Psychological First Aid
| Nebraska Psychological First Aid Curriculum Overview This training program is an adaptation of "Community-Based Psychological Support" developed by the International Federation of Red Cross and Red Crescent Societies. The purpose of the Nebraska psychological first aid program is to equip natural helpers to provide psychological support to survivors of critical events (e.g. disasters, conflicts, accidents, etc.). This training program is 8 hours long and designed to fit into the busy schedule of natural helpers and community responders. It is segmented into seven modules, each addressing critical skills that can make an immediate and lasting impact on a person's psychological health following a crisis. * Curriculum Overview * Presenter Manual * Participant Guide * Module 1 - Psychological Support (1hour) o Defines psychological support and provides natural helpers with ways to provide support to individuals following critical events. The module focuses on providing psychological support in disasters, but the approach is applicable and relevant to other contexts as well. Presentation Slides * Module 2 - Stress and Coping (1 hour) o This module focuses on how natural helpers can help people manage stress. Basic information about stress and coping is provided along with simple intervention techniques. Presentation Slides * Module 3 - Supportive Communication (1.5 hours) o Natural helpers may themselves in challenging situations, where feeling confident about how to communicate well with other people is vitally important. This module provides practical communication tips that can be used in many situations. Presentation Slides * Module 4 - Promoting Community Self-Help (1 hour) o Module 4 explores how to engage individuals and communities in their own recovery process. Engaging people in their own recovery can reduce feelings of powerlessness which in turn may reduce the risk of developing more serious psychological problems later. Presentation Slides * Module 5 - Populations with Special Needs (1 hour) o Module 5 describes populations who are vulnerable to the psychological effects of a disaster or traumatic event. It explores the psychological needs of these groups, while recognizing the vital role they play in social and community structures. Presentation Slides * Module 6 - Helping the Helpers (5 hours) o Timely and adequate support for helpers is a prerequisite for providing quality care and relief to others. Helpers are affected both positively and negatively by the experiences they have caring for others. This experience is framed with information about how the helpers can care for your own mental health needs. Presentation Slides * Module 7 - De-escalation (2 hours) o This module focuses on working with agitated or angry individuals and the strategies that can be employed to assist them. Natural helpers are introduced to active listening, interviewing and empathy skills that are useful in helping others manage fear and anxiety. Presentation Slides * References Copyright © 2005 University of Nebraska Public Policy Center |
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| Disaster Mental Health for Responders: Key Principles, Issues and Questions NOTE: These materials represent highlights of the kinds of mental-health related information that might be beneficial in a disaster. Because of their brevity, they do not provide an exhaustive, formal review or compilation of the wealth of available knowledge on disaster mental health. This is a starting point. There are companion pieces that provide similar information for city, county and state Public Health officials and as a general primer. Sources of additional information are listed at the end of this document. Guiding Principles (It is helpful to keep these points in mind when preparing for or responding to a disaster.) * No one who experiences a disaster is untouched by it. * Most people pull together and function during and after a disaster, but their effectiveness is diminished. * Mental health concerns exist in most aspects of preparedness, response and recovery. * Disaster stress and grief reactions are “normal responses to an abnormal situation.” * Survivors respond to active, genuine interest and concern. * Disaster mental health assistance is often more practical than psychological in nature (offering a phone, distributing coffee, listening, encouraging, reassuring, comforting). * Disaster relief assistance may be confusing to disaster survivors. They may experience frustration, anger, and feelings of helplessness related to Federal, State, and non-profit agencies’ disaster assistance programs. They may reject disaster assistance of all types. Survivor Needs & Reactions (Responses differ, but there are common needs.) * A concern for basic survival * Grief over loss of loved ones and loss of valued/meaningful possessions * Fear and anxiety about personal safety and physical safety of loved ones * Sleep disturbances, often including nightmares and imagery from the disaster * Concerns about relocation and the related isolation or crowded living conditions * A need to talk, often repeatedly, about events and feelings associated with the disaster * A need to feel one is a part of the community and its recovery efforts Reactions that Signal Possible Need for Mental Health Referral (Many responses to trauma can be expected, but some are cause for extra attention/concern.) * Disorientation (dazed, memory loss, unable to give date/time or recall recent events…) * Depression (pervasive feeling of hopelessness & despair, withdrawal from others…) * Anxiety (constantly on edge, restless, obsessive fear of another disaster…) * Acute psychosis (hearing voices, seeing visions, delusional thinking…) * Inability to care for self (not eating, bathing, changing clothing or handling daily life) * Suicidal or homicidal thoughts or plans * Problematic use of alcohol or drugs * Domestic violence, child abuse or elder abuse Common Disaster Worker Stress Reaction Checklist (It is not unusual for responders to have these reactions. Check yourself and your buddies.) Behavioral and Emotional Responses/Symptoms * Anxiety, fear * Grief, guilt, self-doubt, sadness * Irritability, anger, resentment, increased conflicts with friends/family * Feeling overwhelmed, hopeless, despair, depressed * Anticipation of harm to self or others; isolation or social withdrawal * Insomnia * Gait change * Hyper-vigilance; startle reactions * Crying easily * Gallows humor * Ritualistic behavior Cognitive Responses/Symptoms * Memory loss, Anomia (difficulty naming objects or people) * Calculation difficulties; Decision making difficulties * Confusion in general and/or confusing trivial with major issues * Concentration problems/distractibility * Reduced attention span and/or preoccupation with disaster\ * Recurring dreams or nightmares Physiological Responses/Symptoms * Fatigue * Nausea * Fine motor tremors * Tics * Paresthesia * Profuse Sweating * Dizziness * GI Upset * Heart Palpitations * Choking or smothering sensation Mis-Attribution of Normal Arousal (Misinterpretation of normal physiological responses can increase anxiety and the number of unnecessary ER visits.) * Interpretation of normal physiological arousal as serious illness * Misinterpretation often is increased by rumors and false information * Increased by hyper-suggestibility in victim fueled by changes in routine and surroundings * Risk communication and rumor control can help reduce unnecessary drains on healthcare Longer-Term Effects Checklist (Potential down-stream consequences of exposure to a natural or human- caused disaster.) * Nightmares * Intrusive thoughts * Uncontrolled affect * Relationship problems * Job/school related problems * Decreased libido * Appetite change * Blame assignation * Decreased immune response Sources of Stress for Responders Checklist (These can increase stress.) * Role ambiguity * Lack of clarity of tasking * Mismatching skills with tasks * Lack of team cohesion * Discomfort with hazardous exposure * Ineffective communication within team, with non-team members, with headquarters * Lack of or too much autonomy * Intense local needs for information (media/health officials) that cannot await clearance delay * Database issues, linkage between epidemiology, laboratory, and environmental sampling * Laboratory specimen tracking, reporting * Resources/equipment shortages * Command and control ambiguities * Re-integration barriers * Coworkers had to pick up your work…or no one did and it is overwhelming * Lack of understanding of or appreciation for what you have been through * Domestic/family conflict Individual Approaches to Avoid/Reduce Stress Checklist (Things you can do to help maintain your own mental, emotional, physical, spiritual balance.) * Management of workload o Set task priority levels and create a realistic work plan o Delegate existing workload so workers not doing usual job too * Balanced Lifestyle o Exercise and stretch muscles when possible o Eat nutritionally, avoid junk food, caffeine, alcohol, tobacco o Obtain adequate sleep and rest, especially on longer assignments o Maintain contact and connection with primary social supports * Stress Reduction Strategies o Reduce physical tension by deep breathing, meditating, walking o Use time off for exercise, reading, listening to music, taking a bath o Talk about emotions & reactions with coworkers at appropriate times * Self-Awareness o Recognize and heed early warning signs for stress reactions o Accept that one may not be able to self-assess problematic reactions o Be careful not to identify too much with survivors/victims’ grief and trauma o Understand differences between professional relationships and friendships o Examine personal prejudices and cultural stereotypes o Be vigilant not to develop vicarious traumatization or compassion fatigue o Recognize when own disaster experience interferes with effectiveness Self-Care Examples Checklist (Examples, by category, of things you can do.) * Physical Diet, exercise, sports, sleep, relaxation… * Emotional Stay in contact with family, friends, social support * Cognitive Training, reading, perspective * Behavioral Civic involvement, personal & family preparedness * Spiritual Meditation, prayer, fellowship, volunteerism Some of the Sources of Information Used in this Overview The Centers for Public Health Preparedness Program American Psychiatric Association National Center for Post Traumatic Stress Disorder The National Child Traumatic Stress Network Uniformed Services University of the Health Sciences U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Page last modified December 16, 2005 |
| Tips for Managing and Preventing Stress: A Guide for Emergency and Disaster Response Workers Normal Reactions to a Disaster Event * No one who responds to a mass casualty event is untouched by it * Profound sadness, grief, and anger are normal reactions to an abnormal event * You may not want to leave the scene until the work is finished * You will likely try to override stress and fatigue with dedication and commitment * You may deny the need for rest and recovery time Signs That You May Need Stress Management Assistance * Difficulty communicating thoughts * Difficulty remembering instructions * Difficulty maintaining balance * Uncharacteristically argumentative * Difficulty making decisions * Limited attention span * Unnecessary risk-taking * Tremors/headaches/nausea * Tunnel vision/muffled hearing * Colds or flu-like symptoms. * Disorientation or confusion * Difficulty concentrating * Loss of objectivity * Easily frustrated * Unable to engage in problem-solving * Unable to let down when off duty * Refusal to follow orders * Refusal to leave the scene * Increased use of drugs/alcohol * Unusual clumsiness Ways to Help Manage Your Stress * Limit on-duty work hours to no more than 12 hours per day * Make work rotations from high stress to lower stress functions * Make work rotations from the scene to routine assignments, as practicable * Use counseling assistance programs available through your agency * Drink plenty of water and eat healthy snacks like fresh fruit and whole grain breads and other energy foods at the scene * Take frequent, brief breaks from the scene as practicable. * Talk about your emotions to process have seen and done * Stay in touch with your family and friends * Participate in memorials, rituals, and use of symbols as a way to express feelings * Pair up with a responder so that you may monitor one another's stress KEN-01-0098 04/03 |
| For Mental Health and Human Services Workers in Major Disasters KEY CONCEPTS OF DISASTER MENTAL HEALTH The following principles guide the provision of mental health assistance following disasters. The truth and wisdom reflected in these principles have been shown over and over again, from disaster to disaster. KEY CONCEPTS No one who sees a disaster is untouched by it. There are two types of disaster trauma-individual and community. Most people pull together and function during and after a disaster, but their effectiveness is diminished. Disaster stress and grief reactions are normal responses to an abnormal situation. Many emotional reactions of disaster survivors stem from problems of living brought about by the disaster. Most people do not see themselves as needing mental health services following disaster and will not seek such services. Survivors may reject disaster assistance of all types. Disaster mental health assistance is often more practical than psychological in nature. Disaster mental health services must be uniquely tailored to the communities they serve. Mental health workers need to set aside traditional methods, avoid the use of mental health labels, and use an active outreach approach to intervene successfully in disaster. Survivors respond to active, genuine interest, and concern. Interventions must be appropriate to the phase of the disaster. Social support systems are crucial to recovery. Most people who are coping with the aftermath of a disaster are normal, well-functioning people who are struggling with the disruption and loss caused by the disaster. They do not see themselves as needing mental health services and are unlikely to request them. This is why disaster mental health workers must go to the survivors and not wait and expect that survivors will come to them. Survivors often find terms like "assistance with resources" and "talking about disaster stress" to be acceptable, and services described as "psychological counseling" and "mental health services" to be for someone else. Going to survivors means using community outreach strategies. Soon after the disaster, survivors gather in shelters, at mass feeding sites, at disaster recovery centers, at disaster information meetings, and in their neighborhoods to clean up and repair their homes. Churches, senior -centers, local cafes, schools, and community centers are also likely locations where survivors congregate. A considerable amount of psychological support can occur informally over a cup of coffee. Most importantly, survivors respond to genuine concern, a listening ear, and help with immediate problem-solving. Survivors find brochures and information about "normal reactions to disaster stress" and "how to cope" to be extremely helpful. Disaster mental health services must actively fit the disaster-affected community. This means workers are culturally sensitive, provide information in the languages spoken, and work with local, trusted organizations, and community leaders to better understand survivors' needs. |
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