Psychological First Aid: Responding to Emergencies at Colleges and Universities

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Psychological First Aid Responding to
Emergencies at Colleges and Universities
Train the Trainer
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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

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Acknowledgements

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

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Work on PFA endorsed by

• Ohio Department of Mental Health
• Ohio Board of Regents
• Ohio Department of Alcohol Drug Addiction
  Services

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Goals for Today

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

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• 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

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• Part Two--Consider how you will teach it

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Basic Housekeeping

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

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Evolution of PFA
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• 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

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(No Transcript)
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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 [phone] www.nimh.ni
h.gov/health/publications/massviolence.pdf
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• Findings and recommendations led to
• Psychological First Aid
• Field Operations Guide
• National Child Traumatic Stress Network
• National Center for PTSD

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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

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Continuities

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

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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

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Goals for Today

• Teach the model
• Define psychological first aid
• Identify PFA core actions
• Practice PFA skills

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

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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).

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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

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PFA

• Introduction and Overview
• Preparing to Deliver Psychological First Aid

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Core Actions

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

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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)

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• 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

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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)

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

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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

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• 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

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• 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

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• 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

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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

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• 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

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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

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(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.

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(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.

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Core Action 2 Safety and Comfort

• Goal
• enhance immediate and ongoing safety
• -and-
• provide physical and emotional comfort

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(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.

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(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.

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(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

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Core Action 3 Stabilizing

• Goal
• To calm and orient emotionally overwhelmed or
  disoriented individuals

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(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

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Demonstration
(3)

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

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• 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.

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Core Action 4 Gathering Information

• Goal
• To identify immediate needs and concerns
• gather information and tailor PFA interventions

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(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.

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(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

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Core Action 5 Practical Assistance

• Goal
• To offer practical help for
• immediate needs and concerns

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(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

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(5)

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

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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.
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• 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

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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

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(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)

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(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.

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Core Action 7 Information on Coping

• Goal
• Provide information about stress
• reactions and coping to reduce distress
• and promote adaptive functioning

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(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.

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(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.

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Core Action 8 Linking with Collaborative
Services

• Goal
• Link individuals with available services for
  immediate use of in the future

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(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.

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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.
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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

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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

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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

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Part TwoConducting Your Training
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Overview

• Learning objectives for the training that you
  provide
• Key take home messages
• Strategies for delivering your training
• Preparing for the training day

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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

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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)

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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

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In the days before

• Review materials
• Double check equipment handouts

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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!

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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

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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

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Choice of exercises

• When to use
• Small group discussion
• Large group discussion
• Demonstrations
• Role plays
• Debriefing after role plays (or not)
• Other

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Conducting role plays

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

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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

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Tailor to your setting

• How will you develop scenarios for discussion
  role plays

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Suggestions to keep in mind throughout the
training

• What are the basics of good public speaking

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Keep it interesting

• Sharing your own perspective and insights makes
  training material meaningful to your audience

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

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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

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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

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Tips for concluding your training session

• Discuss plans to hold future trainings and
  refresher sessions
• How can you institutionalize the program
• Finish strong how

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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.

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• Questions comments final discussion
• Written evaluations

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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.