4/26/2020 Be the Helper: Implementing Psychological First Aid - - PDF document

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Be the Helper: Implementing Psychological First Aid during Covid-19 Crisis

Noelle L. Lefforge, Ph.D.

Learning Objectives

– Participants will be able to: – provide the rationale for utilizing Psychological First Aid and Skills for Psychological Recovery appropriately. – facilitate effective coping during a crisis by applying Psychological First Aid. – provide those affected by the current crisis with helpful resources. – locate additional resources and manuals to provide PFA and SPR.

What is Psychological First Aid (PFA)?

– Evidence-informed – Initial Distress caused by traumatic event – short- and long-term adaptive functioning and coping

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Psychological First Aid

Exposure to Traumatic Events Coping Resiliency Exhaustion of Coping PTSD Vicarious Trauma Decreased Resiliency Compassion Fatigue

What is Psychological First Aid (PFA)?

– Evidence-informed – Initial Distress caused by traumatic event – short- and long-term adaptive functioning and coping – 4 standards

– Consistency with research evidence on risk and resiliency following trauma – Applicable and practical in field settings – Appropriate across life span – Culturally informed and flexible

PFA is NOT Psychotherapy

(Watson, 2015)

– MBH Providers need to manage their expectations – Expecting the same as traditional psychotherapy can have unintended effects – Unable to predict long-term psychopathology in the early aftermath of crises – Mechanism for referrals for those who need additional treatment – PFA Message: “Many people will need a little bit of assistance to feel better and function better, without necessarily needing formal diagnosis or treatment.”

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PFA is NOT Psychotherapy (Watson, 2015)

Psychological First Aid

Maximizes Protective Benefit Protects from Potential for Harm due to Intervention

Not Without It’s Limitations

(Fox et. Al, 2012; Shultz & Forbes, 2013)

– Effectiveness has yet to be demonstrated – Reviewers could not find any randomized trials, non-randomized, or large descriptive studies. The best available “evidence” appears to be limited to peer-reviewed consensus statements and guidelines. – PFA is conceptualized as “documenting and operationalizing good common sense--those activities that sensible, caring human beings would do for each other anyway.” – Previous interventions (e.g., psychological debriefing) were widely used and later found to cause harm among some recipients – Know very little about its effectiveness, especially in terms of for who & in what circumstances

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Increasing Evidence for Effectiveness (Despeaux et al., 2019)

– A Randomized Controlled Trial Assessing the Efficacy

• f Group Psychological First Aid

– Laboratory setting, not actual traumatic event – Group PFA vs Group Conversation – PFA Condition: – Lessened anxiety immediately after – Even greater lessened anxiety after 30-min delay – Lessened negative affect immediately after

Principles of PFA consistent with Guidelines (NATO, 2008; Bison & Lewis, 2009)

– “the abilities of people to accept and use social support and the availability of it are two of the key features of resilience.” NATO

Who is Psychological First Aid For? Delivers PFA?

It is For…..

– Exposed to disaster or terrorism – Children – Adolescents – Parents/caretakers – Families – Adults – First Responders – Disaster Relief Workers

It is Delivered By….

– Mental health and other disaster response workers

– First responder teams – Primary and emergency health – School crisis response teams – Faith-based organizations – Etc.

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Training in PFA

– Training is generally effective – Those trained tend to perceive PFA as appropriate – Generally respond as “satisfied” by PFA training – especially 1st time disaster responders – Increases sense of emergency preparedness and self- efficacy – Train-the-trainer approaches are effective and lead to networks of trained individuals

Connect Safety Calm Problem- Solve Support Inform

Basic Objectives of Crisis Intervention /PFA Guidelines for Delivering PFA

– 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.

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Guidelines for Delivering PFA

– 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. – 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, look and talk to the person you are addressing. – The goal of PFA is to reduce distress, assist with current needs, and promote adaptive functioning, not to elicit details of traumatic experiences and losses.

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 expectable given what people exposed to disaster have experienced. – Do not talk down to or patronize the survivor, or focus on their helplessness, weaknesses, mistakes, or disability. – Do not assume that all survivors want to talk or need to talk to you. – Do not “debrief” by asking for details of what happened. – Do not speculate or offer possibly inaccurate information.

Contact and Engagement Safety and Comfort Stabilization Information Gathering: Current Needs and Concerns Practical Assistance Connection with Social Supports Information on Coping Linkage with Collaborative Services

Core Actions

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Contact and Engagement – 42% Safety and Comfort – 72% Practical Assistance – 44%

Top 3 Most Helpful to Survivors

(Allen, Steinberg, Vernberg, & Speier, 2010)

Contact and Engagement – 64% Safety and Comfort – 42% Practical Assistance – 42%

Top 3 Most Helpful to Providers

(Allen, Steinberg, Vernberg, & Speier, 2010)

Contact and Engagement

– Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner – Culture Alert – Eye contact, physical touch, physical proximity, etc. are culturally

• determined. May be important

to determine spokesperson for the family to address initially.

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Safety and Comfort

– Goal: To enhance immediate and

• ngoing safety, and provide physical

and emotional comfort. – Culture Alert – Privilege influences

• ne’s ability to obtain and maintain

physical safety, and must be taken into account. Be aware of your own privilege and you assist others and make recommendations. Attending to grief may have a spiritual component. – Ensure Immediate Physical Safety – Provide information relevant to the crisis (e.g., services, common stress reactions) –

• Attend to physical comfort

– Promote social engagement – Protect from additional traumatic experiences (e.g., limit media) – Attend to experiences of death (e.g., normalize grief reactions, provide information on funerals)

Stabilization

– Goal: To calm and orient emotionally overwhelmed or disoriented survivors. – Often not required – only if emotional response persistently interferes with functioning – Utilize existing social support – Provide information on emotional response (e.g., emotions are like waves) – Utilize calming and/or grounding techniques

Information Gathering: Current Needs and Concerns

– Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions. – Caution – focus on gathering basic information, rather than in-depth reliving of traumatic events

– Assess needs to provide referrals and/or follow-up

– Survivor Current Needs Worksheet – Where are the difficulties?

– Behavioral – Emotional – Physical – Cognitive

– Consider death, on-going threat, separation, illness, losses, guilt or shame, SI/HI, social support, prior substance use, prior trauma, interruption of significant events

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Practical Assistance

– Goal: To offer practical help to survivors in addressing immediate needs and concerns. “Providing people with needed resources can increase a sense

• f empowerment, hope, and

restored dignity.”

– Step 1: Identify the most immediate needs – Step 2: Clarify the need – Step 3: Discuss an action plan – Step 4: Act to address the need

Connection with Social Supports

– Goal: To help establish brief or

• ngoing contacts with primary

support persons and other sources

• f support, including family

members, friends, and community helping resources. – Enhance access to primary support persons – Encourage use of immediately available support persons – Learn about and possibly address barriers to seeking support – Model support – Children – Engage in activities (e.g., tic-tac-toe, “fortune tellers”, paper air hockey, group drawing, etc.

Information on Coping

– Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning.

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Linkage with Collaborative Services

– Goal: To link survivors with available services needed at the time or in the future.

Documentation

– PFA Provider Worksheet

– Psychological First Aid Components Provided

Handout for Survivors

– Connecting with Others: Seeking Social Support – Connecting with Others: Giving Social Support – When Terrible Things Happen – Parent Tips for Helping Infants and Toddlers – Parent Tips for Helping Preschool-Age Children – Parent Tips for Helping School-Age Children – Parent Tips for Helping Adolescents – Tips for Adults – Basic Relaxation Techniques – Alcohol and Drug Use after Disasters

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Free PFA Mobile download from iTunes and Google Play Skills for Psychological Recovery (SPR) SPR takes up where PFA left off

– Similar basic standards and evidence-informed – Similar populations delivered treatment by similar providers in similar settings – Designed to accelerate recovery and increase self-efficacy via skill building – Ideally 3-5 sessions of skill building, but can be done in stand alone sessions – During the recovery phase

– After safety, security and other vital and immediate needs met

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Basic Goals and Objectives of SPR

– Protect the mental health of disaster survivors – Enhance the survivors’ abilities to address their needs and concerns – Teach skills to promote the recovery of children, adolescents, adults, and families – Prevent maladaptive behaviors while identifying and supporting adaptive behaviors Building Problem- Solving Skills Promoting Positive Actions Managing Reactions Promoting Helpful Thinking Rebuilding Healthy Social Connection

SPR Core Skills Preparing to Deliver SPR

– Develop a strong rapport with the survivor as a foundation to teaching SPR skills – Gather information about survivors’ reactions, needs, and resources – Teach the core SPR skill sets to survivors – Decide how and when to teach specific skills – Tailor the skills to address survivors’ specific concerns – Strategize ways to support the survivor to engage in more than one SPR session

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Considerations

– Set realistic expectations – Keep a developmental perspective – Be culturally sensitive – Ask yourself

– How many contact should I plan? – Should I deliver SPR in individual or group setting? – Do I have parent permission? – Is the survivor a good candidate for SPR? Information and Prioritizing Problem- Solving Skills Positive Activities Managing Reactions Promoting Helpful Thinking Rebuilding Healthy Social Connections

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Special Populations and Cultural Adaptations – Children

(Akasaka & Kawashima, 2019)

– Qualitative study of staff working with children in Japan’s evacuation centers following 2016 earthquake – Facilitate, rather than interrupt, natural coping such as reenactment of traumatic experience through play, aggression, regression – Active listening – Linking children to social support and loved ones, rather than provider solving all the problems

Special Populations and Cultural Adaptations

(Crooks et. al, 2018)

– Adapted PFA for First Nations population in Canada to include cultural context – Some participants considered the cultural focus a strength, but a minority found it inadequate. – Participants reported gains in knowledge, self-efficacy and skills, and decreased stigma beliefs. – Ensuring cultural relevance is critical - other widely utilized mental health trainings used in First Nations contexts without adaptation have resulted in null or even negative impacts

Special Populations and Cultural Adaptations

– Cultural humility and responsiveness are essential to the delivery of all interventions, including PFA – Particularly important in response to Covid-19, given the inequities in harm and increase in xenophobia and racism

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Resources in Nevada

– Mental Health, Financial, Housing, Food, Utility, Healthcare, Transportation, Tax, Etc. – Senator Cortez Masto – Covid-19 Resource Guide - https://www.cortezmasto.senate.gov/download/covid-19-resource-guide – Senator Cortez Masto – Covid-19 Resource Guide in Spanish – https://www.cortezmasto.senate.gov/download/guia-de-recursos-del-covid-19 – Senator Rosen – Covid-19 Resource Guide - https://www.rosen.senate.gov/covid-19-nevada-resource-guide – United Way - Southern Nevada Resources - https://www.uwsn.org/COVID19

Covid-19 Specific Considerations

Personal Reflections 43 44