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 (45)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 (678)Purpose To practice skills from 678Shots 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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