CRANA p lus Responding to Disaster Level 2 Interventions Jane Nursey - - PowerPoint PPT Presentation

CRANAplus

Responding to Disaster – Level 2 Interventions Jane Nursey – Phoenix Australia

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I acknowledge the Traditional Owners of these lands. We acknowledge that the land on which we meet was the place of age-old ceremonies, of celebration, initiation and renewal, and that the local Aboriginal peoples have had and continue to have a unique role in the life of these lands.

Acknowledgement of Country

The Nature of Disaster and Trauma

• Generate high emotions (fear,

sadness, anger)

• Often shatter (or challenge)

basic assumptions about the world, other people, ourselves the old “rules” no longer apply

• Often subsequent stressors

(e.g., financial, rebuilding, legal, climate, possible recurrence)

• Recovery is a long process with

fluctuations

• May result in a range of

individual, group/family, community effects

Impacts of Disaster:

Community Social Environment Built Environment Economic and Financial Environment Natural Environment Human Psychosocial Impacts

The impact of experiencing a critical incident on psychological well being may be: Valence: Good, bad, mixed Severity: Negligible, mild, moderate, severe Duration: Brief, long-lasting, permanent The vast majority of people do not develop long term mental health problems

Mental Health Response

Prototypical Patterns Over Time

Event Months Years

Disruptions in normal functioning

Growth Chronic Resilient Resistant Delayed

Stepped care Advised

• Ensures individuals receive care commensurate with

the severity and complexity of their need.

• Involves ongoing monitoring of people that are more

distressed/or at heightened risk of poor outcomes

• Increasingly intensive interventions delivered as

indicated

Key recommendations:

Interventions: Stepped Care Approach

Levels of Intervention Post-Disaster

Level 3: Specialist Mental Health Providers (reserved for low prevalence, serious conditions) Level 2: Primary Care Providers (for medium prevalence, moderate severity) Level 1: Self Care and Community Support (for high prevalence, low severity)

Mark Creamer & Associates

Psychosocial Recovery from Trauma: Five Early Intervention Principles

Self- Efficacy Calming Safety Hope Connectedness

Level 1: Psychological First Aid

Level Two Interventions

Brief interventions aimed at selective/indicated prevention

• All aim to be delivered by non-mental health

professionals

• Health care workers (nurses)
• Social security case workers
• Volunteer support workers
• Developed for ease of training
• Teach skills 4-5 sessions
• Focus on simple, evidence based strategies

for those with “sub-clinical” problems

SPR background

Developed by the US National Center for PTSD & The National Child Traumatic Stress Network in the aftermath of Hurricane Katrina www.ptsd.va.gov and www.nctsn.org Authors are leading trauma and disaster experts

“Package” of recommended strategies to assist people to gain skills to reduce their distress and cope more effectively following disaster Multiple strategies but each one can “stand alone” 1-5 sessions and encourage multiple visits Build skills with between-session practice Flexible and tailored approach Not therapy and no assumption of mental illness

SPR overview

Berkowitz, et al. 2010 National Center for PTSD and National Child Traumatic Stress Network, Skills for Psychological Recovery: Field Operations Guide. Forbes et al,. (2010) Practitioners perceptions of skills for psychological recovery. ANJP

• Protect the mental health of people who have lived through a

disaster

• Enhance the ability of individuals to address their needs and

concerns

• Teach skills to promote the recovery of children, adolescents,

adults, and families

• Prevent unhelpful behaviours while identifying and supporting

more helpful behaviours

Goals of SPR

A manualised approach

A manualised approach is not a “cookbook” Vital issues such as empathy and rapport are assumed but not covered in detail in the manual It is expected that the SPR interventions will be delivered in a compassionate, flexible and responsive manner This is necessary to facilitate appropriate engagement and to adequately identify and meet the needs of individuals

• Gathering Information and Prioritising Assistance
• btain important information about needs and concerns
• Building Problem-Solving Skills
• a method to define a problem and goal, brainstorm a

number of ways to solve it

• Promoting Positive Activities
• a way to improve mood and functioning by identifying

and engaging in positive and pleasurable activities

Components of SPR

• Managing Reactions
• Skills to cope with and reduce distressing physical and

emotional reactions to upsetting situations

• Promoting Helpful Thinking
• Steps to identify upsetting thoughts and to counter

these thoughts with less upsetting ones

• Rebuilding Healthy Social Connections
• A way to rebuild positive relationships and community

supports

Components of SPR

• 21 international trauma and disaster

mental health experts

• Reached consensus on content of SOLAR

program (Adult and Child versions)

Skills of Life Adjustment and Recovery (SOLAR)

SOLAR – Skills for Life Adjustment and Resilience

Transdiagnostic approach

• Behavioural activation – value driven

behavioural activation

• Arousal/affect management – relaxation,

present centred

• Heathy living – importance of exercise, diet

and sleep

• Worry/rumination control
• Emotional processing – narrative processing of

the trauma

• Promoting healthy relationships

Emerging evidence

SOLAR modules

Figure 2: Six key modules that make up SOLAR.

Problem Management Plus (PM+)

• Arousal management - Managing Stress
• Problem solving - Managing Problems
• Activity scheduling - Get Going
• Activity scheduling- Keep Doing„
• Relapse prevention

Dawson, K. S., R. A. Bryant, et al. (2015). "Problem Management Plus (PM+): a WHO transdiagnostic psychological intervention for common mental health problems." World Psychiatry: Official Journal Of The World Psychiatric Association (WPA) 14(3): 354-357. Sijbrandij, M., S. Farooq, et al. (2015). "Problem Management Plus (PM+) for common mental disorders in a humanitarian setting in Pakistan; study protocol for a randomised controlled trial (RCT)." BMC Psychiatry 15(1): 1-6. Sijbrandij, M., R. A. Bryant, et al. (2016). "Problem Management Plus (PM+) in the treatment of common mental disorders in women affected by gender-based violence and urban adversity in Kenya; study protocol for a randomized controlled trial." International Journal of Mental Health Systems 10: 1-8.

• Designed to support people in distress – not MH disorder
• Designed to be delivered quickly and efficiently
• May be only one session – but can do 5 or 6
• Is not therapy – skills training to build resilience
• Does not require in-depth history taking or case formulation
• Target what is the most pressing problem for them.
• Sessions kept mostly short – 20-40 mins but longer if necessary

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Key points to remember:

• APS/Red Cross: PFA – An Australian Guide (available from

www.psychology.org.au)

• APS Psychosocial Support in Disasters

(www.psid.org.au)

• WHO: PFA Guide for Field Workers (available from

www.whqlibdoc.who.int/publications)

• NCPTSD: PFA Field Operations Guide (available from

www.ptsd.va.gov)

• https://www.phoenixaustralia.org/resources/bushfires/
• https://www.recoveryonline.org.au/

Key Resources

phoenixaustralia.org @Phoenix_Trauma @phoenixtrauma @phoenix-trauma