Well, here we are, intervention. Now, some of you will say, well, gee I thought reflective listening was an intervention. You're right. Sometimes just listening to people is helpful. Did you ever notice that you have a problem, you call up a friend, you ventilate, hang the phone up, you didn't change anything, but you feel better. Sometimes, all people need is an ear, a non-judgemental ear, but sometimes, people need more. Based upon assessment and prioritization of needs, an acute intervention is implemented. It's designed to attend to basic needs, mitigate acute psychological distress, and if possible, restore acute functional capacity. However, should it be unsuccessful at restoring acute functional capacity, we have other options, later in the model. So, let's reiterate, meet basic needs first. Basic medical and physical needs must be attended to. Once initial basic needs have been met, act to reduce distress, restore capacity, if possible. A lot of you are going to say, how do I do that? It just so happens that the way you restore functional capacity, that seems to work the best, study after study, anecdotal report after anecdotal report. It's not the only the most effective, but oftentimes, the easiest is to enlist social support. Social support, the support of other human beings is the factor most predictive of post-traumatic, and disaster resiliency. A simple structure about how to approach people. Because we don't want you just handing people off, although, if you're inclination was to be thinking as quickly as possible, you say, I know the research, social support is the key. What may be going through your mind is you could ask questions, in terms of, what resources are available? So, how might that sound? Introduce yourself. Explain the purpose of your presence. Simple structure. Keep this in mind, you approach someone, you introduce yourself, you explain the purpose of your presence. Depending on the situation, the next two steps are interchangeable, but it gets back to our emphasis on how important assessment is. Second step, ask what happened. Now, next, you'll see the word paraphrase, we talked a little bit about that in an earlier module. Paraphrasing is where you take someone else's words, turn it into your words, and send it back just to make sure you're hearing the message correctly. So, we ask, what happened? And paraphrase, just the key point. Consistent with our assessment, allowing them to tell the story. We ask about the personal well-being, what's the personal impact been on you? Remember to clarify ambiguous descriptors. Depression. I'm depressed. What does that mean? Now, the person telling you they're depressed, knows what it means, and you probably, know what depression means for you. But, do you know, what depression means for them? That's the key. The same goes for, words like anxiety. Even though, we all think we know what these words mean. Ask, and you ask it very simply. You will say something like, well, you said you were feeling kind of down and depressed. What, what does that really feel like for you? What does that look like? How do you know, you're depressed? Or how do you know, you're anxious? Or you can say, how has your life changed, in light of the fact that you're depressed? You can literally, ask specifically, what are your symptoms of depression? I'm just trying to understand, what you're experiencing, I'm not trying to analyze you, you may quickly add, if you feel uncomfortable asking these types of questions. Once we have the story, and in the back of our mind, we've planted the seed that social support is efficient and effective, and most predictive of post-traumatic and disaster resiliency. We now move on, to different types of interventions, always keeping that social support option available. So, if we look at two types of interventions, you'll see the slide that says, if the person seems psychologically unstable, the first thing you must do is stabilize them, or try to assist in some stabilization of the acute arousal. If you've ever been in an emergency department, you've probably seen people who could have benefited from some assistance at stabilization. What are some specific things you could do? Remove provocative cues the slide says. What does that mean? Well, if two people are arguing, maybe it's a good idea to separate them, and let them talk about things Independently, rather than face to face. If someone is staring at the smoldering remains of what used to be their house, perhaps, it would be good to engage them, so that they are no longer staring directly, over your shoulder at the house. Encourage a task focus for some. What does that mean? One of the things we've learned, especially with first responders, is that give them work to do, and that seems to help them stay stable, it helps resilience. Give people things to do, without a task, some people will simply, languish in memories of what they once had, and the reality of what they've lost. Allow catharsis, allow people to ventilate. Now, admittedly, some people, as they start telling, start telling you the story, will seem to get a little more upset. In most cases, this improves, rather dramatically, but just keep in mind that sometimes telling a stressful story, is accompanied with behavioral reactions that are consistent with stress. Have you ever seen people that were so unstable, agitated that they were about to do something that was quite impulsive, and probably, quite deleterious. Rather than argue, and say, oh, you can't do that, or you shouldn't do that, a more effective strategy might be, to simply delay impulsive actions by saying things like, perhaps, this isn't the best time to think about making major life changes. And sometimes, even distraction, this works particularly, well with children. If people have become stabilized or were, meaning acute arousal is not interfering with their ability to function, they are stable. There's another style of intervention, is to mitigate acute distress, foster improved ability to function. What are some tactics for that? Education, we call it explanatory guidance. People want to know, why did this happen? Sometimes, people want their symptoms normalized. Jim having these reactions, has anyone else ever had reactions like this? And you'll see a deep sigh of relief when people say, you know, we encounter this kind of reaction very frequently, oh, really, oh, thank goodness, I thought I was going crazy. Reassurance, installation of hope, one of the most powerful things we can ever do, is provide hope. The saddest, and oftentimes the most dangerous people on Earth, are the people who've lost hope. Another type of education is anticipatory guidance, I think it's okay, to tell people, by the way, don't expect to sleep the way you've been sleeping. Don't expect to desire intimacy, don't expect to want to be around people, or not want to be around people, just whatever the case may be, some anticipation of what may be coming, in terms of signs and symptoms seems to be helpful for some people, and again, you'll see delay impulsive actions. Stress management techniques, are often useful, I will refer you to any good stress management technique oriented book, which will instruct you in things like deep breathing techniques, or some cues about appropriate nutrition, and avoiding energy drinks, and the like. Problem solving, conflict resolution techniques, are all useful, at least potentially useful, depending on the person, and the situation. Correct misunderstandings, or false information. I once stood in an acute intervention with a person who is suffering post-traumatic stress disorder, and he was particularly, distressed because he truly believed that by virtue of his diagnosis, he was going to murder his spouse. Clearly a misunderstanding, and you breathe that deep sigh of relief, when I said to him, the fact, that you are so concerned about this, tells me that you are the last person on the planet that would ever do it. Reframing, if possible, what does that mean? Well, is the glass half empty, or is the glass half full? Do you know, what the answer is? Yes, it depends on how you view it. The people that focus on what they lost, have a hard time recovering. The people that understand that they had something, is no longer there, but there are opportunities, those are the ones that recover more rapidly. Reframing is just a phrase to say, is there another way of looking at adversity. Within the last 10 years of field, positive psychology in post-traumatic growth has arisen. Some people, will say to themselves, you know, what happened was bad, but it could have been worse. Some people will say, it was bad, but others have it worse than I do. And I've literally, interviewed many people over my career who said, it disrupted the way I thought my life should be unfolding, and what I realize is, as one door closed, another one opened, then it opened the possibilities to a life that I didn't even know existed, that's reframing. And some will say, well, that is the job of the therapist, to help them with that reframing, and largely, you're correct, but you can always plant seeds. What did people do before there were disaster mental health professions? What did people do before, there were therapists, psychiatrists, and psychologist, and social workers? A lot of people who recover from adversity, figured this stuff out for themselves. Reframing is a natural phenomenon that we observed, and then analyze so that we teach it to others. Somehow are related to optimism, perhaps, and we know that optimists tend to be happier, healthier people. And by the way, if you know, an optimist, hang around with them, because it is contagious, but before we end this module on intervention, understand that you cannot fix people's problems. You can assist them, you can get them resources, and again, social support is a single best predictor of resiliency. How many people do you think you can intervene with, during the course of a day, a day in the field, an eight hour, nine hour day in the field? If you say, one, you're missing the boat, you should go to therapy school. We basically say, that the person trained in psychological first aid, should be able to do anywhere from 8 to 15 people, 8 to 15 different interventions a day. And you do not want to be the Pied Piper of Hamelin, so the idea is stabilize, mitigate, those are our operational intervention terms. Stabilize and mitigate. There's one more aspect, however, and that is, what happens when stabilization is not effective, or mitigation is not as effective, as you'd like. There is persistent distress, persistent dysfunction, that this interferes with one's ability to move on, or interferes with one's ability to meet the needs who depend on them. I'm thinking of a mother or a father who have children to take care of, perhaps, or someone who has a key role in the community recovery process, and they cannot function, or I think of the person who simply, cannot take care of themselves. What do you do then? So, we will end here, and resume our discussion.
