in-depth description. Give clear reasons for asking (for example, “Sometimes events like this can remind individuals of previous bad times . . .” “Sometimes individuals who use alcohol to cope with stress will notice an increase in drinking following an event such as this . . .”) Prior Alcohol or Drug Use Exposure to trauma and post-disaster adversities can increase substance use, cause relapse of past substance abuse, or lead to new abuse. Get information about this by asking: Adult/Caregiver/ Has your use of alcohol, prescription medications, or drugs Adolescent Has your use of alcohol, prescription medications, or drugs Adolescent increased since the disaster? Have you had any problems in the past with alcohol or drug use? Are you currently experiencing withdrawal symptoms from drug use? Prior Alcohol or Drug Use ● For those with potential substance use problems, provide information about coping and social support, link to appropriate services, and offer a follow-up meeting. For those with withdrawal symptoms, seek medical referral. Prior Exposure to Trauma and Death of Loved Ones ● Those with a history of exposure to trauma or death of loved ones may experience more severe and prolonged post-disaster reactions and a renewal of prior trauma and grief reactions. For information about prior trauma, ask: ○ Sometimes events like this can remind people of previous bad times. Have you ever been in a disaster before? ○ Has some other bad thing happened to you in the past? ○ Have you ever had someone close to you die? ● For those with prior exposure and/or loss, provide information about post-disaster and grief reactions, information about coping and social support, and offer a follow-up meeting. Specific Youth, Adult, and Family Concerns over Developmental Impact * ● Survivors can be very upset when the disaster or its aftermath interferes with upcoming special events, including important developmental activities (for example, birthdays, graduation, start of school or college, marriage, vacation). For information about this, ask: ○ Were there any special events coming up that were disrupted by the disaster? ● For those with developmental concerns, provide information about coping and assist with strategies for practical help. ● It is also useful to ask a general open-ended question to make sure that you have not missed any important information. ○ Is there anything else we have not covered that you are concerned about or want to share with me? ● If the survivor identifies multiple concerns, summarize these and help to identify which issues are most pressing. Work with the survivor to prioritize the order in which concerns should be addressed. Practical Assistance Practical Assistance Goal: To offer practical help to survivors in addressing immediate needs and concerns. ● Exposure to disaster, terrorism and post-event adversities is often accompanied by a loss of hope. Those who are likely to have more favorable outcomes are those who maintain one or more of the following characteristics: ○ ○ ○ ○ ○ ○ ○ Optimism (because they can have hope for their future) Confidence that life is predictable Belief that things will work out as well as can reasonably be expected Belief that outside sources act benevolently on one’s behalf (responsive government) Strong faith-based beliefs Positive belief (for example, “I’m lucky, things usually work out for me”) Resources, including housing, employment, financial Practical Assistance ● Providing people with needed resources can increase a sense of empowerment, hope, and restored dignity. Therefore, assisting the survivor with current or anticipated problems is a central component of Psychological First Aid. Survivors may welcome a pragmatic focus and assistance with problem-solving. ● Discussion of immediate needs occurs throughout a Psychological First Aid contact. As much as possible, help the survivor address the identified needs, as problem-solving may be more difficult under conditions of stress and adversity. Teaching individuals to set achievable goals may reverse feelings of failure and inability to cope, help individuals to have repeated success experiences, and help to reestablish a sense of environmental control necessary for successful disaster recovery. Offering Practical Assistance to Children and Adolescents ● Like adults, children and adolescents benefit from clarifying their needs and concerns, developing a plan to address them, and acting on the plan. Their ability to clarify what they want, think through alternatives, select the best option, and follow through develops gradually. For example, many children can participate in problem-solving, but require the assistance of adolescents or adults to follow through with their plans. When appropriate, share the plans you have developed with parents/caregivers, or involve parents/caregivers in making the plans, so that they can help the child or adolescent to carry them through. Offering practical assistance is composed of four steps: Step 1: Identify the Most Immediate Needs ● If the survivor has identified several needs or current concerns, it will be necessary to focus on them one at a time. For some needs, there will be immediate solutions (for example, getting something to eat, phoning a family member to reassure them that the survivor is okay). Other problems (for example, locating a lost loved one, returning to previous routines, securing insurance for lost property, acquiring caregiving services for family members) will not be solved quickly, but the survivor may be able to take concrete steps to address the problem (for example, completing a missing persons report or insurance form, applying for caregiving services). As you collaborate with the survivor, help him/her select issues requiring immediate help. For example, you might say: Adult/Caregiver I understand from what you’re telling me, Mrs. Williams that your main goal right now is to find your husband and make sure he’s okay. We need to focus on helping you get in contact with him. Let’s make a plan on how to go about getting this information. Adolescent/Child It sounds like you are really worried about several different things, like what happened to your house, when your dad is com ing, and what will happen next. Those are all important things, but let’s think about what is most important right now, and then make a plan. Step 2: Clarify the Need ● Talk with the survivor to specify the problem. If the problem is understood and clarified, it will be easier to identify practical steps that can be taken to address it. Step 3: Discuss an Action Plan ● Discuss what can be done to address the survivor’s need or concern. The survivor may say what he/she would like to be done, or you can offer a suggestion. If you know what services are available ahead of time, you can help obtain food, clothing, shelter, or medical care; mental health or spiritual care services; financial assistance; help in locating missing family members or friends; and volunteer opportunities for those who want to contribute to relief efforts. Tell survivors what they can realistically expect in terms of potential resources and support, qualification criteria, and application procedures. Step 4: Act to Address the Need * ● Help the survivor to take action. For example, help him/her set an appointment with a needed service or assist him/her in completing paperwork.