Randy Beaton

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Published on March 8, 2008

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Coping with Trauma and Psychological First Aid for Disaster Survivors: Suggestions for American Indians:  Coping with Trauma and Psychological First Aid for Disaster Survivors: Suggestions for American Indians EMERGENCY PREPAREDNESS CONFERENCE August 9, 2007 Portland, Oregon Research Professor Schools of Nursing and Public Health and Community Medicine :  Research Professor Schools of Nursing and Public Health and Community Medicine Faculty Northwest Center for Public Health Practice University of Washington Randal Beaton, PhD, EMT Funding Support:  Funding Support CDC/ASPH Centers for Public Health Preparedness Cooperative Agreement U09/CCU024247-03. (J. Thompson, PI) HRSA Advanced Nurse Education Training grant #1 D09HP08334-01-00- Disaster & Environmental Health Nursing (R. Beaton, PI) Special Thanks :  Special Thanks Linda Frizzell, E. Cherokee & Lakota June Strickland, Cherokee Ticey Casey, Siletz Iris HeavyRunner PrettyPaint, Blackfeet Jay LaPlante, Blackfeet National Child Traumatic Stress Network and the National Center for PTSD Learner Objectives :  Learner Objectives To identify various ways of coping with traumatic events including disasters To examine some existing coping strategies in American Indians as well as other potential coping strategies To analyze Psychological First Aid as a potential intervention for American Indian individuals and tribes in the aftermath of trauma & disaster Traumatic Events:  Traumatic Events Traumatic stressors are events that challenge our existing ways of making sense out of our own reactions, our perceptions of others and challenge our “fair world assumptions”: The world is safe, The world is predictable and “Bad things do not happen to good people” Traumata can evoke fear, uncertainty (can I cope?), helplessness & hopelessness Types of Traumatic Events:  Types of Traumatic Events Time-limited single events- such as a motor vehicle accident or sexual assault Sequential stressors which can have a cumulative effect– such as the exposures that firefighters experience in line of duty Complex– long lasting exposures to danger such as war zone combat or intrafamilial child abuse Disaster Magnitude:  Disaster Magnitude Crisis—almost routine. Usually can be handled by family & support system; e.g., job loss Emergency—may require 911 response or visit to hospital; e.g. injury or acute illness Disaster—may require resources from outside community (FEMA definition) Catastrophe—Poster child: “Katrina” Cataclysmic Events:  Cataclysmic Events These are events or a series of events that are of such a magnitude, scope and severity that “disaster” is not really the appropriate term. For example: the “Historical Trauma” of American Indians which occurred over a span of 500 years resulting in collective emotional injury over life spans & across generations (Yellow Horse Brave Heart & DeBruyn, 1998) Types of Disasters- (From Beaton & Bridges, “Disaster Nursing”,in press):  Types of Disasters- (From Beaton & Bridges, “Disaster Nursing”,in press) Mental Health: Are we ready? Ready for what? :  Mental Health: Are we ready? Ready for what? Coping with Traumatic Events:  Coping with Traumatic Events Obviously depends on the nature, type & duration of the trauma, threat or disaster As examples, marriage, divorce & death of a spouse are all major life events that challenge our ability to cope. Disaster Exemplar(s) Compare and contrast the Exxon Valdez Oil Spill/ Ecological Disaster with the Great Alaskan Earthquake/Tsunami of 1964. The Great Alaskan Earthquake:  The Great Alaskan Earthquake On Mar. 27, 1964 (5:36 pm Alaska standard time) a 9.2 magnitude earthquake struck Alaska Epicenter was North Prince William Sound Earthquake lasted 4-5 minutes and spawned a deadly tsunami Slide14:  The six-story Four Seasons apartment building in Anchorage was completely destroyed. Slide15:  Tsunami – Mechanism Slide16:  Close-up view of tsunami damage along the waterfront at Kodiak. Disaster Impact(s):  Disaster Impact(s) Resulted in 115 fatalities in Alaska– 106 due to the tsunami The tsunami caused damage and casualties along the Western Canadian, Washington and Oregon Coasts $84 million in property damage in Alaska alone The Exxon Valdez Oil Spill:  The Exxon Valdez Oil Spill On March 24, 1989 just after midnight the Exxon Valdez oil tanker struck a reef in Prince William Sound and eventually leaked 10.8 million gallons The oil covered large areas of the surface of Prince William Sound and drifted with the currents & winds onto the rocky shores of many of the beaches in the region Slide19:  Map of the Exxon Valdez Oil Spill Slide20:  Exxon Valdez tanker circled with containment boom. Slide21:  Dead murrelet. Slide22:  Oiled sea otter on shore. Ecological Disaster Impact(s):  Ecological Disaster Impact(s) No human casualties Animal deaths included an estimated 250,000-500,000 seabirds, 2,800-5,000 sea otters, 300 harbor seal, 250 bald eagles and 22 orca whales Impact on fishery, fishing, seafood, sports fisheries & tourism industries- economic and lifestyle impacts in Alaska Natives Protracted litigation Coping may also be viewed from a variety of perspectives:  Coping may also be viewed from a variety of perspectives Individual Family Community Tribal In many cases trauma and disaster impact(s) exceed the coping capability of individuals and families and require community and tribal intervention and structures Coping Strategies: Defined :  Coping Strategies: Defined Coping strategies refer to specific efforts– social, behavioral, cognitive and emotional– that people (and families/ communities/tribes) employ to master, tolerate or minimize threats associated with stressful events. (after Taylor et al, 2002) Problem vs. Emotion Focusing Coping:  Problem vs. Emotion Focusing Coping Problem-focused coping- trying to figure out what the problem is, addressing the root cause of the problem and trying to resolve it Emotion-focused coping- engaging in emotional discharge; for example crying, yelling, venting; e.g., “rants” Tiet et al (2006) Approach & Avoidance Coping:  Approach & Avoidance Coping Approach coping— making plans, confronting difficult situations, trying hard to work things out & focusing on the positive Avoidance coping— Social withdrawal, trying to avoid and/or not think about the problem, avoid confrontations and conflict & even emotional numbing (avoiding one’s feelings) Adaptive vs. Maladaptive Coping:  Adaptive vs. Maladaptive Coping Adaptive coping: effective coping which protects or buffers us against stress and helps reduce tension; e.g. exercise may be an adaptive coping strategy even though it does not solve “the problem” Maladaptive coping: ineffective coping which neither reduces stress nor resolves the situation. (Beaton & Murphy, 2002) Empirical investigation of coping in Puget Sound Firefighters (Beaton et al, 1999):  Empirical investigation of coping in Puget Sound Firefighters (Beaton et al, 1999) H. Simpson Very difficult to measure “sense of humor” in fire service The Importance of Stressor Appraisal & “Self-talk” :  The Importance of Stressor Appraisal & “Self-talk” How we label our perceptions can influence our response. Little difference in stress physiology between “excitement” and “anxiety” Paramedics who label a task or event as a “challenge” as opposed to a “stressor” have lower blood pressure readings Most people, most of the time are resilient- and say to themselves: “I know I can handle this challenge”=self-efficacy Slide31:  Coping & Self-talk in Apollo Astronauts Little empirical data are available to guide recommendations for coping with trauma in American Indians:  Little empirical data are available to guide recommendations for coping with trauma in American Indians Importance of tribal cultural traditions in building community resilience Importance of ceremony and ritual in coping- the drums, the colors Importance of tribal connectedness and cohesion through song, dance Importance of native art as therapy Skokomish Tribe:  Skokomish Tribe Importance of nature and resources: Siletz hatchery:  Importance of nature and resources: Siletz hatchery JUNE STRICKLAND, RN, PhD OBSERVATIONS:  JUNE STRICKLAND, RN, PhD OBSERVATIONS Water is very important to coastal people- to go to and walk by the water Plateau people drink water and wash face with water under stress Prayer songs sung to one’s self or others Prayer is generally a part of the way for all Families may use talking circles in crisis Youth talk of going to the mountains Benchmark Mountain 9/01/06:  Benchmark Mountain 9/01/06 Sacred Places: Siletz Medicine Rock:  Sacred Places: Siletz Medicine Rock Canoe Journey :  Canoe Journey Since 1997 the Canoe Journey has been hosted by different tribes each summer and is now attended by 6,000 people daily during the celebration and potlatch Incorporates safety, strength, traditional regalia, language, song, plants & food. The canoe journey gives meaning & is a unifying force for Indian Nations & culture Skokomish Tribe:  Skokomish Tribe Tribal healers & elders:  Tribal healers & elders Medicine persons and tribal elders possess Wisdom and compassion Sacred knowledge Leadership in times of stress; Nisqually earthquake example Contrast with non-Indian culture: youth & celebrity worship Iris HeavyRunner PrettyPaint’s Worldview Philosophy(2003)© :  Iris HeavyRunner PrettyPaint’s Worldview Philosophy(2003)© Used with permission of Iris HeavyRunner PrettyPaint Lens through which we learn to nurture, protect and dream Traditional Native Culture & Resilience (from HeavyRunner PrettyPaint & Morris, 1997):  Traditional Native Culture & Resilience (from HeavyRunner PrettyPaint & Morris, 1997) Sacredness of all creation Sharing material possessions Cooperation vs. competition Harmony & balance- maintained by not imposing on an individual’s rights & beliefs Humor Oral traditions Gathering of Native Americans (GONA) -LaPlante:  Gathering of Native Americans (GONA) -LaPlante Four day gathering of Native Americans who want to become change agents & leaders GONA is a safe place for communities to share, heal and plan for action GONA offers hope, encouragement, a framework and presents a prevention model based on traditional native cultural values Conceptual Model of Nursing in Native American Culture (Struthers & Lowe, 2003):  Conceptual Model of Nursing in Native American Culture (Struthers & Lowe, 2003) Holistic model that incorporates a number of elements in nursing care with American Indians including: Trust Respect Spirituality Traditions and Connections Additional Coping Strategies:  Additional Coping Strategies In addition to American Indian customs, traditions and tribal ways of coping These coping strategies may or may not be culturally appropriate for some or most American Indians—Western approaches to care have not been embraced by American Indian populations and most forms of mental health treatment have yielded disappointing results Think of these additional coping strategies as a MENU– pick and choose ones that may work for you, your family & your tribe Preventive Approaches to Coping with Disaster:  Preventive Approaches to Coping with Disaster Disaster planning- everybody and every family needs a family disaster plan (in my opinion) Washington State Disaster Preparedness Handbook is available @ http://www.metrokc.gov/prepare/docs/PR_WaDisPrepHandbk2005.pdf This includes concrete suggestions for helping children adjust after a disaster Helping Children After a Disaster (From Washington DOH Disaster Preparedness Handbook, 2005):  Helping Children After a Disaster (From Washington DOH Disaster Preparedness Handbook, 2005) Talk with the children about how they are feeling. Assure them that it’s OK to have those feelings. Children should not be expected to be brave or tough. Tell them it’s OK to cry. Don’t give children more information than they can handle about this disaster. Other Preventive Approaches to Foster Individual & Community Resilience:  Other Preventive Approaches to Foster Individual & Community Resilience Survival and Red Cross Training– learn CRP and basic survival skills (if you don’t already know them) Join a community emergency response team such as CERT. UW CERT webpage site http://www.washington.edu/admin/business/oem/cer/ CERT for Tribal Nations:  CERT for Tribal Nations In Nov. of 2002 members of five Midwest tribes– the Kickapoo Tribe in Kansas, the Omaha Tribe of Nebraska, the Prairie Band of the Potawatomi Nation, the Sac and Fox Nation of Missouri and the Winnebago Tribe of Nebraska– participated in a CERT course supported by a FEMA grant Preventative Approaches to Coping with Trauma & Disaster:  Preventative Approaches to Coping with Trauma & Disaster An ounce of prevention is worth a ton of cure. Strategies that can prevent a crisis or emergency or mitigation strategies that minimize the impact of a disaster are the most effective in terms of avoiding the harmful mental health effects of trauma Personal Strategies to Foster Resilience in the Aftermath of Trauma and Disaster (Adapted From APA, 2002 Resilience Fact Sheets):  Personal Strategies to Foster Resilience in the Aftermath of Trauma and Disaster (Adapted From APA, 2002 Resilience Fact Sheets) Avoid viewing event as insurmountable– “I will recover, my family will recover, my tribe will survive and thrive” Rely on connections with family, friends, elders and tribal leaders Accept that change and loss are part of living Fostering resilience (continued):  Fostering resilience (continued) Avoid withdrawal coping strategies- engage in problem solving and take action Potential for posttraumatic growth- trauma can actually lead to opportunities for growth and self-discovery (Tedeschi et al, 1998) Meditation & spiritual practices Maintain a hopeful outlook. There is very, very little downside to optimism Some “Unrealistic” Optimism may actually be adaptive:  Some “Unrealistic” Optimism may actually be adaptive 50% of marriages fail within five years (perhaps even higher rates of divorce in American Indians), yet marriage remains very popular 95% of cancer survivors think they are “doing better than most” Key is to avoid “catastrophizing”– that is, assuming the worst (and even worse) Slide54:  Psychological First Aid (PFA) National Child Traumatic Stress Network www.NCTSN.org National Center for PTSD www.ncptsd.va.gov Basics of Psychological First Aid:  Basics of Psychological First Aid What is Psychological First Aid? An evidence-informed approach to assist children, adolescents, adults, and families in the immediate aftermath of disaster and terrorism This approach to disaster survivors’ mental health has been adopted by: American Red Cross Medical Reserve Corps Community Emergency Response Teams (CERT) Among others Slide56:  “You’ve lost your home, your job and your pet–how do you feel about that?” Sigmund Freud Some Basics :  Some Basics Expect normal recovery Assume survivors are competent Recognize survivor strengths Promote resilience Offer practice solutions Five Empirically-Supported Early Intervention Principles:  Five Empirically-Supported Early Intervention Principles Promotion of Psychological Sense of Safety & Comfort :  Promotion of Psychological Sense of Safety & Comfort Reduces biological aspects of traumatic stress reactions Positively affects thoughts that inhibit recovery Promotion of Calming :  Promotion of Calming Reduces anxiety, high arousal, numbing, or strong emotions Supports better: Sleep Eating Decision-making Performance of life tasks May reduce the probability of long-term psychological difficulties Promotion of Self-Efficacy :  Promotion of Self-Efficacy Encourage disaster survivors to play an active role in their own recovery Increases people’s beliefs about their capabilities Increases self-control of thought, emotions, and behavior Promotion of Connectedness :  Promotion of Connectedness Related to better emotional well-being and recovery Provides opportunities for: Information about resources Practical problem-solving Emotional understanding Sharing of experiences Normalization of reactions and experiences Sharing of ways of coping Instilling Hope :  Instilling Hope Favorable outcomes are associated with: Optimism Positive expectancy A feeling of confidence in life and/or self Strong faith-based beliefs Summary and Conclusions– Coping with Trauma and Disaster:  American Indian tribes and peoples have 500 years of experience coping with trauma Historical trauma has been considered a “risk factor” for adverse trauma outcomes but it may also serve as a source of strength & resolve Effective ways of coping depend on the cultural context, the nature, intensity & duration of the trauma or disaster Summary and Conclusions– Coping with Trauma and Disaster Summary and Conclusions– Coping with Trauma and Disaster:  Summary and Conclusions– Coping with Trauma and Disaster American Indian tribes and individuals possess a number of protective traditions, rituals and ceremonies as well as other cultural sources of resilience which are consistent with the principles and actions of Psychological First Aid (PFA) including: - connectedness - hope and - self-efficacy Resilience in American Indian Tribes and Individuals in the Face of Trauma & Adversity:  Resilience in American Indian Tribes and Individuals in the Face of Trauma & Adversity “Resilience is not a new concept to our (American Indian) people. It is an ancient principle of a philosophy of American Indian life It teaches: “stand strong…try hard…and never give up” Iris HeavyRunner PrettyPaint, 2006 University of Montana

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