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Engaging Families and Communities in
Psychological First Aid:Advancing Practice in Multidisciplinary Fieldwork
Tai J. Mendenhall, Ph.D., LMFTUniversity of Minnesota
Jerica M. Berge, Ph.D., LMFTUniversity of Minnesota Medical School
Collaborative Family Healthcare Association 15th Annual ConferenceOctober 10-12, 2013 Broomfield, Colorado U.S.A.
Session #G1a Friday, October 11, 2013
Faculty Disclosure
We have not had any relevant financial relationships during the past 12 months.
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.
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.
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)
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…
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
Human-Caused Disasters
• Terrorism• School-shootings• Gang-related violence• Hospital crises / disasters• Structural failures• Technology failures• Other
Natural Disasters
• Tsunamis• Hurricanes• Tornadoes• Earthquakes• Mudslides• Avalanches• Other
Systems Thinking inInterdisciplinary Trauma Work
• “Systems Thinking”– Broadly defined
• Biological Systems• Psychological Systems• Relational / Social Systems• Eco-Systems
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
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
Clinical Challenges, con’t
• Ambiguous Loss– Psychological Presence / Physical Absence– Psychological Absence / Physical Presence
Clinical Challenges, con’t
• Increased Appreciation for Loved-Ones– Survivor guilt– Life review
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?
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.
Practice-related challenges, con’t
• Cross-disciplinary Tensions– Competitions or conflict between providers– Especially noticeable in everyday-practice
between “sibling disciplines”
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
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
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
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
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
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
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: [email protected]
Learning Assessment
Audience Question & Answer
Session Evaluation
Please complete and return theevaluation form to the classroom monitor
before leaving this session.
Thank you!