1. Psychological First Aid for Caregivers of Wounded Veterans Presented by Jim Messina, Ph.D.,

2. Objectives for Program Identify reason why caregivers of wounded Vets might need Psychological First Aid Identify components of Psychological First Aid Identify competencies, skills and strategies needed to provide Psychological First Aid Identify Triage for people needing PFA

3. Why would caregivers need Psychological First Aid? They have experienced a crisis due to the trauma experienced by their love ones They are very confused and caught off guard by this crisis They feel overwhelmed by needing to problem solve all the issues they have to deal with They need help to cope with their fears and worries stemming from their crisis

4. Challenges Caregivers Face Trying to maintain normalcy despite the crisis they are dealing with Repeated exposure to “surreal” life experiences of their wounded loved ones Having to maintain “one’s cool” in face of emotionally difficult and exhausting circumstances Lacking sleep and feeling fatigued Feeling like “no matter what gets done is never enough for my wounded love one”

5. Other Obstacles Faced by Caregivers Facing dilemmas in dealing with issues in care of their loved ones which are not easily resolved by simple responses or answers Being exposed to the raw emotions of their wounded loved ones on a daily basis Feeling frustrated by policies and decisions by the organizations which are dealing with their wounded Vets

6. The signs coming from caregivers of their needing PFA  Wounded ideals and/or cynicism  Feeling unappreciated by wounded loved one  Betrayed by “helping” organizations  Mistrusting everyone around them  Loss of enthusiasm and dimming hope  Neglecting personal safety and physical needs  Excessive sleep difficulties  Inability to concentrate  Symptoms of illness or disease  Excessive use of alcohol, tobacco or drugs

7. What is Psychological First Aid? The practice of providing a compassionate presence to people in crisis who need help because they are feeling stress, resulting from the traumatic situations within which they find themselves

8. Skills and Attitudes to be Effective Providers of Psychological 1 st Aid  Good Listening skills  Patient  Caring attitude  Trustworthy  Approachable  Culturally competent  Empathetic  Non-judgmental approach  Kind  Committed  Flexible  Able to tolerate chaos

9. Why you should know how to provide Psychological First Aid To create a compassionate environment for caregivers to help them build their resilience To assess what caregivers might need at a particular time To provide immediate support to caregivers in stressful situations To create a helping environment which helps caregivers cope in the face of stressful events

10. Psychological First Aid Actions to use with caregivers:  Making a connection with them  Helping them maintain healthy boundaries with one another  Being kind, calm, and compassionate  Meeting their basic needs  Listening to them  Giving realistic assurance to them  Encouraging them to use good coping  Helping them to connect with one another for emotional support

11. Creating a Psychologically Supportive Recovery Environment Providing sound guidance and support in their problem solving personal solutions Creating an open and sharing communications lines with them Demonstrating and encouraging respect for confidentiality Creation of peer support system for mutual support, problem solving, advocacy, fun, rest, and recreation

12. What lessons can be taught through Psychological First Aid? What are the normal reactions to stressful events experienced by caregivers How to be aware of one’s tension and consciously try to relax Encouragement of the use of a buddy system between caregivers Encouraging caregivers to talk with someone they trust and with whom they feel at ease Encourage listening to what caregivers say and think about their daily stressors

13. Self-Help Psychological First Aid Strategies:  Use one of the following strategies to express your feelings on a daily basis: 1.Keep a journal about your feelings about what you experience as you handle this process 2.Use painting or drawing art projects which help you get out the stress and anxiety faced in your care giving process 3.Playing or listen to music to get out the stress and anxiety you face 4.Conduct a weekly or daily “debriefing” session with fellow caregivers to “tell your stories” about the stressors experienced in your process of supporting your loved ones

14. Triage to determine if Psychological First Aid is not enough! If a caregiver begins to show signs of physical and mental fatigue where compassionate presence is not enough! If a caregiver shows signs of excessive self- medicating If a caregiver has frequently witnessed death of the loved ones of fellow caregivers

15. Immediately refer Caregivers for Outside Professional Help If in triage you recognize that PFA is not enough refer out especially if you witness the caregiver: 1.Threatens to harm or kill self or others 2.Cannot be calmed after PFA attempts to comfort and respond to requests and/or needs 3.Behaves erratically and exhibits questionable judgment, because of possible influence of alcohol or drugs 4.Acts confused and disoriented, saying or doing things that do not make sense in the context of the situation and that may result in harm to self or others

16. Can You Help Caregivers of Wounded Vets? Through the use of Psychological First Aid: You create an environment of compassion You show respect for the caregivers You build up caregiver’s capacity to cope with the daily stressors faced You encourage caregivers to be resilient in the face of the trauma, pain, and suffering their loved ones are going through in their recovery process