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Psychological First Aid: Responding to Emergencies at Colleges and Universities

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Title: Psychological First Aid: Responding to Emergencies at Colleges and Universities


1
Psychological First Aid Responding to
Emergencies at Colleges and Universities
Train the Trainer
2
Curriculum developed by
  • Carol Yoken, Ph.D.
  • Member of ODMH University Linkages Committee,
  • Director, Counseling Center, University of
    Cincinnati
  • Craig Vickio, Ph.D.
  • Member of ODMH University Linkages Committee,
  • Director, Counseling Center, Bowling Green State
    University

3
Acknowledgements
  • Rebecca Herrin, MPA , UC
  • Colleen Carroll, AAB, UC
  • Catherine Stein, Ph.D., BGSU

4
Work on PFA endorsed by
  • Ohio Department of Mental Health
  • Ohio Board of Regents
  • Ohio Department of Alcohol, Drug, Addiction
    Services

5
Goals for Today
  • Part Oneteach the model
  • Define psychological first aid
  • Review the PFA Guide
  • Identify PFA core actions
  • Practice PFA skills

6
  • We will NOT discuss all facets of disaster
    preparedness, response, or recovery
  • Each institution has its own model and practices
  • PFA is one possible component

7
  • Part Two--Consider how you will teach it

8
Basic Housekeeping
  • Agenda
  • Breaks, lunch, basic needs
  • Questions and comments
  • Materials in binder
  • Caution subject matter can evoke distress

9
Evolution of PFA
10
  • Workshop held in late 2001 for peer review of
    published literature in journals
  • 58 experts from 6 countries
  • Included American Red Cross, DOD, VA, HHS, DOJ

11
(No Transcript)
12
Single copies of report available through The
National Institute of Mental Health Office of
Communications and Public Liaison 6001 Executive
Boulevard, Room 8184 Bethesda, MD
20892-9663 Telephone 301-443-4513 www.nimh.ni
h.gov/health/publications/massviolence.pdf
13
  • Findings and recommendations led to
  • Psychological First Aid
  • Field Operations Guide
  • National Child Traumatic Stress Network
  • National Center for PTSD

14
College/University Version
  • Developed in Ohio 2008-2009
  • Available on-line at
  • ODMH What We Do Provide
  • Emergency Preparedness
  • Training and Professional Resources
  • PFA Colleges and Universities

15
Continuities
  • Focus group developed
  • Evidence-informed
  • Strengths based
  • Non-intrusive
  • Modular
  • Flexible
  • Cultural awareness and sensitivity
  • NOT THERAPY

16
and changes
  • Tailored to college and university settings
  • Awareness of university structures and
    environments
  • Tips for working with students, their families,
    faculty and staff
  • Re-organization regarding children
  • Additional appendices

17
Goals for Today
  • Teach the model
  • Define psychological first aid
  • Identify PFA core actions
  • Practice PFA skills

18
  • We will NOT discuss all facets of disaster
    preparedness, response, or recovery
  • Each university has its overall plan
  • PFA is one possible component

19
Debriefing vs. PFA?
  • Long-standing debate, sometimes heated, in
    literature about intent, focus, use, and effects
    of
  • Critical Incident Stress Debriefing (CISD),
  • Critical Incident Stress Management (CISM).

20
Review Article
  • McNally, R.J., Bryant, R.A., Ahlers, A.
  • (2003) Does early psychological
    intervention promote recovery from post-traumatic
    stress? Psychological Science in the Public
    Interest. 4 (2) 45-79

21
PFA
  • Introduction and Overview
  • Preparing to Deliver Psychological First Aid

22
Core Actions
  • contact and engagement
  • safety and comfort
  • stabilizing
  • gathering information
  • practical assistance
  • connecting with social supports
  • information on coping
  • linking with collaborative services

23
Appendices
  • Service Delivery Sites and Settings
  • Psychological First Aid Provider Care
  • Provider Worksheets
  • Handouts for Survivors, PFA Providers, and Others
    in Contact with Survivors
  • Working with Children and Adolescents
  • (including handouts)

24
  • Preventing Suicide Knowing the Signs and
    Symptoms
  • Dealing with the Aftermath of Tragedy in the
    Classroom (For faculty)
  • In the Aftermath of Campus Tragedies What Family
    Members Can Do
  • Sample Mutual Aid Agreement
  • Sample Protocol for Mobilizing Campus PFA
    Providers

25
Introduction and Overview
  • What is Psychological First Aid?
  • assistance aimed at reducing acute distress
    and promoting successful coping and
  • functioning
  • used in the immediate aftermath of traumatic
    events (hours, days, weeks)

26
  • helpful to people of diverse backgrounds and ages
  • can be delivered by anyone who has received
    appropriate training
  • appropriate for use in field settings

27
Preparing to Deliver PFA
  • Should YOU be delivering PFA?
  • Have you been trained in providing such services?
  • Are you part of the institutions network that
    has been assembled to provide PFA?
  • Do you possess the cultural sensitivity and
    knowledge to work with those impacted?
  • Are you too personally involvedand in need of
    such services yourself?

28
  • After a traumatic event, who will need PFA?
  • Some individuals who are most directly impacted
    will not need or want PFA.
  • Some who appear far removed from the traumatic
    event will need PFA.
  • Be observant and an active listener

29
  • Who is most likely to need PFA?
  • exposed to grotesque phenomena or experienced
    extreme life threat
  • significant loss of people or possessions
  • pregnant or have babies or young children
  • lack a support network and feel socially isolated

30
  • contending with significant life stressors
  • physical disability or illness
  • serious mental illness
  • substance abuse problem
  • prone to take risks
  • previously experienced other disasters
  • themselves providing emergency services

31
Small Group Discussion
  • Purpose Review preparation in a specific
    situation
  • Scenario A fire in a classroom building has
  • resulted in several injuries and
    deaths
  • Instructions Choose a spokesperson to summarize
  • and report on key
    conclusions for all participants

32
  • Discuss these questions
  • How will PFA providers roles interface with
    those of first responders?
  • Who should and should not be called upon to
    provide PFA in this scenario?
  • Who is most likely to benefit from PFA?
  • What should the PFA provider do in the hours,
    days, and weeks after the fire?

33
Core Action 1 Contact and Engagement
  • Goal
  • respond to contacts initiated by individuals
    who have experienced a traumatic event
  • -or-
  • initiate contacts in a non-intrusive,
    compassionate, and helpful manner

34
(1)
  • Key Points
  • First contact is key. Show respect and
    compassion. Even a look of interest and calm can
    help ground a person in crisis. Model calmness,
    clear thinking, a
  • sense of hope. Listen without interrupting.
  • First priority is to those who seek you out. If
    many come at once try to at least make initial
    contact with all and revisit as time allows.

35
(1)
  • Key Points
  • Second priority is to seek out others you
    identify as possibly needing help. Timing and
    approach is everything. Even if they decline your
    help immediately they know you are available to
    help.
  • Be sensitive to culture. Follow the individuals
    lead for personal space eye contact, family
    spokesperson. Know local resources, including
    interpreter services.

36
Core Action 2 Safety and Comfort
  • Goal
  • enhance immediate and ongoing safety
  • -and-
  • provide physical and emotional comfort

37
(2)
  • Key Points
  • Immediate needs come first cleaning up the
    physical environment calling on law enforcement
    to help those who are injured, in shock, or at
    risk or harm to self or others obtaining
    glasses, prescriptions, etc.
  • Shield people from additional trauma and
    reminders.

38
(2)
  • Provide information only when an individual is
    ready to hear the content and can comprehend it.
    Avoid technical jargon, be concise. Do not
    reassure unless you have direct information of
    accuracy.

39
(2)
  • Encourage group and social interaction.
  • Grief reactions vary by culture. Do not probe.
    Be aware of spiritual beliefs and cultural
    practices.
  • Give special support to those dealing with death

40
Core Action 3 Stabilizing
  • Goal
  • To calm and orient emotionally overwhelmed or
    disoriented individuals

41
(3)
  • Key Points
  • Stabilize the emotionally overwhelmedintense,
    persistent reactions interfere with the ability
    to function.
  • Use calming and orienting techniques-remain calm,
    quiet, and present provide information about the
    surroundings ask orienting questions who, where
    are they?
  • Groundingfor more extreme distress or
    disorientation

42
Demonstration
(3)
  • Core Actions 1, 2, and 3
  • Contact and Engagement
  • Safety and Comfort
  • Stabilizing (with Grounding)

43
  • A car accident occurred on Saturday night
    killing three international students from India.
    Two were newly arrived in the US and the other
    was a well-known graduate student in
    Engineering, active in the Indian Students
    Association. Another engineering student, also
    from India, is in critical condition.
  • It is Sunday morning and you are meeting with
    faculty and students who have heard the terrible
    news and come to campus. Many are from India. The
    injured students fiancee, a graduate student
    from China, is especially distraught and appears
    dazed.

44
Core Action 4 Gathering Information
  • Goal
  • To identify immediate needs and concerns,
  • gather information, and tailor PFA interventions

45
(4)
  • Key Points
  • Gathering and clarifying information begins
    immediately and continues throughout PFA.
  • The information helps you prioritize needed
    interventions.
  • Avoid asking for in-depth descriptions as they
    may provoke additional distress.

46
(4)
  • Information helps you tailor interventions to
    specific needs
  • Nature and severity of experiences during the
    traumatic event
  • Concerns about on-going problems
  • Separation or loss of loved-one
  • Personal illness
  • Social support availability
  • Prior exposure to trauma
  • Coping techniques

47
Core Action 5 Practical Assistance
  • Goal
  • To offer practical help for
  • immediate needs and concerns

48
(5)
  • Key points
  • Engender hope and confidence positive
    expectations are associated with a more favorable
    outcome.
  • Provide needed resources
  • Help them anticipate problems so they can plan

49
(5)
  • Four steps toward practical assistance
  • Identify immediate needs, clarify
  • Focus one at a time
  • Discuss action plan
  • Help the person act

50
Role Play
(4,5)Purpose To practice skills of Core
Actions 4 and 5A truck carrying a toxic
chemical overturned about a quarter mile from
campus. The local police have shut down and
quarantined the areano one is allowed to travel
on the local roads, so everyone on campus must
stay there. It has now been about an hour since
the accident. Little definite information has
been provided about the nature of the spill, but
the sky has gotten very hazy and rumors are
flying from cell phones and the news media.
People are gathered in groups in buildings (the
police have told them not to be outside). Panic
is mounting. You are in a classroom building and
asked to assist.
51
  • Roles PFA provider
  • Distressed student -- young mother
    with 2 kids in
  • day care a few miles away
  • Older student having difficulty
    breathing
  • Hearing impaired student
  • Professor who is remaining calm
  • Instructions Gather information, prioritize
    immediate needs, help person make an
    action plan

52
Core Action 6 Connecting with Social Supports
  • Goal
  • Help establish brief or ongoing
  • contact with support, including family, friends,
    clergy, culturally relevant resources on campus
    or in community

53
(6)
  • Key Points
  • Social support includes physical and material
    assistance, emotional nurturance, advice and
    information, reassurance of self worth and
    belonging
  • Assist people in contacting their primary
    relationships if unavailable, encourage their
    use of readily available supports (relief
    workers, you)

54
(6)
  • Always model positive supportive responses,
    Including reflective, clarifying, supportive, and
    empowering comments
  • Help people both give and receive support
  • Reliability of support is important. Let people
    know your availability and connect them to others
    if you must leave.

55
Core Action 7 Information on Coping
  • Goal
  • Provide information about stress
  • reactions and coping to reduce distress
  • and promote adaptive functioning

56
(7)
  • Key Points
  • Stress reactions include intrusive phenomena,
    avoidance and withdrawal, physical arousal, often
    prompted by reminders. Loss and grief are common
    in traumatic situations.
  • Educate and normalize stress reactions. They are
    expectable and understandable, but everyone
    recovers in his or her own way and time.

57
(7)
  • Provide information about coping
  • Adaptive coping includes getting information,
    talking, journaling, physical exercise and other
    healthy habits, positive distraction, acceptance,
    taking breaks, relaxation, and re-establishing
    routines
  • Maladaptive coping includes using alcohol or
    drugs, withdrawing, excessive blame and anger,
    and risky behavior.
  • If problems persists more than 1 month, the
    individual may benefit from professional help.

58
Core Action 8 Linking with Collaborative
Services
  • Goal
  • Link individuals with available services for
    immediate use of in the future

59
(8)
  • Key Points
  • Reconnect people with prior service providers
    when relevant
  • Use campus resources and/or community agencies
  • Introduce, give written information, clarify
    understanding of the need and referral
  • To avoid sense of abandonment and helplessness,
    provide a direct hand-off to another provider
    if possible.

60
Role Play
(6,7,8)Purpose To practice skills from
6,7,8Shots were fired in a residence hall room
a few hours ago, killing two students--a young
woman and her new boyfriend. It was a crime of
passion. The shooter was arrested and is in jail.
People from the building and especially the
floor are feeling traumatized. You are sent to
the residence hall to work with people who were
on the floor at the time or were close to the
victimssuitemates, RAs, a few other friends.
61
Roles PFA Provider Close friend
of one of the victims, sobbing and
inconsolable Other friends and
acquaintances who heard the shots RA of
the victims who feels guilty for not having
seen a potentially violent situation
building up Instructions Provide
social support or link to primary
supporters, talk about ways of coping positively,
talk about referral options

62
Flexibility
  • Not every situation requires all the core actions
  • The core actions are not mutually exclusivethere
    is overlap
  • The order of core actions may vary

63
Large Group Discussion(s)
  • Imagine that a reporter hears about your training
    in PFA and asks What are the three most
    important points to keep in mind when delivering
    PFA?
  • Having learned about what you may do as a PFA
    provider, how will you take care of your own
    needs (self care) during and after using these
    skills to assist others?

64
Part TwoConducting Your Training
65
Overview
  • Learning objectives for the training that you
    provide
  • Key take home messages
  • Strategies for delivering your training
  • Preparing for the training day

66
In the months prior to the training
  • Reflect on why youre offering the training
  • Secure permission from necessary authorities to
    conduct your training
  • Identify co-facilitator(s)
  • Consider your audience
  • How big an audience can you effectively
    accommodate in any single training?
  • Do you want your first training to be a pilot?
  • Who will you train? Will they volunteer or be
    required to attend?

67
In the weeks prior to the training
  • Carefully review all materials
  • Consider timing
  • When should you hold your training(s)?
  • Should you offer the entire training at one time
    or break it into two sessions?
  • Reserve space for your program(s)
  • Determine multiple ways of promoting your
    training program(s)

68
In the weeks prior to the training
  • Meet with your co-facilitator(s) to plan the
    training
  • Engage in contingency planning
  • When in doubt, consult--with ODMH, your ADAMHS
    board, and those listed in the trainers manual

69
In the days before
  • Review materials
  • Double check equipment, handouts

70
Tips for beginning your training session
  • Learn about your audience
  • Prepare your audience for what they will
    experience in the trainingboth intellectually
    and emotionally
  • Mention how disaster-relief work will require
    stepping outside of traditional roles
  • Provide participants with instructions about
    asking questions
  • Remember to attend to your participants most
    basic needs!

71
Key ideas
  • We noted things like modular, culturally
    sensitive, evidence-based
  • Think about your audience, your values, and
    integrity of the model what do you want to
    convey?

72
Core Actions Small group brainstorming
  • How will you explain the meaning and importance
    of this core action to your future trainees?
  • How will you help your trainees know when to use
    this action?

73
Choice of exercises
  • When to use
  • Small group discussion?
  • Large group discussion?
  • Demonstrations?
  • Role plays?
  • Debriefing after role plays (or not)?
  • Other?

74
Conducting role plays
  • Role plays help build skills and confidence
  • Clarify the instructions and purpose
  • Defuse performance anxiety
  • Divide participants into groups what size?

75
Conducting role plays
  • Sample guidelines for role-plays
  • Ask each group to select rolesfor example,
    survivor, PFA provider, role play observer
  • Provide scenario of traumatic event(s)
  • Ask audience members to review relevant material
    in PFA Guide
  • Circulate and lend assistance as needed
  • Provide an opportunity for processing the
    experience

76
Tailor to your setting
  • How will you develop scenarios for discussion,
    role plays?

77
Suggestions to keep in mind throughout the
training
  • What are the basics of good public speaking?

78
Keep it interesting
  • Sharing your own perspective and insights makes
    training material meaningful to your audience

79
  • Be positive, show respect for your trainees, show
    appreciation and confidence in their ability to
    provide PFA effectively

80
Four Important Dos
  • DO utilize the knowledge, talents and experiences
    of your participants
  • DO speak in practical terms (and avoid the use
    sophisticated clinical jargon)
  • DO stay on time!
  • DO encourage audience participation

81
Troubleshooting
  • What to do if
  • you disagree with elements of the model?
  • you have an overly talkative audience member?
  • an audience member is very vocal in criticizing
    certain aspects of the training?
  • you fall significantly behind schedule during
    the training?
  • your co-facilitator is ill the day of training?

82
Tips for concluding your training session
  • Discuss plans to hold future trainings and
    refresher sessions
  • How can you institutionalize the program?
  • Finish strong how?

83
Looking to the future
  • In your future trainings, what will be the most
    important message(s) that you would hope to
    convey?
  • Make a tentative plan before you leave. Use
    checklist. Share with small group.

84
  • Questions, comments, final discussion
  • Written evaluations

85
Our contact information
  • Carol carol.yoken_at_uc.edu, 513-556-0648
  • Craig cvickio_at_bgsu.edu, 419-372-2081
  • This material may be used with
  • acknowledgment of authors role in
  • developing it. For more information on
    our
  • experiences using it or to discuss how you
  • may want to adapt it, please contact one
    of us.
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