Disaster – Flashcard

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undamental purpose of PFA: providing comfort and support -establish safety, stress related symptom reduction, rest/sleep restoration, linkage to critical resources, connection to social support -presence and comfort, provide soothing basic, practical and emotional support, compassion -counselors figuratively and literally “hold” survivors so that they do not fall apart Beverly Raphael coined the term Psychological First Aid in 1977 Interventions should first do no harm and not interfere with natural recovery The majority of survivors recover without help PFA often helps facilitate recovery by removing obstacles PFA derived from work of Carl Rogers and Abraham Maslow Rogers: unconditional positive regard, empathy, genuineness -Helper’s attitude determines effectiveness Maslow: motivations are tied to hierarchy of needs -Attend to physical and safety needs first in PFA Goals of PFA: -relieve physical and emotional suffering -improve short term functioning -help course of recovery -link to vital resources Attitudes of PFA workers: -calm, warm, acknowledges and recognizes suffering, empathy, genuine, empowers survivor -Attend to physiological needs, safety, information and orientation to services (info about loved ones, future, and resources) giving social support access Social Support: Reunite with loved ones, keep families together Different types of social support: -Instrumental: practical in nature, usually in the form of money or help with tasks and chores -Emotional: provides warmth, caring, and trusting relationship -Informational: includes advice or guidance intended to help someone cope with their difficult circumstances (providing solutions to problems, etc.) Social integration: participation in a broad range of social relationships (this promotes self-esteem, stability, self-regulation, sense of purpose, and positive feelings) Relationships are usually beneficial but can sometimes be a source of stress. *Negative reactions from family and friends are a strong predictor of not recovering from PTSD, and a stressful environment (one involving impoverishment, blaming, demands, anxiety, and invalidation) creates chronic PTSD risk Triage: process of evaluating and sorting victims by immediacy of treatment needed and directing them to immediate or delayed treatment. Goal: do the greatest good for the greatest number of people In DMH, there is constant Needs Assessment, which appraises the current status of individuals, groups, and the affected community Guidelines for DMH Triage suggest that mental health workers should give special attention to those who are injured/hospitalized, those who have lost a loved one, those whose exposure to the event was long/grotesque, and those with mental illness history Psychoeducation: provides information about a range of biopsychosocial processes including common reactions to disaster, stages of reactions to disaster, symptoms, resilience, treatment, effective and ineffective coping strategies, the stages of loss, and other info about grief, and ways parents can help children -they are experiencing a normal reaction to an abnormal situation Debriefing? (not sure if we need to know about this) Cognitive Behavioral Therapy: Exposure therapy: anxiety and trauma treatment- imagining the trauma Implosive therapy: forces clients to confront an anxiety-producing conditioned stimulus Flooding therapy: clients imagine only the actual feared stimuli Always consider which disorders are comorbid with each other Stress Inoculation Therapy (SIT): developed by Meichenbaum Teaches patients skills needed to manage anxiety and decrease avoidance, and how to cope with stress LECTURE NOTES Logotherapy- values focused therapy Viktor Frankl: “Man’s Search for Meaning” three overlapping dimensions of human conceptualization: Physical, psychological, and spiritual Life-meaning may be experienced under all circumstances PFA: Make a Connection Help People Be Safe Be Kind, Calm, and Compassionate Listen Give Realistic Reassurance Encourage Good Coping Give Accurate and Timely Information Make a Referral End the Conversation Take Care of Yourself Utilize Triage! Local Chapter of ARC: Northwest Mississippi Chapter Psychoeducation: one of the least controversial interventions; and most recommended Goal: to let survivors know what they might experience without alarming them or causing them to anticipate future distress Henry Dunant: International ARC Cultural Competency 4 Ps in Commercial Marketing: Product, Price, Place, People Marketing of DMH: 1. Formative Research 2. Strategic Program Planning and Implementation 3. Program Development 4. Program Monitoring Dissociation: sealing off a traumatic experience USA PTSD Prevalence Rate: 8-9% with women being twice as likely 10-20% among disaster workers 30-40% of direct disaster victims Drug use and abuse may increase after a disaster, as it acts as a stressor, persons in recovery may relapse, substance use may increase, particularly in PTSD, responders may also increase use. Definitions from pg. 305 Halpern and Tramontin- Vicarious Traumatization: permanently transformative, inevitable changes that result from doing therapeutic work with trauma survivors Compassion fatigue (Figley): when compassion stress has become severe and is ongoing Compassion stress: a natural outcome of knowing about the trauma experienced by a client rather than as a pathological process. Symptoms include helplessness, confusion, and isolation Grief: Normal reaction to the loss of a loved one Stages of grief in adults: 1. Moving beyond denial and accepting the reality of loss 2. Experiencing the pain or emotional aspects of the loss 3. Adjusting to an environment in which the deceased is missing with every detail of life altered 4. Emotionally relocating the deceased as a psychological presence or memory and moving on with life Prolonged Exposure (PE) is an effective treatment for PTSD I have read F&T 17-19 and H&T 8&9 and filled in all info in those chapters so try and focus on the rest! Team work wahooo! FINAL EXAM REVIEW: 1. Have a good understanding of the training modules of PFA. 1. Defining psychological First Aid 2.Recognizing Disaster-Related stress 3. Embracing the Principles of psychological first aid 4. Making appropriate referrals 5. Practicing Psychological First Aid Principles This is the course structure so I am assuming this to be correct?? 2. Red cross values Compassionate: We are dedicated to improving the lives of those we serve and to treating each other with care and respect. Collaborative: We work together as One Red Cross family, in partnership with other organizations, and always embrace diversity and inclusiveness. Creative: We seek new ideas, are open to change and always look for better ways to serve those in need. Credible: We act with integrity, are transparent guardians of the public trust and honor our promises. Committed: We hold ourselves accountable for defining and meeting clear objectives, delivering on our mission and carefully stewarding our donor funds. 3. How Red Cross-typically operates? The American Red Cross prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors? * getting this from handout but I am not sure. the primary function of ARC is to provide the basic needs and to not discriminate against anyone. The American Red Cross works with many community organizations and agencies to help with short-term and long-term needs. 4. What is DSO and how does it work? Disaster services overview. Interactive class with videos and ways to help in disaster 5. PTSD and prevalence rates in direct survivors of disaster events, what do we know about them? Prevalence rates range from 30-40 percent among direct victims. 6. PTSD prevalence rate in rescue workers? Prevalence rates range from 10-20 percent among rescue workers. 7. Prevalence among general population? Prevalence rates range from 5-10% among the general population. 8. PTSD treatment based on different stages. Long term treatments- CBT (cognitive behavioral therapy) is the most effective treatment for PTSD. CBT includes a number of components, including psychoeducation, anxiety management, exposure, and cognitive strategies. Exposure and Cognitive restructuring are thought to be the most effective components. Exposure involves having survivors repeatedly re experience their traumatic event by confronting feared situations by imagining their traumatic event (imaginal exposure) and/or by entering previously avoided situations that elicit fear (in vivo exposure.) Cognitive strategies focus on challenging and modifying maladaptive beliefs related to trauma. PE (prolonged exposure) has also received a lot of attention and seems to be beneficial to those with PTSD. Stage 3: Paradigm, CBT, Positive Psych 3-Stage Model of Principle-Driven Treatment Following Disasters Methods of Treatment Stage 1: Acute Support PFA fits in, know core actions Main goal is support (not clinical treatment) Enhance ability to cope Don’t push survivors through Know your role Tyranny of Urgency :Pull that you have to be doing something as a clinician. Stage 2: Intermediate Support Follows acute care, within 30 days post disaster Mental Health Professionals Cognitive-Behavioral Model Provide relationship support Provide skills training Alone or sequential intervention Variety of settings Repeat Visits (3-5) Techniques Psycho education: Worry, difficulties, concentrating Supportive, collaborative environments Communicating basis for treatment Identifying and assessing thoughts Cognitive Restructuring Stage 3: Ongoing Treatment Tailored to meet client needs Heavily CBT based Organized by nature of symptoms Internalizing: Supportive techniques and prolonged exposure Supportive Techniques: Relationship qualities and structure Exposure: Raises client awareness and anxiety tolerance Reintroduces traumatic experiences Recommended Stage 3-Not Before Structure for Internalizing Clients Early Sessions: Education and Monitoring Later on – Exposure, coping training Review Medical/drug use status Homework Motivation for change Education Social Support Symptom Monitoring Provide stable therapy environments Adhere to time limits Focus sessions on daily problems Address barriers to a stabilized external environment Provide exposure practice (imaginal experiencing) Provide support and reassurance Staying in the moment while anxiety passes Breathing relaxation techiniques Identify achievements (self-esteem) Learn adaptive self-talk Expectations How realistic are ^? How can I make small changes? What is the next step to get through this? Plan next steps and make future appointments 9. What is prolonged exposure and what are the characteristics? p.302-304 hard to define alone Starts with education about treatment (psychoeducation), breathing, In Vivo Exposure (real world practice), talking through the trauma. 10. What are the primary mental health problems following a disaster? PTSD? 11. What is prolonged grief and what do we know about it? often times happens if it was a sudden death, can last for months or years Grief that follows the death of a loved one that is so prolonged and intense that it exceeds the expectably wide range of individual and cultural variability 12. What is logotherapy? Logos=Meaning (Greek). Created by Viktor Frankl, Emphasizes human beings’ unique capacity for meaning, he created this during his early years of working with children and adolescents of Vienna. A values-focused therapy. Logotherapy is intended to be collaborative. Logotherapy in clinical Practice. Very healthy, If you have meaning then you will have a greater sense of where you are going and protecting yourself. Tenets DO NOT GET THIS AT ALL!!! I DO. 13. What is CISD, who is Jeffrey Mitchell and why is this important? Critical incident stress debriefing–treatment of trauma survivors also known as the Mitchell model. Within 72 hours of even, usually one long session, regardless of whether symptoms experienced, encouraged to remember the trauma details. People who did this faired worse. CISD slows natural recovery. 14. EMDR, what is this? EMDR (eye movement desensitization and reprocessing) a CBT that involves engaging in imaginal exposure to a trauma while simultaneously performing saccadic eye movements. It is related to Long term treatments for PTSD. 15. What is the chapter of our local Red Cross called? NORTHWEST MISSISSIPPI CHAPTER. 16. Goals of PFA? 1. To relieve suffering, both physical and emotional. 2. To improve survivors short-term functioning. Immediately following a crisis sometimes people have to make serious decisions that at the time they cannot mentally incapacitated and therefore a disaster and mental health worker might need to help them make a decision. 3. To help survivors course of recovery. Early support has shown to help facilitate long term recovery. 4. To provide linkage to critical resources. psychological or material resources that one needs to function after a disaster. **** this is strictly from the book. 17. What is psychoeducation when do we use it and is it a good thing or bad thing? Do people like it? Psychoeducation in the aftermath of a disaster involves providing information about a range of biopsychosocial processes including common reactions to disaster, stages of reactions to disasters, symptoms, resilience, treatment, effective and ineffective coping strategies the stages of loss and other information about grief and ways that parents can help children. It is one of the most recommended in early interventions. One element of psychoeducation is to provide information on stress and stress management and to let victims know that what they are experiencing is a normal reaction. Psychoeducation is recommended not only for trauma, but also for those losing a loved one in a disaster. There is little evidence to support that it is effective, and I could not find any literature validating if people liked it or not. 18. Red cross philosophy and how they do things? Is it appropriate for Red Cross workers to do x,y,z; values? They aspire to turn compassion into action so that all people affected by disaster across the country and around the world receive care, shelter and hope, our communities are ready and prepared for disasters, everyone in our country has access to safe, lifesaving blood and blood products, all members of our armed services and their families find support and comfort whenever needed, and in an emergency there are always trained individuals nearby and ready. They shouldn’t touch?? (males) Shouldn’t say it will be ok because they honestly do not know. Don’t say you will see them again unless you really will. just stuff like this. 19. What does SIT mean? And what is it important? SIT (Stress inoculation training) created by Edna Foa, was used with PE (prolonged exposure) to try and treat PTSD, but research tells us that combination the two was ineffective most likely due to an overload of the victim. 20. What are the 5 initial actions of ARC? 21. What is meant by mass care? sheltering feeding bulk distribution safe and well linking 22. What is meant by support services? deliver and return supplies, pull inventory off shelves, assess damage to homes, set up/take down computer equipment,work with financial data, drive vehicles, teach response skills, administrative work. **supporting shelters and other offices of red cross** 23. What is meant by direct services? examples such as working hands on: prepare or serve food, help reunite families, drive vehicles, set up/close shelters, provide health care, interview people, administrative work. **look on handout from class** 24. Humanity, Partially, Neutrality— More AMR values? Humanity: Endeavors to prevent and alleviate human suffering wherever it may be found, ensures respect for all humans, and promotes mutual understanding, friendship, cooperation and lasting peace among all people. Impartiality: Makes no discrimination as to nationality, race, religious beliefs, class or political opinions; endeavors to relieve suffering of individuals guided solely by their needs and giving priority to the most urgent case of distress. Neutrality: To continue to enjoy the confidence of all, the Movement may not take sides in hostilities and engage in controversies of a political, racial, religious or ideological nature. Independence: Works cooperatively as an auxiliary in the humanitarian services of each country’s government, while still maintaining autonomy to act in accordance with the Principles of the Movement. Voluntary Service: A voluntary relief movement; not prompted, in any manner, by desire for gain Unity: There is only one Red Cross or Red Crescent Society in any one country; it is open to all and carries out its humanitarian work throughout its territory. Universality: All societies, worldwide, have equal status and share equal responsibilities and duties in helping each other. 25. Before Clara Barton developed ARC QUESTION # 21!! The person who established the international Red Cross… Henry Dunant 26. What is the 2007 world disasters report and why is it important? p. 343 F&T. The World Disaster Report 2007 points out that the impact of disasters on many indigenous and minority populations are often exacerbated by the shortage of disaggregated information that is normally obtained during disaster mitigation planning. For example, during Hurricane Katrina in 2005 the country’s emergency warning system was activated in Gulfport MS informing local residents of the need to evacuate prior to the storm, but the communication system did not include the message in Vietnamese and therefore many Vietnamese who work in the shrimp fishing industry did not receive the warning and did not evacuate prior to the hurricane. 27. Book talks about equal access, cultural competency what are these and why are they important? Cultural competency: defined as a set of congruent behaviors, attitudes, and policies enabling a system, agency, or group of professionals to effectively work in cross-cultural situations. It is one of the primary means to closing the disparities gap in disaster preparedness. 28. Commercial marketing, what are the four P’s? 1. Product- refers to disaster mental health service utilization. Ex: people who have been forced to relocate after a disaster may seek services to remedy their employment, social and financial losses and not treatment for symptoms of depression and anxiety although many may meet full diagnostic criteria for a mental health disorder. Therefore is may be usual to package together mental health services with other things such as (financial compensation, employment services etc.) 2. Price- Price encompasses tangible (cost, travel expenses, time off work) and intangible costs ( embarrassment, time, hassle, stigma) 3. Place – Refers to the locations and times clients can use mental health services. it also can be used to encompass the physical evidence or facilities where services are provided, including ease of parking, waiting area comfort and overall clinic appearance. 4. Promotion- This includes an integrated set of activities intended to encourage use of disaster mental health services. Customer service training, service delivery enhancement, and community based activities are often combined with more traditional communications. 29. What are the four helping actions of PFA? 1. Attending to physiological needs- these need include requirements for air, water, food, sleep, proper body temperature, and so on. people need to first focus on their physical and material state in the case of a disaster. 2. Attending to safety needs- A core component of PFA involves supplying safety and security and protecting survivors from danger and further harm. Counselors can further support client safety and stability by encouraging families to maintain their routines. When the immediate danger has passed, families should try and eat their meals together at regular times. Children should have regular bedtimes and waking up times even if schools are closed due to the disaster. 3. Providing information and orientation to services- Helpers should use effective risk-communication techniques to provide survivors with information about the post disaster situation as well as education about what they might experience in the future. This action includes; Information about loved ones, information about resources, and information about the future. 4. Helping clients access social support- the quality and quantity of social relationships can influence not only emotional well being but also physical well being. Social integration defined as participation in a broad range of social relationships, promotes self-esteem, stability, self-regulation, and a sense of purpose and positive feeling. Instrumental, emotional, and informational support is located under this module. *** All information taken from the book 30. What is a social marketing plan in disaster and mental health? Analogous to the four phases of disaster planning- mitigation, preparedness, response, and recovery- effective marketing of disaster mental health services can also be divided into phases. The process includes 1. formative research 2. strategic program planning and implementation 3. program development 4. program monitoring, evaluation and modification. Each phase is distinct, but the phases may overlap. 10-Step Strategic marketing planning process: 1. Step 1: Background, Purpose, and Focus Statement: The first step in the planning process is to develop a background statement to frame, within a historical and current context, the status of disaster survivors’ mental health. The background statement will also paint a clear picture of the role of disaster mental health services and why they are worthy of promoting to survivors. 2. Step 2: SWOT Analysis: A SWOT analysis is an assessment of how disaster mental heath is situated in the current environment. SWOT is an acronym for strengths, weakness, opportunities, and threats. 3. Step 3: Target Audiences: Selecting one or more target audience is a key step in maximizing the projects return on investment. Target audience selection begins with segmenting the market into smaller more homogenous groups. 4. Step 4: Goals and Objectives: After identifying the purpose, focus, and target audience, campaign goals and objectives can be determined. Goals and objectives are related to the projects purpose and focus but are distinct in that they are specific, measurable, attainable, relevant and time sensitive. Most social marketing campaigns will have a specific behavioral objective or what you wish to influence the target audience to do. An example of a behavioral objective for a specific audience segment affected by disaster is to screened for depression. 5. Step 5: Competition and Perceived Barriers and Benefits: At this phase, insights gained when segmenting and prioritizing audience populations are explored in greater depth. Formative research is conducted to understand consumers’ perceptions of barriers and benefits to mental health service utilization. 6. Step 6: Product Positioning: Product positioning refers to how the sponsoring organization wants the product to be perceived by the target audience. Positioning or repositioning when there is a current ineffectual product position may be oriented to behaviors, benefits, barrier or the competition. 7. Step 7: Marketing Mix: Formative research results are used to create a comprehensive, integrated marketing plan. In addition to product benefits and costs discussed previously, strategies are developed for the other elements of the marketing mix-placement, people, processes and promotion. 8. Step 8: Monitoring and Evaluation Plan: A plan for monitoring and evaluation will encompass both campaign outputs and outcomes. 9. Step 9: Budgets and Funding Sources 10. Step 10: Implementation Plan: The implementation plan specifies the overall time frame for project execution. It details exactly what, when, and how campaign activities will take place as well as who is responsible for each activity. 31. Dos and don’ts? (Not really sure what these means?) 32. Grieving and stages of grieving in the book know about these theories and who created them? grief- the emotional reaction to loss. traumatic grief- process of dealing with traumatic loss, it is sometimes called traumatic bereavement. complicated grief- the process following a loss, under traumatic circumstances or not, that is characterized by unremitting bereavement, it is sometimes called chronic or difficult bereavement. Stages of Grief: Developed by Worden 1. Moving beyond denial and accepting the reality of the loss 2. Experiencing the pain or the emotional aspects of the loss 3. Adjusting to an environment in which the deceased is missing with every detail of life altered. 4. Emotionally relocating the deceased as a psychological presence or memory and moving on with life 33. What is it called when a person basically seals off a traumatic experience? 34. Why is EMDR controversial and CISD, who administers these and how? EMDR (eye movement desensitization and reprocessing) a CBT that involves engaging in imaginal exposure to a trauma while simultaneously performing saccadic eye movements. It is controversial because there is growing evidence that the theorized eye movements are an unnecessary component which suggest that the mechanisms for action might be the exposure component. CISD has been found to slow the natural recovery process and to make recovery harder for those exposed to it. 35. Know about the cognitive biases and irrational thoughts. 36. There are names for people’s specific errors? 37. PFA—how you screen people?? What is that model called? Screening involves attempting to identify those who are at risk for developing symptoms but may not have yet shown signs of this outcome. Brewin suggests an alternative more rational strategy called “screen and treat.” This involves carefully monitoring survivors’ symptoms and referral for treatment only when symptoms are failing to subside naturally. The National Screening Committee says screening should only be done if it falls under these questions? 1. Is the condition serious? 2. Is there evidence that early intervention would lead to better outcomes? 3. Do people recover on their on? * ⅓ of people with PTSD fail to recover after many years. 4.Are there effective treatments? * Psychotherapy helps most people most of the time. 5.Do people come forward? * Large numbers of people with PTSD do not come forward on their own. 6. Does it work? *** Screening is highly controversial and has no significant empirical data validating it. 38. Behavioral health triage. Triage is a specific type of assessment. it derives from the medical practice of deciding who is most in need of care and delivering services first to these clients. Triage has been defined as “the process of evaluating and sorting victims by immediacy of treatment. The goal of triage is to do the greatest good for the greatest number of people. 39. Vicarious trauma and compassion fatigue? Vicarious trauma- introduced by Laurie and Perlman and Lisa Mccann is identified as the profound psychological effects that can be destructive and painful for the helper and persist for months or years after work with traumatized persons. The experience of trauma symptoms in counselors often mirrors that of their clients and is attributed to hearing their client’s trauma. This distress has been identified as compassion fatigue or vicarious trauma most recently known as secondary traumatic stress (STS). 40. What do we know about disasters and substance use? Those who had previous substance abuse problems prior to a disaster are at higher risk for “relapsing” those who were borderline substance abuse problems prior to a disaster are likely to develop a problem that could become life threatening. Youth and rescue workers are especially at risk for substance abuse problems post-disaster. 41. Know the different forms of support? Programmatic vs. social. Vs. instrumental? Instrumental support is practical in nature, taking the form of money or help with tasks and chores. Emotional support provides an individual with warmth, caring, and a trusting relationship. informational support includes advice or guidance that is intended to help someone cope with difficult circumstances. (these are the ones I found in the book, so not sure about programmatic?) 42. Backlash against disaster and mental health services, why? In what circumstances? when they say they are there to help but they really aren’t doing anything…video example of woman maybe?? 43. Conceptual drift in relation to PTSD? 44. Causes of PTSD: Conceptual Drift, LECTURE NOTES: PFA Core Action: Connection with Social Supports Goal: To help establish brie or ongoing contacts with primary support persons and other sources of support Including family members, friends, and community helping resources Enhance access to primary support persons (e.g., family) Take steps to facilitate contact Encourage the use of available support persons (e.g. relief workers) Discuss support seeking and giving When social support is not working Information on coping Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning Provide basic information about stress reactions Avoid pathologizing (e.g., symptoms) When appropriate, people may benefit from learning that responses are normal/ expectable (psychotherapy) Review common reactions to traumatic experiences and losses Grief, sadness, anger, guilt, regret, anxiety, physical reactions Positive coping Talk to others/ spend time with others Rest, diet, and exercise Negative coping Using alcohol/ drugs to cope Withdrawing from supports and activities Risky behaviors Anger, blaming others Over eating Overworking Not taking care of basic needs Special considerations for children Reestablish family routines Encourage taking care of physical health Awareness of children troubled by reminders/ hardships Developmental milestones may be delayed as a result of disaster E.G., entering preschool, getting a first job, graduating Assist with anger management Address highly negative emotions (guilt, shame) Clarify misunderstandings Identify alternatives to negative beliefs Sleep problems (very common) Go to bed and get up at the same time Eliminate caffeine in afternoons/ evenings Wind down before bedtime Limit daytime naps Substance abuse Education on dangers of “medicating” bad feelings; perception of pros/ cons using substances to cope Appropriate action plan Linkage with Collaborative Services Goal: To link survivors with available services needed at the time or in the future Provide direct link to needed services Walk the person over to an agency representative who can help them Promote continuity in helping relationships Methods of Treatment 3 – stage Model of principle – driven treatment following disasters Methods of treatment Stage 1: Acute support Where PFA fits in Know your core actions! Main goal is support (not clinical treatment) Enhance people’s ability to cope Benefits are manifold From research – many things that should be helpful may be Know role Obtain permission to assist Direct survivors to services providing continuing and direct support Greatest risk to helpers – “Tyranny of urgency” Stage 2: Intermediate support Follows acute care Within about 30 days post disaster Mental Health Professionals Cognitive – behavioral model Most easy to support with research Meaning making model Provide relationship support Facilitate hope Provide skills training Increase coping Increase adaptability Used alone or sequential intervention Can be done in a variety of settings Requires repeat visits (3 to 5) Techniques Supportive, collaborative environment Communicating basis for treatment Psychoeducation Relationship between thoughts ,emotions, and behaviors Thought intrusions Emotional numbing Avoidance What makes your traumas, anxieties, fear, larger Physical arousal Loss of interest Loss of appetite Constant worry Sleep difficulties Difficulty concentrating Depression Anger Positive coping Negative coping Identifying and assessing thoughts Cognitive restructuring Homework Anxiety management Stage 3: Ongoing treatment Exposure goes here Tailored to meet client needs Heavily CBT based Organized by nature of symptoms Internalizing Externalizing Internalizing Interventions Basis: Supportive techniques and prolonged exposure Supportive techniques Relationship qualities and structure Exposure Raises client awareness and anxiety tolerance Reintroduce traumatic experiences *Recommended stage 3 – not before Structure for Internalizing Clients Early session – education and monitoring Later on – Exposure, coping training Review Medical / drug use status Homework Motivation for change Education Social support Symptom monitoring Provide stable therapy environment Adhere to time limits Because this is more traditional therapy Focus sessions on daily problems Address barriers to a stabilized external environment Provide exposure practice (imaginal experiencing) Provide support and reassurance Practice staying in the moment while anxiety passes Breathing, relaxation techniques Identify achievements (self-esteem) Learn adaptive self-talk What are my expectations? How realistic are they? What can I do to make a small change? What is the next step to get through this? Plan next steps and make future appointments Imaginal Exposure · Avoidance prevents understanding and processing · Trauma – related thoughts return in distressing ways · Symptoms = “unfinished business” · Put the event into perspective, reduce distress · Talk about the details of the event · Repetition until symptoms decrease American Red Cross: Psych First Aid · Know what Triage means Logotherapy in clinical Practice · Very healthy · If you have meaning then you will have a greater sense of where you are going and protecting yourself · Viacharacter.org · Tenets · Fankel argues that you can basically derive meaning values o Creative (what you give to the environment) Athlete, dance o Experiential (what you receive from the environment o Attitudinal values / life belief How one responds to it Self – Transcendence · Reaching out beyond ourselves for something other than ourselves · A cause or someone to love · Getting out of your own grooves so that You may help yourself while helping others
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Fundamental purpose of PFA: providing comfort and support -establish safety, stress related symptom reduction, rest/sleep restoration, linkage to critical resources, connection to social support -presence and comfort, provide soothing basic, practical and emotional support, compassion -counselors figuratively and literally “hold” survivors so that they do not fall apart Beverly Raphael coined the term Psychological First Aid in 1977 Interventions should first do no harm and not interfere with natural recovery The majority of survivors recover without help PFA often helps facilitate recovery by removing obstacles PFA derived from work of Carl Rogers and Abraham Maslow Rogers: unconditional positive regard, empathy, genuineness -Helper’s attitude determines effectiveness Maslow: motivations are tied to hierarchy of needs -Attend to physical and safety needs first in PFA Goals of PFA: -relieve physical and emotional suffering -improve short term functioning -help course of recovery -link to vital resources Attitudes of PFA workers: -calm, warm, acknowledges and recognizes suffering, empathy, genuine, empowers survivor -Attend to physiological needs, safety, information and orientation to services (info about loved ones, future, and resources) giving social support access Social Support: Reunite with loved ones, keep families together Different types of social support: -Instrumental: practical in nature, usually in the form of money or help with tasks and chores -Emotional: provides warmth, caring, and trusting relationship -Informational: includes advice or guidance intended to help someone cope with their difficult circumstances (providing solutions to problems, etc.) Social integration: participation in a broad range of social relationships (this promotes self-esteem, stability, self-regulation, sense of purpose, and positive feelings) Relationships are usually beneficial but can sometimes be a source of stress. *Negative reactions from family and friends are a strong predictor of not recovering from PTSD, and a stressful environment (one involving impoverishment, blaming, demands, anxiety, and invalidation) creates chronic PTSD risk Triage: process of evaluating and sorting victims by immediacy of treatment needed and directing them to immediate or delayed treatment. Goal: do the greatest good for the greatest number of people In DMH, there is constant Needs Assessment, which appraises the current status of individuals, groups, and the affected community Guidelines for DMH Triage suggest that mental health workers should give special attention to those who are injured/hospitalized, those who have lost a loved one, those whose exposure to the event was long/grotesque, and those with mental illness history Psychoeducation: provides information about a range of biopsychosocial processes including common reactions to disaster, stages of reactions to disaster, symptoms, resilience, treatment, effective and ineffective coping strategies, the stages of loss, and other info about grief, and ways parents can help children -they are experiencing a normal reaction to an abnormal situation Debriefing? (not sure if we need to know about this) Cognitive Behavioral Therapy: Exposure therapy: anxiety and trauma treatment- imagining the trauma Implosive therapy: forces clients to confront an anxiety-producing conditioned stimulus Flooding therapy: clients imagine only the actual feared stimuli Always consider which disorders are comorbid with each other Stress Inoculation Therapy (SIT): developed by Meichenbaum Teaches patients skills needed to manage anxiety and decrease avoidance, and how to cope with stress 2007 World Disasters Report “Hurricane Katrina is now symbolic of what happens even in the most ‘developed’ of countries, when disaster hits communities already disadvantaged by deeply rooted forms of discrimination. This vital report demands awareness of the reality of discrimination in the delivery of essential humanitarian assistance.” -Gay J. McDougall, United Nations Independent Expert on minority issues, Gender, race, color, religion, age – there are so many reasons why people can be excluded from their society. Those who are face an uphill struggle for equality, even if they have the strength and wherewithal to take the first steps. However many do not. What, then, is the reality for these groups when disaster strikes? Hidden, ignored or simply invisible, the most vulnerable – and those potentially in the greatest need – are rarely, if ever, at the forefront of aid operations. This report turns the spotlight on these groups, examining how and why they face discrimination. It calls on communities, governments and agencies to work harder to identify the most vulnerable and work together to ensure that their specific needs are addressed in an emergency. – See more at: http://www.ifrc.org/en/publications-and-reports/world-disasters-report/wdr2007/#sthash.8IYBVWvb.dpuf Henry Durant developed the International Red Cross. Clara Barton developed the American Red Cross. BACKLASH AGAINST DMH SERVICES- victims perceive the helpers to be responsible for tragedy and blame them for their losses Psychological First Aid Core Actions Contact and Engagement 1. Goal: To respond to contacts initiated by survivors, or to initiate contacts in a non- intrusive, compassionate, and helpful manner. Safety and Comfort 2. Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort. Stabilization 3. (if needed) Goal: To calm and orient emotionally overwhelmed or disoriented survivors. Information Gathering: Current Needs and Concerns 4. Goal: To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions. Practical Assistance 5. Goal: To offer practical help to survivors in addressing immediate needs and concerns. Connection with Social Supports 6. Goal: To help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources. Information on Coping 7. Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning. Linkage with Collaborative Services 8. Goal: To link survivors with available services needed at the time or in the future. What causes PTSD? Living through or seeing something that’s upsetting and dangerous can cause PTSD. This can include: • Death or serious illness of a loved one • War or combat • Car accidents and plane crashes • Hurricanes, tornadoes, and fires • Violent crimes, like a robbery or shooting. DSO- DISASTER SERVICES OVERVIEW Objective: To Train volunteers on the outcomes of disasters. Single Family fires are the most common types of disasters. After disasters, people experience Power outages, roads blocked, loss of drinking water, clothes, jobs and even food. Pressure rises and the amount of stress may be unbearable. PFA- PSYCHOLOGICAL FIRST AID DO’S » Be honest and trustworthy. » Respect people’s right to make their own decisions. » Be aware of and set aside your own biases and prejudices. » Make it clear to people that even if they refuse help now, they can still access help in the future. » Respect privacy and keep the person’s story confidential, if this is appropriate. » Behave appropriately by considering the person’s culture, age and gender. DON’TS » Don’t exploit your relationship as a helper. » Don’t ask the person for any money or favour for helping them. » Don’t make false promises or give false information. » Don’t exaggerate your skills. » Don’t force help on people, and don’t be intrusive or pushy. » Don’t pressure people to tell you their story. » Don’t share the person’s story with others. » Don’t judge the person for their actions or feelings. % of direct survivors experience PTSD, % of rescue workers experience PTSD, % of people in general experience PTSD PTSD Recovery Stage One: The Emergency Stage The first of the post-traumatic stress stages is referred to as either the outcry stage or the emergency stage. During this stage, your responses to everything around you will be intense and your anxiety levels will be off-the-chart high; this often the stage where you will feel the instinctual “fight or flight” response kicking into gear. You may arrive at the emergency stage during the traumatic experience, or it may be something that occurs when you are faced with some of your triggers. This stage will last for as long as you believe that you are in imminent danger, even if logically on some level you know that you are not. You may have feelings of intense fear, helplessness, and hopelessness surging through your body. Some of the physical symptoms of this stage are rapid breathing, sky-high blood pressure, and a pounding heart. PTSD Recovery Stage Two: The Numbing Stage The second of the PTSD stages is referred to as the denial or the numbing stage. When it comes to PTSD, denial is a fairly large concern that will need to be addressed during treatment. In this phase, you will instinctively do your utmost to protect yourself from further mental anguish by denying the emotions that you are truly struggling with. The avoidance of emotion is very often your mind’s way of trying to reduce and eliminate the high levels of stress and anxiety that you are feeling. Without the proper PTSD recovery program and compassionate professional treatment, many find that they are not able to move beyond the numbing stage. PTSD Recovery Stage Three: The Intrusive/Repetitive Stage The third of the PTSD stages is referred to as the intrusive repetitive phase. You may find that despite your best efforts to deny how you are feeling, you are now experiencing nightmares, flashbacks, and are increasingly anxious and jumpy. This can often be the most destructive of all of the post-traumatic stress stages, but it is also the stage at which you may finally be willing to wholly confront PTSD trauma that is controlling your life and the lives of those who care about you. Prolonged Exposure (PE) is one exposure therapy that works for many people who have experienced trauma. It has four main parts: • Education. PE starts with education about the treatment. You will learn as well about common trauma reactions and PTSD. Education allows you to learn more about your symptoms. It also helps you understand the goals of the treatment. This education provides the basis for the next sessions. • Breathing. Breathing retraining is a skill that helps you relax. When people become anxious or scared, their breathing often changes. Learning how to control your breathing can help in the short-term to manage immediate distress. • Real world practice. Exposure practice with real-world situations is called in vivo exposure. You practice approaching situations that are safe, but which you may have been avoiding because they are related to the trauma. An example would be a Veteran who avoids driving since he experienced a roadside bomb while deployed. In the same way, a sexual trauma survivor may avoid getting close to others. This type of exposure practice helps your trauma-related distress to lessen over time. When distress goes down, you can gain more control over your life. • Talking through the trauma. Talking about your trauma memory over and over with your therapist is called imaginal exposure. Talking through the trauma will help you get more control of your thoughts and feelings about the trauma. You will learn that you do not have to be afraid of your memories. This may be hard at first and it might seem strange to think about stressful things on purpose. Many people feel better over time, though, as they do this. Talking through the trauma helps you make sense of what happened and have fewer negative thoughts about the trauma 4 P’S OF COMMRCIAL MARKETING 1. Product. The right product to satisfy the needs of your target customer 2. . 2. Price. The right product offered at the right price. 3. 3. Place. The right product at the right price available in the right place to be bought by customers. 4. 4. Promotion. Informing potential customers of the availability of the product, its price and its place. 10 Social Marketing Plans 1. Describe Background, Purpose and Focus: Note the social issues the plan will address (e.g., eye health) and summary of factors that have led to the development of the plan. • Purpose & Focus: A purpose statement reflects the benefit of a successful campaign, and then a focus is selected to narrow the scope of the plan. • Example: In 2011 the Save Our Sight Program developed a 5-year social marketing plan with a purpose to protect the sight of athletes with a focus on wearing protective eyewear. 2. Situation Analysis (SWOT): A quick audit of factors and forces in the internal and external environment, particularly those anticipated to have some impact on or relevance for subsequent planning decisions. 2.1 SWOT: strengths, weaknesses, opportunities, threats 2.2 Past or similar efforts: activities, results and lessons learned 3. Target Market(s) Profiles 3.1 Size 3.2 Demographics, geographics, related behaviors 3.3 Stage of change (readiness to “buy”) 4. Marketing Objectives and Goals 4.1 Marketing objectives: Behavior, knowledge and beliefs 4.2 Objectives: Measurable and time sensitive 5. Target Market Barriers, Benefits, and the Competition 5.1 Perceived barriers to desired behavior 5.2 Potential benefits for desired behavior 5.3 Competing behaviors/competition 6. Positioning Statement: How you want the target groups to see your target behavior relative to the competition 7. Marketing Mix Strategies (4P’s) 7.1 Product • Core: benefit to target market of desired behavior • Actual: desired behavior and any name and sponsors • Augmented: tangible objects and services 7.2 Price • Monetary fees, incentives, and disincentives • Non-monetary incentives and disincentives 7.3 Place • Where and when to promote that the target market perform the behavior • Where and when to acquire any tangible products and services 7.4 Promotion • Messages • Messengers • Communication channels 8. Evaluation Plan 8.1 Purpose and audience for evaluation 8.2 What will be measured: output/process, outcome, and impact measures 8.3 How and when measures will be taken 9. Budget 9.1 Costs for implementing marketing plan, including evaluation 9.2 Any anticipated incremental revenues or cost savings 10. Implementation: Who will do what, by when? Phases of Social Marketing 1. Formative Research- The first step in developing a social marketing plan is to conduct formative research. 2. Strategic Program Planning and Implementation 3. Program Development- This phase involves the development of program materials and tactics. 4. Program Monitoring, Evaluation and Modification- This section presents how to determine what, how, and when monitoring and evaluation will take place. Installation phase is when someone shields themselves from trauma. AMERICAN RED CROSS MISSION The American Red Cross prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors. Vision Statement The American Red Cross, through its strong network of volunteers, donors and partners is always there in times of need. We aspires to turn compassion into action so that… …all people affected by disaster across the county and around the world receive care, shelter and hope; …our communities are ready and prepared for disasters; …everyone in our country has access to safe, lifesaving blood and blood products; …all members of our armed services and their families find support and comfort whenever needed; and …in an emergency, there are always trained individuals nearby, ready to use their Red Cross skills to save lives. Values • Along with the new mission and vision statements, we also want to lay out the values that are essential to our continued success; compassionate, collaborative, creative, credible and committed. • These values are not new to the Red Cross, but this gives us a common language and foundation to grow on. The values drive how we accomplish our goals and conduct ourselves to execute and achieve our Strategic Journey. • Compassionate: We are dedicated to improving the lives of those we serve and to treating each other with care and respect. • Collaborative: We work together as One Red Cross family, in partnership with other organizations and always embrace diversity and inclusiveness. • Creative: We see new ideas, are open to change and always look for better ways to serve those in need. • Credible: We act with integrity, are transparent guardians of the public trust and honor our promises. • Committed: We hold ourselves accountable for defining and meeting clear objectives, delivering on our mission and carefully stewarding our donor funds. Principles Of International Red Cross Humanity: The International Red Cross and Red Crescent Movement, born of a desire to bring assistance without discrimination to the wounded on the battlefield, endeavors, in its international & national capacity, to prevent and alleviate human suffering where it may be found. Its purpose is to protect life and health and to ensure respect for the human being. It promotes mutual understanding, friendship, cooperation and lasting peace amongst all peoples. Impartiality: It makes no discrimination as to nationality, race, religious beliefs, class or political opinions. It endeavors to relieve the suffering of individuals, being guided solely by their needs, and to give priority to the most urgent cases of distress. Neutrality: In order to continue to enjoy the confidence of all, the Movement may not take sides in hostilities or engage at any time in controversies of a political, racial, religious or ideological nature. Independence: The Movement is independent. The National Societies, while auxiliaries in the humanitarian services of their governments and subject to the laws of their respective countries, must always maintain their autonomy so that they may be able at all times to act in accordance with the principles of the Movement. Voluntary Service: It is a voluntary relief movement not prompted in any manner by desire for gain. Unity: There can be only one Red Cross or one Red Crescent Society in any one country. It must be open to all. It must carry on its humanitarian work throughout its territory. Universality: The International Red Cross and Red Crescent Movement, in which all Societies have equal status and share equal responsibilities and duties in helping each other, is worldwide. The Oxford Chapter of ARC is called the Northwest MS Chapter. The 5 initial actions of American Red Cross 1. Immediate assistance 2. Sheltering 3. Feeding 4. Disaster assessment 5. Communications STAGES OF GRIEVING 1. Moving beyond denial and accepting the reality of the loss. 2. Experiencing the pain or the emotional aspects of the loss. 3. Adjusting to an environment in which the deceased is missing with every detail of life altered. 4. Emotionally relocating the deceased as a psychological presence or memory and moving on with life. DEFINITIONS 1. Equal Access- everyone should have the same amount of access to certain things; such as, healthcare, education, etc. 2. Cultural Competence- is a set of congruent behaviors, attitudes and policies that come together in a system, agency, or amongst professionals and enables that system, agency or those professionals to work effectively in cross-cultural situations. 3. Mass care- actions taken to protect migrants and other disaster victims from the effects of a disaster. 4. Support services- Psychology Non-health care-related ancillary services-eg, transportation, financial aid, support groups, homemaker services, respite services, and other services 5. Direct services- active service on cases and work with patients as distinguished from staff functions 6. Vicarious trauma- typically refers to a counselor who experiences a trauma reaction due to exposure to their client’s traumatic experiences. 7. Compassion fatigue- a symptom caused by overextending one’s capacity for selflessness. 8. Substance abuse- Excessive use of a potentially addictive substance, especially one that may modify body functions, such as alcohol and drugs. 9. Conceptual drift-occurs when the values of hidden variables change over time. That is, there is some unknown context for concept learning and when that context changes, the learned concept may no longer be valid and must be updated or relearned. 10. Prolonged grief- refers to a syndrome consisting of a distinct set of symptoms following the death of a loved one that are so prolonged and intense that they exceed the expectably wide range of individual and cultural variability. 11. Logotherapy- a highly directive existential psychotherapy that emphasizes the importance of meaning in the patient’s life especially as gained through spiritual values. 12. CISD- Critical Incident Stress Debriefing. Developed by Jeffrey Mitchel Very controversial, because it is more likely to cause more harm than help. 13. EMDR- Eye Movement Desensitization and Reprocessing- a type of exposure therapy because patients are asked to imagine a feared or anxiety-producing stimulus as a treatment. Francine Shapiro( 1995) developed EMDR based on the theory that people have an innate tendency to process disturbing life experiences to an “adaptive resolution”. It is controversial within the mental health field, because no one can fully explain why the addition of hand movements might increase efficacy beyond other types of exposure therapy. 14. Psychoeducation- helpers tell receptive individuals about the typical reactions and symptoms experienced by many trauma survivors and inform them about treatment resources. It appears to be one of the least controversial and most recommended early interventions in DMH. 15. Triage- the process of evaluating and sorting victims by immediacy of treatment needed and directing them to immediate or delayed treatment. 16. Social Support- The providing of assistance or comfort to other people to help them cope with a variety of problems. 17. Pragmatic Support- A branch of linguistics concerned with the use of language in social contexts and the ways in which people produce and comprehend meanings through language. 18. Instrumental support- is practical in nature, taking the form of money or help with tasks and chores. Unanswered questions. The % PTSD IN DIRECT SURVIVORS OF DISASTER EVENTS, RESCUE WORKERS, AND IN GENERAL. COGNITIVE ERRORS DEFINITION? (IRRATIONAL THOUGHTS)

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