Psychological Triage           Presentation by   Lucille A. Montes, M.D., Ph.D.         Based on seminar of      Stephen E...
DefinitionThe process of evaluating and sorting victims by immediacy of treatment needed and directing them to immediate ...
Rationale1. Not all will be equally affected by a calamity2. Recovery is the norm    Intervention offered only if there’s...
The basis for sorting:Risk factorsCrisis exposure Physical proximity Emotional proximityPersonal vulnerabilities Inte...
Risk factors: internalvulnerabilityAvoidance coping stylePre-existing mental illnessPoor self regulation of emotionLow...
Risk factors: externalvulnerabilityFamily resources  Not with nuclear family  Ineffective and uncaring parenting  Fami...
Risk factors: threat perceptionsSubjective impressions can be more important than actual crisis exposureAdult perception...
Risk factors: crisis reactionsReactions suggesting need for immediate mental health referral Dissociation Hyper-arousal ...
Developmentalconsiderations Preschoolers  Reactions not as clearly connected to   the event  Reactions expressed nonverb...
DevelopmentalconsiderationsSchool age children More directly connected to crisis event Event-specific fears may be manif...
DevelopmentalconsiderationsPreadolescents and adolescents  Reactions more like adults  Sense of foreshortened future  O...
Triage: the processPreparation1. Identify mental health resources and other   community support resources2. Develop or obt...
Triage: the processPrimary assessment Starts a soon as possible and before  any interventions Based on crisis exposure a...
Triage: the processSecondary assessment Begins as soon as interventions  begin to be provided Identifies those who show ...
Triage: the processTertiary assessment of trauma Begins weeks after a crisis event has  ended Identifies those who will ...
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STEP 2. Psychosocial Response

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Step by Step Guide sa Disaster Management:
1. Rapid Assessment Form
2. Camp Management Checklist
3. Psychosocial Response
4. Sphere Standards
Psychosocial Response Volunteers
a. Children Intervention
Play Therapy, Art Therapy, Music Therapy
b. Adult Intervention

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STEP 2. Psychosocial Response

  1. 1. Psychological Triage Presentation by Lucille A. Montes, M.D., Ph.D. Based on seminar of Stephen E. Brock, Ph.D.
  2. 2. DefinitionThe process of evaluating and sorting victims by immediacy of treatment needed and directing them to immediate or delayed treatment. (NIMH, 2001, p. 27)Goal: greatest good for the greatest number of victims
  3. 3. Rationale1. Not all will be equally affected by a calamity2. Recovery is the norm  Intervention offered only if there’s a demonstrated need1. There is a need to identify those who will recover relatively independently  Intervention may cause harm if not needed1. To use wisely resources that are limited
  4. 4. The basis for sorting:Risk factorsCrisis exposure Physical proximity Emotional proximityPersonal vulnerabilities Internal vulnerability factors External vulnerability factorsThreat perceptionsCrisis reactions
  5. 5. Risk factors: internalvulnerabilityAvoidance coping stylePre-existing mental illnessPoor self regulation of emotionLow developmental levelPoor problem solvingHistory of prior psychological traumaExternal locus of control
  6. 6. Risk factors: externalvulnerabilityFamily resources Not with nuclear family Ineffective and uncaring parenting Family dysfunctions (alcoholism, violence, etc) Parental PTSD/maladaptive coping with stressor Poverty/financial stressSocial resources Social isolation Lack of perceived social support
  7. 7. Risk factors: threat perceptionsSubjective impressions can be more important than actual crisis exposureAdult perceptions influence children’s threat perceptions
  8. 8. Risk factors: crisis reactionsReactions suggesting need for immediate mental health referral Dissociation Hyper-arousal Persistent re-experiencing of the crisis event Persistent avoidance of crisis reminders Significant depression Psychotic symptoms
  9. 9. Developmentalconsiderations Preschoolers Reactions not as clearly connected to the event Reactions expressed nonverbally May not display as many PTSD symptoms Temporary loss of recently achieved developmental milestone Trauma expressed in play
  10. 10. DevelopmentalconsiderationsSchool age children More directly connected to crisis event Event-specific fears may be manifested Reactions often expressed behaviorally Feelings often expressed through physical symptoms Trauma related to play Repetitive verbal descriptions of the event Problem with attention
  11. 11. DevelopmentalconsiderationsPreadolescents and adolescents Reactions more like adults Sense of foreshortened future Oppositional/aggressive behavior to ganin sense of control School avoidance  Self-injurious behavior and thinking Revenge fantasies Substance abuse Learning problems
  12. 12. Triage: the processPreparation1. Identify mental health resources and other community support resources2. Develop or obtain psychological screening tools3. Develop crisis intervention referral forms4. Understand/learn culture-specific crisis reactions
  13. 13. Triage: the processPrimary assessment Starts a soon as possible and before any interventions Based on crisis exposure and personal vulnerabilities
  14. 14. Triage: the processSecondary assessment Begins as soon as interventions begin to be provided Identifies those who show warning signs of trauma
  15. 15. Triage: the processTertiary assessment of trauma Begins weeks after a crisis event has ended Identifies those who will require mental health treatment referrals Survivors of traumatic events who do not manifest symptoms after about 2 months generally do not require follow up

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