CRANA p lus Responding to Disaster – Level 2 Interventions Jane Nursey – Phoenix Australia
Acknowledgement of Country 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. 2
The Nature of Disaster and Trauma • Generate high emotions (fear, sadness, anger) • Recovery is a long process with • Often shatter (or challenge) fluctuations basic assumptions about the • May result in a range of world, other people, ourselves individual, group/family, the old “rules” no longer apply community effects • Often subsequent stressors (e.g., financial, rebuilding, legal, climate, possible recurrence)
Impacts of Disaster: Community Human Social Psychosocial Environment Impacts Natural Built Environment Environment Economic and Financial Environment
Mental Health Response 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
Prototypical Patterns Over Time Disruptions in normal functioning Growth Resistant Resilient Delayed Chronic Event Months Years
Key recommendations: 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
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 Hope Safety Self- Calming Efficacy 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
SPR overview “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 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
Goals of SPR • 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
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
Components of SPR • Gathering Information and Prioritising Assistance • obtain 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
Skills of Life Adjustment and Recovery (SOLAR) • 21 international trauma and disaster mental health experts • Reached consensus on content of SOLAR program (Adult and Child versions)
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.
Key points to remember: • 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 24
Key Resources • 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/
phoenixaustralia.org @Phoenix_Trauma @phoenixtrauma @phoenix-trauma
Recommend
More recommend
