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.

Reactions to Stress Adults

Physical Behavioral Emotional Cognitive Spiritual

Reactions to StressChildren

Physical Behavioral Emotional Cognitive Spiritual

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

GROUP PARTICIPATION

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

Q: There is an adjustment period after returning from a crisis.True or False

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