First On The Scene: Enriching The Clinical Experience Of .
First on the Scene:Enriching the ClinicalExperience of FirstRespondersPresented by:Erica Gilmore, MSEd CADC LCPCUnit Coordinator, Rosecrance Florian Program
Objectives Have an understanding of the types of symptomsfirst responders haveIdentify ways to develop a therapeutic rapport withthe first responder clientGain knowledge of the evidencedbased programs and clinicaltheory effective in treatmentRecognize the ways firstresponders are differentthan other clients
A day in the life Firefighter 24 hour shifts/48 hour offLong periods of down timeWaking up throughout thenightHyper alertExtended episodes ofdealing with crisis situationsRepeated exposure totrauma and vicarious traumaPolice Officer Working aloneNot always welcome on thesceneBe prepared for theunexpectedHyper alert and awareExtended periods of dealingwith crisis situationsRepeated exposure totrauma and vicarious trauma
Unhealthy Beliefs “Suck it up, buttercup.”“Men don’t cry.”“I’m weak if this effects me.”“I helps others, I don’t askfor help.” “If I’m effected by the job,I’m not good at it.”
Cultural Components Super-hero complex– This can present as ego ornarcissism in treatment Gallows humorDon’t let it shock youStoicism – having a wall upBonding through giving eachother a difficult time
Symptoms Depression– Presents as anger– Pushing others andhelp away– Isolating– 6.8% EMS diagnosed– 47% police officersinvolved in 9/11 werediagnosed withDepression Anxiety––––Panic AttacksSleeplessnessHyper AlertInaction
Symptoms PTSD––––––IrritabilityPushing others awayCynicism/ negative attitudeCriticalNightmaresTrauma Responses
Symptoms Suicidal Ideation––––Reported in higher ratesCriticism about the research28% felt life is not worth living10% had serious ideation
Substance Use Disorders Part of the first responder culture–––– TraditionCelebratoryFOMOCoping SkillExcessive free time and boredomSleeping aidAnxiety reductionSubstance abuse is higher forco-occurring PTSD
Risk Factors Poor trainingBeing unfit mentally andphysicallyPoor/ lack of leadershipFavoritismPersonal trauma Low perceived safetyLength of time at the siteExcessive exposure togory scenesUnclear directives or jobduties
Protective Factors Longer length of employmentSpecialized trainingConfidence in abilitiesWorkplace satisfactionResilienceSocial supportComradery
Organizational InterventionsPreparedness Develop a protocol Involve staff Gather as much infoabout the disaster Clear leadership lines Ask responders to beaware of their stress Empower staffhttps://www.samhsa.gov/Response Clear communication Assess welfare of team Develop a buddy system Provide mental healthand resilience training Provide group sessions
Clinical Interventions Mental health first aid Resilience training– Cognitive restructuring Counseling Peer support Co-occurringprograms
Early Crisis Intervention Contact engagementSafety and comfortStabilizationInformation gatheringPractical assistanceConnecting with supportsLinkage to serviceshttps://www.mentalhealthfirstaid.org/
Treatment Programs Seeking Safety - Lisa Najavits– Addresses SA and PTSD Trauma for Men/ Healing Trauma for Women –Stephanie Covington– Gender specific issues related to trauma Dialectical Behavioral Therapy – MarshaLinehan– Emotional Skills– Cognitive Skills Co-occurring Disorders ProgramCBT for PTSDhttps://www.nami.org/
Long-term Interventions EMDRCognitive Processing TrainingExposure TherapySkills Training in Affective andInterpersonal Regulation (STAIR)Stress Inoculation Therapy (SIT)Narrative Therapy
Pharmacological Interventions No specific trauma drugWithdrawal from substancescan enhance mental healthsymptomsMelatonin can makenightmares worseShould be monitored carefullyby medical professionalDoes not “fix” the problemhttps://www.ncbi.nlm.nih.gov
First Responder Treatment Lack of consistencyLack of commitmentStruggle with subjectivity of SA and MH treatmentNeed for controlLength of treatmentFamily involvementWork scheduleDemeanor is how theyhandle crisis
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815.391.10001.888.9AT.LASTwww.rosecrance.org* Pictures of individuals in this presentation are for illustration purposes only. These pictures portray models and are not pictures of actual clients of Rosecrance. No inference should be made, or is implied,that the pictures used here are of individuals connected in any way to Rosecrance or to its affiliates or programs.
* Pictures of individuals in this presentation are for illustration purposes only. These pictures portray models and are not pictures of actual clients of Rosecrance. No inference should be made, or is implied, that the pictures used here are of individuals connected in any
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