I.

Psychological support helps to relieve emotional suffering so that beneficiaries are sooner able to rely on their own resources and cope more successfully with the hardships they face on the road to recovery. Psychological support, then, describes any activity that improves a persons ability to function under the extraordinary level of stress observed in the context of a critical event.
b. Psychological First Aid Psychological First Aid is an evidence-informed1 modular approach to help elderly persons and persons with disabilities in nursing homes, other adults, families, adolescents and children in the immediate aftermath of disaster and terrorism. Principles of Psychological Support Program II. Stress and Coping 1. Define Stress Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance. It refers to the consequence of the failure of an organism human or other animal to respond adequately to mental, emotional, or physical demands, whether actual or imagined. 2. Signs of Traumatic Stress Reaction symptoms for PTSD include re-experiencing the original trauma(s) through flashbacks or nightmares, avoidance of stimuli associated with the trauma, and increased arousal such as difficulty falling or staying asleep, anger, and hypervigilance. Formal diagnostic criteria (both DSM-IV-TR and ICD-10) require that the symptoms last more than one month and cause significant impairment in social, occupational, or other important areas of functioning. Critical incidents produce characteristic sets of psychological and physiological reactions or symptoms (thus the term syndrome) in all people, including emergency service personnel. Typical symptoms of Critical Incident Stress include: Restlessness Irritability Excessive Fatigue Sleep Disturbances Anxiety Startle Reactions Depression Moodiness Muscle Tremors Difficulties Concentrating Nightmares Vomiting Diarrhea Suspiciousness Physical Exhaustion, throbbing headaches, dizziness Emotional Grief, anger, depression, irritability, fear, anxiety, suicide Cognitive Confusion, nightmares, poor concentration, memory loss Behavioural Restlessness, withdrawal from environment,

Psychological Support Program 1. Define the ff.: a. Psychological Support

2.

drug/alcohol abuse, change in appetite, loss of libido 3. Sorrow and Grief a. Common Reaction to Loss Individuals experiencing grief from a loss may choose a variety of ways of expressing

it. No two people will respond to the same loss in the same way. It is important to note that phases of grief exist; however, they do not depict a specific way to respond to loss. Rather, stages of grief reflect a variety of reactions that may surface as an individual makes sense of how this loss affects them. Experiencing and accepting all feelings remains an important part of the healing process.
III. Critical Incident Stress Debriefing 1. Define the ff.: a. Crisis Caplan (1964) initially defined a crisis as occurring when individuals are confronted with problems that cannot be solved. These irresolvable issues result in an increase in tension, signs of anxiety, a subsequent state of emotional unrest, and an inability to function for extended periods. James and Gilliland (2005) define crises as events or situations perceived as intolerably difficult that exceed an individuals available resources and coping mechanisms. b. Critical Incident

A "critical incident" is any event that causes an unusually intense stress reaction. The distress people experience after a critical incident limits their ability to cope, impairs their ability to adjust, and negatively impacts the work environment. Examples of traumatic events that produce such reactions include: A coworkers or students death or serious illness Suicide A violent or threatening incident in the work setting Natural or manmade disaster that affects the workers ability to function in the workplace Critical incidents are traumatic events that cause powerful emotional reactions in people who are exposed to those events. The most stressful of these are line of duty deaths, co-workersuicide, multiple event incidents, delayed intervention and multi-casualty incidents.[9] Every profession can list their own worst case scenarios that can be categorized as criticalincidents. Emergency services organizations, for example, usually list the Terrible Ten.[10] They are:
1. 2. 3. 4. 5. Line of duty deaths Suicide of a colleague Serious work related injury Multi-casualty / disaster / terrorism incidents Events with a high degree of threat to the personnel

6. 7. 8. 9. 10.

Significant events involving children Events in which the victim is known to the personnel Events with excessive media interest Events that are prolonged and end with a negative outcome Any significantly powerful, overwhelming distressing event

c. Critical Incident Stress Debriefing A debriefing is normally done within 72 hours of the incident and gives the

individual or group the opportunity to talk about their experience, how it has affected them, brainstorm coping mechanisms, identify individuals at risk, and inform the individual or group about services available to them in their community. [13] The final step is to follow up with them the day after thedebriefing to ensure that they are safe and coping well or to refer the individual for professional counselling.

Critical Incident Stress Debriefing is a process that prevents or limits the development of post-traumatic stress in people exposed to critical incidents. Professionally conducted debriefings help people cope with, and recover from an incident's aftereffects. CISD enables participants to understand that they are not alone in their reactions to a distressing event, and provides them with an opportunity to discuss their thoughts and feelings in a controlled, safe environment. Optimally, CISD occurs within 24 to 72 hours of an incident. Importance of CISD First, the "debriefer or facilitator" assesses individuals' situational involvement, age, level of development and degree of exposure to the critical incident or event. Consider that different aged individuals, for example, may respond differently based on their developmental understanding of the event (Davis, 1993) . Second, issues surrounding safety and security surface, particularly with children. Feeling safe and secure is of major importance when suddenly and without warning, individuals' lives are shattered by tragedy and loss. Third, ventilation and validation are important to individuals as each, in their own way, needs to discuss their exposure, sensory experiences, thoughts and feelings that are tied to the event. Ventilation and validation are necessary to give the individual an opportunity to emote. Fourth, the debriefer assists the survivor or support personnel in predicting future events. This involves education about and discussion of the possible emotions, reactions and problems that may be experienced after traumatic exposure.

By predicting. preparing and planning for the potential psychological and physical reactions surrounding the stressful critical incident, the debriefer can also help the survivor prepare and plan for the near and long-term future. This may help avert any long-term crisis reactions produced by the initial criticalincident. Fifth, the debriefer should conduct a thorough and systematic review of the physical, emotional, and psychological impact of the critical incident on the individual. The debriefer should carefully listen and evaluate the thoughts, mood, affect, choice of words and perceptions of the critical incident and look for potential clues suggesting problems in terms of managing or coping with the tragic event. Sixth, a sense of closure is needed. Information regarding ongoing support services and resources is provided to survivors. Additionally, assistance with a plan for future action is provided to help "ground" or "anchor" the person during times of high stress following the incident. Seventh, debriefing assists in short-term and long-term recovery as well as the reentry process. A thorough review of the events surrounding the traumatic situation can be advantageous for the healing process to begin. 2. Objectives of CISD The main objectives of CISD are: 1. to prevent, if not to mitigate, the devastating impact of traumatic stress; and, 2. to serve as a mechanism to identify a person in the group who may require further special assistance such as psychotherapy and other services. 3. CISD Ground Rules
Ground Rules A. Absolute confidentiality B. Only people impacted by the traumatic event. No management or supervisory staff should be present. If a supervisory person was part of the traumatic event, consideration should be given to conducting an individual CISD as oppose to a group CISD. In some cases, they might be included but this should be the exception, not the norm. (my wording and perception stated here) C. No comments or criticisms regarding others feelings or reactions (this is not the time to assess performance its about what did happen and how they felt about it) D. Positive, supportive, understanding atmosphere, based on concern E. Active listening F. Providing Structure 4. CISD Outline

5. a. b. 6.

Basic Facilitating Skills Types of Facilitating Skills Guidelines in Improving Facilitating Skills When to Hold Debriefing

Only conduct a debriefing at the request of a respondent after the award is made and the contract is in place. Do not hold a debriefing before the contract is awarded. Sometimes the unsuccessful respondent will try to influence the evaluation process by challenging the evaluation score. Similarly, to get maximum benefit from adebriefing, try not to delay it beyond two weeks after contract award.
7. 8. IV. Crisis 1. How to Identify High Risk Individual Tips for Reducing Stress Intervention / Helping Process Define Counseling

Crisis counseling is brief and focused on reducing stress, providing support and improving coping skills. Purposes of Counseling Crisis intervention has several purposes. It aims to reduce the intensity of an individual's emotional, mental, physical and behavioral reactions to a crisis. Another purpose is to help individuals return to their level of functioning before the crisis. Functioning may be improved above and beyond this by developing new coping skills and eliminating ineffective ways of coping, such as withdrawal, isolation, and substance abuse. In this way, the individual is better equipped to cope with future difficulties. Through talking about what happened, and the feelings about what happened, while developing ways to cope and solve problems,crisis intervention aims to assist the individual in recovering from

the crisis and to prevent serious long-term problems from developing. Research documents positive outcomes for crisis intervention, such as decreased distress and improved problem solving.
2. Counselors Needs a. Communication Skills b. Self-Awareness c. Confidentiality 3. Difficult Moments in Counseling 4. Define the ff.: a. Interview b. Referral Keeping a referral and resource list is an important aspect of crisis work. The effective crisis responder researches and maintains information regarding agencies and programs in a clients community that can be sources of future help. If time allows, it might be helpful to visit these agencies before referring a client to them. Such visits increase the responders familiarity with the services of the referral resources. Knowing whether they have a waiting list, sliding scale of payment, or whether they give priority to crisis victims is important additional information. Once a list is generated, make sure that phone numbers, addresses, and names of contact persons are constantly updated. It can be frustrating for clients in crisis to call a disconnected number for help. Information about potential resources should be clearly printed on a card and carefully reviewed with clients. Clients are better informed if they have some knowledge about the process involved before services are sought. Remember, one of the challenges for people in crisis is the ability to concentrate and remain focused; short-term memory can often be seriously impaired. The crisis responder should have clients review their next steps before departing. It is a good idea to call clients after a few days to get an update on how they are feeling. 5. Principles of Interview 6. When, How and Where to Refer 7. Basic Principle of Referral 8. Identifying and Mobilizing Resources Helping the Helpers Roles of Helpers Stress in the lives of Helpers Warning signs of BURNOUT Methods of caring for the Psychological Needs of Helpers Self-Help Techniques

V. 1. 2. 3. 4. 5.