Psychological First Aid An Overview and Update for the Medical Reserve Corps

Transcription

1 Psychological First Aid An Overview and Update for the Medical Reserve Corps Webinar Program September 11, 2007 Edward M. Kantor, MD, FAPA Associate Professor of Psychiatry and Emergency Medicine Psychiatry Residency Training Director Director, Consult-Liaison, Emergency and Community Psychiatry University of Virginia School of Medicine

2 Acknowledgements MRC National Program Office NACCHO MRC Mental Health Work Group NCTSN and NCPTSD Jack Herrmann, LCSW

3 Polling Question #1 Have you ever taken a PFA training?

4 Today s s Program Disaster Mental Health and the MRC Overview and controversies in DMH What is Psychological First Aid (PFA) Key elements of PFA Benefits and Limitations of PFA Training Opportunities in PFA Questions and Answers

5 Moment of Reflection September 11th, 2001 "I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." ~ Mother Teresa

6 Disaster Mental Health and the MRC

7 Polling Question #2 Have you ever administered PFA?

8 Disaster Mental Health MRC Workgroup MH Workgroup Efforts Identifying & Defining Core Competencies for DMH Position Statement on Psychological

9 Disaster Mental Health MRC Workgroup MH Work Group Efforts Identifying and Defining Core Competencies for DMH Position statement on Psychological Debriefing Reviewing and promoting training opportunities Linking Competencies to Curricula, Training and Evaluation Defining Prerequisites, Minimum Standards, Reciprocity

10 Disaster Mental Health Core Competencies Identifying and Defining Competencies for DMH General Areas of Attention: Roles, Credentials and Job Actions in DMH Link Competencies to existing and developing curricula Identify and compare standard training programs & reciprocity Identify strategies and resources for assessment and evaluation Identify minimum areas of expected Knowledge, Skill and Attitude

11 Disaster Mental Health Core Competencies MRC Core Competency Matrix includes elements of Disaster MH and PFA KNOWLEDGE: Identify the basic elements of Psychological First Aid and the key ways to provide emotional care and comfort to disaster survivors, MRC members and others in the early aftermath of disaster. ATTITUDE: Acknowledge that MRC members are in a unique role to provide emotional care and comfort to disaster survivors, MRC team members, and others Embrace the concept that providing emotional care and comfort in the early aftermath of disaster may mitigate short and long-term psychological consequences in disaster survivors, MRC team members, and others

12 Disaster Mental Health Overview & Controversy

13 Disaster Mental Health Overview Disaster Defined from a Behavioral Perspective A traumatic event that overwhelms a community A severe disruption which greatly exceeds the coping capacities of that community. All-Hazards perspective (Natural- Technological- Mass Violence)

14 Disaster Mental Health Overview Crisis-Disaster Continuum crisis disaster individual community

15 Disaster Mental Health Overview Disaster Mental Health DOES NOT EQUAL Trauma Treatment

16 Disaster Mental Health Overview First Order Intervention- Peer, Lay, Paraprofessional Psychological First Aid- awareness, support, talk -mobilize relevant supports- religious, schools, extended family, etc. Intervention at scene or immediately post event Second Order Intervention- Professional, Paraprofessional Often by referral after first order contact For those with severe or ongoing symptoms Multimodal Approaches -Supportive & Cognitive Therapy, Psychiatric Hosp. for safety issues -Detoxification/maintenance for substances of abuse -Medications- maintaining prescribed - evolving unclear role for new medication

17 Disaster Mental Health Overview Clear and consistent communication and direction to reign in chaos. Quick and easy access to basic needs like food, shelter and safety. Advertise the process for help over and over. Minimize administrative hoops. By and large, with some exceptions, those exposed are essentially normal people reacting to overwhelming circumstances with typical human emotions...so the sadness and grief is not a mental health problem, it it is a human process that needs to be supported and not medicalized up front. The mental health response should be integrated with the whole recovery process and not highlighted as something to be sent to unless severe symptoms surface.

18 Disaster Mental Health Overview Recovery is a process and will go on for a while. Take necessary time to grieve and be with supports, Return to activities quickly when possible, Look for extreme behavior changes in individuals suffering from grief, look for hopelessness or thoughts of self harm. Use outreach and existing social structure to reach those affected. (clergy, peer organizations, known agencies, local community leaders and activists) Provide specific sensitivity to those persons from groups that might be villainized or have special needs such as non-english speaking, minority religion or pre-existing mental illness. Have a referral mechanism for those with issues that exceed the grief and loss response or are at risk/unsafe.

19 Disaster Mental Health Overview 1. EMDR Controversies 2. Psychological Debriefing 3. Unproven or unknown techniques

20 Disaster Mental Health Overview EMDR Controversies There is no credible evidence that eye movement desensitization and reprocessing (EMDR) as an early mental health intervention, following mass violence and disasters, is a treatment of choice over other approaches*. *Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence National Institute of Mental Health. NIH Publication No , Washington, D.C.: U.S. Government Printing Office,

21 Disaster Mental Health Overview Controversies Psychological Debriefing There is no convincing evidence that psychological debriefing prevents PTSD or other trauma- related mental disorders. Some individuals may be harmed by debriefing, with the systemic ventilation of feelings as the potentially most harmful phase An individual sense of control or mastery is important in (one s) recovery. The term debriefing should be used only to describe operational debriefings. Although operational debriefings can be describe as early interventions, they are done primarily for reasons other than preventing or reducing mental disorders. *Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence National Institute of Mental Health. NIH Publication No , Washington, D.C.: U.S. Government Printing Office,

22 Disaster Mental Health Overview Other practices Controversies Medication, acupuncture, massage, bloodletting, etc Many practices that may have captured public interest have not been proven effective, and some may do harm. *Mental Health and Mass Violence: Evidence-Based Early Psychological Intervention for Victims/Survivors of Mass Violence National Institute of Mental Health. NIH Publication No , Washington, D.C.: U.S. Government Printing Office,

23 Disaster Mental Health What is Psychological First Aid?

24 What is Psychological First Aid An evidence-informed informed modular approach to assist children, adolescents, adults and family in the immediate aftermath of disaster or terrorism Designed to reduce the initial distress caused by traumatic events Foster short and long term adaptive functioning and coping

25 Strengths of PFA Relies on field tested, evidence-informed informed strategies Includes basic information gathering techniques to help make rapid assessment of what is needed and what to do Guidelines for delivery and concrete examples Developmentally and culturally appropriate interventions for survivors of various ages and backgrounds Includes important elements of risk communication, behaviors to avoid and education via use of materials and handouts

26 Psychological First Aid Field Operations Guide Medical Reserve Corps National Child Traumatic Stress Network National Center for PTSD

27 PFA disclaimer Has received considerable support from disaster mental health experts as the acute intervention of choice Many of the components have been tested and validated Consensus is at this time should at worst, produce no harm at best, provide effective ways to manage post-disaster stress and identify those that need additional psychological support No model to date has empirically validated or rigorously tested the efficacy of this supportive intervention and resultant outcomes are unknown

28 Who is PFA For? Individuals experiencing acute stress reactions or who appear to be at risk for significant impairment in functioning

29 Polling Question #3 What is your profession?

30 Who Delivers PFA? All members of the MRC who provide acute assistance as part of the organized disaster response

31 When Should PFA be used? Supportive behavioral intervention for use in the immediate aftermath of disasters and other traumatic events Intended to blend into the MRC response structure early in stabilization and recovery efforts

32 Where Should PFA Be Used? Designed for delivery in diverse settings

33 MRC Delivery Sites and Settings Shelters Respite Centers Hospital-ER, Field Service Centers Emergency Operations Centers Community Outreach Teams First Aid Stations Phone banks- hotlines PODS Staging Areas Family Reception Centers Family Assistant Centers First Responders and Disaster Relief Personnel units Schools Following WMD events: Mass casualty collection points Field post decontamination sites Mass prophylaxis sites

34 PFA Core Actions Contact and engagement Safety and comfort Stabilization ( if needed) Information gathering: Current needs and concerns Practical assistance Connection with social supports Information on coping Linkage with collaborative services

35 Contact and Engagement Establish a connection in a non-intrusive compassionate manner Adult/caregiver Hi, my name is Pat. I m I m with the Medical Reserve Corps. We re checking with people to see if we can be of any help. Is it ok if I talk to you for a moment? May I ask your name? Mrs. Williams, before we talk, is there something right now that you need, like water or juice? Adolescent/ child And is this your daughter? ( Get on child s s eye level, smile and greet child, using his/her name and speaking softly) Hi Lisa, I m I m Pat and I m I here to try to help you and your family. Is there anything you need n right now? There is some water and juice over there, and we have a few blankets with toys in those boxes

36 Safety and Comfort Enhance immediate and ongoing safety, and provide physical and emotional comfort Basic Needs

37 Stabilization Calm and orient emotionally overwhelmed or disoriented survivors Signs and symptoms What to do

38 Information Gathering: Current Needs and Concerns Identify immediate needs and concerns Gather additional information as appropriate to the situation

39 Information Gathering: Current Needs and Concerns Provider alerts Examples Avoid asking for in-depth descriptions of traumatic experiences, as this may provoke unnecessary additional stress Avoid blanket reassurance that stress reactions will disappear. This may set up unrealistic expectations, resulting in negative views of self if reactions persists.

40 Practical Assistance Offer practical assistance and information to address survivor s s immediate needs and concerns Identify Clarify Discussion action Act

41 Connection with Social Supports Connect survivors as soon as possible to social support providers, including family, friends and community helping resources The most positive results from early interventions are usually for f those that mobilize community support and address survivor s s human affiliation needs ( eg.. helping survivors establish contact with relatives) rather than interventions that focus on individual psychological reactions. Orner,, Kent, Pfefferbaum,, Watson The Context of Providing Immediate Post Intervention In: : Ritchie, Watson, & Friedman (eds( eds) ) Intervention Following Mass Violence and Disaster. New York: The T Guildford Press, 2006

42 Information on Coping Provide the individual with information that may help him/her with the event and its aftermath

43 Information on Coping Provide information about stress and coping to reduce distress and promote adaptive functioning Basic information about stress reactions Ways of coping (see handouts in the back of the field guide to PFA) Developmental issues Highly negative emotions Sleep Hygiene Anger management Substance abuse

44 Linkage with Collaborative Services Possible indications for referral Making a referral

45 Appendix Resources Training Resources Issues and populations of special consideration Disaster relief organizations, agencies and programs Planning tools and technical resources Risk communication

46 Appendix Handouts Tips for helping preschool children Tips for helping school age children Tips for helping adolescents Connecting with others- seeking social support Connecting with others- giving social support When Terrible Things Happen Basic Relaxation exercises Alcohol and Drug use after disasters

47 Additional Appendices Special Considerations for Acutely Bereaved Individuals Service Site Challenges More to come..

48 Take Home Messages PFA is an acute intervention of choice Supported by the MRC as a basic approach for ALL MRC MEMBERS! Supports position paper: do not debrief Easy access- MRC website Field Guide to PFA Can be carried in GO BAG as a Field Manual Will be continuously updated and expanded MRC feedback critical

49 Disaster Mental Health Training A variety of disaster mental health trainings available in the public and private domain On-site On-line Hybrid

50 Disaster Mental Health Training American Red Cross DHHS/SAMHSA New Course through the ARC in PFA

51 Disaster Mental Health Training New York State/University of Rochester Commonwealth of Virginia New Version Available soon Online version of PFA at the University of Rochester Developed for VDH and DMHMRSAS together Evolved to include PFA- 6-8 hours Lecture and Role plays

52 Disaster Mental Health Training Center for Disaster Epidemiology and Emergency Preparedness University of Nebraska National Rural Behavioral Health Center at the University of Florida

53 Polling Question #4 Does your local community's disaster plan include how to prepare for and respond to mental health issues after disaster?

54 Virginia Tech Tragedy

55 Mon 4/16/2007 1:22 PM To all Psychiatric Society of Virginia Members: There was a mass shooting at Virginia Tech today. At least 20 dead and report of more shot. I have been in touch by phone with the Student Health psychiatrist at VA Tech. They are on lock down currently and awaiting guidance. We spent time talking about crisis and disaster response and I sent him some materials to look at while they are on hold. He has a good head on his shoulders and is aware of early response issues. Not sure what their needs will be over the next week or so, but expect there could be a call for assistance as the issues unfold. For now the details are unclear and no acute need for mental health specific care other than support in the early aftermath. I will coordinate any of our efforts with the response structure there. If anyone has interest in assisting over the next two weeks, SHOULD the need arise, please me and I will keep track of possible volunteers. Please also let me know if you are already a registered disaster volunteer with an organized group. Ed Kantor Disaster Chair- Psychiatric Society of Virginia

56 Disaster Mental Health Questions?