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Psychological First Aid: Johns Hopkins Lectures on Rapid Model and Reflective Listening, Apuntes de Psicología

John Hopkins College Psicología

An overview of Psychological First Aid (PFA) as taught by Johns Hopkins University. The lectures cover terms and concepts, the RAPID model, reflective listening and rapport, assessment of needs, and prioritization. PFA is a compassionate and supportive presence designed to mitigate acute distress and assess the need for continued mental health care. The RAPID model includes rapport and reflective listening, prioritization, observation, and stabilization. Reflective listening techniques include active listening, empathy, and rapport building. Assessment of needs involves identifying benign and severe psychological and behavioral reactions, and prioritization focuses on recognizing and prioritizing dysfunctional inclinations and behaviors.

Tipo: Apuntes

2019/2020

Subido el 29/09/2021

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Psychological first aid – Johns Hopkins

Lecture 1: terms and concepts

Psychological first aid: compassionate and supportive presence designed to mitigate acute

distress and assess the need for continued mental health care. It is NOT THERAPY. Its primary

goal is to stabilize and mitigate acute distress.

Severe impairment: interference with the ability to function normally

Lecture 2: Johns Hopkins’ RAPID model

RAPID model

R: rapport and reflective listening. The most important thing I can do is listen, people will tell what they

need.

A: assessment. The ability to tell who might be experiencing acute distress in that moment and who

may not. It is not formulating a diagnosis.

P: prioritization. Who needs help, to who should I respond first? Triage.

I: intervention. What do we do? What can I do now to offer some sense of stabilization, of mitigation of

acute distress?

D: disposition and follow up. How effective was my intervention? What do I do now? Observing the

person, are they able to go to a level of productive function?

PFA is not designed to be a once only intervention.

Lecture 3: reflective listening and rapport

Resilient communities are best built from the inside out. PFA is not only a form of individual crisis

intervention, but a way of building community resilience.

The rapid model begins with establishing rapport (empathy, being syntonized) and employing

techniques that are sometimes called active or reflective listening. The goals are to make a contact,

provide an introduction, establish rapport and use specific active reflective listening techniques to

establish some degree of empathy.

Life skill useful in crisis.

Reflective listening: techniques that make listening more effective, it’s also refers as active listening.

Demonstrate that the person in distress is understood, which conveys trust that often conveys

compliance. It has been successfully applied in counseling, crisis intervention, parent-child

communication, sales and hostage negotiations.

Step-by-step

1. Establishing rapport as quickly as possible, to provide acute assistance.

2. Observe and listen

Vista previa parcial del texto

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Psychological first aid – Johns Hopkins

Lecture 1: terms and concepts  Psychological first aid: compassionate and supportive presence designed to mitigate acute distress and assess the need for continued mental health care. It is NOT THERAPY. Its primary goal is to stabilize and mitigate acute distress.  Severe impairment: interference with the ability to function normally Lecture 2: Johns Hopkins’ RAPID model RAPID model R: rapport and reflective listening. The most important thing I can do is listen, people will tell what they need. A: assessment. The ability to tell who might be experiencing acute distress in that moment and who may not. It is not formulating a diagnosis. P: prioritization. Who needs help, to who should I respond first? Triage. I: intervention. What do we do? What can I do now to offer some sense of stabilization, of mitigation of acute distress? D: disposition and follow up. How effective was my intervention? What do I do now? Observing the person, are they able to go to a level of productive function? PFA is not designed to be a once only intervention. Lecture 3: reflective listening and rapport Resilient communities are best built from the inside out. PFA is not only a form of individual crisis intervention, but a way of building community resilience. The rapid model begins with establishing rapport (empathy, being syntonized) and employing techniques that are sometimes called active or reflective listening. The goals are to make a contact, provide an introduction, establish rapport and use specific active reflective listening techniques to establish some degree of empathy. Life skill useful in crisis. Reflective listening: techniques that make listening more effective, it’s also refers as active listening. Demonstrate that the person in distress is understood, which conveys trust that often conveys compliance. It has been successfully applied in counseling, crisis intervention, parent-child communication, sales and hostage negotiations. Step-by-step

Establishing rapport as quickly as possible, to provide acute assistance.
Observe and listen

Ask well phrased questions that derive a sense of value and participation in the solution for the person in distress. The well phrased questions can also convey a sense of support. It shows that you are interested in who the person is and what happened. a. Close-ended questions: the answer is yes or no. Good for quickly establishing facts b. Open-ended questions: “wh” questions. These are good for filling in details and probing for further information.
Summary paraphrase: take someone else’s words, turn them into your words and send them back, sometimes in the form of a yes or no question. E.g.: “sounds to me like…”, “so, in other words…”, “what you’re saying is…”. The goal is to gather as much information as possible and to establish empathy, to make the person feel he’s being understood. Reflect back the person’s emotional state and/or the most salient content within their message. It’s a good idea to start with the emotional content, especially in tragedies. Lecture 4: how reflective listening works These techniques work by demonstrating a willingness to be present, to listen. They communicate an effort to establish rapport, empathy. They suggest value in what the other person has to say, rather than rushing in. They communicate a desire to assist in problem solving and provide a sense of interpersonal support, which is the single best predictor of resilience. These techniques communicate empathy, the attempt to identify how the other person feels. Remember, empathy leads to understanding, understanding leads to trust, and trust leads to compliance. It’s important to be present with your mind and body when assisting someone, not just showing up. These techniques allow catharsis, they let people vent out, express their frustration, express their sense of grief and loss. Don’t diminish or trivialize people’s concerns in order to make them feel better, validate what they’re saying, what they’re feeling, don’t argue Lecture 5: assessment of needs What happened and how the individual is responding to it, his reaction. Assessment  identifying benign from severe psychological and behavioral reactions. We are trying to find out what the physical and psychological needs are. It allows the survivor to tell us what happened (the context) and what reactions they’ve had. Elicit the person’s physical and psychological status and put that in an event-based context. The intervention is based on the needs of the person in distress. In order to formulate it, I must listen very carefully to the event and the reactions as told by the person in distress. There will be three groups of survivors in the continuum

 Questioning faith  Questioning God’s actions (Theodalitic challenge)  Cessation of faith-related practices  Projecting faith into others Physiological domain  Change in appetite  Change in libido  Psychogenic headaches, muscle aches or spasms  Psychogenic muscle aches or spasms  Decreased immunity  Changes in cardiac and GI function  Dizziness or unconsciousness  Chest pain  Numbness or paralysis  Inability to speak or understand speech Lecture 6: prioritization Prioritization is about which person I should help first, psychological triage. Triage means to pick, select o create a hierarchy, in this case, based on the knowledge we gained from the assessment. The key is to recognize and prioritize dysfunctional inclinations and behaviors. Our attention should focus upon those people and those needs which require emergent help, emphasizing on assisting basic functional capacity. Maslow’s hierarchy of needs: all the steps should be completed.

Physical needs: these should be assessed and taken care of first
Safety
Affection, acceptance and support: seeking interpersonal support in order to achieve security.
Self-esteem
Self-actualization Approaches to triage (after medical and physical needs are met): they are not mutually exclusive; they serve as filters.
Evidence-based: focuses on the acute crisis triad. We are looking for evidence of diminished cognitive capacity (self-defeating, self-injury, loss of future orientation, feelings of helplessness or hopelessness) and functional capacity
Risk-based: relies on the 3 Ds “death, dislocation and disabling”. We focus on the risk factors that increase the risk of psychological distress, disability and impairment. a. Death: we look for people who saw human remains and these imaged seared into their memory, people who thought their experience was a near-death experience. b. Dislocation: is the person separated from interpersonal support, do they have a place to stay, etc. c. Disabling: physical injures that require immediate attention, experiences of peri- traumatic dissociation. Lesson 7: Intervention

Based upon assessment and prioritization of needs, an acute intervention is implemented. This intervention is designed to attend to basic needs, mitigate acute psychological distress, and if possible, restore acute functional capacity.

Approach, explain the purpose of your presence
Ask what happened, paraphrase, ask about the personal wellbeing, clarify ambiguous terms
Meet basic needs: basic physical and medical needs must be attended, stabilize (if the person seems unstable physically or psychologically) by removing provocative cues and encouraging a task focus
Reduce distress: reassurance, installation of hope, stress management techniques, correct misunderstandings or false information, reframe the situation
Restore capacity: enlist social support, look for available resources Lesson 8: Disposition Based upon the evidence that a person can function effectively in the wake of adversity, a decision is then made concerning the need to facilitate access to a higher level of care and, ideally, some form of follow up is attempted. Review the interventions made, see if they worked, if not, what can you do. Lesson 9: Self-care The best way of caring for others is to care for yourself. There should be psychological assistance for first responders. Ask before deployment: reporting when? duration? transportation? where and to whom do I report? authority? malpractice? specific duties? safety? how to handle violence, suicide, homicide, acute psychosis. Consequences of poor self-care: burnout, compassion fatigue, getting sick or injured, substance abuse, risk taking/impulsive actions, can`t function effectively, guilt.  Burnout: slow erosion of psychological, physical resources. The symptoms are procrastination, chronic fatigue, cynicism, chronic lateness, anhedonia, pessimism, sense of a foreshortened future, loss of satisfaction, questioning one’s own faith. This doesn´t happen in a heartbeat, it is an accumulative process over time.  Vicarious trauma: psychological trauma from listening and seeing the trauma of others. It has also been called compassion fatigue. Responders can experience depression, difficulties sleeping, startle, hyper-vigilance, nightmares, anxiety, obsessive thoughts of the trauma, PTSD.  Substance abuse: responders can start using substances trying to stop their “bad or wrong” feelings. The most abused substances are alcohol, energy drinks, antihistamines and illicit drugs.  Guilt: for doing something, for not doing something, survivor guilt. Stress-management techniques: relaxation techniques, breathing techniques, interpersonal support, faith. Focus on what you’re doing well, not on what needs to be done.