1. Engaging Families and Communities in Psychological First Aid: Advancing Practice in Multidisciplinary Fieldwork Tai J. Mendenhall, Ph.D., LMFT University of Minnesota Jerica M. Berge, Ph.D., LMFT University of Minnesota Medical School Collaborative Family Healthcare Association 15 th Annual Conference October 10-12, 2013 Broomfield, Colorado U.S.A. Session #G1a Friday, October 11, 2013

2. Faculty Disclosure We have not had any relevant financial relationships during the past 12 months.

3. Objectives Participants will: Communicate familiarity with the nature, content, and conduct of critical incident / trauma response fieldwork. Learn key strategies for interdisciplinary, systems- informed and community-based interventions with individuals, couples, and families within acute phases of fieldwork.

4. Objectives, con’t Participants will: Learn key strategies for interdisciplinary, systems- informed and community-based interventions with individuals, couples, and families within long-terms phases of fieldwork. Learn about common challenges in trauma response teams associated with inter- professional boundaries, interpersonal boundaries, and intra/inter-agency collaboration.

5. Trauma-response Teams Interdisciplinary by Nature – Multidisciplinary representation e.g., emergency physicians, psychologists, family physicians, marriage and family therapists – Professional and non-professional representation e.g., MD, Ph.D., MA, BS, no-professional degree (lay persons)

6. Trauma-response Teams (con’t) Mobilized in-response to large- and small-scale disasters and crises – Man-made disasters – Natural disasters Specialized Training is Requisite – Medical Reserve Corps – Red Cross – International Critical Incident Stress Foundation – Green Cross / Traumatology Institute – FEMA – Other…

7. What do we see? “Being there” is vastly different than media portrayals – and thereby difficult to wholly convey – What we see (visually) – What we hear – What we feel (physically, emotionally) – What we taste – What we smell

8. Human-Caused Disasters Terrorism School-shootings Gang-related violence Hospital crises / disasters Structural failures Technology failures Other

9. Natural Disasters Tsunamis Hurricanes Tornadoes Earthquakes Mudslides Avalanches Other

10. Systems Thinking in Interdisciplinary Trauma Work “Systems Thinking” – Broadly defined Biological Systems Psychological Systems Relational / Social Systems Eco-Systems

11. Inherent Challenges in Interdisciplinary Fieldwork Clinical Challenges – Meaning-making – Ambiguous loss – Increased appreciation for loved-ones Practice-Related Challenges – Scope of practice – Cross-disciplinary tensions – Interpersonal boundaries and dual-relationships – Compassion fatigue

12. Clinical Challenges Meaning-Making – Answering the question, “Why did this happen?” – Dealing with “shattered assumptions” Individual Meaning-making – Psychological responses to disaster Co-created Meaning-Making – Alignments vs. Conflicts

13. Clinical Challenges, con’t Ambiguous Loss – Psychological Presence / Physical Absence – Psychological Absence / Physical Presence

14. Clinical Challenges, con’t Increased Appreciation for Loved-Ones – Survivor guilt – Life review

15. Practice-Related Challenges Scope of Practice – Should a physician provide mental health services if there is another member on the team whose primary professional identity is that of a therapist? – Can a psychologist assist in the drawing up of medications or vaccinations? – Can a marriage and family therapist assist in cleaning a wound?

16. Practice-Related Challenges, con’t Scope of Practice, con’t – The overlap(s) of roles played by trauma team members is relatively broad. – While some situations call for a distinct skill set and training background, many of the roles assumed by trauma team members do not. – Maintaining flexibility in your role(s) – whatever this includes – is essential to the conduct of effective fieldwork.

17. Practice-related challenges, con’t Cross-disciplinary Tensions – Competitions or conflict between providers – Especially noticeable in everyday-practice between “sibling disciplines”

18. Practice-related challenges, con’t Cross-disciplinary Tensions, con’t – Providers are reminded that patients do not generally care about academic / disciplinary credentials – Turf battles are generally less visible in fieldwork than as compared to everyday practice

19. Practice-related Challenges, con’t Interpersonal Boundaries and Dual Relationships – Unlike everyday practice, fieldwork oftentimes presents situations that make the maintenance of baseline boundaries more difficult. Crowded living quarters Locker-room facilities Team debriefings Providing “care” vs. “support” for friends /colleagues

20. Practice-related Challenges, con’t Boundaries and Dual Relationships, con’t – Straightforward and frank conversations with colleagues, supervisors, and students – Arrange team members’ living quarters by professional rank and sex – Bathroom/shower facilities available 24/7 – Supervisors attend to team members’ psychology and remove from field, refer, etc. as indicated

21. Practice-Related Challenges, con’t Compassion Fatigue – Common themes relate to breaking-down processes in which our physical, emotional, and even spiritual resources are depleted – Signs/Symptoms are extant across multiple systems levels – Higher risk for ethical violations

22. Practice-Related Challenges, con’t Compassion Fatigue, con’t – Deployments are generally ≤ 2 weeks – Sequential teams sent to a single area usually overlap by a couple of days to effectively and smoothly transition one team to another – While in the field, team members work for only 3-5 consecutive days – followed by 1-2 days of rest. – Even in the contexts of working long hours, we encourage our team members to think about, and take care of, their own health

23. Practice-Related Challenges, con’t Compassion Fatigue, con’t – Take time for yourself – Consult with colleagues – Think about, and take care of, your own health – Be social – Be intentional about your personal relationships – If you are hurting, seek help

24. Contact Information Tai J. Mendenhall, Ph.D., LMFT, CFT University of Minnesota Family Social Science 290 McNeal Hall; 1985 Buford Ave. Saint Paul, MN 55108 Office: 612-624-3138 Email: mend0009@umn.edu

25. Learning Assessment Audience Question & Answer

26. Session Evaluation Please complete and return the evaluation form to the classroom monitor before leaving this session. Thank you!