4/26/2020 Be the Helper: Implementing Psychological First Aid during Covid-19 Crisis Noelle L. Lefforge, Ph.D. 1 Learning Objectives – Participants will be able to: – provide the rationale for utilizing Psychological First Aid and Skills for Psychological Recovery appropriately. – facilitate effective coping during a crisis by applying Psychological First Aid. – provide those affected by the current crisis with helpful resources. – locate additional resources and manuals to provide PFA and SPR. 2 What is Psychological First Aid (PFA)? – Evidence-informed – Initial Distress caused by traumatic event – short- and long-term adaptive functioning and coping 3 1
4/26/2020 Psychological First Aid Exhaustion of Coping Resiliency Coping Exposure to Traumatic PTSD Events Vicarious Trauma Decreased Resiliency Compassion Fatigue 4 What is Psychological First Aid (PFA)? – Evidence-informed – Initial Distress caused by traumatic event – short- and long-term adaptive functioning and coping – 4 standards – Consistency with research evidence on risk and resiliency following trauma – Applicable and practical in field settings – Appropriate across life span – Culturally informed and flexible 5 PFA is NOT Psychotherapy (Watson, 2015) – MBH Providers need to manage their expectations – Expecting the same as traditional psychotherapy can have unintended effects – Unable to predict long-term psychopathology in the early aftermath of crises – Mechanism for referrals for those who need additional treatment – PFA Message: “Many people will need a little bit of assistance to feel better and function better, without necessarily needing formal diagnosis or treatment.” 6 2
4/26/2020 PFA is NOT Psychotherapy (Watson, 2015) 7 Psychological First Aid Maximizes Protective Benefit Protects from Potential for Harm due to Intervention 8 Not Without It’s Limitations (Fox et. Al, 2012; Shultz & Forbes, 2013) – Effectiveness has yet to be demonstrated – Reviewers could not find any randomized trials, non-randomized, or large descriptive studies. The best available “evidence” appears to be limited to peer-reviewed consensus statements and guidelines. – PFA is conceptualized as “documenting and operationalizing good common sense--those activities that sensible, caring human beings would do for each other anyway.” – Previous interventions (e.g., psychological debriefing) were widely used and later found to cause harm among some recipients – Know very little about its effectiveness, especially in terms of for who & in what circumstances 9 3
4/26/2020 Increasing Evidence for Effectiveness (Despeaux et al., 2019) – A Randomized Controlled Trial Assessing the Efficacy of Group Psychological First Aid – Laboratory setting, not actual traumatic event – Group PFA vs Group Conversation – PFA Condition: – Lessened anxiety immediately after – Even greater lessened anxiety after 30-min delay – Lessened negative affect immediately after 10 Principles of PFA consistent with Guidelines (NATO, 2008; Bison & Lewis, 2009) – “the abilities of people to accept and use social support and the availability of it are two of the key features of resilience.” NATO 11 Who is Psychological First Aid For? Delivers PFA? It is For….. It is Delivered By…. – Exposed to disaster or terrorism – Mental health and other disaster response workers – Children – First responder teams – Adolescents – Primary and emergency health – Parents/caretakers – School crisis response teams – Families – Faith-based organizations – Adults – Etc. – First Responders – Disaster Relief Workers 12 4
4/26/2020 Training in PFA – Training is generally effective – Those trained tend to perceive PFA as appropriate – Generally respond as “satisfied” by PFA training – especially 1 st time disaster responders – Increases sense of emergency preparedness and self- efficacy – Train-the-trainer approaches are effective and lead to networks of trained individuals 13 Basic Connect Objectives of Crisis Inform Safety Intervention /PFA Support Calm Problem- Solve 14 Guidelines for Delivering PFA – Politely observe first; don’t intrude. Then ask simple respectful questions to determine how you may help. – Often, the best way to make contact is to provide practical assistance (food, water, blankets). – Initiate contact only after you have observed the situation and the person or family, and have determined that contact is not likely to be intrusive or disruptive. – Be prepared that survivors will either avoid you or flood you with contact. – Speak calmly. Be patient, responsive, and sensitive. 15 5
4/26/2020 Guidelines for Delivering PFA – Speak slowly, in simple concrete terms; don’t use acronyms or jargon. – If survivors want to talk, be prepared to listen. When you listen, focus on hearing what they want to tell you, and how you can be of help. – Acknowledge the positive features of what the survivor has done to keep safe. – Give information that directly addresses the survivor’s immediate goals and clarify answers repeatedly as needed. – Give information that is accurate and age-appropriate for your audience. – When communicating through a translator, look and talk to the person you are addressing. – The goal of PFA is to reduce distress, assist with current needs, and promote adaptive functioning, not to elicit details of traumatic experiences and losses. 16 Behaviors to Avoid – Do not make assumptions about what survivors are experiencing or what they have been through. – Do not assume that everyone exposed to a disaster will be traumatized. – Do not pathologize. Most acute reactions are understandable and expectable given what people exposed to disaster have experienced. – Do not talk down to or patronize the survivor, or focus on their helplessness, weaknesses, mistakes, or disability. – Do not assume that all survivors want to talk or need to talk to you. – Do not “debrief” by asking for details of what happened. – Do not speculate or offer possibly inaccurate information. 17 Contact and Safety and Comfort Stabilization Engagement Information Connection with Gathering: Current Practical Assistance Social Supports Needs and Concerns Core Linkage with Information on Collaborative Actions Coping Services 18 6
4/26/2020 Contact and Safety and Comfort – Engagement – 42% 72% Practical Assistance – 44% Top 3 Most Helpful to Survivors (Allen, Steinberg, Vernberg, & Speier, 2010) 19 Contact and Safety and Comfort – Engagement – 64% 42% Practical Assistance – 42% Top 3 Most Helpful to Providers (Allen, Steinberg, Vernberg, & Speier, 2010) 20 Contact and Engagement – Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner – Culture Alert – Eye contact, physical touch, physical proximity, etc. are culturally determined. May be important to determine spokesperson for the family to address initially. 21 7
4/26/2020 Safety and Comfort – Goal: To enhance immediate and – Ensure Immediate Physical Safety ongoing safety, and provide physical – Provide information relevant to the and emotional comfort. crisis (e.g., services, common stress – Culture Alert – Privilege influences reactions) one’s ability to obtain and maintain – -Attend to physical comfort physical safety, and must be taken – Promote social engagement into account. Be aware of your own privilege and you assist others and – Protect from additional traumatic make recommendations. Attending experiences (e.g., limit media) to grief may have a spiritual – Attend to experiences of death (e.g., component. normalize grief reactions, provide information on funerals) 22 Stabilization – Goal: To calm and orient – Often not required – only if emotionally overwhelmed or emotional response persistently disoriented survivors. interferes with functioning – Utilize existing social support – Provide information on emotional response (e.g., emotions are like waves) – Utilize calming and/or grounding techniques 23 Information Gathering: Current Needs and Concerns – Goal: To identify immediate needs – Survivor Current Needs Worksheet and concerns, gather additional – Where are the difficulties? information, and tailor – Behavioral Psychological First Aid interventions. – Emotional – Physical – Caution – focus on gathering basic information, rather than in-depth – Cognitive reliving of traumatic events – Consider death, on-going threat, separation, illness, losses, guilt or shame, SI/HI, social support, prior – Assess needs to provide substance use, prior trauma, referrals and/or follow-up interruption of significant events 24 8
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