273  Psychological Triage and First Aid

273 Psychological Triage and First Aid

this episode was pre-recorded as part of
a live continuing education webinar on demand CEUs are still available for this
presentation through AllCEUs.com I’d like to welcome everybody to today’s
presentation on psychological first aid and triage or triage and first aid
however you want to put it and the goal of this presentation is to go over some
things because psychological first aid is often used after traumas and after
disasters but it can really go a long way toward early identification of
problems triage is the word that I’m using for it today we really want to be
able to equip school counselors ourselves employers nurses doctors
clergy anybody who’s working with people who might be able to identify a problem
we really want to help them identify be able to identify oncoming issues today
we’re going to explore applications for psychological triage and first aid in
crisis situations now remember a crisis is not always a mass disaster it people
can have personal crises will discuss the applicability of this approach for
clinicians reception staff clergy teachers and employers so psychological triage and first-aid is
basically a method of becoming aware of and providing initial response to a
crisis situation that’s all it is really simple think about you know when you get
an injury if you take care of it right away
if you triage it and get first aid then it’s not going to get worse and that’s
really what we want to do we want to identify things early and get the person
the resources they need in order to prevent it from getting worse a lot of
times people experience crises and traumas and various other things and you
know what they don’t end up having any long-standing problems they are able to
cope with the coping resources that they have but we want to make sure that they
understand that there are outlets should they need them and sometimes it’s
helpful to bring it to people’s awareness that you know I notice that
you’re struggling and they may be like oh I didn’t realize it was coming out
that much so clinicians of course we do this on a daily basis reception staff
can be aware of it if a client calls in for an appointment and is in crisis
reception staff needs to know how to handle that now the person may not be in
crisis in terms of you know their suicidal or homicidal but it is not
uncommon for a client to call and be crying be tearful be just beside
themselves and reception staff are often like well you know I can make an
appointment but I don’t know what to do if we can equip them with some basic
tools it will help them become engaged with the client it’ll help get the
client into your office but it can also help defuse any potential situations
that may develop between when they talk to the receptionist and when they come
in for an appointment clergy teachers and employers come in contact with
people in crisis every day I wish that wasn’t the case
I do but that’s just the reality people are going to have crises in their lives
and again this doesn’t have to be something like community-wide huge and
dramatic it can be their dog died or they found out they’re getting divorced
or or something like that so one activity that I would encourage you to
do is to take seven cards on one card write the name of your best friend on
the next one your closest family member on the next one one of your favorite
belongings and then on one something you enjoy an activity or a hobby another one
will have an ability another one is just health housing and financial security so
those are your seven cards after you’ve written on each card place them face
down on the table and shuffle them around and then close your eyes and pick
three cards these are three things you’re going to lose and you know think
about how are you going to feel from if you lose these sorts of things and that
will help give you a little bit of empathy and recognize the fact that
again it doesn’t have to be a huge thing it could be you know your best friend
move moves away they don’t even have to die or you get into a huge fight and say
you’re never going to talk again the point is to recognize that crises are
different for everybody so what constitutes a crisis the largest number
of reactions during a disaster are common reactions in an uncommon
situation so people are going to naturally probably get better without
immediate intervention but we do want to triage go in start talking to people and
identify people who might have a more difficult time coping and we want to
help make sure that those people are going to get resources with the
appropriate support and assisting techniques people are able to assist a
large number of individuals who are affected by some sort of a disaster so
we can go along and a lot of times a comforting word the compassion that we
express just being there to hear people’s pain
and stories and whatever’s going on is all they need they don’t need some
miracle intervention they just need somebody to listen and be compassionate
and that helps them start moving forward again provide that unconditional
positive regard for a smaller number of people their reactions are going to be
chronic and pathological or unhelpful and they may need further professional
help so we want to start looking at you know we have a hundred people who are
touched by a disaster 85% of those people if they get unconditional
positive regard a little reassurance and understanding and maybe you know
assistance with some basic necessities they’re going to be okay it’s not fun
but they’re gonna be okay the other 15 people you know ten of them may be
struggling a little bit because they don’t have the social support or they’ve
already had a bunch of crises in their life so they may need referral to
eventual other resources but just by being there by by listening by engaging
with people those 85 people are going to do far better than they may have without
some intervention so we’re able to touch lives more rapidly and again this isn’t
in-depth intervention this is letting people know that hey I’m here for
personal crises basically a person’s coping skills have been overwhelmed for
some reason and it can be dependent on that person what overwhelms their coping
skills with the appropriate support and techniques you’ll be able to identify
people that are at risk and make appropriate referrals and accommodations
so we want to make sure that everybody who come comes in contact with other
people which you know it’s all of us you know we’re not Hermits ideally have the
skills and tools we need to identify people who are at risk of developing
problems after some sort of a personal crisis and we know how to make wreck
nations if nothing else we everybody should know how to call United Way
information and referral you know that is kind of the one-stop shop if you will
to get referrals in your local area so if you don’t know anything else you can
help people reach out to that I regularly still consult United Way
information and referral for resources I had a client just recently who was in a
domestically violent situation and needed help getting out she needed you
know help with the first and last month’s rent to get into a new place and
help with sheltering and children and other things I went to United Way
information and referral because I didn’t know what those resources were
here so that is always a place that you can go and I have never had a bad
experience with them so what’s the role of the layperson you know the non
clinician we want to help our receptionists our text those people be
able to protect our clients or other people from danger be direct and active
in this process instead of kind of tiptoeing around going are you are you
doing okay we want them to say I see that you’re struggling provide accurate
information about what they’re going to do reassure the person but not give
false assurances recognize the importance of taking action and provide
an ensure emotional support so basically we’re teaching general active listening
skills and the awareness of some signs that people may be struggling with some
sort of a crisis that will help our you know clinicians and and supervisors and
those sorts of people to identify these problems early so the person doesn’t
become clinically depressed develop a substance abuse issue become violent or
any of those things if we can intervene early people typically rely on past
strategies to cope with new stressful situations so if their past strategies
have been helpful we’re going good past strategies have been unhelpful then they
may need more assistance past coping mechanisms can be functional or
dysfunctional and hardiness or resilience has been identified as a
buffer now if you remember hardiness is the combination of commitment control
and challenge the person recognizes that there are things in their life that are
going okay there are things in their life that are important and worthwhile
and they’re committed to those they recognize what parts of this situation
as well as what parts of their life they have control over and they view
obstacles that get in their way or they view the current situation as a
challenge it’s not a barrier it’s not something that ends everything it’s a
challenge because now in order to get everything back going smoothly forward
they need to figure out how to deal with it
children can be vulnerable because they have no experience or known patterns of
actions as a response to the experience so if a the first time a child goes
through a tornado they may not understand what to do and it may be
really scary even if the tornado didn’t come if you have to you know get into
your little shelters and bunkers it can be really scary for people I know the
first time that I had to have my kids go down and shelter because there was a
tornado warning they were kind of freaked out and they were older at that
point because we had never been through anything like that before so we do want
to make sure that we’re reaching out to people who may be experiencing things
but they’re not used to common physical reactions and I want you to think in
terms of step outside of being a clinician for a minute I want you to
think in terms of if you are a receptionist a tech an employer or just
a family member what are some clues that you might have that any of these things
were happening so sleep difficulties gastrointestinal tests ”’l problems
stomach upset nausea eating disturbances elevated heart rate blood pressure and
blood sugar headaches skin eruptions reduced libido increased aches and pains
and with extended stress suppression of immune
them alright so let’s think about some clues that we might see if you are I’ll
take the role of an employer if I’m an employer and I noticed that my employee
suddenly seems to be dragging in every day or a lot of the days that might give
me a clue that something’s going on it could be they’re out partying but it
could be something else so I might pay a little bit more attention if they seem
to be skipping lunch because they’re just not hungry that’ll give me some
clues if they start complaining of headaches that’ll give me a clue you can
look for skin eruptions that’s more common in children and teenagers than
adults but it can’t happen as an employer I’m not going to know
about their libido thank you very much but I may know about suppression of
their immune system if they’re dragging in really exhausted all the time they
seem to be not eating lunch having stomach problems maybe more headaches
and then they start calling in sick more often that tells me that there may be
something going on they may be struggling with some sort of a personal
crisis now does that mean I need to intervene and refer out maybe maybe not
it depends on the intensity hopefully the place where I’m working has an
Employee Assistance Program so I can reach out to my employee and go you know
what it seems like you’ve been struggling with something lately and you
know I don’t want to get too personal and into your business but I wanted you
to know that I was here and you know I care and don’t forget you’ve got this
Employee Assistance benefit that you can see somebody for free for four sessions
and yada yada so these are the clues that I’m going to look for as a parent
you know you’re gonna see some of those sorts of things in your potentially in
children when we’re talking about reception staff they may not see as many
of the physical reactions but they may notice if the person
is coming in and and they’re sick more often or they’re calling in and
canceling their appointments more often common emotional reactions again think
what kinds of clues might you see in any of these different roles individuals may
have difficulty identifying feelings due to lack of experience with emotional
expression in their family or community not everybody talks about the f-word so
they may not know how to communicate these sorts of things they may also
associate strong feelings with past traumas and believe that emotional
expression is too dangerous you know I don’t want to go there
because I may lose control completely and so if somebody sent seems to be
emotionally withdrawn or sort of emotionally numb we want to pay
attention to that especially if it’s a difference from prior functioning the
feelings that can come out include fear anxiety and vulnerability fear of
reoccurrence or Consequences a sense of helplessness and hopelessness depression
anger irritability guilt being numb withdrawn or disconnected fear of being
left alone and this can apply to adults as well as children and loss of a sense
of safety so again what are some clues we might look for I mean a lot of this
sounds like depression and PTSD that’s true that’s we would notice some of
these things probably before other people would but we’re sitting there
talking to the person once a week for an hour so if you’re just the supervisor or
the pastor what might you notice you might notice that hyper vigilance that
increased startled reaction the person may seem to be more irritable lately
than normal they may be flatter or seem more depressed I mean emotional
reactions a lot of times people carry and and project on their person so
looking at their nonverbals and one of the things you can do when you’re
training staff is to have them look at different models and you can roleplay
have have people roleplay different feelings
and emotional reactions to make sure that staff can pick up on subtle clues
not overt anger but if somebody is irritable and just cranky you know have
them pretend like they’re sitting in the waiting room and making grouchy faces at
everybody who makes noise or something you can see some people getting numb
withdrawn and disconnected if your employees or you know whatever start
withdrawing and they’re not interacting with other staff members like they used
to they’re just coming in doing their work and leaving and they don’t want
anything to do with anything else they may be completely overwhelmed with
whatever’s going on in their personal life there also could be something going
on in a team but there’s all of these things are clues that something is amiss
whether it’s a crisis in their own life or some trouble on the floor or whatever
it’s important for us to be aware of these things so we can intervene if a
staff person notices that a client or employee or whatever is exhibiting some
of these emotional reactions it’s important that we try to provide some
reassurance we provide some compassion and those sorts of things and maybe some
referrals because we don’t want it to get any worse and you know sometimes if
your reception staff is noticing people are overly irritable or depressed or
crying in the waiting room one of the best things to do is to be able to help
get them to some privacy if they’re having a hard time controlling their
emotions and let the therapist know that you know you’ve got a client who’s in
crisis so don’t run late common behavioral reactions after crises family
difficulties substance abuse being overprotective of family and family can
be defined in a lot of different ways you can have as Sakurai points out
family doesn’t have to be just two legged human family
our four-legged creatures can be very much a part of your family and this is
true whether it’s a domestic animal or somebody’s horse if they have a strong
connection to that animal then if that animal passes or gets really sick it
could be devastating so it’s important to you know expand our view of what may
cause crises but when a person’s in crisis they can have family difficulties
because they’re becoming more withdrawn or more irritable or more depressed they
may abuse substances they may be overprotective of those family members
they may isolate they may be very alert at times and startling easily so again
that hyper vigilance they may avoid places activities or people that bring
back memories when might when my dog Kenny passed I could not watch all dogs
go to heaven or homeward bound for about a year you know it just those
two shows reminded me of him and I just didn’t want to expose myself to that so
being aware if somebody starts showing a resistance to person people places or
activities then we want to ask what’s going on what’s changed you know can I
help you with something they may not enjoy involvement in their old favorite
activities and again they may be agitated or or crying easily so as a
clinician or as a receptionist and a clinicians office we want to look for
any behavioral reactions of crisis where somebody seems to be really struggling
and those are probably some of the most obvious ones that we can pick up on if
they are physically and they’re non verbals or just communicating I’m
struggling here in terms of clergy and employers if we notice that the person
you know maybe they start sleeping at the office or looks like they’re
sleeping in their car I’ve had both of those in my employees you know that’s
time those are times that you may want to intervene and go hey
I’m noticing that some things have changed you want to talk about it if
they’re isolating and they didn’t used to something to be aware of common
behavioral reactions in youth now we don’t see these as much in adults so I
separated the slide out for youth they can have childish or regressive behavior
if we see that a lot when there’s a stressor and remember crises are
different for a four-year-old having a new baby in the house could be a crisis
because they feel like they’re losing mom and dad for a 14 year old there
could be other things that trigger a crisis like a breakup in their first
relationship where they may regress some and start being come becoming more
oppositional or regressive and not taking care of things and not doing what
they’re supposed to they may act out they may have bedtime problems obviously
if this is more if it’s a trauma like a tornado or a hurricane or a death or a
break-in and a break-in even if you’re not home can be extraordinarily
traumatic to people not just children but they may have sleep onset insomnia
so when it’s time to go to bed all of a sudden they’re wide awake again mid
night awakenings fear of the dark and fear of reoccurrence of the event during
the night so we want to provide youth ways to get grounded oriented and feel
safe as clinicians we want to help youth help parents know how do they can help
youth if you’re a teacher and you notice that one of the kids in your class is
suddenly regressing a lot acting out seeming tired a lot again it indicates
there’s some sort of something that’s amiss and it’s probably worth checking
out referring to the school counselor or whatever your policy is at your school
so the cognitive triad of trauma your views about the world may change you may
start the world’s a dangerous place people
can’t be trusted and life’s unpredictable well you know life is
unpredictable but can you handle it views about self change as well people
can start thinking they’re incompetent because they didn’t handle the situation
as well or because they didn’t prevent the situation I should have reacted
differently you reacted how you reacted in the moment and cognitive processing
therapy is really helpful at encouraging people to look back with hindsight and
look at the big scope of things because when we’re in trauma when we’re in
crisis we’ve got tunnel vision we’re not seeing all the other things that
contributed to the decisions that we made at that point in time views about
self and also include is too much for me to handle and I feel damaged so we want
to empathize with that I’m not gonna tell people oh yeah you can handle this
you’ve got this that’s invalidating that’s not going to
help them I want to understand why they feel like it’s too much for them to
handle and then we can start challenging those beliefs eventually but in triage
we’re hearing right now and we’re providing support and going you know
what if it’s too much for you to handle you’ve got somebody you can lean on and
then we can move forward from there and trauma also impacts your views of the
future people think things will never be the same what’s the point I’m never
going to get over this it’s hopeless and all of these things can kind of converge
to create a crisis vortex if you will and we want to help people identify how
crisis how this particular incident affected their views of the world their
views of their self and the views about the future and then look at those
objectively and we do this in counseling not in in triage and triage we just want
people to understand that individuals who go through crisis are going to have
some change viewpoints of things and we don’t want to contradict that we want to
empathize with it we want to hear what they’re saying and help them feel
nurtured and supported common cognitive reactions intrusive memories nightmares
and flashbacks difficulty communicating difficulty concentrating and in children
this could present as behavioral problems if a child sitting in the
classroom and they’re having to concentrate for 20 minutes 30 minutes
however long it is and they just can’t do it
then they often will engage in alternate behaviors which causes some disruption
in the classroom sometimes when people are still after a trauma that trauma
feels oppressive it comes it just comes flooding into their mind again
so they do things in order to try to distract themselves from what’s going on
so we want to look at you know is this behavioral problem new for this child if
so what’s causing it and how can we best intervene
are they having difficulty concentrating so we need to break things down into
smaller chunks are they unable to be still with themselves because all of a
sudden those thoughts and memories start flooding back if so what kind of
referrals can we make to help them deal with that people may have memory
problems the brain is really cool because during a trauma especially an
intense trauma it secretes all kinds of chemicals including the cortisol and the
fighter everything needed for the fight-or-flight reaction but it also
secretes certain chemicals that prevent the memory of the trauma from
solidifying and there are articles you can read on
neurobiology of trauma that are really cool to work read through but it
explains and it helps us explain to clients why they may not totally
remember all the details of the trauma or why when they think back about it the
details seem to change and they can’t get a grip on it and they’re like it
just happened an hour ago how can I not remember this
that’s your brains way of protecting you your brains going you don’t want to
remember this this kind of sucked so awesome
the memories of the trauma may not be solidified so you may not be haunted by
them as much but that also means other stuff going on at that point in time may
also not be solidified as well and if you’re having sleep difficulties that’s
also going to negatively impact memory so we want to help people if they’re
struggling with something what can you do in order to support your cognition
right now in order to support your memory do you need to write more things
down do you need more reminders in your phone what can we do to help you because
you’re doing the best you can what can we do to facilitate this while your
brain you know processes everything that’s gone on and so you can go start
going about a more normative life they may have difficulty following
complicated instructions this is especially true right after an a severe
trauma so write them down if you’re gonna ask people to do things don’t give
them for things to do in one sentence give them one thing to do and then
another thing to do you know just like you would for people who are having
difficulty with cognitive functioning well in trouble we are in trauma our
body is in fight or flee not think about it so all of those think about it memory
consolidation concentration chemicals those are doing other stuff right now
your body is not worried about all these things so we need to help people figure
out how can they accommodate themselves just like when you have a broken leg you
use crutches alright what kind of crutch can we help you have for your memory and
problem-solving and orientation right now people may have a pessimistic
attitude and this is one of the biggest signs for other than clinicians that
gives you an idea that something may be going a little wonky if the person has
normally been pretty you know even keel you know not overly positive but not
super pessimistic and then all of a sudden they just seem to be a negative
Nellie something changed so we want to
understand what changed what’s going on can you share with me you know what
happened that seems to be making you feel like
there’s no hope in the world we also see a lot of blaming after a trauma people
want to blame somebody they want to blame the perpetrator they want to blame
the you know if a bridge collapses they want to blame the architects of the
bridge if you know whatever it is they look for somebody to blame and if they
can’t find a human person they may look to blaming their higher power but
they’re trying to figure out why this happened how to know if it’s gonna
happen again and preferably how to prevent it from
happening again so blaming is kind of throwing that anger out and sometimes
blaming can move on to seeking revenge or justice which is why a lot of
lawsuits are often filed and you know other things may happen common faith and
spiritual reactions some people turn even more strongly to their faith during
times of crisis other people start questioning their values and beliefs
thinking how can an all-powerful God let this happen how could this possibly be
they may direct their anger toward their higher power and say things like if God
loves us and if loves bears all things believes all things hopes all things and
endures all things then how can this happen you know if he
loves us then he should why is he letting this happen and they may
experience a loss of meaning which again goes with that anger towards their
higher power I don’t know why I’m doing this
if everything I did was to make my higher power proud of me to revere my
higher power if I don’t believe that person that entity exists anymore then
why do I do anything what’s the point and this can turn into cynicism and
self-centeredness and and other things so we want to look at what is their
spiritual reaction what is their sense of connected
to others after this kind of event sensory reactions sensory input can
elicit flashbacks or comforting memories I encourage clients to really be aware
of the things that are going on in their environment at this point in time what
are some sights sounds smells and things that may trigger comforting memories
what can they put in their environment you know if it’s for children sometimes
it’s a security blanket or a teddy bear or a picture of their mom and dad the
what types of things can be can be put in there what types of sounds can they
hear we also want to be aware of things that elicit flashbacks and we want to
prepare parents if children are exposed to a trauma about certain things that
may elicit flashbacks there’s a lot of things on the media in the media on TV
in the news online that can trigger flashbacks but that’s only part of it
you know there are other things that can trigger flashbacks and we want people to
be aware when every year and I’ve shared this with you guys before when it comes
around to Christmastime my stepfather experienced a trauma many many years ago
during Christmas and seeing Christmas lights is a huge trigger for him he’s
gotten to the point where he can deal with the Christmas tree and the
Christmas presents and all that but Christmas lights which caused the fire
super traumatic for him and this has been you know 40 years ago but it’s
still extremely poignant and I want people to be aware of that if you’re
aware that somebody one of your employees has a prior trauma that
revolves around a holiday or some sort of potential sensory trigger trying to
be aware of those things and conscious of them if you have
um maybe not an employee if you are working with somebody who was assaulted
by a clergy member if you have I don’t think you guys can see it in here if you
have any religious memorabilia up there I have my rosary hanging on on my
bookshelf you know that would be something that I would probably take
down for the time being in order to avoid triggering them Sara points out is
that is she finds that after a crisis children often take on the
responsibility of protecting their family and come up with elaborate and
often unrealistic plans for doing this and parents don’t realize how much kids
are pressuring themselves and parents are at the in the perfect place to do
psychological triage and first aid they can’t just like they clean up the
boo-boos on the knees they can be there to help their child dress those wounds
so to speak and it is important for parents to recognize that for children
all of a sudden the world turned upside down and it was really scary but it’s
even scarier to think that especially since they can’t take care of themselves
as something could happen to their parents so then they start becoming very
concerned about their parents demise very concerned about it happening again
and their parents getting hurt and so it is important to ensure that parents have
an open dialogue with their children after a crisis and it’s also important
that again teachers be aware of these sorts of things because sometimes
parents aren’t gonna pick up on it or you see the behavior more while the
child is at school when they don’t have eyes on parent so it’s important for
teachers to be able to identify these things and communicate back with a
parent that you know it seems like Johnny struggling sometimes you’ll even
see some of these types of behaviors during a divorce because the child feels
like it’s their responsibility to try to keep the family
together the psychological footprint of a
disaster is much larger than the medical footprint think about 9/11 there were
thousands of people that were injured killed affected that day physiologically
but there were millions of people that were affected psychologically because we
saw it on TV we recognized that you know what this world may not be as safe as we
thought it was so the psychological impact was huge compared to the medical
impact and we need to remember that when we see traffic crashes especially
particularly bad traffic crashes medical footprint pretty small
the psychological footprint could be really big all the first responders
anybody who directly observed what happened you know it can trigger stress
reactions and a lot of people an event is more traumatic when the person has
prior experience with a similar event if they’ve been through a tornado before
they’re like oh here we go again and all that stuff from the past that they may
not have dealt with comes flooding forward if the event happens next to a
safe zone where the person’s going well those types of things don’t happen in
Maya neighborhood or to people like me if the impact if it impacts a large area
so an entire community such as a flood that can be more traumatic if it’s
unexpected we like to feel like we’re in control of situations so when events are
unexpected then that leaves us feeling powerless to a certain extent if the
event or repercussions from the event lasts a long time after Hurricane
Katrina people were displaced from their houses some forever and but a lot of
people were still living in FEMA trailers a year 18 months two years
later and they were not in their hometown they were still in a different
state so there was a lot of disruption if the cause of the thing is unknown if
the event is poignant or meaningful or involves multiple losses so if somebody
passes on for example you know you heaven forbid you should a child one a
child parent should pass away in a car accident okay they lost that person
that’s true they also lost the stability you know a caregiver so not only is it a
person is gone but it’s a caregiver that’s gone I guess a better example
would be if you lost your spouse you may have lost your best friend
you may have lost an income provider you may have lost you know that person may
fill multiple roles and the more roles that person filled and the more
repercussions you have maybe you have to move because you can’t afford that house
anymore now you’re not only losing that person but you’re losing the house and
your neighborhood and your friends that you hung out with so that can make an
event more traumatic if the victims in an event are similar to the person so
when I work with law enforcement when they go on calls in which a a child is
injured or killed in some way if they have children at home or they came from
a big family I mean most of us have been around children but some more than
others and if they have children of the similar
age at home it tends to have impact them more the person has experienced other
stressors in the prior six months so they’re already worn down if the person
has a history of mental health issues or little resilience if you have somebody
with bipolar disorder schizophrenia and if social support is not received within
for 24 and 72 hours why the three numbers within four hours is your
critical window people are still really raw after a critical event four hours
afterwards so if you can provide that emotional support that’s going to help a
lot within 24 hours it still helps it helps the person not feel so isolated
and 72 hours you know you’re getting kind of out there the person is
– you know suppress some of the memories and box it up and compartmentalize more
but support is still helpful at 72 hours if the social support comes after 72
hours it’s a lot less impactful so we really want to make sure that people
when they experience a crisis have access to social support in those
critical periods losses associated with a crisis and think in terms of crises
natural disasters divorce or even retirement loss of loved ones loss of
their home loss of material goods loss of employment and income loss of safety
or security whether it was real or perceived you know a person felt
comfortable in their environment loss of predictability loss of social cohesion
connection and support this is a big one when people retire that is a major
adjustment because their work family is not a part of their life anymore loss of
dignity trust and safety loss of positive self-image and self-esteem they
you know those images and those thoughts about the world start to change loss of
trust in the future loss of hope and loss of control even if you’re not a
total control freak most of us like to be able to expect that our environment
is somewhat predictable so we want to make sure that we’re considering all
these different losses that people are experiencing as a result of the crisis
and and again remember the more losses somebody experiences because of an
incident the more likely it is to be traumatic to them tips for responders
active understanding sometimes you’ll have somebody call up on the phone and
you know I still do occasionally and they want to make an appointment but
they’re gonna tell you the whole story about what’s going on and if you can
active understanding is hopeful at that point try not to interrupt the story
until it’s ended ask questions to clarify yes
stablish a sequence of events now your receptionist probably isn’t going to do
this but a clergy member or an employer may be in a position a supervisor may be
in a position to ask a few questions try to avoid why or why not questions
because those sound judgmental and remember that silence is okay not
telling people what to do or acting like you understand what they’re going
through is really important one of the fastest ways to break that alliance
is to go or engagement is to say I totally understand
and the person’s gonna be looking at you like what no you don’t you you haven’t
walked a mile in my shoes don’t tell the person you know what you did everything
that you could because you don’t know what they feel like they should have
done the most important thing is for responders just to be present and to
listen to the thoughts and feelings of the victim without any judgment or
comment and again you may be going well that’s kind of weird for a supervisor to
do but if you’ve been a supervisor before you know occasionally a staff
member will be struggling and with something and generally it may be other
employees or something you call them into your office and you go hey we need
to have a chat what’s going on here this is when all this comes out you want to
hear what’s going on and understand the sequence of events be present listen and
then offer any support or resources that are appropriate do’s and don’ts avoid
asking for in-depth description of traumatic experiences this is reserved
just for clinicians you know and even clinicians in the first few sessions we
don’t want to go okay let’s just go ahead and rip the scab off that wound
right now we want to make sure that people are psychologically prepared
so during triage we don’t want to have all the nitty-gritty details we want to
know you know generally what’s going on if Sally’s husband just left her that’s
all we need to know we don’t need to know
he leave you for why did he leave you did you know it was coming
that’s not important what’s important is the fact that Sally is really right now
because her husband just left her when we do listen to people you know we’re
following the lead of that they’re providing in discussing what happened we
don’t want to push them into additional details now the caveat is if they start
going too deep into detail it’s often helpful especially for untrained
laypeople that are working with them to be able to say you know what I hear
you’re really hurting right now and it’s going to be more helpful if you work
with a clinician or something and help them understand and find it a kind way
to say you know I hear you’re struggling and what you’re going through
I can’t imagine and I want to make sure you get the right assistance so there
don’t go into extreme depth right then and throw themselves into a further
crisis and a good Samsa has a treatment improvement protocol on trauma I believe
it’s true tip 59 that talks about you know how to work with people who’ve been
in trauma and prevent them from going too deep too soon so what assists in
readjustment regaining a sense of safety and routine when I managed the Hurricane
Katrina recovery grant for Florida that was one of the biggest things I would
visit the shelters and we would start helping people regain a sense of safety
and there was order and routine even though they were living in a shelter
there was order and routine to what was going on so they felt like they had some
control over the day-to-day activities and they could see how what they were
doing now was going to help them get out of the shelter in short order shortish
order acceptance of the event and the losses associated with it is really
important acceptance is a hard thing for a lot of people that’s the last stage of
the grief process and trauma involves grieving
trauma often involves a lot of losses and people need to grieve each loss so
helping people move toward acceptance through the denial anger bargaining and
depression encourage people to identify label and express appropriately their
emotions adults need to do this – not necessarily in front of the children
children are already kind of on edge enough so if adults have really strong
emotions which they very well may it’s important for them to be able to get
those out but it’s helpful often to do it apart from the children now there’s a
difference between you know getting dealing with emotions apart from the
children and being authentic with children if the children are you know
they’re and they’re feeling stressed and the parent is feeling stressed it’s okay
for the parents ago you know what I’m I’m really stressed because this is
tough for us – it’s gonna be okay or whatever they want to tell the child so
we want to make sure that parents are are authentic with the children but
don’t expose the children to more than they really need to hear social support
a compassionate presence a calm voice listening just active listening we’re
not fixing being sure to say I don’t know if you don’t know the answer to
some something and being willing to help the person find the answer is another
important trait in social support in this triage process and help people
regain a sense of mastery and control over their life so sit down and
brainstorm solutions you know if the person has recently gotten divorced and
now they’ve got to find a new place to live and yo yada yada yada there’s a
whole bunch of stuff that needs to be done help them figure out okay how can
we just get this down on paper so you can see it and then you can organize it
in a way so you can start tackling it one thing at a time connectedness also helps with
readjustment help them connect with friends and loved ones
if they’re living in a shelter help them connect with people there and develop
friend friendships help them connect with their pets if they’ve lost pets in
a disaster you know try to help them find those pets if they have pets during
a disaster ideally try to get them to pet friendly shelter so they don’t have
to leave Fido behind because that is extraordinarily traumatic encourage them
to connect with disaster resources and support services if there’s been a
disaster and make sure people know what community resources and support services
are out there including support groups and individual counseling and food
support and help with rent and first in math first and last month’s rent and
security deposit if they need to move and you know whatever things people need
to make sure that they’re getting their basic needs met resources are probably
out there you just have to know where to find them and again
United Way information and referral it’s important to also provide basic
information about common stress reactions after a trauma and help people
understand what they may be going through and normalize it you know lots
of people go through this and you know initially you may have trouble sleeping
your stomach may hurt talk with them hear their symptoms normalize what
they’re going through so they don’t feel like they’re damaged or they’re they’re
a freak for some reason they are having a normal reaction to an abnormal event
coping strategies that are really helpful during this time include
cognitive processing therapy and you can google that and there’s a list in in the
manual for cognitive processing therapy called challenging questions super
helpful lists unhooking is another thing if they are saying I am terrified right
now okay we can we can talk about that but also encourage them to unhook from
their feelings and say I’m having the feeling I’m having the thought right now
that I’m terrified I’m having the thought that things are never going to
get better I’m having the thought that because we can address thoughts
you know I am is a much more permanent sort of situation versus I am having the
thought tshh distress tolerance techniques
sometimes you’re just not going to be able to make things better and people
are going to have to learn how to distract themselves or tolerate the
distress until it goes away and dialectical behavior therapy has two
acronyms accepts and improves again if you google DBT and accepts and DBT and
improves you will come up with all kinds of infographics that list those
encourage people to actively seek assistance support groups friends family
whomever so they have social support and provide options to help them react
constructively to environmental challenges and recognize potential for
growth even in non disaster related things so in a divorce you know that can
be traumatic for somebody where’s the potential for growth if you lose your
job that can be traumatic where’s the potential for growth so have them see it
as a challenge remember commitment control and challenge have them see it
as a challenge instead of a barrier encourage them to practice flexibility
and this is for both the survivors and the responders people have limits in
situations there’s only so much you have control over so they need to recognize
if they are limited by limited resources and that can be limited time limited
access to professional help limited whatever an atmosphere of chaos or
discord if it’s in the middle of a disaster situation like after a truck
tornado goes through it could be very chaotic if you’re in a shelter shelters
can sometimes be very chaotic too so there are certain limits on how much
help you can provide if there are continued threats to safety that’s
important too and organizational and operational realities with law
enforcement and Fire Rescue for example they can’t stay on a scene for 3 4 6 12
hours and help people decompress they need to handle
and move on to the next call so there are some realities that they’re going to
have to face that there’s only so much they can do in the time that they have we want to empower people by providing
reintegration information and helping them work toward meeting their own needs
and returning toward normal routines and practical problem-solving as clergy
supervisors counselors all of us can help people establish these routines if
you’re scheduling your employees you know you want to talk to this person
who’s in crisis right now and say you know what what kind of schedule will
work best for you can I maybe you can keep them on the same schedule for a
month so they don’t have to worry about
juggling those sorts of things in their head and we want to promote resilience
because everybody who experiences a traumatic event is touched by it
so encourage people to understand they have the ability to bounce forward to a
new normal it’s not always a setback it’s not always an end of everything
it’s an end of some things but the beginning of something else encourage
them to use bibliotherapy and write a story about what happened you know
that’s this chapter alright that story is coming to a close now what is the
next chapter hold brief assessment identifies people who are distressed or
acutely affected and identifies high-risk individuals and groups in
order to quickly refer them to mental health professionals and help them
access hospitalization and outpatient treatment if needed things you want to
look for and everybody needs to know these every single person not just
clinicians if somebody is unresponsive to verbal questions or demands they just
seem like they’ve checked out if they have glassy eyes and a fake aunts vacant
stare that’s important if they look like they’re staring a million miles away if
they’re disoriented and seemed to be walking around and doing things that are
aimless and disorganized and you’ll see this in people in crisis even at work
you know be aware of that and if they have strong emotional responses such as
uncontrollable crying hyperventilating raah
gang or being particularly irritable with others then that could mean the
person is in acute distress that means right now and we need to do something to
help them diffuse the situation when to refer if the person is talking
about harming to harming themselves saying they want to end it all or go to
sleep and never wake up again if they’re preoccupied with death if
they refuse to talk about future plans and this is a big one if they won’t tell
you about what they’re gonna do tomorrow they say well let’s just see if I make
it through today that’s a huge warning bell if they’re giving away possessions
or excessively using substances driving under the influence working under the
influence these are all things to be aware of if they talk about harm to
others child abuse spousal abuse not everybody’s a mandatory reporter but
clinicians and clergy and I believe teachers are so we do need to be aware
of this loss of control significant withdraw or unable to care for
themselves if they stop eating they stop bathing I’ve had employees who’ve gone
through crises before who’ve come to work and I’ve had to send them home
because they haven’t bathed in about a week and they haven’t changed their
clothes in a couple of days and you know I’ve had to do some interventions with
them and you know get them back on the right path but you know this does
occasionally happen with employees I’m sure it can happen in at churches and
because people when they’re struggling make go out go and seek out their pastor
remember that there’s a cost to caring we professionals who are paid to listen
to the stories of fear pain and suffering of others may feel similar
fear pain and suffering because we care when we empathize part of us goes down
there with that person and it can be exhausting we need to make sure that we
take care of ourselves so what can we do pay attention to cues from our family
that we’re becoming too involved prepare for world view changes that may not be
mirrored by others in our life if we see things and there were like
oh this isn’t right well our our loved ones weren’t in session with us so they
weren’t exposed to the same knowledge that we were exposed to so they may not
mirror the same changes pay attention to rekindle and close interpersonal
relationships that’s your social support participate in informal help and support
increase leisure activities and pay attention to time management pay extra
attention to your health and nutrition and practice good sleep routines when
you’re under stress it’s hard to get good quality sleep
so it’s really important to prevent those physical vulnerabilities make time
for self-reflection and insight practice receiving from others gifts help kind
words anything like that and find things to make you laugh each day laughter
helps relief and release endorphins which can help us recover from some of
the trauma and exhaustion from working with people in crisis and develop a
resiliency plan this should be for everybody not just the the first
responder employees parishioners responders everybody should have a
personal resilience resiliency plan that helps them figure out how to focus
beyond the short-term when things go wrong what can I do but what can I do
now in order to make sure that I’m as strong and as you know fortified as I
can be if crisis comes my way encourage people to understanding what triggers
stress for them so they know what they need to address the more stressed they
are the more difficult it will be to deal with trauma so if they start
identifying their stress triggers now in dealing with them then if trauma comes
their way they’re not going to be as worn down encourage people to know their
personal unique stressors and red flags where they need further assistance at
what point is it that they need to go see the doctor encourage them to create
a written menu of positive coping responses that they can consult when
they’re under stress and identify five practical stress steps
for daily stress reduction and self-care I used to have my staff create a
personal resiliency plan and we would review it every year when I would do her
performance evaluations because I wanted to make sure that they were taking care
of themselves and modeling for their clients what we’re asking them to do so
many people in the community are in a position to provide early identification
of someone in crisis many times people in crisis who receive support connect
with available resources and have adequate coping and health related
behaviors will adjust perfectly fine without professional help people who are
alert to other people’s distress can easily start experiencing compassion
fatigue it’s not just counselors it’s law enforcement it’s EMS is clergy its
nurses it’s vital to remember that for a responder to be responsive he or she
must be healthy we must be able to bounce we don’t want to be you know
think about a tennis ball that’s been popped if you throw it on the ground it
doesn’t bounce back well that is a responder that isn’t taking care of
themselves they’re like a pop tennis ball we want to be a bouncy tennis ball
and make psychological triage a part of the routine of teachers clergy law
enforcement supervisors so they can assist in reducing mental illness and
substance abuse and increase individual welfare and economic stability in their
communities you can look for more information at the
psychological first aid Field Operations guide and the guide from the Minnesota
Department of Mental Health if you enjoy this podcast please like and subscribe
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