BEHAVIORAL HEALTH DISASTER RESPONSE(S)

BEHAVIORAL HEALTH - Behavioral Health Disaster Response Psychological First Aid Joan M Culley PhD MPH RN CWOCN Revised Sept 2010 1 This

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Unformatted text preview: Behavioral Health Disaster Response Psychological First Aid Joan M. Culley, PhD, MPH, RN, CWOCN Revised Sept 2010 1 This presentation was created by the Massachusetts Department of Public Health and Lisa Gurland R.N. Psy.D Director of Behavioral Health Planning and Development Massachusetts Department of Public Health In collaboration with CMG Associates with support from the Massachusetts Department of Mental Health and Disaster Behavioral Health Program of New Hampshire 2 Objectives • • Understand how emergency events affect the behavioral health of individuals, families and communities Describe the symptoms and manifestations of disaster stress (the normal response to an abnormal event) and the relevant issues of prevention and intervention Define and formulate psychological first aid techniques in behavioral health disaster response Outline self care techniques to reduce stress and prevent secondary trauma among Behavioral Health Disaster Responders 3 • • The Impact of an Incident Depends Upon • Physical proximity to event • Emotional proximity to the emergency • Secondary effects (school closings, shelter in place) 4 Psychological Effects • Pre-exposure (chronic threat versus acute threat) • Exposure (includes perceived exposure) • Post-exposure 5 Behavioral Health Emergency Preparedness Principles • No one who experiences a disaster is untouched by it • Disaster stress and grief reactions are normal responses to an abnormal situation 6 The Rationale for Behavioral Health Intervention • People experience common emotional and psychological reactions to disasters – disaster stress • These reactions subside with time for most people • A behavioral intervention (psychological first aid, crisis counseling, etc.) helps people understand the experience and builds and supports coping skills • Appropriate interventions can prevent long term problems by returning people to their pre-disaster level of functioning as quickly as possible 7 The Rationale for Behavioral Health Intervention • Interventions “normalize" reactions, reducing the fear that “something is wrong" or “dangerous" or “crazy" about particular thoughts and feelings • Interventions validate and affirm the experience and offer practical assistance 8 Behavioral Health Response • How people respond in an emergency has life or death ramifications • We want people to behave in ways that support their well being • We want to support optimal functioning 9 Definition of Behavioral Health • Addresses our ability to function as individuals, families, institutions and communities • Behavioral Health Response mitigates the consequences of a disaster through prevention and intervention 10 Understanding Behavioral Health and Disaster Stress • • • • Improve the quality of interactions Allow for better communication Reduce symptoms of burnout Support an effective and timely response to an emergency 11 Purpose of a Behavioral Health Intervention • Builds resiliency in communities pre-disaster in order to reduce the behavioral consequences post disaster • Assists individual/family at time of crisis • Prevents or reduces future problems for individual/family • Reduces inappropriate use of medical/first responder resources • Supports the rebuilding of an affected community 12 What We Know About Disasters • Significant disruption of family dynamics • Significant disruption of natural support systems • Changes in school configurations • Disruption of community infra-structure 13 Unanticipated Effects of Disasters • Significant influx of outsiders • Interface with large and complex bureaucracies • Impact of new social patterns • Impact on marginalized groups 14 SCUD Missile Attacks Israel • 1,059 war-related E.R. visits • 22% (n=233) direct casualties (inj. by missiles or debris) • 78% (n=826) indirect casualties – (inj. due to response / psych) (Bleich, et al., 1992) 15 SCUD Missile Attacks Israel Indirect Casualties • 544 acute anxiety • 230 atropine injections • 40 injured while running for safety – 11 deaths • 7 - faulty use of gas masks • 4 - M.I.’s • NB: Highest rates following 1st attacks (Bleich, et al., 1992) 16 Aum Shinrikyo • Experimented with Anthrax • Tried to obtain Ebola virus • 1994 Matsumoto Sarin attack: – 6 deaths – 200 casualties • 1995 Tokyo subway Sarin attack: – – – – 12 deaths 62 severely injured 984 hospitalized 4023 examined 17 First 24 Hours After a Disaster • …at least 25% of the population may be stunned and dazed, apathetic and wandering---suffering from the disaster syndrome---especially if impact has been sudden and totally devastating… At this point, PFA and triage are necessary…” (Raphael, 1986) 18 INCIDENT PHYSICAL CASUALTIES 234 BEHAVIORAL HEALTH CASUALTIES 825 PSYCHOLOGICAL: MEDICAL 3.5:1 SCUD MISSILE ATTACK, ISRAEL 1991 SARIN ATTACK TOKYO 1995 RADIOLOGICAL CONTAMINATION, BRAZIL, 1987 WORLD TRADE CENTER, NYC 9-11-2001 12 >6,000 500:1 250 Exposed to radioactive materials >3,000 Killed ? Injured 125,000 sought medical screening 500:1 Many thousands nationally Many:One 19 20 What is a Traumatic Event? • An incident that is seen as threatening to one’s life or bodily integrity • Witnessing an act of violence • Hearing about violence to family or close associates • Traumatic events include terrorism, natural and human caused disasters, accidents, and diagnoses of lifethreatening conditions 21 How Do People Respond to Traumatic Situations? • The “fight or flight response” is activated in our body through a series of reactions in the brain • The intense emotional and physiological reaction we have to traumatic events is a NORMAL reaction to ABNORMAL events • Most reactions subside within a month or so after a traumatic event 22 Circle of Impact of Traumatic Event Community Family and Friends Witnesses Affected Person Co-Workers 23 Immediate Effects of Exposure to a Traumatic Event (1) – Feeling detached or emotionally “numb” – Being in a daze – Feeling as though things aren’t quite real – Difficulty sleeping – Recurrent thoughts or images of the event – Inability to remember parts of the event 24 Immediate Effects of Exposure to a Traumatic Event (2) • Avoidance of places, people or things that remind you of the trauma • Anxiety and hyper vigilance • Difficulty concentrating • Irritability and restlessness • Feeling unsafe, having difficulty trusting 25 How Emotions are Expressed FEAR • Usually directed towards a concrete, external object or situation • Usually within the bounds of possibility 26 How Emotions are Expressed Anxiety • A response to a vague, distant or even unrecognized danger • More an internal response than a response to a clear threat • A subjective state of apprehension and uneasiness 27 How Emotions are Expressed Anxiety • Bodily reactions such as rapid heartbeat, muscle tension, sweating • In a state of anxiety, people are often unable to think clearly, express themselves or deal with everyday situations 28 How Emotions are Expressed Panic • A state of extreme anxiety is known as a panic attack • Can be a very overwhelming and frightening experience 29 How Emotions are Expressed People having a panic attack experience four or more of these symptoms: • Sweating – Choking – Nausea – Shortness of breath – Rapid or irregular heartbeat – Trembling or shaking • • • • • Dizziness Fear of dying Numbness Hot flashes or chills Fear of going crazy and out of control 30 What is Post Traumatic Stress Disorder (PTSD)? Post Traumatic After Life-and-death danger or a horrible violation or loss The body’s alarm system Interferes with normal living 31 Stress Disorder Stress The Body’s Alarm System Normal stress - Dealing w/problems • Clear memories • Feel angry/scared but able to regain composure • Feel stretched but able to regain/remain in control • Feel frustrated/disappointed but accepting of circumstances • Creating solutions PTSD - Trying to survive • Memory like a broken puzzle • Feel enraged/doomed • Feel helpless/out of control • Feel worthless/hopeless • Disruption in ability to function (family, work, friendships, etc.) 32 Facts About PTSD • Everyone exposed to disaster experiences stress, but stress isn’t automatically a disorder • The closer you are to death or danger (as a witness, a victim, or a loved one) the more stress you experience • The best way to prevent PTSD is to recognize and deal with stress reactions before they become a disorder 33 Children’s Responses Normal Reactions to Abnormal Situations • Questions and concerns about safety and security • Anger and thoughts of revenge • Focus on frightening things or thoughts • Continual playing or talking about the event 34 Impact on the Child’s Developing Self • Children’s interpretation of their own behavior after the traumatic event may transform the way they look at themselves and who they are in the world • The way children see their physical abilities, activity level and level of self-efficacy can be changed by a traumatic event 35 Possible Effects Specific to Preschool-Age Children • Verbal memory of a traumatic event is developed between 2 ½ to 3 years of age • Even then, most recollections are spotty and incomplete 36 Possible Effects Specific to Preschool-Age Children • Reenactments and play involving traumatic themes • Anxious attachment behaviors/separation fears • Regression to previous levels of developmental functioning • Disruptions in sleeping and toileting • Startle responses • Withdrawal 37 Possible Effects Specific to School-Age Children • • • • • • • • • Decline in school performance Withdrawn behavior Repeated retelling of traumatic event Anxious arousal/hyper vigilance Difficulty calming down Fearfulness/fear of recurrence Sleep disturbances Behavioral problems Regression to previous levels of developmental functioning 38 Possible Effects Specific to School-Age Children • • • • • • Intrusive thoughts, images Problems relating to peers More elaborate reenactments Psychosomatic symptoms Loss of interest in pleasurable activities Feelings of personal responsibility 39 Possible Effects Specific o Pre- Adolescents and Adolescents • • • • Acting-out behavior/substance abuse Fear of repetition of event in the future Efforts to avoid overwhelming feelings Distress related to intrusive trauma images and memories • Increased vulnerability to psychiatric disorders • Flight into adulthood 40 Possible Effects Specific to Pre- Adolescents and Adolescents • • • • Hyper vigilance Social withdrawal Thoughts of revenge Self-criticism 41 Impact of Children’s Trauma on Other Family Members • Siblings and other relatives of traumatized children may experience feelings of guilt, fear, anxiety, and secondary trauma symptoms 42 Impact of Parental Trauma on Children • Children may experience secondary traumatic stress as a result of parental traumatization, through: – Direct witnessing of a parent’s trauma (e.g., domestic violence, sexual assault) – Direct experiencing of the post-traumatic reactions of symptoms in the parent (e.g., nightmares, flashbacks, startle responses) 43 Family Issues • Helping children includes helping caretakers • If adults can not attend to children then the outcome for everyone will be less than optimal • Adults may underestimate impact on children or alternatively displace own feelings on children 44 PSYCHOLOGICAL FIRST AID (PFA) 45 Institute of Medicine Definition of PFA • “A set of skills identified to limit distress and negative health behaviors that can increase fear, arousal and subsequent health care utilization.” 46 Where Can PFA Be Used? • • • • • • • • Shelters Schools Hospitals Staging Areas Feeding Locations Family Assistance Centers Community Settings Field Decontamination/Mass Prophylaxis • Emergency Operations Centers 47 Who Should Provide PFA? Any Helper involved in a response to disasters or critical incidents: • • • • • • • • Behavioral health specialists Public Health Workers Human Service Providers First Responders Primary and emergency health care providers School personnel Faith based providers Volunteers such as (MRC, CERT) 48 Basic Principles of PFA • Promote Safety • Care for basic needs • Create Calm • Validate feelings • Let them tell their story • Goal oriented behavior • Re-establish routine • Utilize existing support networks • Instill hope 49 Five Steps of PFA 1. 2. 3. 4. 5. Make Contact Stabilize Gather Information Develop and Implement Plan of Action Follow Up 50 Helper Behavior • Create opportunities for individual to talk • Care for individual’s physical needs (e.g. water,blanket, chair, etc.) • Begin ‘information gathering • Use supportive communication skills 51 Communication Attributes • • • • Positive Regard Empathy Respect Non-judgment • • • • • Culturally competent Empowering Practical Confidential Ethical 52 Initiating Supportive Communication • • • • • • • • Enter the setting, circulate, observe Don't intrude Introduce self, ask what they want to be called Don't shorten their name or use first name w/o their permission Address basic needs: “Can I get you some water?” If survivors want to talk, be prepared to listen Ask simple, respectful questions Use positive language 53 Communication Skills: Non-Verbal • Calm & Compassionate Presence – In general face the person – Maintain an open gesture – Keep a respectful distance – Frequent and “soft” eye contact • Be culturally sensitive to what gestures are “supportive” 54 Active Listening • • • • Attend to both verbal and non-verbal Validate: nod and affirm Summarize and Paraphrase Respect silence 55 Tips for Making Contact • • • • Operate within framework of ICS Maintain confidentiality as appropriate Pay attention to your own reactions Be sensitive to culture, diversity and atrisk populations 56 What Do We Stabilize? • Physical discomfort – Cold, wet, thirsty, hungry, injured, etc. • Psychological discomfort – Understanding what has happened, safety • Emotional discomfort – Fear, grief, hopelessness, anger, etc. • Spiritual discomfort – Shattered assumptions 57 Verbal De-escalation Skills • Speak calmly and slowly • Maintain empathy and respect • Keep it simple – Avoid acronyms, complicated sentences or directions • Avoid absolutes – (“always” or “never”) • Open ended questions and statements • Reframe if message sent is not the message received 58 Assessment Leads to Referral • Be aware of available mental health resources • Identify immediate need(s) • Make the referral when necessary 59 Connect Person with Psychosocial Support Systems • • • • • Family, friends and co-workers Community mental health centers Employee Assistance Programs Faith based resources Others? 60 Stress is a central theme in any critical incident and is a state of both physical and psychological arousal 61 Psychological First Aid is not... • Counseling • Psychotherapy • Mental health "treatment" 62 Goals of Providing PFA • Provide support • Reduce morbidity and mortality • Provide linkage to helping resources 63 Psychological First Aid • Protect • Direct • Connect 64 Protect • Individuals from further physical or emotional harm, including gruesome or graphic sights and sounds • Individuals' dignity and privacy following a crisis • Individuals from media intrusion or curious well-wishers • Individuals from danger to self or others 65 Direct Individuals • To quiet, safe areas • With calm, compassionate but authoritative tone • To appropriate personnel for additional comfort and support 66 Connect With • Mental health and social service resources • Available printed and online resources for coping with the emotional consequences of crises • Friends, family, co-workers and other sources of emotional support • Relevant information about the event 67 Psychological First Aid • Psychological First Aid is voluntary unless the magnitude of the impairment is such that the individual represents a threat to self or others 68 Trauma Reminders • Sights, sounds, places, smells, specific people, times of the day, situations, or even feelings: – Might bring to mind upsetting thoughts and mental images about the event – Might make it hard for people to function normally because they want to avoid being reminded of the event 69 Trauma Reminders • • • • • • • • Death notification Ending search and recovery Criminal justice proceedings Returning to impacted areas Funerals and memorials Anniversary dates & holidays Notification of eligibility for assistance Similar events or incidents 70 Psychological First Aid: Coping Skills • The following will support health and well being: – Maintain a regular schedule (if possible) – Schedule activities not related to the event – Eat healthy meals – Take time out to rest 71 Mobilizing Social Support • Educate survivor about importance of social support “Some people choose not to talk about the traumatic experience at all. At times, just spending time with people you feel close to, without having to talk, can feel best. Only you can decide whether talking would feel helpful and when.” 72 Decision-Making • Identify and discuss imminent and anticipated decisions during the posttrauma/disaster period • It is unwise to make major decisions immediately after a trauma or loss • Use social and professional support in making necessary decisions 73 Critical Incidents and Substance Abuse Prevention • Alcohol or other drugs can interfere with ability to think clearly • Important decisions need to have clarity • Coping strategies need to be constant, long term and healthful 74 Substance Abuse Prevention and Disaster Preparedness • People with a substance abuse history are at risk for relapse • Substance abuse prevention programs are an important component of community-wide disaster preparedness activities • The objective of substance abuse prevention programs following a critical incident or disaster is to restore and renew support systems that are culturally sensitive and developmentally appropriate 75 Dealing with the Public after a Traumatic Event • Remember that lack of trust is part of the normal response to trauma • Intense emotions are also normal – This often takes the form of anger towards the authorities “How could you have let this happen to us?” 76 Dealing with the Public after a Traumatic Event • Dealing with a traumatized public can be especially difficult if the staff are also dealing with the effects of the event themselves • The impact of a traumatic event goes beyond the people directly affected. It can impact the entire community 77 Skills For Effective Emergency Response • Technical knowledge • Analytical skills • People skills – An important part of providing good public service is providing good customer service – Attitude – Attention – Taking responsibility 78 Skills for Effective Emergency Response: Maintaining a Positive Attitude • Prepare yourself – Put your own feelings aside (anger, fear, frustration) – Maintain a positive calm demeanor • Be prepared to serve everyone 79 Skills For Effective Emergency Response: Paying Attention • Focus on the customer’s words and body language –what are they saying with words and what else are they communicating (feelings, thoughts) • Reduce distractions in order to focus on the distressed individual. Avoid multitasking. 80 Skills For Effective Emergency Response: Taking Responsibility • • • • • Make “I” statements Complete tasks Take notes Keep your word Evaluate yourself 81 Skills for Effective Emergency Response • To provide a consistent and effective response, you need: – Thick skin – Positive attitude – Belief in the work – Confidence in what you have to offer 82 Skills for Effective Emergency Response • Easy to do when you feel great • Difficult to do when you feel overwhelmed or are dealing with problems in your own life • Requires courage, leadership and a strong spirit • Imagine how your role models/mentors would behave 83 Skills for Effective Emergency Response • To respond appropriately when you don’t feel like it: – Put your own feelings/concerns in the background – Focus on the person in front of you – Bring his/her issues to the center of your attention – Take care of his/her needs 84 Listening Skills Effective Listening • A way of acknowledging someone, of saying they are important • Sets in motion a positive, mutually rewarding process • Is sometimes the only help required • Involves tuning into others as well as tuning into OURSELVES • Involves active listening 85 Active Listening Skills Repeat –Paraphrase and reflect back • Use people’s names • Open ended questions • Validation – acknowledging what was said • Empathy – trying to put yourself in their shoes • Listening to them helps them to listen to you 86 Levels of Listening: Level I • The perspective of the worker may be different than the perspective of the person affected by the disaster • It is important to take the time to understand a perspective different from our own • Understanding someone else’s perspective doesn’t mean giving up our own perspective • The goal is to work towards a perspective that meets the needs of everyone 87 Levels of Listening: Level II • What is not being said? • Feelings – ours and theirs – are often at the heart of our interactions • It is important to think about the person’s vulnerabilities 88 A Road Map for Effective Communication: Establishing Rapport “They don’t care how much you know until they know how much you care” • The importance of connecting – Use person’s preferred name – Attend to your body language – show interest – Tone of voice is at least as important as the content of what is being said 89 Establishing Rapport: Do’s • Use active listening skills Paraphrase what you heard – To check your understanding – To show that you are paying attention – Acknowledge feelings – Listen past the words for the feelings – Acknowledge feelings before problem solving 90 Establishing Rapport: Don’ts • Argue about who is right • Judge or blame • Control the other person’s reaction 91 A Road Map for Effective Communication: Assessment • Exploring Needs – Primary Need/Problem – Underlying Need/Problem – Knowing your role – what can you do? – Gathering information – Summarizing the information 92 A Road Map for Effective Communication: Problem Solving • • • • Present available resources Establish next steps Paraphrase Repeat 93 Barriers to Effective Communication • • • • • • Anxiety Panic Anger Unrealistic expectations Symptoms of cognitive problems Cultural issues 94 Milieu Observation • The media is reporting an explosion in a downtown building. The area has been secured and no one is allowed in except emergency personnel. People concerned about family members are arriving at the family assistance center which has been set up in a nearby building. 95 Milieu Observation • You have been assigned to the family assistance center. The team leader asks you to observe the milieu and to make note of anyone who seems to need special assistance. • What are you looking for? 96 Milieu Observation • You do see some people who seem to need special assistance. The team leader suggests that you approach individuals as needed. • What are some ways to approach people who might be anxious, fearful, angry, etc? • What information do you need before you interact with distressed individuals? 97 Decision Tree # 1 How does the person seeking assistance present? Information Seeker Anxious/Needy “Not in touch with reality”, confused, in shock Angry Give Information Reassure Reassure/ De-escalate De-escalate 98 Decision Tree # 2 What is the nature of the situation? Yes Is the person feeling threatened or vulnerable? Is the threat real? Yes What can you do to help the person minimize the threat? No What does the person want? No Is the person seeking information? Yes Provide appropriate information No What does the person want? Is the person satisfied with your help? 99 Decision Tree #3 What does the person want? Empathy? Use when the person perceives a threat or when they are too anxious to process Information Provide an empathic, understanding stance Referral, Resources, Triage? Use when the person wants something more than what you can offer Connect person with someone who can help them Is this helping the person? 100 Decision Tree # 4 Is your response helping the person? Is the person satisfied with your help? Assess how the interaction is going. No Reassess the situation. What is person asking for? Use listening skills Yes Continue to provide support/information/etc. as appropriate Return to start of decision tree 101 Things to Remember after a Difficult Interaction • You can still follow the guidelines, give information and be respectful • You can not always make things better • You can only try to do your best • In situations for which there is no solution or no good solution –“acknowledge the Gray Area” – Validate – Be empathetic 102 More Things to Remember • Sometimes the situation is such that it is impossible to be effective at that time – You may not be able to help, but the next person or the person after that may be able to help. It may be the 50th link in the chain that is effective • Even if you may not have the answer, listening, validating and/or referring them to someone else may be enough at that time 103 SELF CARE 104 Self Care • Self care is an essential component of disaster planning for all responders • There is a direct relationship between how well responders take care of themselves/each other and the quality of care provided to people affected by the emergency event 105 Self Care • There can be a cost to caring for others • This is exhausting and demanding work • Create an individualized plan for recovery and recreation 106 Self Care • De-activation Meetings (debriefing) is an essential step in self care • This is an opportunity for Behavioral Health Disaster Responders to review and process the experience of providing psychological first aid in an emergency event • It is best done with a trained facilitator at the end of each shift 107 Post Deployment Check-In • • • • • • • • Name and role during deployment? What worked well? Not so well? How did we function as a team? Anything about your experience today that you want to talk about? How has the experience today affected you? How are you going to take care of yourself over the next 24/48 hours? Remind about self-care strategies! If they need to talk to someone, refer 108 Impact of Secondary Traumatic Stress on Professional Functioning 109 Secondary Traumatic Stress • Being in close, prolonged contact with traumatized people can be a constant stressor • Family members and professionals often experience symptoms of trauma • Symptoms are considered secondary ”because they occur in those who have not directly experienced the event • Professionals may not be aware of, or may deny secondary trauma effects • This denial can lead to “savior-rescuer ”behavior 110 Secondary Traumatic Stress Guidelines • Maintain an awareness of secondary trauma and take steps to mitigate negative consequences • Effective helping professionals work as a team and must have opportunities to meet with others to openly discuss the effects of secondary trauma and its impact on service delivery 111 Impact of Secondary Traumatic Stress on Professional Functioning • Interaction with colleagues: – Withdrawal from interactions – Impatience – Decrease in quality of relationship – Poor communication – Subsume own needs – Staff conflicts 112 Impact of Secondary Traumatic Stress on Professional Functioning • Common symptoms: – Intrusive and persistent upsetting memories or thoughts about the event – Absenteeism/tardiness – Exhaustion/irritability – Faulty judgment/Irresponsibility – Overwork – Frequent job changes 113 Stay Alert for Signs and Symptoms • Consider professional help if severe symptoms last beyond a couple of weeks after the event 114 Sources of Helper Stress • • • • • • • • • Unprepared for their own reactions Repeated exposure to grim experiences Lack of sleep and fatigue Inability of being able to “do enough” Guilt over privileged access to resources Facing moral and ethical dilemmas Angry and seemingly ungrateful victims Frustrated by leadership decisions & policies Detached from personal supports 115 “We don’t have to become heroes overnight, just a step at a time, meeting each thing that comes up, seeing it as not as dreadful as it appears, discovering that we have the strength to stare it down.” Eleanor Roosevelt 116 Self Care “In the Moment” • Self Care “In the Moment” – Setting limits – Knowing when and how to end the interaction – Being able to refer or triage if it’s appropriate to do so • Having a place to get support • Knowing why you feel frustrated, angry – What pushes your buttons? 117 Making a Plan for Self Care • Self care is most effective when it is a regular part of your daily routine – Hard work requires that you take care of yourself • Create an individualized plan for recovery and recreation 118 Self Care Strategies • How much sleep do you need to function adequately? • What foods are soothing and what foods bother your stomach? • Who in your personal/professional life makes you feel good about yourself? • How much time by yourself do you need? • How much social interaction lifts your spirits? 119 Self Care Strategies • • • • Crafts/hobbies Meditating Playing with pets/animals Participating in religious events/talking with clergy • Meeting with a professional counselor • Exercise/nutrition/sleep 120 Specific Self Care Strategies • Have an emergency plan for your family – Importance of knowing your family is taken care of while you are taking care of others • Make time to connect with friends and colleagues in/out of work • Take time off from work to rest and recreate 121 If you could not leave the building right now for a whole week, what items do you wish you had brought with you? 122 Self Care Plan 1. What plan do you have to maintain contact with your family during an emergency? 2. If you couldn’t go home for a few days (beginning right now) what would you wish you had with you? 3. How are you going to address #1 and #2 so that you can comfortably respond to an emergency? 123 • How do you help yourself stay centered and calm? • What skills do you have to help others stay centered and calm? • How might others help you stay centered and calm? 124 Communication and Role of a Health Care Provider in Emergency Preparedness How are you perceived by the public at large? • How do they see what you do and how you do it? • What image do you want to project? • How do you feel about yourself in this role? 125 Obstacles to Your Best Efforts as Health Care Provider in Emergency Preparedness • What do you need from your team leader? • What do you need from your team members? • What do you need to do to support the team? 126 Caring for Each Other • End of shift (De-activation) meeting • Management of work schedule: Nourishment, hydration, breaks, time off, etc. • Rotating tasks • Create climate of support 127 Chinese Proverb You can’t prevent the birds of sorrow from flying over your head, but you can prevent them from building a nest in your hair 128 ...
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This note was uploaded on 02/16/2011 for the course NURS 504 taught by Professor Culley during the Spring '11 term at South Carolina.

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BEHAVIORAL HEALTH - Behavioral Health Disaster Response Psychological First Aid Joan M Culley PhD MPH RN CWOCN Revised Sept 2010 1 This

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