Following on from our Psychological First Aid (PFA) in the Workplace webinar, Sarah Phillips gives an overview of how PFA looks in the context of supporting each other and those we provide care for, before discussing some case studies illustrating PFA in practice. This session will give you insights into how you can provide Psychological First Aid.
Sarah is a Counselling Psychologist based at the Rivers Centre, NHS Lothian. She oversaw the running of the NHS Lothian staff support line during the early stages of the COVID 19 pandemic and serves as clinical lead for the National Wellbeing Hub.
Following on from our Psychological First Aid (PFA) in the Workplace webinar, Sarah Phillips gives an overview of how PFA looks in the context of supporting each other and those we provide care for, before discussing some case studies illustrating PFA in practice. This session will give you insights into how you can provide Psychological First Aid.
Sarah is a Counselling Psychologist based at the Rivers Centre, NHS Lothian. She oversaw the running of the NHS Lothian staff support line during the early stages of the COVID 19 pandemic and serves as clinical lead for the National Wellbeing Hub.
- Good afternoon everyone and welcome to this webinar entitled Psychological First Aid in Practise which is part of a series in the fifth series of the Focus and Wellbeing programme that is linked to the National Wellbeing Hub. I'm delighted to welcome back, I should say, Sarah Phillips. Sarah's a counselling psychologist. And Sarah and another colleague of hers run a psychological first aid introductory webinar on psychological first aid some time ago earlier this year now, and that webinar is available on the National Wellbeing Hub, and Sarah will highlight that, the link to it later in the session. If I could just say, for those who of you who weren't at that, and this is a sort of follow up, although they are not linked Sarah will run this as an independent session, particularly for those who may not know much about PFA. And so what we will do is have a brief introduction to Psychological First Aid, which has many of you will know has underpinned our package of measures, it is the principle on which a number of our measures to support staff are based, and it is a very much an evidence-based approach. So just throughout the session if you have a questions and answers, the way this will run is Sarah will do a presentation for just probably around an hour. If you have any questions or issues you'd like to raise, you can use the Q&A box. I will be looking at that box and I'll be trying to pick out some questions, gather, aggregate some questions, gather if they on a similar theme and put them to Sarah at the end. So that's the way the session will run. So without further ado, Sarah, thank you very much for agreeing to deliver this for us, and over to you.- Thanks Ray, for that introduction. So in today's session we're going to have time to think about what psychological first aid looks like in the context of supporting each other and those that we provide care to in the context of a post-incident intervention. And so this webinar is really focusing on the use of PFA following a critical incident. The previous webinar on the hub focused on PFA in the context of general staff wellbeing during the pandemic. And at the River Centre and on the hub, we often hear how staff, including managers, are not sure about how to use PFA or lack confidence in their skills. And there seems to be a lot of uncertainty or concern about using it. And I think people are often wary about it because it's about responding to someone who has experienced a traumatic incident and staff are worried about doing or saying the wrong thing. So it's important to remember that PFA is a humane response to someone who is distressed and that anyone can use PFA and you don't need specific training in it. And in this webinar there are a couple of case studies or scenarios illustrating PFA in practise in the workplace. And hopefully that'll give you a chance for you to think about how you can provide PFA in your place of work and develop your confidence in developing PFA. So, as Ray mentioned we had a webinar on psychological first aid in the workplace on the hub back in June. And I'm hoping that the link for this can be put in the chat so that if you want the link it's there. But also NES has a really good module on PFA for COVID. And you will need a Toros account to watch that, but that's another really good resource available out there. So what is psychological first aid? PFA is an internationally recognised model for providing humane, supportive, and practical assistance to fellow human beings who've recently suffered exposure to serious stresses. It's about providing non-obtrusive practical care and support. It's about assessing needs and concerns. It's about helping people to address basic needs and listening to people but not pressuring them to talk. It's about comforting people and helping them to feel calm and about protecting people from further harm, including those who may need special attention. So why use PFA? Evidence tells us that people are more likely to be able to cope with and recover from traumatic or stressful events if they feel safe, feel connected to others, have access to social, physical, and emotional support, and feel able to help themselves as individuals and/or communities. It's well known that the case of major disasters, majority of affected individuals, families, and communities cope with great resilience and do not require more formal psychiatric or psychological intervention. However, a rise in psychological morbidity is to be expected. Psychosocial support recognises that our wellbeing comes from a combination of factors and aims to enhance or restore these to peak to help people cope at times of stress or distress. These factors include having our basic needs met such as shelter, money, food, and the availability of good social support and positive coping skills. The River Centre was commissioned by the Scottish government to develop guidance targeted at responding to the psychosocial and mental health needs of people affected by emergencies. And this guidance, based on the principles of PFA, is available in the Preparing Scotland document. There are a number of components of effective psychological first aid. There's no particular order to follow as the order will depend on the individual and the emergency. The components should be modified to match the needs of the individual. And it might be helpful at this point to spend a moment on debriefing and in what ways PFA differs from psychological debriefing. The concepts of debriefing and psychological debriefing can be potentially confusing in terms of what they refer to, and therefore, a bit of clarity on definitions may be helpful. Some of you may be very familiar with the terms medical or hot debriefing, this refers to gathering people involved in difficult situations, for example, a patient death. And so gathering people together immediately after the incident has occurred in order to discuss the professional and practical needs of a team at that point, eg, what went well, didn't go well, and how best the team can be supported. Cold debriefing refers to a more in-depth discussion with the staff involved in a difficult situation days or weeks after it. The purpose is usually an opportunity for professional reflection and learning rather than the sharing of emotional responses. And then there's psychological debriefing or critical incident stress management. The concepts of psychological debriefing or critical incident stress debriefing were developed in the 1980s and '90s, primarily for use with emergency service personnel. They encourage the processing of a single incident traumatic event through a series of stages in one session. The debriefing session would last from one to three hours and ideally take place between 24 to 72 hours after the incident. The intent behind this was to reduce future symptoms of post-traumatic stress disorder. Psychological debriefing became popular for a time due to anecdotal reports that it was helpful and useful. However, research into its effectiveness began to challenge this position. And in 2001, findings from a large scale review of the literature by the Cochrane Group reported that this type of debriefing was not effective and could be harmful to some people and should not be used. So in light of the emerging literature against single session psychological debriefing, psychological first aid was proposed as an alternative. PFA is an evidence informed, modular approach developed to help people in the immediate aftermath of an incident. It is designed to reduce the initial distress caused by traumatic events and to foster short and longterm adaptive functioning and coping. PFA is not counselling nor is it asking the person to analyse the situation or pressuring them to talk. Instead, PFA is based on a set of principles that we know help people to cope with and recover from traumatic and distressing situations. The seven components of psychological first aid are: one, care for immediate needs. Two, protect from further threat or risk. Three, comfort and console. Four, support for practical tasks. Five, provide information on coping. Six, connect with social support. Seven, educate about normal responses. And I'm gonna go into more detail of these components later in the webinar. And it's important to remember that this approach includes elements such as compassionate listening, psychoeducation and normalising. So what PFA is not, it's not counselling, it's not psychological debriefing, and it's not asking a person to analyse their situation or pressurising a person to talk about their feelings. Nor is it something that only professionals can do. And I think that's really important to remember, that you don't need to be a trained professional to use PFA. It's not something that everybody affected by an emergency or an incident will need. It's about remembering that people should neither be encouraged or discouraged from giving detailed accounts of their experience, but rather given the opportunity to talk if, and when they choose to do so. It's really important to remember that it's not about saying somebody can't talk about it if they want to. And you as an individual also need to be mindful that if you have somebody who's experienced something traumatic, you need to be mindful that you feel able to manage supporting them about the incident. And I'm gonna come back to this point later on. So identifying the need for PFA. So as a manager or a colleague, how do you, how do you identify when you need to use PFA? So when should you be using it? So when there's a direct threat to you and or your colleagues. Or when there's been an accident involving you and or your colleagues. Or when people have serious injuries. Or people who are dying or have lost a loved one. Or when there's intense human suffering, especially of the vulnerable, including children, older adults, people with a learning disability. Or when you encounter human cruelty or violence. When there's been a major incident or emergency. And again, it's important to remember that PFA is not just used following major incident or emergencies. In the course of our work, for those of us working in health and social care, we can encounter situations in which it would be appropriate to use PFA quite frequently. And as Ray mentioned, PFA is the model that the National Wellbeing Hub, adopted when the hub was first developed. And it's also reflected the use of PFA support staff at the start of the pandemic. So I think it might be helpful for us to think about the factors that influence how someone responds to stressful situations. Our age has an impact. So where we are in the life cycle can have an impact on how we cope. Whether we're young, with relatively little experience or whether we're older with more experience. Or where we're at in terms of our own personal situation, what's going on at home. So our age has an impact. Other factors include levels of support being connected with others, and our willingness to seek help. Being able to discuss difficult emotions with others. The severity of the event will have an impact on our responses. Our prior experiences with distressing events. Some people may have experienced a number of traumatic incidents over the years, and that buildup, maybe the thing that causes them to struggle with the last event. Our physical and mental health has an impact. Our perceived ability to cope with stressful situations. And our resilience. So let's think a little bit about what helps people be well or resilient at work. Having a clear role. So knowing what we are doing and why we are doing it. Having a sense of a common purpose with our team. Feeling competent in our work. So having the appropriate training and being ready for events. Having supportive colleagues. So knowing each other well and having confidence in your colleagues' knowledge and skills. Having mutual respect and trust and knowing that your colleague has got your back. And that there is a balance between resources and demands and that the demands don't exceed our resources. And our ability to distance ourselves. So recognising our professional selves as well as our personal selves and being able to step back from our work. Feeling valued. Feeling comfortable to talk about how we feel. And support from our family. All of these things help us to be resilient at work So now I'd like you just to spend a little bit of time thinking about situations that you may already have used PFA in. And you might not even have been aware that you were using PFA. And just think a bit about how you responded to colleagues. I wanted to spend a little time looking at the components in a bit more depth. Remember, not all the components will be needed in every situation, And it's not a linear process. You may need to return to components at different times. So care for immediate needs. What is needed will depend on the situation or the event. At its most extreme, for example, if you're working with somebody who has experienced a house fire or an RTC, it may involve treating injuries, providing shelter, clothing, and food. In other cases, it may not be so obvious what is needed. It may be about finding somewhere quiet for you and the individual to sit, to have a conversation, to enable you to check in with them what their immediate needs are. It's also worth considering who is the best person to have that conversation with them. If it's a colleague, do you have a good relationship with them, or would there be somebody else on your team who'd be better place to have that conversation? Is the incident likely to be something that triggers your own stress or distress response? For example, has the incident involved children of a similar age as your own? Does it involve elderly parents experiencing something similar to your own parents? Also consider the wider network of the individual when you're thinking about their immediate needs. For example, if they're injured and need medical attention, do they have children that need to be picked up from school and fed? Are they worrying about them rather than focusing on what they need? Do they have a pet, a dog that needs letting out at home? And if they're not injured, is your colleague coming off shift immediately or do they still have a number of hours to work? Would it be better if they went home or would it be better if they stayed at work where they can be supported by colleagues? And if they went home, will they have somebody at home to provide comfort and support? And how are they getting home? Are they safe to drive or to get public transport? Do they need a lift or a taxi home? So thinking about protection from further threat or distress. Exposure needs to be minimised and they need to be helped to feel safe. So it's about ensuring their immediate safety. Can they be taken away from the immediate situation? And minimise exposure beyond what is required to fulfil their role. Do they need to document the incident as part of their role? If so, does it need to happen straight away? And asking them what will help them to feel safe. And then thinking about what we can do to increase their sense of safety. Is that about helping them to be away from the situation or be in a particular place that helps them to feel safer. And thinking about their own emotional safety, do they need to help with managing that distress? So moving on to the comfort and console. Often this is an area that people struggle with because they are fearful of having conversations about distressing events, as they are worried about how to comfort people, and worried that they will say the wrong thing. And sometimes it can be difficult having these conversations with colleagues, particularly if we're in an environment where people have their professional mask on. So think a bit about your body language when you're with somebody. Think about sitting with someone rather than standing above them looking down at them. Sit so that you can be eye to eye and you can make good eye contact. Think of your tone of voice, how your face is looking, having open body language. Use active listening. So listening and summarising what they're saying, and reflecting back to them, and maybe paraphrasing what they're saying. And it might be helpful to think about having some set phrases you could be using. For example, it sounds like it was extremely difficult or distressing for you. Or, it's okay to be feeling this way. And allow for silence. Silence is okay. You may feel uncomfortable with it, but the person may need the silence to gather their thoughts or compose themselves. And try not to bring it back to you and how you're feeling. Try to reduce the distractions around you. And don't rush them or force them to talk. Just let them bring whatever they want to. And it's okay not to have all the answers. But also think a bit about what might be an unhelpful response. And these might include things like, you could have died. I don't know how you survived that. It's not helpful reminding someone of their own mortality. And often that is something that will stick out for people. So moving onto the support for practical tasks. You are likely to have picked up an idea of what support they need with practical task when you were looking at their immediate needs. So it might be, they need a taxi home. Think about organisational processes that need to be followed. Do they need support with that? Is there form filling needs to be done? Do they need you to sit with them while they do this? Do they have questions about how to fill that form? They're often not that straightforward. Does that form need to be filled in straight away, or could it be left until they're on shift next? And if they've decided that they feel okay to stay at work are there lighter duties that they can be given? Or is there somebody that could support them with some tasks? And thinking a bit about those practical tasks, thinking about their wider network. Is there somebody at home that needs to know what has happened? Do they need you to ring their partner if they're to distressed to? Does their kid's school need to know what has happened and that mum or dad might not be there to pick them up and somebody else will be? And then providing information on coping. The information you provide is likely to differ depending on the situation. If it's a colleague, you may feel that it's appropriate to share with them the strategies that you find helpful.
Coping strategies may include:reminding them of physical exercises that they do. Thinking about having a healthy diet. Breathing exercises. Getting control of that distress and focusing on their breathing to try and calm themselves down and to feel more in control of their physical responses. Coping strategies also include talking about it. They may not feel like talking about it now with you, but encouraging them to talk about it when they get home with other people. Talking about sleep and the importance of getting a good sleep and kind of sticking to their sleep routine. And remember, often people will say they're fine when they're not. So it's important to reiterate the importance of looking after self and reminding them, how can we look after others as well if we're not in a good place. And it might be that you need to signpost to useful resources. So the National Wellbeing Hub, we've got lots of good resources on there. There are apps that people can be using. There's top tips, there are posts, there are videos. And it's probably worth talking about the concept of self-compassion. People often engage in high levels of self-criticism, guilt or shame after an incident. We often hear that people felt that they did not do enough at the time, or are not coping in the aftermath. Encouraging people to be self compassionate is important. Remind them that given the circumstances they did the best that they could. Self criticism is not going to change anything and will just add to their distress. And again, talk about unhelpful coping strategies. People often use strategies in the short term that provide relief, but in the longer term can cause more difficulties. These can include over use of alcohol or drugs, avoidance of similar situations or avoidance of talking about what has happened. Talk to the person about these unhelpful strategies and remind them that in the long-term it can lead to more difficulties. I mentioned earlier that PFA is not a linear process, and you're likely to need to check in with the individual several times. Maybe several times on the day, the day after, the week after and depending on the severity of the incident a couple of weeks later. So revisiting coping strategies will be important. So some tips for discussing coping strategies might be things like, it sounds like you've been really struggling with what has happened. What are you doing in and out of work to cope? Is there anything that we can do at work to help you with the difficulties? Or it sounds like you haven't been for a run for a while. What would you need to change to be able to do this? Or having a conversation with them about the strategies that they use and that they might not be working. And asking them what other things have you done before at times of high stress? What helps you to relax? And again, point them in the direction of the hub for ideas. So connecting with social support. It's important to help them to identify who there is that they can be talking to. Who's around? Is there a colleague they can talk to? Can they talk to family or friends? Can help family and friends to understand what's going on? If there's no one available at home, then make a plan on how they can be supported. It might be that your team needs a WhatsApp group, or it might be about thinking of having a buddy system, buddying up your colleague with somebody else who may be able to provide them with the support. And then educating about normal responses. This section is really important. Different kinds of crises affect people in different ways. And most of us will respond with resilience. However, there's a wide range of responses that people can have. The emotional, that upset, angry, or worried response. The physical responses. So feeling tense, shaky, nauseous, having poor sleep. Psychological responses. So lots of questions. Why did it happen? Could I have done things differently? Why did that person do that? Why has that happened to me? Ruminations, intrusions. So again, it might be intrusive thoughts during the day or intrusive images. And dreams, dreams about the event. And then there are behavioural responses. So avoiding. And that might be avoiding the place where it happened. It might include avoiding talking about it. It might include avoiding thinking about it. And checking behaviour. So checking that things are as they should be and checking that everything is okay to help increase that sense of self safety. And most of these responses will resolve with time and support. So it's really important that when we educate about normal responses that we stress that a range of responses will occur and that we don't pathologize what is a normal response. These are normal reactions which we would expect in the immediate aftermath. People often worry about how they responded at the time. They often worry that maybe they froze, or maybe they went into fight mode and became angry, or maybe the only way they could cope with the situation was to leave, was to go into flight mode. People also worry about how they are responding after the event. We would expect somebody to be jumpy, experiencing sleep difficulty, both dropping off or having bad dreams. Playing over the incident in their mind. Asking questions, trying to make sense of the event. All of these responses we would expect within the first few weeks afterwards. And those are normal responses. And it's at this point helping people to understand that what they're experiencing is a common response, will help them to be more compassionate with themselves. And again, direct them to self care resources. This will help to empower them and gain a sense of control over what they're experiencing. And we know people do better if they are helped to empower themselves. There is a need for concern if these trauma or stress responses last longer than four weeks, then it would be appropriate to consider more support if they have... So if they haven't used self care resources so far, point them in the direction of the National Wellbeing Hub. There are both apps. So Sleepio to help with sleep, Daylight for anxiety and SilverCloud to help with low mood. And there are posts on the website that will help people to empower themselves, to care for themselves. And videos of people with lived experience, which will help to normalise the responses that people are experiencing. And also on the website, there's information about how to access more formal support, both nationally and locally, if it's needed. So educating about normal responses helps us to understand our reactions, which helps to empower us, and it gives us choices, and it helps to reduce our shame and self-blame. If we don't understand what's happening, we may feel that we're losing control or going crazy. We're not, it's a normal response. In a study of 50 experts in 2011, the most commonly endorsed treatment following an incident is education about trauma. So, remember, PFA is not a linear model and you may not need all the components. What I would suggest is that the care component is revisited. Keep checking in with your colleague if they have experienced a stressful event. Don't let it be a one off check-in straight after the incident. Check in the next day, the week after, and a couple of weeks after. Keep checking in until you are satisfied that the person is doing okay. And it might be helpful for you to have conversations with them about their coping strategies. So now we're gonna move on to the scenarios. And many of these scenarios... So I've tried to develop scenarios that could be applied in both health and social care settings. So in this first scenario, a young inexperienced carer, Sandy, who's new to your team has found a service user dead in the bathroom. The death is unexpected, and Sandy had only seen the service user earlier in the day. Sandy had never seen a dead person before. She is partway through her shift and still has a couple of hours until she is due to go home. So although this scenario is based in a care home, it could be on a hospital ward. So it's about being in both health and social care settings. And it could be... So we would apply PFA in a similar way. So thinking about this scenario, how would you be using PFA? So caring for Sandy's immediate needs. You check in with her, have a chat with her about how she's feeling and about how she feels about continuing to work. Does she need to go home? Will there be somebody at home that she can talk to or would she be better staying at work, doing low demand tasks, but with other staff present for support? And at the end of the shift, how is she getting home? Is she okay to drive or get public transport? Does she need a lift or a taxi? So protecting from further threat or distress. It would be about ensuring that Sandy is not involved in the practical tasks, following the death. For example, calling the doctor or letting relatives know. Providing comfort and consolation. So giving Sandy an opportunity to discuss what has happened without pressure. For example, would you like to tell me what has happened or does that feel too difficult? I'm here, if you want to talk. Providing practical help and support if she's very distressed. Would it be helpful for you to ring the person she lives with to let them know that she's had a difficult situation at work? And while she's at work, does she need help with writing up the incident? Can you sit with her while she does it? Can it be delayed until the next shift? And providing information on coping. Ask her what she's going to do when she gets home. What helps her to feel okay when she's had a difficult day? Share with her what you do when you've had a difficult day. Maybe direct it to the resources on the hub. Connect her with social support. Is there somebody that she feels comfortable on the team with, that she can talk to? Does your team have a WhatsApp group so that she can get support from other members of the team? Has she got friends who work in similar environments that she can chat to? And educate about normal responses. Give her reassurance about what she is feeling and that it is okay to feel that way. Explain to her that we all respond in different ways and that there isn't a right way of responding. So moving on to scenario two. And again, this scenario could happen in any setting. So Beth, the receptionist for your team is assaulted at work. A client or a patient or a service user has not responded well to procedures and has become increasingly aggressive towards Beth. As the person gets more wound up, he slaps Beth across the face and spits at her as he leaves the building. So how would you use PFA in this scenario? What would your immediate response be? You'd be caring for Beth's immediate needs. You'd be checking that Beth is okay and hasn't sustained a serious injury. You'd be helping Beth cleanup if she needs to. If she's got spit on her, you'd be helping her with that. You'd withdraw her from the public view. You take her into another room, sit her down. If she experiencing a high level of distress, you'd be getting her to focus on slowing her breathing down, and getting her breathing into a steady rhythm, enabling her to get control of her physical responses. You might be offering her a cup of tea and checking in with her to see how she's feeling and to see what she needs immediately. It might be that you just need to sit with her for awhile. You'd be checking in, does she need to go home? Would she rather stay at work? In terms of protecting her from further threat or distress, you'd be ensuring that the assailant has left the building and calling the police. And if Beth is staying at work, you'd be ensuring she's not manning reception. And maybe finding somebody else to do that task for the rest of today. And then thinking about what is gonna help Beth return to sitting at reception when she's next in. Are there practical or physical issues that need to be addressed with the reception and its location? And in terms of comfort and consolation, you'd be giving Beth an opportunity to talk about what has happened without pressure. Would you like to tell me what happened or does that feel too difficult? I'm here if you want to talk. You'd be giving her reassurance. And then thinking about the practical help and support. Again, this is linking to the earlier modules. What is Beth going to need right now, but also when she returns to reception? And are there reception tasks that can be given to somebody else for the rest of the day or tomorrow? And if she needs to go home, is she okay to do this journey on her own? Does she need a lift? Is there somebody that you could ring to pick her up? And again, providing information on coping. So talking about how to manage her physical responses, and that might be about talking through a breathing exercise, helping her to calm herself down, asking her what she's going to do when she gets home. What helps her to feel okay when she's had a difficult day? What does she do to wind down? And again, maybe directing her to the hub for more information. And thinking a bit about the social support. What support can she have from the team? What support is there at home? Are there people that she can be talking to about what has happened? Especially if she's part time or it's gonna be the weekend or she's got annual leave. And again, educate about normal responses. Give her reassurance about what she's feeling and that it's okay to feel that way. And again, explain to her that we all respond in different ways. And when she's next in, going back to that caring for immediate needs, asking her what she needs to be okay at work. So in the last scenario, A&E staff are giving news to parents regarding the death of their teenage daughter following an accidental drug overdose. Parents respond with understandable high levels of distress. So this scenario is thinking about how we deliver PFA to either patients or their family members. And again, this scenario, it could occur in a lot of circumstances, delivering bad news, which can lead to an intense response from somebody. So how would you use PFA with the parents? So caring for their immediate needs. Withdrawing them from public view. Is there a side room or a quiet room that you can talk to them in? Ask them what they need. Do they need you to contact anyone? Have they come in on their own? Do they have a partner or other family members that need to be informed? Have they left other children at home that a friend or a neighbour could look after? Or is it that they just need you to sit with them quietly while they begin to make sense of what you've said and for you to be available to answer some of their questions? And remember, that maybe not all of these components are needed. So it might not be about protecting from further threat or distress, or it might not be possible to do that if they have to have a conversation with the police. It's about comfort and consolation. So offer your consolation. I'm really sorry. This must be very difficult for you. The reality is that there is nothing that you can say that is gonna ease their pain at that moment, but being there with them and offering your consolation is something that they will remember later on. And they will remember that member of staff who sat with them and offered them that compassion and that comfort. So thinking about practical help and support. Again, is there anything that you can help them with? Bringing a relative. Providing them somewhere quiet to sit. Finding them a cup of tea. Providing them information on what to do following a death. Providing information on coping. Discuss with them the importance of maintaining their self-care routine. That it's really important for them to look after themselves at this point. That they need to try and eat healthy. They need to try and get enough sleep. All of those things, which will feel really, really difficult for them, but it's important for them to be maintaining. And connecting with social support. Think about who they've got who can support them. Have they got close family or friends that can be with them? And educate about normal response. There is no normal way of grieving. They will feel a range of different emotions at different points and that's okay, that's normal. And maybe it's about providing them with information about useful resources. Maybe directing them to NHS inform and their section on grief and bereavement. And if you work in an environment where you are likely to be given bad news, it is worth thinking of some stock phrases that you can use to offer comfort and consolation that will help you to feel better prepared. It may be worth asking colleagues who've more experience if they have particular phrases that they use. So in summary, protect. Address the individual's immediate safety and practical needs. And if it's a colleague, check in with them. Acknowledge that it was a difficult situation. Give them that space to exhale, to just physically and emotionally stabilise. And make sure debriefs are positive. So thinking about that hot and cold debriefs, particularly the hot debrief. Not asking why did you do that? But giving them the opportunity to talk about what has happened. Share tips for help or coping. Educate about common responses. Connect with social support, and provide information about additional support that's available. And say to them that you're gonna check in again. And make sure that you do. And don't forget that there are resources out there. If you feel that you don't have the knowledge, there's lots of information that has good knowledge that you could be visiting. The Wellbeing Hub has a whole range of topics that are written posts, but there are videos and there are apps. So there's a lot out there. So that's the end of the slideshow. And maybe if we could move on to the, if there are any questions.- Sarah, thank you. It's Ray. And good afternoon colleagues. I should have introduced myself at the beginning of the session. I launched straight into it with the intention of giving Sarah as much time as possible giving you the opportunity to hear as much from Sarah as possible within the hour. As I was saying, I'll go back to say my name is Ray D'Souza, and I oversee that the Natural Wellbeing Hub and Sarah, besides her role as counselling psychologist where the River Centre is one of our principal advisors to the hub and helping us to develop content for the National Wellbeing Hub and so on. So I think there aren't any questions at the moment. You've obviously been very explicit in how to take this forward. You've clearly given people a lot of food for thought through the case studies. I guess one of the things that you're reminding me of is that you've mentioned the hot debriefs and the whole debriefing process and in a way it's natural tendency to try and say to people after an incident, or let's make sense of this, let's go into it. When in fact what's actually needed is what I guess is the concept of psychologically holding somebody, just being beside them. And I suppose if I was going to say a couple of things, and maybe this will stimulate further some thoughts and or questions, is that after most incidents we hear on the TV, for example, there was one major incident that happened within a school setting. I can't remember what it was last week. And the first thing we heard from the responders, the education authority, was that we've got counsellors on site, as if all the children will rush towards a counsellor, when in fact we know that children, the first place they will go to for support is each other. They'll huddle together and hug each other, give each other comfort in various ways. So that's really important for you. What I guess you are saying to us is counselling is not the answer. It's something more practical. And then I guess my next question, if you could just take these few together, I'd be interested in your comments, is that what you're reminding us is that we can all be good at delivering psychological first aid. We don't need to be trained in counselling. We don't need to be trained in anything other than what we are trained professionally or experienced to do. But I guess we do need to be good listeners. And I guess we do need to be empathetic toward colleagues who've experienced something. Your comments on that, on those two points.- Yeah, I think there is an idea out there that people need lots of training in PFA. And I would be saying no. People don't. It's about being humane. It's about thinking what would I be needing in that situation, and putting yourself in somebody else's shoes and thinking what is needed right now. And not just from the emotional point of view, but the practical point of view. So kind of thinking a little bit wider for the individual. I think we kind of get stuck on the idea of maybe having PFA, psychological first aiders and training them. And I think the message is we're probably all psychological first aiders. We are all working in health and social care so we have this desire to work with people, and we have an instinctual humane response. Does that kind of answer that, Ray?- It does indeed. Sometimes I think after every incident, we all want to show our value by being sort of technical experts, that we show that we have some expertise in something when in fact, I think what you're describing to us is, to use your word, humane. And it is about the current rhetoric around kindness and being kind to people and being there for them. And if we look at various studies have shown, for example, annual surveys that are done within the health service and within the social care environments what are commonly known as the people surveys, they show that a large proportion of people who are feeling stressed or needing comfort get that comfort from a friend, a colleague, ask a colleague.- Absolutely.- It is. So that's really important for us, a takeaway message from your presentation.- And I think it's really hard in terms that dealing with somebody who is distressed. I think sometimes we feel that if somebody is talking about feeling extremely anxious or panicky, that can be really hard for a colleague to hear. And often there's this idea, well, you need professional help. But there's often just that reassurance, actually, it's really normal to be feeling this way. It's okay for you to be feeling anxious and panicky, something awful has happened. How would anybody feel in that situation? And it's that kind of reassurance which is really important. And if you were talking to a friend after an incident, that's probably what your friend would be saying to you.- It's interesting that's prompted Amanda to make the comment. Sometimes it's helpful to talk to somebody from the same workplace as they've been through it. Not helpful sometimes if referred to a staff member or manager. Sorry, my screen is... Not helpful sometimes if referred to staff member/manager re debrief, who hasn't experienced it. Amanda is talking in her capacity as a paramedic so that's really interesting. And another one from Allie who said, that's very helpful. Thank you for that, Sarah. With the health and safety requirements in my workplace, I do need to gather details about what happened in detail if a serious incident happens. And I need to gather this promptly, so that sort of fits with what debrief if you like, or asking.- And there will be times where actually you have to do it straight away, and it does have to be done. But if people are working in other services where there can be a little bit of a delay, well, that's helpful. Allie is agreeing with you in saying that I feel that I may be prompting people to detail events when it may not be the best thing for them to do, but I'm obliged to do that. That's like conflict manager and wanting to be sympathetic and empathetic. And there's one here. Just, if you might want to answer this. Is there a checklist that we can use when we practise PFA, in the way you having a slide there?- Use the slide. Just have that little diagram. But I think there's also a bit about remembering. You kinda don't want that piece of paper in front of you while you're doing the PFA with the person, because there's nothing worse than if you're having an emotional response and your manager getting out a piece of paper with a checklist that they're going through. So I think it's about being mindful and about how you are with the person. And I think that's the important thing. It's about being that compassionate colleague or that compassionate manager. And if there are bits that you miss, don't worry because you'll see them again and you can check in with them again. I think the important thing is about being there with them and offering them that comfort and that care.- Thanks Sarah. Other similarities between psychological first aid and mental health first aid?- Yeah. And that's probably a whole other kind of webinar. But yes, I think that there's a bit about thinking what keeps us well. And both at work and at home, are there certain things that we need to be thinking about for keeping ourselves well and keeping our mental health well.- Sarah, there's a question here, and it's one that I know that you and I debate and you're probably dreading me asking this. PFA and trauma informed practise, the overlaps or the similarities between them. But the question from one of the audiences is, is PFA recommended if someone has a history of complex trauma?- Yes. Absolutely. Absolutely. If you've got a colleague in front of you who has just experienced an incident and they have a history of complex trauma, yes, you would be using PFA with them. It's not about providing therapy at that point. If they've just come out of an extremely difficult situation, PFA is the response that you would be needing to use. Does that make sense? Does that answer the question, do you think Ray?- Yes, it does. I'm slightly reluctant to answer the question, you're the expert on this, but this comes down to that point, is how deep do you delve? How do you know when somebody has? Any incident is likely to help to trigger previous traumas in people and how deep do you delve?- Well, and I think the whole thing with PFA is it's not about counselling and it's not about asking them to analyse. So it's about asking them, how are you feeling right now? What's going on for you? What can I help you with? And if they are kind of going down that route of talking about lots of other incidents and in that immediate situation it will be about signposting them to resources that are helpful. And then again, checking in on them later on seeing if any of their trauma responses have kind of resolved over time. And if not, then it would be about directing them to more formal support. Does that help clarify?- Yes. And it fits with your principles, nobody can be an expert, and it's not about counselling or getting delving. You are not ready to divulge further information to do so.- And also, thinking a bit about how appropriate would it be to expect your colleague to tell you all of that if they have a history of complex trauma They're your colleague, you're not their therapist. So there's a bit about kind of thinking about what the boundaries are.- Next question. Comment and a question from Jackie. Thinking about the factors that improve people's resilience at work. My team will not be alone in having a big imbalance between our resources and demands placed on us. What can we do when there is no end in sight to this situation? Also, what difference does it make when giving PFA virtually rather than face to face, if any?- As I was doing that slide and that point, I was thinking about resources and demands and just thinking, gosh, it's been a long haul for the people and the end is an insight. And I think it's about teams thinking about their wellbeing, along the way, and thinking about what teams need to help themselves stay well and trying to carve out that time to enable wellbeing. So it might be about making sure that you are having the regular team meetings. And when possible and when practical can any of that be done in a face-to-face environment? And the news at the beginning of this week is not looking good for that, but making sure that even if it's online and team meetings are online, thinking about as a team, what do you need to be doing to keep well, you know. Is it that you need to actually have a virtual team day where you're looking at self-care and the wellbeing of the team and having that as a priority for the team?- Yeah, that's an interesting one because it leads onto a question here from, well, a number of questions along a similar theme if I take this one to sort of capturing the sense of a few others. It's from Heather, from an emergency medicine perspective, should we stop hot debriefs entirely and focus on PFA instead? I think you touched on that. Any further thoughts?- I think that's a difficult one. PFA is what we would be recommending. It's kind of wider than the hot debrief. So I think maybe there's a bit about thinking how does the hot debrief fit into the PFA model?- Absolutely. I think you're right, because somebody else has made a comment. In fact it's Heather, a supplementary comment she makes, is that hot debriefs have been seen in the past and in some professions, some organisations, they're still seen as a supportive thing. And I think there is still a culture of thinking that if we help people to debrief, we are doing good and we are helping.- And it's not about saying a hot debrief isn't doing good, it's that psychological debrief, that critical incident debrief that's not helpful, that immediate, actually, what just went on there as a team is helpful for people just to kind of press the pause button and it does happen and can be really helpful. But I think PFA is a little bit more wider than the hot debrief. It's about looking wider than that incident. It's about what else is needed for the individuals within the team.- So it's almost holistic, isn't it? Because somebody else here is making a comment just on that. In I'm my experience of immediate post-traumatic event debriefing, the conversation often moves to blame, not necessarily intentionally. Do you have recommendations to move the conversation past blaming? Whether it's someone blaming themselves or colleagues starting to suggest elements of blame.- Maybe name that. Maybe it's about while you're in the debrief, naming what's going on and thinking a bit about blame, whether that's self-blame, or there's blame within the team, maybe just naming actually blame right now is not helpful. Let's think about what is helpful. Let's think about what we have done well right now. And what are you needing right now? How are you feeling? How are you all gonna cope when you get home tonight? So just kind of moving that on and recognising at that point, it is gonna be heightened emotion. You know, you've just been in the middle of an instance where the adrenaline has kicked in and it's been fight flight or freeze response. So adrenaline is gonna be running high. So maybe just kind of naming the blames coming in we're all feeling quite... We're full of adrenaline. Let's think about what we do need to be doing rather than pointing the finger, either at ourselves or other team members.- Thanks, Sarah. And here's a comment from Wendy who obviously works in the community in caring for people in their own homes. And first of all she says she's found this really interesting. So thank you for that and thank you for the feedback Wendy. The staff are, in her service, are often lone working and there can inevitably be a delay in getting support to them in a crisis. So there's an issue there I suppose for staff who work on their own in the community.- And I think there's a bit about thinking about having buddy systems. So knowing who it is that as a lone worker you can turn to if you've had a difficult visit and vice versa, being the person that a colleague can turn to because managers aren't automatically gonna know if you've had a difficult visit. So I think even if there's not a formal buddy system, just having an informal buddy system, knowing who is kind of your friend at work, who's gonna be the person that you can turn to.- Wendy goes on to give the example and say that after sudden deaths in people in their own homes and so on. And another interesting comment, a different perspective and I think you touched on it, is often after debriefs this person has said they've had a hot debrief where the stock phrase from manager often used, what could you have done differently in future? Or what could you do differently in future? Which makes a person feel even worse.- And I would be saying that something that maybe needs to be held off until the cold debrief because the cold debrief is about that professional reflection and the hot debrief is more about right then and there, how are you all coping?- [Ray] Could you just touch a little bit, a couple of people I've asked whether you could just clarify what a hot and a cold.- So the hot debrief would happen immediately after the incident or the event. So the coming together of the team to talk about right there and then, what has just happened. How they're feeling. What do they all need? And the cold debrief might happen later. So it might be a couple of days later or a couple of weeks later. And that might be about going through kind of processes, and thinking a bit about professionally, how was that situation managed? Were organisational processes followed at that point?- Thanks very much. Sean asked the question, how would you respond to a person who begins to disclose information that may be taken into consideration with the police and subsequent police investigation?- I think if it was a colleague I would be cautioning them about what they were saying. And I guess it depends what he means by that, what kind of scenario that is, whether it's about the colleague maybe saying something that could be incriminating them or whether it's about commenting on the situation and having information that would be useful for the police in their inquiries with respect to somebody else.- I guess so what you're reminding me often in terms of the several of the questions that have been posed, is that sometimes in the cold light of day, if you're like, or the comfort when we've got some space or time at work is probably to think about some stock phrases. You mentioned a few through your presentation. We may not use the language every time, or day in day out, or as common parlance but it's sometimes it's worth thinking about how we will respond to somebody in certain situations and the words or the phrases or the language we will use, and that's where listening comes in.- Absolutely. Absolutely. I think of the number of times that I've worked with people who work in either in-house or social care where they've had to deal with difficult situations and they've not known what to say. And my number one recommendation is think about having some stock phrases. We're working in health and social care. There are gonna be some times where people are experiencing a high level of distress and you need to be able to have a compassionate response, but you also don't need to have all the answers, and it's okay to say, I'm really sorry, I don't know. I can find out for you, and I'm really sorry you're feeling this way or this is happening to you.- Sarah, there's one more question here, which I will then end on this last question. It's so important that managers are trained in PFA as I've heard of managers saying, what would you do differently during the hot debrief, and this individual makes a comment, that can be really damaging.- Yeah, yeah. Or even a comment of why did you do that?- Absolutely. So it comes back to your point that sometimes the language and the way we approach things. But the point somebody else made earlier was we do have an obligation to try and end this old saying that takes me back to my days, get the information of what happened. We need to report. It's almost as if the individual and our colleagues, wherever they are, come second to the needs of the organisation. And that's something for us to take away from this and think how we would respond in the imperative versus to the needs of the individual.- And I think there is that balance in that if you are a manager and you have that expectation, it's how do you have that conversation? Or how do you support that member of staff to do that process in a compassionate way? So helping them to think through what has happened, and if they need to document it. Do they need you sat there with them? Do they need you to pass them the tissues, give them a cup of tea. You know, it's about remembering that that person is experiencing a trauma response at that moment, and that's normal, but how do you support them through that?- Thanks Sarah- It's okay.- Here's one where we end on, which I will take away and commit you and I to doing something, and we would put this on the hub. Someone put in a comment, do you have examples of stock phrases? You and I probably can think about that and sometimes as simple as it seems, if we don't practise that language, we are likely to be called short is probably the best way-- And I think sometimes people think, oh, that feels a bit cheesy to say that, but it's not in the moment, not in that context. Things like, you did everything you could given the circumstances. Or, gosh, this must be really hard for you. I can see how upsetting it is for you. I'm really sorry you're having to go through this. But often it's not just what we say it's how we say it.- Great. And to end the number of comments, again, thanking you for the presentation today, lots to think about and how we can support our colleagues in the months ahead when the demand is high and capacity is so reduced. Thanks for your insight, knowledge, and skills and for sharing that with us. I couldn't put any better, Sarah, so thanks again. And colleagues who are attending this session, could I draw your attention to the focus on wellbeing programme. Tomorrow there is a session on anxiety and using how mindfulness can help. And the majority of the programme this time round, this fifth series is trying to provide you with some skills, not saying that you don't have any, some insights, some ways of helping you through what is commonly become known as going to be a very highly pressurised winter for everyone working in the public sector, but more specifically in health and social work, social care services. So if you can make it to the webinar tomorrow, please register via the National Wellbeing Hub or look at the others in the series between now and Christmas and some in January as well. So thank you for participating today. I'm sorry we couldn't... The questions all kept coming in at the end, and we will definitely try and answer some of them, take some of them on board and answer them in top tips sort of sheet that we'll put onto the National Wellbeing Hub. Thanks again, take care and all the best. Bye bye.