7. ANNEXOS
7.3. Buidatge de les assignatures
7.3.21. Universitat de Vic
Overview of Psychological First Aid Psychological First Aid Worksheets
Handouts for Survivors
Connecting with Others: Seeking Social Support (for adults and adolescents)
Connecting with Others: Giving Social Support (for adults and adolescents) When Terrible Things Happen (for adults and adolescents)
Parent Tips for Helping Infants and Toddlers (for parents/caregivers) Parent Tips for Helping Preschool-Age Children (for parents/caregivers) Parent Tips for Helping School-Age Children (for parents/caregivers) Parent Tips for Helping Adolescents (for parents/caregivers)
Tips for Adults (for adult survivors)
Basic Relaxation Techniques (for adults, adolescents, and children) Alcohol and Drug Use after Disasters (for adults and adolescents)
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Psychological First Aid - Field Operations Guide
Overview of Psychological First Aid
Section Headers
Preparing to Deliver Psychological First Aid
Entering the setting Providing services Group settings
Maintain a calm presence
Be sensitive to culture and diversity Be aware of at-risk populations 1. 2. 3. 4. 5. 6. Contact and
Engagement 1.2. Introduce yourself/ask about immediate needsConfidentiality Safety and Comfort Ensure immediate physical safety
Provide information about disaster response activities and services Attend to physical comfort
Promote social engagement
Attend to children who are separated from their parents/caregivers Protect from additional traumatic experiences and trauma reminders Help survivors who have a missing family member
Help survivors when a family member or close friend has died Attend to grief and spiritual issues
Provide information about casket and funeral issues Attend to issues related to traumatic grief
Support survivors who receive death notification Support survivors involved in body identification
Help caregivers confirm body identification to a child or adolescent 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14.
Stabilization Stabilize emotionally overwhelmed survivors Orient emotionally overwhelmed survivors The role of medications in stabilization 1.
2. 3. Information
Gathering: Current Needs and Concerns
Nature and severity of experiences during the disaster Death of a loved one
Concerns about immediate post-disaster circumstances and ongoing threat Separations from or concern about the safety of loved ones
Physical illness, mental health conditions, and need for medications
Losses (home, school, neighborhood, business, personal property, and pets) Extreme feelings of guilt or shame
Thoughts about causing harm to self or others Availability of social support
Prior alcohol or drug use
Prior exposure to trauma and death of loved ones
Specific youth, adult, and family concerns over developmental impact 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12.
National Child Traumatic Stress Network National Center for PTSD
Overview of Psychological First Aid
- continuedSection Headers
Practical Assistance Offering practical assistance to children and adolescents Identify the most immediate needs
Clarify the need Discuss an action plan Act to address the need 1. 2. 3. 4. 5. Connection with
Social Supports Enhance access to primary support persons (family and significant others)Encourage use of immediately available support persons Discuss support-seeking and giving
Special considerations for children and adolescents Modeling support 1. 2. 3. 4. 5. Information on
Coping Provide basic information about stress reactionsReview common psychological reactions to traumatic experiences and losses
Intrusive reactions
Avoidance and withdrawal reactions Physical arousal reactions
Trauma reminders Loss reminders Change reminders Hardships
Grief reactions
Traumatic grief reactions Depression
Physical reactions
Talking with children about physical and emotional reactions Provide basic information on ways of coping
Teach simple relaxation techniques Coping for families
Assist with developmental issues Assist with anger management Address highly negative emotions Help with sleep problems
Address alcohol and substance use 1. 2. • • • • • • • • • • • 3. 4. 5. 6. 7. 8. 9. 10. 11. Linkage with Collaborative Services
Provide direct link to additional needed services Referrals for children and adolescents
Referrals for older adults
Promote continuity in helping relationships 1.
2. 3. 4.
Psychological First Aid - Field Operations Guide
Provider Worksheets
Survivor Current Needs
Date: _______ Provider: _________________________ Survivor Name: ___________________________________ Location: ________________________________________ This session was conducted with (check all that apply):
Child
Adolescent Adult Family Group
Provider: Use this form to document what the survivor needs most at this time. This form can be used to communicate with referral agencies to help promote continuity of care.
Check the boxes corresponding to difficulties the survivor is experiencing.
Behavioral Emotional Physical Cognitive
Extreme disorientation Excessive drug, alcohol, or prescription drug use Isolation/ withdrawal
High risk behavior Regressive behavior Separation anxiety Violent behavior Maladaptive coping Other __________ Acute stress reactions Acute grief reactions Sadness, tearfulness Irritability, anger Feeling anxious, fearful Despair, hopelessness Feelings of guilt or shame Feeling emotionally numb, disconnected Other __________ Headaches Stomachaches Sleep difficulties Difficulty eating Worsening of health conditions Fatigue/exhaustion Chronic agitation Other __________ Inability to accept/ cope with death of loved one(s) Distressing dreams or nightmares Intrusive thoughts or images Difficulty concentrating Difficulty remembering Difficulty making decisions Preoccupation with death/destruction Other __________ 1.
National Child Traumatic Stress Network National Center for PTSD Check the boxes corresponding to difficulties the survivor is experiencing.
Past or preexisting trauma/psychological problems/substance abuse problems Injured as a result of the disaster
At risk of losing life during the disaster Loved one(s) missing or dead
Financial concerns Displaced from home Living arrangements Lost job or school
Assisted with rescue/recovery Has physical/emotional disability Medication stabilization
Concerns about child/adolescent Spiritual concerns Other: __________________________________________________________________ Please.make.note.of.any.other.information.that.might.be.helpful.in.making.a.referral. ___________________________________________________________________________ ___________________________________________________________________________ Referral
Within project (specify) _______________
Substance abuse treatment
Other disaster agencies
Other community services
Professional mental health services
Clergy Medical treatment Other: _______________ Was.the.referral.accepted.by.the.individual? Yes No 2. 3. 4. 5.
Psychological First Aid - Field Operations Guide
Provider Worksheets
Psychological First Aid Components Provided
Date: _______ Provider: _________________________ Location: ________________________________________ This session was conducted with (check all that apply):Child
Adolescent Adult Family Group
Place a checkmark in the box next to each component of Psychological First Aid that you provided in this session.
Contact and Engagement
Initiated contact in an appropriate manner
Asked about immediate needs
Safety and Comfort
Took steps to ensure immediate physical safety
Gave information about the disaster/risks
Attended to physical comfort
Encouraged social engagement
Attended to a child separated from parents
Protected from additional trauma
Assisted with concern over missing loved one
Assisted after death of loved one
Assisted with acute grief reactions
Helped with talking to children about death
Attended to spiritual issues regarding death
Attended to traumatic grief
Provided information about funeral issues
Helped survivor after body identification
Helped survivors regarding death notification
Helped with confirmation of death to child
Stabilization
Helped with stabilization
Used grounding technique
Gathered information for medication referral for stabilization
Information Gathering
Nature and severity of disaster experiences
Death of a family member or friend
Concerns about ongoing threat
Concerns about safety of loved one(s)
Physical/mental illness and medications(s)
Disaster-related losses
Extreme guilt or shame
Thoughts of harming self or others
Availability of social support
Prior alcohol or drug use
History of prior trauma and loss
Concerns over developmental impact
Other _______________
National Child Traumatic Stress Network National Center for PTSD
Practical Assistance
Helped to identify most immediate need(s)
Helped to clarify need(s)
Helped to develop an action plan
Helped with action to address the need
Connection with Social Supports
Facilitated access to primary support persons
Discussed support seeking and giving
Modeled supportive behavior
Engaged youth in activities
Helped problem-solve obtaining/giving social support
Information of Coping
Gave basic information about stress reactions
Gave basic information on coping
Taught simple relaxation techniques(s)
Helped with family coping issues
Assisted with developmental concerns
Assisted with anger management
Addressed negative emotions (shame/guilt)
Helped with sleep problems
Addressed substance abuse problems
Linkage with Collaborative Services
Provided link to additional service(s)
_______________________________________
Promoted continuity of care
_______________________________________
Provided handout(s)
Psychological First Aid - Field Operations Guide
Connecting with Others
Seeking Social Support
Making contact with others can help reduce feeling of distress
Children and adolescents can benefit from spending some time with similar-age peers
Connections can be with family, friends, or others who are coping with the same traumatic event
Social Support Options Spouse/partner or parents
Clergy Support group
Trusted family member
Doctor or nurse Co-worker/Teacher/Coach
Close friend
Crisis/School counselor or
other counselor
Pet
Do . . .
Decide carefully whom to talk to
Start by talking about
practical things
Ask others if it’s a good
time to talk
Decide ahead of time what you want to discuss
Let others know you need to
talk or just to be with them
Tell others you appreciate
them listening
Choose the right time and place
Talk about painful thoughts
and feelings when you’re ready
Tell others what you need
or how they could help–one main thing that would help you right now
Don’t . . .
Keep quiet because you don’t want to upset others
Assume that others don’t want to listen
Keep quiet because you’re worried about being a burden
Wait until you’re so stressed or exhausted
that you can’t fully benefit from help
Ways to Get Connected
Calling friends or family on the phone
Getting involved with a support group
Increasing contact with existing acquaintances and friends
Getting involved in community/school
recovery activities
Renewing or beginning involvement in religious group activities
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Psychological First Aid - Field Operations Guide
Connecting with Others
Giving Social Support
You can help family members and friends cope with the disaster by spending time with them and lis- tening carefully. Most people recover better when they feel connected to others who care about them. Some people choose not to talk about their experiences very much, and others may need to discuss their experiences. For some, talking about things that happened because of the disaster can help those events seem less overwhelming. For others, just spending time with people they feel close to and accepted by, without having to talk, can feel best. Here is some information about giving social support to other people.
Reasons Why People May Avoid Social Support Not knowing what they need
Not wanting to burden others Wanting to avoid thinking or
feeling about the event
Feeling embarrassed or “weak”
Doubting it will be helpful, or
that others will understand
Assuming that others will be
disappointed or judgmental
Fearing they will lose control
Having tried to get help and
feeling that it wasn’t there
Not knowing where to get
help
Good Ways to Give Support Show interest, attention, and care
Show respect for the person’s
reactions and ways of coping
Talk about expectable
reactions to disasters, and healthy coping
Find an uninterrupted time and place to talk
Acknowledge that this type
of stress can take time to resolve
Express belief that the person
is capable of recovery
Be free of expectations or judgments
Help brainstorm positive
ways to deal with reactions
Offer to talk or spend time
together as many times as is needed
National Child Traumatic Stress Network National Center for PTSD Behaviors That Interfere with Giving Support
Rushing to tell someone the he/she will be okay or that they should just “get over it”
Acting like someone is weak or exaggerating
because he or she isn’t coping as well as you are
Discussing your own personal experiences without listening to the other person’s story
Giving advice without listening to the person’s
concerns or asking the person what works for him or her
Stopping people from talking about what is bothering them
Telling them they were lucky it wasn’t worse
When Your Support is Not Enough Let the person know that experts think that avoidance and withdrawal are likely to increase distress, and social support helps recovery.
Encourage the person to talk with a counselor,
clergy, or medical professional, and offer to accompany them.
Encourage the person to get involved in a support group with others who have similar experiences.
Enlist help from others in your social circle so
that you all take part in supporting the person.
Psychological First Aid - Field Operations Guide
When Terrible Things Happen - What You May
Experience
Immediate Reactions
There are a wide variety of positive and negative reactions that survivors can experience during and immediately after a disaster. These include:
Domain Negative Responses Positive Responses
Cognitive Confusion, disorientation, worry, intru-
sive thoughts and images, self-blame Determination and resolve, sharper perception, courage, optimism, faith Emotional Shock, sorrow, grief, sadness, fear, an-
ger, numb, irritability, guilt and shame Feeling involved, challenged, mobi-lized Social Extreme withdrawal, interpersonal
conflict Social connectedness, altruistic helping behaviors Physiological Fatigue, headache, muscle tension,
stomachache, increased heart rate, ex- aggerated startle response, difficulties sleeping
Alertness, readiness to respond, in- creased energy
Common negative reactions that may continue include:
Intrusive reactionsDistressing thoughts or images of the event while awake or dreaming Upsetting emotional or physical reactions to reminders of the experience Feeling like the experience is happening all over again (“flashback”) Avoidance and withdrawal reactions
Avoid talking, thinking, and having feelings about the traumatic event
Avoid reminders of the event (places and people connected to what happened) Restricted emotions; feeling numb
Feelings of detachment and estrangement from others; social withdrawal Loss of interest in usually pleasurable activities
National Child Traumatic Stress Network National Center for PTSD Physical arousal reactions
Constantly being “on the lookout” for danger, startling easily, or being jumpy Irritability or outbursts of anger, feeling “on edge”
Difficulty falling or staying asleep, problems concentrating or paying attention Reactions to trauma and loss reminders
Reactions to places, people, sights, sounds, smells, and feelings that are reminders of the disaster
Reminders can bring on distressing mental images, thoughts, and emotional/physical reactions
Common examples include sudden loud noises, sirens, locations where the disaster occurred, seeing people with disabilities, funerals, anniversaries of the disaster, and television/radio news about the disaster
Positive changes in priorities, worldview, and expectations
Enhanced appreciation that family and friends are precious and important Meeting the challenge of addressing difficulties (by taking positive action steps, changing the focus of thoughts, using humor, acceptance)
Shifting expectations about what to expect from day to day and about what is considered a “good day”
Shifting priorities to focus more on quality time with family or friends Increased commitment to self, family, friends, and spiritual/religious faith When a Loved One Dies, Common Reactions Include:
Feeling confused, numb, disbelief, bewildered, or lost
Feeling angry at the person who died or at people considered responsible for the death Strong physical reactions such as nausea, fatigue, shakiness, and muscle weakness Feeling guilty for still being alive
Psychological First Aid - Field Operations Guide
Intense emotions such as extreme sadness, anger, or fear Increased risk for physical illness and injury
Decreased productivity or difficulty making decisions
Having thoughts about the person who died, even when you don’t want to Longing, missing, and wanting to search for the person who died
Children are particularly likely to worry that they or a parent might die
Children may become anxious when separated from caregivers or other loved ones What Helps
Talking to another person for support or spending time with others Engaging in positive distracting activities (sports, hobbies, reading) Getting adequate rest and eating healthy meals
Trying to maintain a normal schedule Scheduling pleasant activities
Taking breaks
Reminiscing about a loved one who has died
Focusing on something practical that you can do right now to manage the situation better
Using relaxation methods (breathing exercises, meditation, calming self-talk, soothing music)
Participating in a support group Exercising in moderation Keeping a journal Seeking counseling
National Child Traumatic Stress Network National Center for PTSD What Doesn’t Help
Using alcohol or drugs to cope
Extreme avoidance of thinking or talking about the event or a death of a loved one Violence or conflict
Overeating or failing to eat Excessive TV or computer games Blaming others
Working too much
Extreme withdrawal from family or friends Not taking care of yourself
Doing risky things (driving recklessly, substance abuse, not taking adequate precautions)
Withdrawing from pleasant activities
Psychological First Aid - Field Operations Guide
Parent Tips for Helping Infants and Toddlers after Disasters
If Your Child Understand Ways to Help
. . has problems sleeping, doesn’t want to go to bed, won’t sleep alone, wakes up at night screaming.
When children are scared, they want to be with people who help them feel safe, and they worry when you are not together.
If you were separated during the disaster, going to bed alone may remind your child of that separation.
Bedtime is a time for remembering because we are not busy doing other things. Children often dream about things they fear and can be scared of going to sleep.
If you want, let your child sleep with you. Let him know this is just for now.
Have a bedtime routine: a story, a prayer, cuddle time. Tell him the routine (every day), so he knows what to expect.
Hold him and tell him that he is safe, that you are there and will not leave. Understand that he is not being difficult on purpose. This may take time, but when he feels safer, he will sleep better.
. . worries something bad will happen to you.
(You may also have worries like this.)
It is natural to have fears like this after being in danger. These fears may be even stronger if your child was separated from loved ones during the disaster.