PSYCHOLOGICAL FIRST AID Getting through trauma together….

PSYCHOLOGICAL FIRST AID Getting through trauma together .

Understand the psychological impact of disasters and recognize the common reactions in self and others. OBJECTIVES Define the goal and core actions of Psychological First Aid (PFA). Prepare to provide immediate support to residents and coworkers experiencing disasterrelated stress.

STRESS AND DISASTERS MODULE I

WHAT IS A “DISASTER”? Wide - scale emergency events that have a severe impact on a community DISASTERS Traumatize large populations of people at once Can result in epidemics of survivor guilt and other psychological symptoms Create chaotic environment Multiple stressors A smaller event that impacts just one household or person can be a disaster for the survivors

For a community – depletion of resources and slow recovery IMPACT OF DISASTERS For people – Everyone who experiences a disaster is affected in some way – Even the helpers! People pull together Stress and grief are common reactions to uncommon situations

REACTIONS Some people will have severe reactions following a disaster event Most people recover without professional treatment Survivors often to do not seek or accept help, especially from helpers from outside the community

COMMON REACTIONS TO DISASTER STRESS

HOW LONG DO THESE THOUGHTS AND FEELINGS LAST? Most people exposed to disasters recover fully from the psychological affects within one year The most intense reactions will lessen over the first few weeks If they persist over 4-6 weeks or are so bad they impair functioning then professional help is needed.

FACTORS THAT MAY INDICATE THAT PROFESSION AL HELP IS NEEDED “3 Rs” REACTIONS – Severe confusion, impaired thinking, distress that cant be calmed, expressed thoughts of self harm or harm to others RISK – Those that lost a loved one, were injured, believed they were going to die, or saw death of others, extreme community destruction RESILIENCY- Lack good coping skills, has no family support, has experienced other recent traumas prior to the disaster

CHILDREN AND ELDERS CAN BE PARTICULARY SENSITIVE To changes in their routine Separation from familiar environments Separation from familiar people Watch for delayed reactions of several hours to a few days

MODULE 1 QUIZ 1. All people are impacted by a disaster, even those that come to the area help others. True/False 2. All people need professional mental health services after a disaster experience True/False

MODULE 1 QUIZ (cont.) 3. Common reactions after a disaster include: a. Feelings of guilt, anger, hopelessness or a loss of control. b. Difficulty sleeping, remembering, or paying attention c. Headaches, digestive problems, dizziness, tightness in chest d. All of the above 4. What does the “3 Rs” stand for? a. Reactions, Risk factors, Resilience factors b. Respect, Reassurance, Regular factors c. Routine, Respect, Rest factors d. None of the above

PSYCHOLOGICAL FIRST AID MODULE 2

PSYCHOLOGICAL FIRST AID (PFA) Is an approach that: Eases suffering of disaster survivors: both physical and emotional Improves survivors short term functioning Promotes emotional recovery after a disaster event

THE GOAL OF PFA Is to promote an environment of: Safety Calm Connectiveness Self-reliance Hope

CORE ACTIONS OF PFA Helper self-care Connect with survivors Safety and comfort Stabilization Info gathering Offer practical assistance Connect with social supports Info on coping Link to collaborative services

THE STRESS OF A DISASTER EVENT IS CONTAGIOUS TAP INTO YOUR OWN SUPPORT SYSTEMS TO MAINTAIN HOPE TO HELP OTHERS YOU MUST MAINTAIN YOUR HEALTH – PHYSICAL AND EMOTIONAL TAKE BREAKS, LEAVE WHEN YOUR SHIFT IS DONE MAINTAIN A HEALTHY ROUTINE TAKE CARE OF YOURSELF! KNOW YOUR LIMITS AND GET HELP WHEN NEEDED

MAKE A CONNECTION WITH SURVIVORS Make the first move Intro self and ask permission to talk Ask about their immediate needs Present with an air of patience, compassion, and calm Respect their privacy by finding a quiet place to talk Don’t approach too closely or touch them if you are not familiar with their cultural background or personal preferences Protect their confidentiality by sharing their info appropriately

OFFER SAFETY AND COMFORT Make sure the environment is safe Help survivors meet their basic immediate needs Offer physical comforts (food, water, blanket, bathroom) Ask about their needs for eye glasses, medications, hearing aids Protect them from additional trauma and trauma reminders (sights and sounds of danger, destruction or suffering)

SEEK IMMEDIATE PROFESSIONAL HELP IF: The person states a desire to harm themselves or others The person shows signs of shock: Clammy ashen skin Rapid breathing and pulse Nausea /vomiting Faintness, dizziness Extreme agitation

Use a calm and soothing voice Give realistic reassurance STABILIZATIO N Calm and Orient Survivors What you are feeling is understandable We are here to help Calming techniques include: Cool washcloth to forehead Stretching, head roll Clench and release fists Focus on slow deep breaths Provide repeated, simple and accurate information Rumors and the unknown increase stress

Gather information for identification of their needs INFORMATIO N GATHERING Find out the nature and severity of the disaster Those that have been injured or witnessed injury or death are at greater risk for a severe and prolonged distress reaction Ask “What are your immediate concerns? Listen carefully to identify their physical, medical, emotional needs

INFO GATHERING (Cont.) Don’t give simple reassurances like “Everything will be ok” Listen in a patient and caring way Don’t pry or force people to share their stories Some people want to talk and some don’t Be patient, and come back a little later if the survivor is not ready to talk

Meet immediate physical needs if possible OFFER PRACTICAL ASSISTANCE Clarify what they have told you about their needs and concerns “So I heard you say that you are most worried about .” Help them problem solve and develop an action plan for next steps Assist them in accomplishing those steps by: Connecting them with internal or external resources Communicating their needs to appropriate members of your team or community

CONNECTION WITH SOCIAL SUPPORTS Very important to recovery Help survivors contact their family, friends, clergy Sometimes they are reluctant to reach out to loved ones Don’t want to be a burden Embarrassed or feel guilty about needing help Help them to work through these concerns Assist them to contact a support person they trust when they are ready

Provide Information on Coping “Its normal to feel this way .”

Common Stress Reactions Following Disaster Events Behavioral/Emotional Disorientation/numbness Grief Feeling anxious and fearful Despair/hopelessness Feelings of guilt Feelings of anger Isolation/withdrawl Physical/Cognitive Headaches, stomach aches Difficulty sleeping/eating Exhaustion Bad dreams Intrusive thoughts/images Difficulty concentrating, remembering, making decisions

EXPLAIN THAT THESE FEELINGS ARE NORMAL DO SAY DON”T SAY “You are not going crazy” “You should be feeling better tomorrow” “These kinds of reactions are normal after going through something like this” “I have some suggestions for techniques to help you feel more calm. Would you like to hear them?” “Cheer up” “Maybe you better see a doctor” “What you need is .” “I know what it is like”

Coping Technique s To Suggest Deep slow breaths Focus on inhale/exhale Write in a journal Talk to friends/loved ones Stretch exercises Listen to music Reach out for spiritual support Warm bath or shower Make a list of recovery actions Maintain a healthy routine Rest Eat well Drink fluids Exercise Avoid drugs, alcohol, or binge eating Set a small goal for each day related to recovery actions and check off list when done

Link to Collaborative Services Help survivors connect to services related to their needs Medical Financial Spiritual Recovery/replacement assistance related to loss Remember that for most people, PFA is enough Recognize those who need professional help with stress by using the “3 Rs”

MODULE 2 QUIZ 1. The purpose of PFA is to: a. Prepare you to treat injuries after a disaster. b. Enable you to persuade someone not to harm themselves after a disaster. c. Enable to you to provide comfort, care and support to survivors of disasters. d. None of the above. 2. Normal survivors are able to function just fine once the disaster is over and they are safe. True/False

QUIZ Module 2 (cont.) 3. What are some examples of effective coping techniques? a. Rest sufficiently, eat well, drink fluids b. Keep feelings to yourself, avoid friends and loved ones c. Focus on slow, deep breaths d. Have a few alcoholic beverages e. a and c.

PRACTICING PSYCHOLOGICAL FIRST AID MODULE 3

BODY LANGUAGE DO DO’S AND DON’TS Sit facing the person or beside Give eye contact Show attention by leaning forward DON’T Sit back with folded arms Look around distractedly while person is talking Leave while they are talking to you

What to Say DO’S AND DON’Ts Do say Can we talk about what happened? This must be difficult for you. Is there anything I can do for you right now? Its normal to feel this way after something like that. I am here to help you if I can.

What NOT to say DO’S AND DON’TS I know what you are going through. Don’t feel so bad. You are strong and will get through this. Don’t cry, cheer up. Its God’s will. It could have been worse.

LEARNING ACTIVITY – ROLE PLAY PICK A PARTNER ONE IS SURVIVOR AND ONE IS HELPER SWITCH ROLES FOR ROLE PLAY #2 PRACTICE THE TECHNIQUES YOU HAVE LEARNED

ROLE PLAY #1 This morning there was an earthquake that shook things off shelves, caused the fire sprinklers to go off, and knocked out the power to your facility. Several hours have passed and things have settled down but it is starting to get dark. You notice one of the alert female residents wandering around the halls and refusing to go into her room. Practice the principles of PFA to calm and reassure this person.

ROLE PLAY #2 There was a fire at a nearby nursing home that killed two residents and forced all to evacuate. Your facility has accepted five emergency admits from the burned facility. One of these admits is a male resident whose roommate was killed in the fire. You see him in his wheelchair in the corner of the dining room weeping quietly and muttering to himself. Practice the principles of PFA to calm and comfort him. A few minutes into the conversation he tells you “I can’t take all this trouble anymore. I just want to die”. What is your next step?

Additional PFA Resources National Child Traumatic Stress Network https://learn.nctsn.org/course/index.php?categoryid 11 Minnesota Dept of Health http://www.health.state.mn.us/oep/responsesystems/pfa.html John Hopkins University via Coursera https://www.class-central.com/course/coursera-psychological-first-aid -2900

Disaster Mental Health Services Contact List for California County Mental Health Departments https://www.dhcs.ca.gov/individuals/Pages/MHPContactList.aspx Disaster Distress Helpline SAMHSA 1 800-985-5590 http://disasterdistress.samhsa.gov American Red Cross 1 800-RED CROSS

Questions? Regarding this presentation: Jocelyn Montgomery, PHN [email protected] Regarding Continuing Education: Cortney Kesterson, CAHF-DPP Coordinator [email protected]