psychosocial processing - ( critical incident stress debriefing) thelma singson – barrera, rn...

PSYCHOSOCIAL PROCESSING -

(CRITICAL INCIDENT STRESS DEBRIEFING)

Thelma Singson – Barrera, RNPsychosocial Care Specialist

PSYCHOSOCIAL PROCESSING

A PROCESS USED BY A MENTAL HEALTH PROFESSIONAL OR BY A HEALTH CARE PROVIDER TO ASSIST PEOPLE IN CRISIS & TO TRANSFORM THESE VICTIMS OF CRISIS INTO SURVIVORS

THELMA S. BARRERA, RN

A direct PSP intervention for individuals or groups of individuals aimed at:

Helping them reestablish equilibrium & harmony after the disaster;

Regaining personal control


CRITICAL INCIDENT

Any event causing unusually strong or overwhelming emotional reactions which have the potential to interfere with work during the event or thereafter in the majority of those exposed.


PSP – (CISD) A tool used by crisis workers, for the

victims to deal positively with the severe emotional impact of crisis, provide education about current & anticipated stress responses and information about stress management.

Used in identifying commonality & differences in the participants’ reactions

A Phase in Crisis Management


PSP is….. A group session allowing

the ventilation and sharing of experiences, feelings, and reactions during the critical incident.


PSP – Useful in Providing

1. Ventilation of Intense Emotion

2. Exploration of symbolic meaning of the event to those exposed

3. Group support under catastrophic conditions

4. Initiation of the grief process within a supportive environment

5. Reduction of the Fallacy of Uniqueness – that the participant is alone in his feelings

PSP – Useful in Providing (cont’d)

6. Reassurance that intense emotions under catastrophic conditions are normal

7. Preparation for the possibility of the development of a variety (Emotional, Cognitive, Behavioral, Physical, Spiritual) symptoms in the aftermath of a serious crisis


8. Education regarding normal and abnormal stress response syndrome and management

9. Encouragement for continued group support and/or professional assistance


Mass Casualty Incident

1. Ozone disco disaster2. Lung Center Fire3. Payatas tragedy 4. Earthquake of 19905. Mt. Pinatubo eruption in 19916. Armed Conflict in Mindanao 7. Rizal day bombing (Series of

bombings)8. Quezon Disaster (Typhoon)9. Landslide in Guinsaugon, Leyte10.Wowowee stampede

TARGET POPULATION

NOMAL PERSONS

who are capable of functioning effectively but due to Crisis, they show signs of emotional stress


PURPOSES Share Experience Determine how

C.I. Affects & responses to Stress

Identify Coping Styles

Develop Contingency plans


DEBRIEFING

(J. Mitchell model)

PSYCHOSOCIAL PROCESSING(Based on the TRAUMA

Framework)

Introduction RE-ESTABLISHMENT OF SAFETY

Sharing of Facts & Feelings

TELLING & RETELLINGFINDING COMMONALITY

Coping with Stress RECONNECTION

Contingency Plans ORGANIZING FOR COMMUNITY ACTION

Impressions/ Evaluation

PARTS OF PSP INTRODUCTION

FACTS & FEELINGS

STRESS RESPONSES

COPING STYLES

CONTINGENCY PLANS

INTRODUCTION

SELF PARTICIPANTS DEFINITION OF TERMS

PSP Critical Incident Target population Guidelines: Confidentiality, Non-

judgmental, Respect, No Right/Wrong answer, Openness


SHARING OF FACTS & FEELINGS

EXPERIENCE FEELINGS then…. FEELINGS now…. MEANING OF

CRISIS - differences

- commonality - universality* STRETCH BREAK


“Ano ang nangyari? Ano ang mga naramdaman/ naisip mo noon?”

“Kumusta ka na ngayon?”“Ano ang tingin mo sa mga nangyaring yun sa iyo? Ano ang naging kahulugan nun sa iyo?”

Physical

Emotional

Cognitive

Behavioral

Spiritual

Stress Responses


PHYSICAL RESPONSES

Headache Dizziness, faintness Tightness in the

throat/Stomach Chest pains Pounding Heart,

Shortness of Breath GUT reactions

(Diarrhea/Constipation)

Allergies Muscle tensions, Cramps


PHYSICAL RESPONSES

Loss of Energy/ Restlessness

Overactivity Increase

Perspiration Rapid Pulse Extended Fatigue Feeling tired, Drained Frequent Physical

ailments

EMOTIONAL RESPONSES

Fear Shock & denial Anger & frustration Bargaining/

Remorse or Guilt Depression Acceptance/

Resignation/ Helplessness


COGNITIVE RESPONSES Disbelief Confusion Inability/difficulty to

concentrate Absentmindedness Racing thoughts Preoccupation Difficulty in making

simple decisions


COGNITIVE RESPONSE Paranoia/

Suspiciousness Reluctance to begin projects Feeling of

Overload Problems with

prioritizingTHELMA S. BARRERA, RN

BEHAVIORAL RESPONSE

Sleep disturbance Appetite disturbance (Loss of appetite/

Overeating) Increased Smoking, Use of

Alcohol/ Medications Avoidance Behavior Crying/ Inability to talk Restlessness/

Overactivity THELMA S. BARRERA, RN

BEHAVIORAL RESPONSES Uncalled for

Aggressiveness, Irritability

Accident Prone Nervous tics/

mannerisms Absenteeism Withdrawal


SPIRITUAL RESPONSES

Declining investment in others

Doubt of value system/ religious beliefs

Questioning major life areas (profession, employment, etc)

Self pre-occupation Disillusionment


SPIRITUAL RESPONSES Blaming God for what

happened” Kasalanan ng Diyos”

Attributing the disaster to God “Parusa ng Diyos”

Resignation/ Acceptance “Bahala na ang Diyos/Ipasa-Diyos na lang”

Directing one’s anger to God “Walang Diyos/ Anong klaseng Diyos Ka?”


COPING STYLES

What they have done to cope?

Praying - universal coping


POSITIVE & NEGATIVE COPING STYLES

“Ano ang mga ginawa mo nun? Pano mo nakayanan?”

COMMON COPING STRATEGIES

PRAY

MASSAGE

ANALYSE IT

HUGS

MEDITATE WORK

SEX GET HELP

CRY

ESCAPE

SLEEPIGNORE IT

SMOKE

SHOP

SHOP

HIKE

DRINK

SPORTS

SHARE IT

SIGHTSEE EAT

WALK JOG

LAUGH

MEDITATE

MUSIC

WARM B

ATH

CONFRONT IT

EXERCISE

ACCEPT IT


Individual-family-community

CONTINGENCY PLANNINGOrganizing for Community

ActionAno ang balak mong gawin ngayon?

Ano ang mga plano mo sa hinaharap?(Pananaw sa kinabukasan)

CLOSING THE SESSION

Can be done in several ways: Ask participants to say a word or two

of support/ comfort addressed to the group

Meditation/ relaxation exercise A song

SPECIAL CLIENTS


Drawings of children have an assessing and helping value.

By asking the child to draw and later allowing her to talk about his art, one can learn his inner world – his needs, fears, joys, apprehensions.

His art is also a graphic representation of the child’s experience.

Clay, sand, stick can also be used to represent what the child wants to express and share.

Feelings are assigned to different colorsFeelings are assigned to different colors Children can use the colors Children can use the colors to express to express

their feelingstheir feelings as they color their drawings. as they color their drawings. Processing is more important as each child Processing is more important as each child

shares the drawing and the facilitator is able shares the drawing and the facilitator is able to motivate the child to express verbally to motivate the child to express verbally

Venue for rapport buildingVenue for rapport building Graphic representations of the child’s Graphic representations of the child’s

experience, needs, joys, hopes and experience, needs, joys, hopes and innermost feelings otherwise not expressed innermost feelings otherwise not expressed verballyverbally

Enriches the facilitators’ pool of informationEnriches the facilitators’ pool of informationTHELMA S. BARRERA, RN

RED(ANGER)

GREEN(LONELY)

BLUE(SAD)

YELLOW(HAPPY)

WHITE(NERVOUS)

BLACK(SCARED)

BROWN(BORED)

ORANGE(EXCITED)


Using


• builds rapport• relaxes the children• serves as entry point• medium to convey messages• it is a natural way of expressing needs, feelings•helps children work out their fears


NOTE: These activities are just

avenues for children to narrate or share their experience & express their feelings/ reactions.

To assure them that even extreme reactions are normal, experienced by normal people subjected to an abnormal situations.

PITFALLS THAT YOU CAN PONDER ON TO IMPROVE YOUR CONDUCT OF DEBRIEFING

1. Using untrained member

2. When there is no mental health worker to refer extreme cases

3. Debriefing is not a therapy

4. When there is inadequate facts


5. Inadequate networking/ coordination

6. Poor community approach7. Lack of emphasis on confidentiality8. Inadequate support for debriefers9. Writing notes on the session10. When it is intrusive


11. Lack of input on the part of the debriefer (educational aspect)

12. Role of the debriefer is not clear to the group/ organization/community affected

13. Debriefer is LATE in the session14. When participants are seated

apart15. None or not enough EYE CONTACT


16. When debriefer’s body language seems not to convey concern/warmth/sincerity

17.Late comers/ other disruptions18. Language barrier19. No follow-up/ appropriate referral20. No buddy system/ back up (in case debriefer

becomes highly emotional)

21. Accepting too many groups to be debriefed during the day

STRESS REDUCTION TECHNIQUES

TALK IT OUT ESCAPE FOR A WHILE (change of

environment) WORK OFF YOUR ANGER GIVE IN OCCASIONALLY DO SOMETHING FOR OTHERS TAKE ONE THING AT A TIMEMAKE

YOURSELF “AVAILABLE” SCHEDULE YOUR RECREATION MAKE YOURSELF “AVAILABLE”


Some Suggestions to Handle Stress

Try Physical Activity

Talk to Friends It’s OK to cry Create a quiet

scene Avoid Self

medications Find time for fun

Avoid being alone Check your tasks.

Get organized Reduce time

urgency Know your limits.

Practice acceptance

Take care of yourself. Watch your habits.

ISANDOSENANG “S” – IWAS STRESS

1. SMILE2. SIESTA3. SPORTS4. SOCIALS5. SCHEDULING6. SPEAK TO ME7. SPIRITUALITY


8. SOUNDS & SONGS

9. SELF AWARENESS

10. STRESS DEBRIEFING

11. SENSATION TECHNIQUES

12. SENSIBLE DIET & EXERCISE

psychosocial processing - ( critical incident stress debriefing) thelma singson – barrera, rn...

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