Douglas W. Walker, PhD

Transcription

1 Psychological First Aid for Schools and Skills for Psychological Recovery: Immediate and Intermediate Response Interventions for Schools Impacted by Disaster Douglas W. Walker, PhD Clinical Director Mercy Family Center Project Director / Principal Investigator Project Fleur-de-lis & Mercy Community Hope Project New Orleans

2 Objectives Participants will understand the rationale of the core modules that provide trauma-informed structure to Psychological First Aid for Schools (PFA-S) and Skills for Psychological Recovery (SPR). Participants will leave this session understanding how PFA-S and SPR are arranged in a tiered approach along with evidencebased trauma treatment that creates a continuum of postdisaster intervention. Participants will be given an overview of post-disaster trauma programming utilizing SPR in Joplin, MO (EF5 Tornado) and the coastal parishes of southeastern Louisiana (BP Oil Spill).

3 Photo courtesy Wikipedia

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6 National Child Traumatic Stress Network Original awarded September 2008 grant by SAMHSA Category III Site Project period 9/30/2008 9/29/2016

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8 Oklahoma NCTSN Funded Sites Family and Children's Services Inc., F&CS Child Trauma Center, Tulsa Oklahoma Department of Mental Health Substance Abuse, BE-ME, Oklahoma City University of Oklahoma Health Sciences Center, FIRST Program, Oklahoma City

9 PFDL Participating Schools , 45 schools , 57 schools , 64 schools , 58 schools , 55 schools , 60 schools 30,000 students

10 Best Practice Programming Post-Disaster Long-Term Individual Treatment Intermediate Group Treatment THERAPY WITH CHILDREN DX WITH MENTAL CONDITION PRACTICAL HELP AND EDUCATION FOR ALL CHILDREN EXPOSED TO TRAUMATIC EVENT Intermediate Resiliency Education Immediate Practical Help

11 Current Tiered Model of Care > 3 MONTHS > 3 MONTHS > 3 MONTHS Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Skills for Psychological Recovery (SPR) IMMEDIATE Psychological First Aid (PFA)

12 CENTRAL CONCEPTS Skills for Psychological Recovery (SPR) Psychological First Aid (PFA)

13 CENTRAL CONCEPTS Trauma Focused Cognitive Behavioral Therapy (TF-CBT) Cognitive Behavioral Intervention for Trauma in Schools (CBITS) TRAUMA NARRATIVE

14 Psychological First Aid For Schools National Center for PTSD National Child Traumatic Stress Network SAMHSA

15 Five Empirically-Supported Early Intervention Principles Hobfoll et. al, 2007

16 Five Essential Elements of Immediate and Mid Term Mass Trauma Intervention: Empirical Evidence Psychiatry 70(4) Winter 2007 pp Stevan E. Hobfoll, Patricia Watson, Carl C. Bell, Richard A. Bryant, Melissa J. Brymer, Matthew J. Friedman, Merle Friedman, Berthold P.R. Gersons, Joop T.V.M de Jong, Christopher M. Layne, Shira Maguen, Yuval Neria, Ann E. Norwood, Robert S. Pynoos, Dori Reissman, Josef I. Ruzek, Arieh Y. Shalev, Zahava Solomon, Alan M. Steinberg, and Robert J. Ursano

17 What is Psychological First Aid? PFA is: An evidence-informed modular approach to assist students, staff, and families in the immediate aftermath of a trauma.

18 Who Delivers PFA? PFA is delivered by response workers who provide early assistance, including: All school staff First responders Mental health professionals Religious professionals Disaster volunteers Health and public health officials

19 The Emergency Management Cycle Decrease the need for response Plan for a rapid, coordinated, effective response Restore the learning environment; Monitor and assist the healing Execute the plan, ensure safety, coordinate actions

20 Learn about School Previous adverse events Prior experience with post-event intervention Current morale/climate Upcoming events that might be impacted Recent changes impacting staff/students Relationship between school and community Strengths of the school Any staff with known trauma histories

21 Distinguishing Features (Signature) Location of the event Time and duration of the Event Magnitude (e.g., number of persons injured/dead, confined vs. open area, crowded vs. isolated area, level of disturbing features) Impact relative to the size of community Cause of event Level of exposure, including secondary exposures and significant losses Unique features of the event

22 Be Aware of At-Risk Student Populations Direct exposure Injury Recent death of a loved one Close personal relationship with any victim History of depression or suicidal thoughts/attempts History of anxiety, shyness, or low self-confidence History of risk-taking Those with a disability Those with a prior traumatic event

23 Delivering PFA When delivering PFA: Observe first Ask simple respectful questions Speak calmly and slowly without jargon Be patient, responsive, and sensitive Acknowledge the person s strength

24 Psychological First Aid Core Actions 1 Contact and Engagement 2 Safety and Comfort 3 Stabilization 4 Information Gathering 5 Practical Assistance 6 Connection with Social Supports 7 Information on Coping 8 Linkage with Collaborative Services

25 Psychological First Aid Core Actions 1 Contact and Engagement

26 Core Action #1: Contact and Engagement Be non-intrusive, compassionate, helpful Be identifiable as an approved provider Ask for permission to talk Outreach as much as possible Ask about immediate needs Be sensitive to culture Adapt contact to developmental level

27 Psychological First Aid Core Actions 2 Safety and Comfort

28 Core Action #2: Safety and Comfort The goal is to enhance immediate and ongoing safety and provide physical and emotional comfort

29 Psychological First Aid Core Actions 3 Stabilization

30 Core Action #3: Stabilization The goal is to calm and orient emotionally-overwhelmed and distraught students and staff

31 Psychological First Aid Core Actions 4 Information Gathering

32 Core Action #4: Information Gathering The goal is to identify immediate needs and concerns, gather additional information, and tailor PFA interventions

33 Psychological First Aid Core Actions 5 Practical Assistance

34 Core Action #5: Practical Assistance Offer practical help to survivors in addressing immediate needs and concerns Identify most immediate needs Discuss an action response Act to address the need Focus on realistic solutions Focus on empowerment Help students and staff meet their own needs so they feel more in control

35 Psychological First Aid Core Actions 6 Connection with Social Supports

36 Core Action #6: Connection with Social Support The goal is to help establish brief or ongoing contacts with primary support persons, such as family members and friends, and to seek out other sources of support

37 Psychological First Aid Core Actions 7 Information on Coping

38 Core Action #7: Information on Coping Provide information about stress reactions and coping to reduce distress and promote adaptive functioning

39 Psychological First Aid Core Actions 8 Linkage with Collaborative Services

40 Core Action #8: Linkage with Collaborative Services The goal is to link survivors with available services needed immediately or in the future

41 Classroom Intervention Provide current information about the event Attempt to dispel rumors and clarify any misunderstandings Announce support services that the school or community is currently offering Discuss the steps the school is taking to recover from the incident Address safety concerns and safety procedures Identify current needs and concerns

42 Classroom Intervention (cont.) Problem-solve and address students practical needs, especially those related to academic/school functioning Discuss ways that students can help each other Provide psychoeducation about the range of responses students can have in a crisis Teach effective coping strategies Discuss the role of reminders and how to manage them Identify where to get individualized services Afterwards, take care of yourself

43 PFA Translations & Adaptations Spanish Japanese Italian Mandarin/Simplified Chinese Homeless Youth & Families Schools (Primary & Secondary) Religious Professionals Military Firefighters/Emergency Services Personnel (underway) Medical Reserve Corps

44 PFA Online

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46 Skills for Psychological Recovery (SPR) National Center for PTSD National Child Traumatic Stress Network SAMHSA

47 Skills for Psychological Recovery (SPR) Overview SPR is a series of skill sets that have been shown to be effective in making people feel better after traumatic stress SPR is designed to be 1-5 visits, each which can stand alone, but you should encourage multiple visits Be flexible, tailor SPR to people s needs To build skills - encourage between-visit PRACTICE

48 Five Empirically-Supported Early Intervention Principles Hobfoll et. al, 2007

49 Speed up recovery Goals of SPR Prevent mental health problems Support functioning Prevent behaviors that may make things worse

50 Components of SPR Information gathering and prioritizing assistance Building problem-solving skills Promoting positive activities Managing reactions Promoting helpful thinking Rebuilding healthy social connections

51 Component # 1: Information Gathering and Prioritizing Gather information to: Assistance Decide if referral is needed Know the survivor s most pressing current needs and concerns Decide which SPR skills to teach

52 Rationale for Information Gathering and Prioritizing Assistance After disasters, survivors often feel distressed because of their disaster experiences and losses Gathering information helps survivors to identify and prioritize their current needs and concerns

53 Component # 2: Building Problem-Solving Skills Help the survivor tackle a problem situation actively Generate better ideas Have a more thoughtful selection of action Follow through into action Give them a tool for new situations Have them repeat problem-solving steps

54 Rationale for Building Problem-Solving Skills Problems and difficult times after disasters can: Add to the stress level of adults, children, and families Reduce self-care Make a person less able to solve problems Help maintain traumatic stress reactions

55 Component # 3: Promoting Positive Activities Make the survivor feel more in control and that life is more normal Help the survivor feel less sad, hopeless, fearful, or low in energy Remind survivors who feel overwhelmed to make time to do things that improve their health and well-being

56 Rationale for Promoting Positive Activities People stop doing rewarding things because: They are too busy coping with other problems They just don t feel like it anymore They are avoiding reminders of the disaster People become sad, down, or apathetic when they no longer engage in rewarding or meaningful activities

57 Rationale for Promoting Positive Activities Problems with Focusing on Changing Feelings: THOUGHTS FEELINGS Feelings are very difficult to change Telling yourself to feel good does not work It is easier to change your behaviors, which will change feelings

58 Component # 4: Managing Reactions Enhance skills to calm upsetting physical and emotional reactions Learn new strategies to deal with reactions to stressful situations Put words to difficult experiences so as to better understand and manage distress

59 Rationale for Managing Reactions Survivors distressing reactions can affect: Mood Decision-making Relationships Daily functioning Health Reactions to stressful situations and to reminders can add to feeling bad Learning skills to manage these reactions can help with all these areas

60 Component # 5: Promoting Helpful Thinking Help survivors look at disaster-related thoughts, and how these affect feelings and behavior Identify and practice helpful ways of thinking about disaster-related experiences

61 Helpful Thinking is Not the Same as Positive Thinking Positive thinking is too simplistic Negative thoughts may be accurate Helpful thoughts can mobilize and energize Test effect of thoughts on feeling and behavior

62 Rationale for Promoting Helpful Thinking Disasters often change people s thoughts about the world and themselves World is stressful, unpredictable, or dangerous place Trouble trusting other people See personal situation as hopeless People under stress can have thoughts that make their situation even worse by increasing feelings of distress Focus on helpful ways of thinking can improve mood and adaptive coping

63 Component # 6: Rebuilding Healthy Social Connections Increase connections to positive relationships and community supports Individuals may feel isolated due to: Moving from their community Loss of friends and family Sadness, fear, and lack of motivation

64 Rationale for Rebuilding Healthy Social Connections Positive social support is a proven protective factor in disaster survivors Lack of social support or negative social support leads to worse outcomes Social support after a disaster helps survivors meet their emotional and practical needs

65 Example of Social Connections Map friend at Church neighbor son sister by phone me mother by phone counselor aunt best friend by phone younger son cousin

66 SPR in Southeast Louisiana: Mercy Community Hope Project File: Deepwater Horizon oil spill May 24, 2010.jpg (based upon Original image with cropping) Locator by FT2 from File: Map of USA topological.png (Public domain by author demis.nl).

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69 SPR in SE Louisiana: Mercy Community Hope Project 10 Sites Fall 2012: 222 Spring 2013: 197 Total Served Fall2012/Spring2013: 419 Average group size: 7 Total Groups: 57 3 FTE s, 1 intern, 1 school counselor

70 SPR in Joplin: Mercy Community Connections Google Earth

71 Community Connections St. John s Mercy Joplin, MO

72 SPR in Joplin: Mercy Community Connections Community dinners occurring in five sites throughout Joplin. Three elementary schools, two community centers. Use dinners as event to teach Skills for Psychological Recovery (SPR) Dinners offer opportunity for attendees to be referred to more intensive SPR groups or mental health professional if needed. SPR used also with Mercy co-workers, leadership, adapted for seniors citizens in Joplin community. Over 300 people trained as SPR facilitators in Joplin.

73 Mercy Community Connections: Outcome Data Over the entire scope of the Mercy Recovery Joplin initiative, 8,306 people have been served. 4,013 Community Connection Dinner interactions at Joplin Schools 1,227 Senior Connection interactions 2,839 Community Connections with Mercy Co-Workers 231 Community Connections with Human Services Campus occupants (March June 2012) Mercy participation is the highest of any collaborative agency at the H.S. Campus 158 Resilience Class interactions

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75 Photo courtesy Wikipedia

76 About the Development of PFA Mobile PFA Mobile was funded by the U.S. Department of Veterans Affairs National Center for PTSD in partnership with the National Child Traumatic Stress Network, the Substance Abuse and Mental Health Services Administration, the Department of Defense s National Center for Telehealth & Technology (T2), and the VA s Patient Care Services.

77 Evidence-Based Practice: A Dynamic Interplay Best Research Evidence EBP Best Clinical Experience Consistent with Family / Client / Cultural Values

78 PFA - S & SPR Training and Consultation Melissa J. Brymer, Ph.D., Psy.D. Director, Terrorism & Disaster Programs National Center for Child Traumatic Stress - UCLA mbrymer@mednet.ucla.edu

79 Further Resources learn.nctsn.org

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