Title: Psychological First Aid: Responding to Emergencies at Colleges and Universities
1Psychological First Aid Responding to
Emergencies at Colleges and Universities
Train the Trainer
2Curriculum 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
3Acknowledgements
- 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
5Goals 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
8Basic Housekeeping
- Agenda
- Breaks, lunch, basic needs
- Questions and comments
- Materials in binder
- Caution subject matter can evoke distress
9Evolution 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)
12Single 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
14College/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
-
15Continuities
- Focus group developed
- Evidence-informed
- Strengths based
- Non-intrusive
- Modular
- Flexible
- Cultural awareness and sensitivity
- NOT THERAPY
16and 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
17Goals 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
19Debriefing 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).
20Review 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
21PFA
-
- Introduction and Overview
- Preparing to Deliver Psychological First Aid
-
22Core Actions
- contact and engagement
- safety and comfort
- stabilizing
- gathering information
- practical assistance
- connecting with social supports
- information on coping
- linking with collaborative services
23Appendices
- 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
25Introduction 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
27Preparing 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
31Small 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? -
33Core 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.
36Core 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
40Core 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
42Demonstration
(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.
44Core 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
47Core 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
50Role 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
52Core 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.
55Core 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.
60Role 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.
61Roles 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
62Flexibility
- Not every situation requires all the core actions
- The core actions are not mutually exclusivethere
is overlap - The order of core actions may vary
63Large 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? -
64Part TwoConducting Your Training
65Overview
- Learning objectives for the training that you
provide - Key take home messages
- Strategies for delivering your training
- Preparing for the training day
66In 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?
67In 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)
68In 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
69In the days before
- Review materials
- Double check equipment, handouts
70Tips 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!
71Key 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?
72Core 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?
73Choice of exercises
- When to use
- Small group discussion?
- Large group discussion?
- Demonstrations?
- Role plays?
- Debriefing after role plays (or not)?
- Other?
74Conducting role plays
- Role plays help build skills and confidence
- Clarify the instructions and purpose
- Defuse performance anxiety
- Divide participants into groups what size?
75Conducting 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
76Tailor to your setting
- How will you develop scenarios for discussion,
role plays?
77Suggestions to keep in mind throughout the
training
- What are the basics of good public speaking?
78Keep 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
80Four 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
81Troubleshooting
- 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?
82Tips for concluding your training session
- Discuss plans to hold future trainings and
refresher sessions - How can you institutionalize the program?
- Finish strong how?
83Looking 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
85Our 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.