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Psychological First Aid

Christian Disaster Response Ph
A Non-Government Organization

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Psychological First Aid

  1. 1. Psychological First Aid A Presentation : Lucille A. Montes, M.D., Ph.D. Based on: National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, 2nd Ed. , July 2006. www.nctsm.org and www.ncptsd.va.gov Compiled by Ptr. Rimalyn Siriban UPLOADED by BEREAN GUIDE For Educational Purposes only
  2. 2. Psychological First Aid 1. Supportive intervention 2. Evidence-informed 3. Modular approach 4. Acute intervention of choice 5. To reduce the initial distress caused by traumatic events 6. Foster short- and long-term adaptive functioning and coping
  3. 3. For whom 1. Children 2. Adolescents 3. Parents/caretakers 4. Families 5. Adults who are exposed to disaster or terrorism
  4. 4. For whom 1. First responders 2. Other disaster relief workers
  5. 5. Who delivers it?  Mental health workers  Other disaster response workers who provide early assistance as part of an organized disaster response effort IMPORTANT: PROVIDERS SHOULD BE PART OF RESPONSE UNITS
  6. 6. When and where should it be used? IN THE IMMEDIATE AFTERMATH OF DISASTERS AND TERRORISM Diverse settings: 1. General shelters, Special Needs shelters 2. Field hospitals and medical triage areas 3. Staging areas or respite areas for first responders and other relief workers 4. Assistance centers 5. Feeding locations
  7. 7. GENERAL GUIDELINES in delivering Psychological First Aid PROFESSIONAL BEHAVIOR 1. Operate within framework of authorized disaster response system 2. Model healthy responses: calm, courteous, organized, helpful 3. Be visible and available 4. Maintain confidentiality when appropriate
  8. 8. GENERAL GUIDELINES in delivering Psychological First Aid PROFESSIONAL BEHAVIOR 6. Remain within scope of your expertise and your designated role 7. Make referrals when needed or requested 8. Be culture-sensitive 9. Be self aware of own physical and emotional reactions and practice self- care
  9. 9. GENERAL GUIDELINES in delivering Psychological First Aid 1. Politely observe first, don’t intrude. Then ask simple respectful questions to determine how you may help 2. Often, the best way to make contact is to offer practical assistance (food, water, blankets) 3. Initiate contact only after you have observed the situation and the person or family, and have determined that contact will not be intrusive or disruptive.
  10. 10. GENERAL GUIDELINES in delivering Psychological First Aid 4. Survivors will either avoid you or flood you with contact 5. Speak calmly.  Be patient, responsive, and sensitive 6. Speak slowly in simple, concrete terms.  Don’t use acronyms or jargon 7. If survivors want to talk, be prepared to listen.  Focus on what they want to tell you and how you can be of help
  11. 11. GENERAL GUIDELINES in delivering Psychological First Aid 8. Acknowledge what survivor has done to keep safe 9. Give info that directly addresses the survivors immediate goals  clarify answers repeatedly as needed 10. Give info that is accurate and age- appropriate 11. When communicating through interpreter, look at and talk to person you are addressing, not at interpreter
  12. 12. GENERAL GUIDELINES in delivering Psychological First Aid Remember the overall goal of PFA is to 1. reduce distress 2. assist with current needs 3. promote adaptive functioning NOT to elicit details of traumatic experiences and losses
  13. 13. Some dont’s 1. Do not make assumptions about what the survivors are experiencing or what they have been through 2. Don’t assume that everyone is traumatized 3. Don’t pathologize  don’t label reactions as “symptoms”,  don’t speak in terms of “diagnoses”, “disorders”, “pathologies”
  14. 14. Some dont’s 4. Do not talk down or patronize the survivor  Don’t focus on his weakness, helplessness, mistakes or disability  Focus on what person has done that is effective or helpful during the disaster and currently 5. Do not assume that all survivors want to talk or need to talk to you  Often simple physical presence is enough 6. Don’t “debrief” by asking for details of what happened 7. Don’t speculate or offer inaccurate info. If you can’t answer a question, do your best to learn the facts
  15. 15. Preparation 1. Consider your capability, comfort level, health etc 2. Know the organizational structure where you are imbedded: the people, services, sop’s 3. Have important numbers on hand 4. Decide with team how to provide your service:  Designated areas  Circulating around the facility  Both
  16. 16. Preparation Mentally have a classification system (triage) as this is probably not done in a systematic, organized way. Those who need more assistance are: 1. Disoriented 2. Confused 3. Frantic or agitated 4. Panicky 5. Extremely withdrawn, apathetic or “shut down” 6. Extremely irritable or angry 7. Exceedingly worried
  17. 17. Preparation Classify: be alert to at-risk groups 1. Children, especially those separated from parents or caregivers, or whose family members have died or been injured 2. Those with injuries 3. Medically frail 4. Those with serious mental illnesses
  18. 18. Preparation Classify: be alert to at-risk groups 5. Adolescents who may be risk-takers 6. Pregnant women 7. Mothers with babies and small children 8. Those with significant losses of possessions 9. Those exposed first hand to grotesque scenes or extreme life threat
  19. 19. 8 Core Actions 1. Within days or weeks following an event 2. Be flexible 3. Base the amount of time spent on each action on the survivor’s specific needs and concerns 4. Not sequential – sometimes may happen simultaneously, or have to backtrack Note: it may be helpful to provide some training to community leaders if the setting is a natural grouping
  20. 20. 8 Core Actions: Core Action 1 Contact and Engagement Goal: To respond to contacts initiated by survivors, or initiate contact in a non-intrusive, compassionate and helpful manner
  21. 21. CORE ACTION 1: CONTACT AND ENGAGEMENT 1. Prioritize those who seek you out 2. If several people approach you simultaneously, make contact with as many as you can  Even a brief look of interest and calm can be helpful
  22. 22. CORE ACTION 1: CONTACT AND ENGAGEMENT 3. Introduce yourself, title, role 1. Ask permission to talk 2. Addressing person using cultural practice 3. Invite person to sit, ensure some privacy 4. Avoid being distracted 5. Find out if there is a pressing problem that need immediate attention 4. Confidentiality when appropriate
  23. 23. CORE ACTION 2: SAFETY AND COMFORT Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort.
  24. 24. CORE ACTION 2: SAFETY AND COMFORT 1. Make sure there is physical safety, e.g. – Find officials who can address issues on weapons, etc. – Remove broken glass, sharp objects, spilled liquids, etc – Make sure children have safe area to play and are supervised – Containment of threat of harm to self or others
  25. 25. CORE ACTION 2: SAFETY AND COMFORT 1. Make sure there is physical safety, e.g. – Find officials who can address issues on weapons, etc. – Remove broken glass, sharp objects, spilled liquids, etc – Make sure children have safe area to play and are supervised – Containment of threat of harm to self or others 2. Comfort, e.g. – Lighting, noise, temperature – Health-related needs: eyeglasses, medicines, assistance in daily functioning – Immediate medical attention: shock, serious emergencies
  26. 26. CORE ACTION 2: SAFETY AND COMFORT 3. Do not reassure people that they are safe unless you have definite factual information that that this is the case 4. Promote Social Engagement – Facilitate group and social interaction if possible and appropriate • soothing to be near people who are coping well, encourage them to talk to others who are distressed • engage children in activities – Attend to children who are separated from their caregivers • may need to designate child-friendly space
  27. 27. CORE ACTION 2: SAFETY AND COMFORT 5. Protect from additional traumatic experiences and trauma reminders – Shield survivors from reporters – Avoid excessive viewing of coverage of the disaster – Remind parents to be careful what they say in front of the children and clarify things that may be upsetting
  28. 28. CORE ACTION 2: SAFETY AND COMFORT 6. Help survivors who have a missing family member 7. Help survivors when a family member or close friend has died 1. Traumatic grief 2. Funeral arrangements 3. Body identification 8. Attend to spiritual needs
  29. 29. CORE ACTION 3: STABILIZATION (IF NEEDED) Goal: To calm and orient emotionally overwhelmed or disoriented survivors.
  30. 30. CORE ACTION 3: STABILIZATION 1. Identify those with intense and persistent reactions that interfere with functioning – Remain calm, quiet and be close by; give him a few minutes before you intervene – Help them understand their reactions: intense emotions come and go, fight or flight mechanism, calming routines help, family and friends can help calm down – Grounding – If above strategies have no effect, refer to psychiatrist
  31. 31. CORE ACTION 4: INFORMATION GATHERING: CURRENT NEEDS AND CONCERNS Goal: To identify immediate needs and concerns, gather additional information, and tailor PFA interventions
  32. 32. CORE ACTION 4: INFORMATION GATHERING: CURRENT NEEDS AND CONCERNS 1. From moment of engagement and thru the 8 actions 2. Find out a) Nature and severity of experiences (avoid asking in-depth descriptions, just basic info) b) Death of loved one c) Separations d) Concerns about ongoing threat e) Illnesses, need for medication
  33. 33. CORE ACTION 4: INFORMATION GATHERING: CURRENT NEEDS AND CONCERNS 6) Losses 7) Feelings of guilt and shame 8) Thoughts about harming self or others 9) Availability of social support 10) Prior alcohol or drug use 11) Prior exposure to trauma or death of loved ones 12) Specific concerns and developmental impact
  34. 34. CORE ACTION 5: PRACTICAL ASSISTANCE Goal: To offer practical help to survivors in addressing immediate needs and concerns
  35. 35. CORE ACTION 5: PRACTICAL ASSISTANCE 1. Central focus of PFA 2. Let survivors participate in problem-solving: empowerment facilitates recovery – Identify the most immediate needs – Clarify the need – Discuss an action plan – Act to address the need
  36. 36. CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS Goal: To help establish brief or ongoing contacts with primary support persons or other sources of support , including family members, friends, and community helping resources
  37. 37. CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS 1. Fosters well-being and recovery 2. Many forms a) Emotional support b) Social connection c) Feeling needed d) Reassurance of self-worth e) Reliable support f) Advice and information g) Physical assistance h) Material assistance
  38. 38. CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS 1. Enhance access to primary support persons 2. Encourage use of immediately available support persons 1. Shared activity: games, singing, etc. 2. Older people can be cared for by adolescents 3. Etc. 3. Discuss support seeking and giving 1. Reasons why some don’t want to seek support, etc. 4. Be role model of a supportive person
  39. 39. CORE ACTION 7: INFORMATION AND COPING Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning.
  40. 40. CORE ACTION 7: INFORMATION AND COPING 1. Review basic information about stress reactions 2. Review common psychological reactions to traumatic experiences and losses a. Intrusive reactions b. Avoidance and withdrawal reactions c. Physical arousal reactions 3. Teach simple relaxation techniques 4. Help families cope
  41. 41. CORE ACTION 7: INFORMATION AND COPING 6. Assist with developmental issues 1. Children need different approaches 7. Assist in anger management 8. Address highly negative emotions (guilt and shame) 9. Help with sleep problems 10. Address alcohol and substance use
  42. 42. CORE ACTION 8: LINKAGE WITH COLLABORATIVE SERVICES Goal: To link survivors with available services needed at the time or in the future
  43. 43. CORE ACTION 8: LINKAGE WITH COLLABORATIVE SERVICES 1. Refer for additional needed services 2. Promote continuity in helping relationships a. Give names and contact info on local public health and public mental health service providers in the community b. Introduce the survivor to other service providers so s/he knows other helpers by name c. If you are leaving, let the survivor know and if possible endorse personally to the next provider and provide an introduction
  44. 44. JESUS LOVES YOU.

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