Identify Needs & Concerns

Identify Needs and Concerns (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 57-62)

Goal

Identify the person’s immediate needs and concerns to tailor future helping

“You should be flexible in providing Psychological First Aid, and should adapt interventions for specific individuals, and their identified needs and concerns.” (p. 57)

In the course of comforting the survivor, it may be asking permission to ask some direct questions to better identify their most pressing needs and concerns. Good topics to gently explore are summarized below.

Nature and Severity of Individual’s Experiences during the Disaster (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 57-58)

Survivors who experienced direct life-threat to self or loved ones, injury to self, or those who witnessed injury or death are at increased risk for more severe and prolonged distress. Those who felt extremely terrified and helpless may also have more difficulty in recovering. For information about the survivor’s experiences, you may ask:

• You’ve been through a lot of difficult things. May I ask you some questions about what you have been through?
• Where were you during the disaster?
• Did you get hurt?
• Did you see anyone get hurt?
• How afraid were you?

(Caution: In clarifying disaster-related traumatic experiences, avoid asking for in-depth descriptions that may provoke additional distress. Follow the survivor’s lead in discussing what happened. Don’t press survivors to disclose details of any trauma or loss. On the other hand, if they are anxious to talk about their experiences, politely and respectfully tell them that what would be most helpful now is to get some basic information so that you can help with their current needs, and plan for future care. Let them know that the opportunity to discuss their experiences with a counselor may be most helpful.)

For survivors with these kind of experiences, provide information about post-disaster reactions and coping (one of the next actions).

Losses (Home, School, Neighborhood, Business, Personal Property, and Pets) (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 59)

If survivors have extensive material losses and post-disaster adversities, their recovery may be complicated with feelings of depression, demoralization, and hopelessness. For information about such loss, ask questions like:

• Was your home badly damaged or destroyed?
• Did you lose other important personal property?
• Did a pet die or get lost?
• Was your business, school, or neighborhood badly damaged or destroyed?

Extreme Feelings of Guilt or Shame (www.ptsd.va.gov’s PFA Training Manual, Version 2, pp. 57-58)

Extreme negative emotions can be very painful, difficult, and challenging, especially for children and adolescents. Children and adults may be ashamed to discuss these feelings. Listen carefully for signs of guilt or shame in their comments. To further clarify, you might say:

• It sounds like you are being really hard on yourself about what happened.
• It seems like you feel that you could have done more.

For those experiencing guilt or shame, provide emotional comfort and information about coping with these emotions (discussed in a couple steps)

Thoughts about Causing Harm to Self or Others (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 60)

It is a priority to get a sense of whether an individual is having thoughts about causing harm to self or others. To explore these thoughts and feelings, ask questions like:

Sometimes situations like these can be very overwhelming. Have you had any thoughts about harming yourself? Have you had any thoughts about harming someone else?

For those with these thoughts, direct them to get medical or mental health assistance immediately.

Availability of Social Support (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 60)

Family, friends, and community support can greatly enhance the ability to cope with distress and post-disaster adversity. Ask about social support as follows:

Are there family members, friends, or community agencies that you can rely on for help with problems that you are facing as a result of the disaster?

For those lacking adequate social support, help them think through and perhaps even research available resources and services in their area, but also be there to support them as much as you can.

Prior Alcohol or Drug Use (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 61)

Exposure to trauma and post-disaster adversities can increase substance use, cause relapse of past substance abuse, or lead to new abuse. Get information about this by asking:

• Has your use of alcohol, prescription medications, or drugs increased since the disaster?
• Have you had any problems in the past with alcohol or drug use?
• Are you currently experiencing withdrawal symptoms from drug use?

For those with potential substance use problems, provide information about coping and social support, link to appropriate services, and offer a follow-up meeting (give your helper name and set-up a time to talk in the following days or week). For those with withdrawal symptoms, direct to seek medical referral.

Warning: In clarifying prior history of substance use, prior trauma and loss, and prior mental health problems, you should be sensitive to the immediate needs of the survivor, avoid asking for a history if not appropriate, and avoid asking for in-depth description. Give clear reasons for asking:

• “Sometimes events like this can remind individuals of previous bad times.”
• “Sometimes individuals who use alcohol to cope with stress will notice an increase in drinking following an event such as this.”

Prior Exposure to Trauma and Death of Loved Ones (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 61)

Those with a history of exposure to trauma or death of loved ones may experience more severe and prolonged post-disaster reactions and a renewal of prior trauma and grief reactions. For information about prior trauma, ask:

• “Sometimes events like this can remind people of previous bad times. Have you ever been in a disaster before?”
• “Has some other bad thing happened to you in the past?”
• “Have you ever had someone close to you die?”

For those with prior exposure and/or loss, provide information about post-disaster and grief reactions, information about coping and social support, and offer a follow-up meeting.

Physical Illness, Mental Health Conditions, and Need for Medications (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 59)

Pre-existing medical or mental health conditions and need for medications are additional sources of post-disaster distress. Those with a history of psychological problems may experience a worsening of these problems, as well as more sever and prolonged post-disaster reactions. Give a high priority to immediate medical and mental health concerns. Ask questions like:

• Do you have any medical or mental health condition that needs attention?
• Do you need any medications that you don’t have?
• Do you need to have a prescription filled?
• Can you get in touch with your doctor?

For those with medical or mental health conditions, direct them toward obtaining medical or psychological care and medication.

General (www.ptsd.va.gov’s PFA Training Manual, Version 2, p. 62)

It is also useful to ask a general open-ended question to make sure that you have not missed any important information.

“Is there anything else we have not covered that you are con­cerned about or want to share with me?”

If the survivor identifies multiple concerns, summarize these and help to identify which issues are most pressing. Work with the survivor to prioritize which concerns should be addressed first.