Seminar / house orientation

• Welcome to Doc J’s Stopover

• Kitchen and Resto Staff – Leny, Stephen and Stelline
• Tea & Coffee – continuous supply (except for brewed coffee)
• Equal sweeteners available
• Some mixed nuts
• Any food restrictions? – c/o Joyce
• We have 5 Toilets + 1 boys’ urinal Acknowledgment:
• Hand-wash area - by the resto toilets. Joyce – CD = PSYCHE HEALTH
• Other personal concerns- call Joyce . PsPN
. Social Action – San Carlos
. All Pax
SEMINAR
- Soft copy of training materials
- Workshop areas
- Seminar kit – pen, training coverage, PFA –quick guide, drawing &
writing exercises, recycled papers
-
 PSYCHOSOCIAL CARE : PSYCHOLOGICAL
FIRST AID (PFA)
(Establishing Community Mechanisms For Trauma
Healing & Recovery )

by
JOHNNY B. DECATORIA, Ph.D., B.C.E.T.S.
Board Certified Expert in Traumatic Stress
Diplomate, The American Academy of Experts in Traumatic Stress
Founding Consultant , UST Graduate School Psychotrauma Clinic (Manila)
Former Consultant, UNICEF / UNHCR
Consultant, Psychology Clinic- Far Eastern University, Manila
Consultant, Crisis Management Team- San Sebastian College-Recoletos

Dec , 2013
 COVERAGE
1. THE FRAMEWORK OF PSYCHOSOCIAL CARE
IASC GUIDELINES ON MENTAL HEALTH AND PSYCHOSOCIAL
SUPPORT IN EMERGENCY SETTINGS (MHPSS)
- The IASC Pyramid Model
- The RAT (Rapid Assessment Tool)

2. THE IMPACT OF EMERGENCIES / CRISES

3. PSYCHOLOGICAL FIRST AID (PFA): SOME STRATEGIES

. PFA WHO – adopted by PPA
. Stress Debriefing for Adults
. Drawing & Writing Exercises for Children
. Other Techniques & Strategies

4. ESTABLISHING COMMUNITY MECHANISMS FOR

PSYCHOSOCIAL CARE AND COMMUNITY TRAUMA HEALING &
RECOVERY
The Negros / PSPN Model: Phases / Components of the Program
(Developing your own Agency’s Debriefing Team)
 20 min Workshop - Small Groups
1. In times of Crisis / Emergency-
what strategies or techniques of PFA or
psychosocial support, you think is most
useful for the victims / survivors?
Try a couple of strat...

2. Review the PFA guide (WHO) in your

kit. Think of examples; and note how you
can implement the core actions
Sharing follows 4
Today, there are only 2 types of
COMMUNITIES:
1. Those who had experienced a crisis, and

2. Those who are about to…

Emergencies are becoming more

disastrous, massive and powerful…

Even common problems In the home or

school, are no longer the same.
 Understanding
IASC
(Inter Agency Standing Committee)

and Guidelines on

MHPSS
(Mental Health and Psychosocial Support
in Emergency Settings)

6
In 2007, IASC Guidelines on Mental Health and
Psychosocial Support in Emergency Settings was
formulated.

Primary Purpose of the Guidelines

1. To enable humanitarian actors & communities
plan, establish and coordinate a set of
minimum multi-sectoral responses.

2. To protect & improve people’s mental health

and psychosocial wellbeing in the midst of an
emergency.
7
THE CORE IDEA :
In the early phase of an emergency, social
supports are essential to protect & support the
mental health and psychosocial well-being of
the affected population.

MENTAL & PSYCHOSOCIAL SUPPORT =

Any type of local or outside support that aims to protect
or promote psychosocial well-being and/or prevent or
treat mental disorder.

• PSYCHOSOCIAL REHABILITATION – bring back to normalcy

• PSYCHOSOCIAL TREATMENT -recovery
Types of response in Emergency
Scenarios

• Minimum Response- high-priority responses that

should be implemented as soon as possible in an
emergency.

• Comprehensive Response- These interventions are

most often implemented during the stabilized phase
and early reconstruction period following an
emergency.

• Emergency preparedness- enable the rapid

implementation of minimum responses.
9
 Phases of Emergency Management
To communities to reduce vulnerability to threats and cope
with disasters

the immediate reaction to

a disaster. It may occur as
Mitigation or Prevention: the disaster is anticipated,
Any acts that avert an as well as soon after it
begins.
emergency; diminishing
the chance of an
emergency to happen,
or reduce the damaging
effects of inevitable
Activities that continue beyond the
emergencies
emergency period to restore community
functions and manage reconstruction
10
 5 PHASES OF CRISIS MGMT

Learning

Recovery (Back To Biz)

Damage Containment / Limitation

Prevention / Preparation

Signal Detection
Psychosocial support = PFA

Action principles
of PFA – • LOOK

the 3 L’s • LISTEN

• LINK

12
Look
Check for safety.
Check for people with obvious urgent basic needs.
Check for people with serious distress reactions.

Listen
Approach people who may need support.
Ask about people’s needs and concerns.
Listen to people, and help them to feel calm.

Link
Help people address basic needs and access services.
Help people cope with problems.
Give information.
Connect people with loved ones and social support.

13
 The Eight Core of PFA
The NCTSN/NCPTSD Model (2006)
1. Contact & engagement
2. Safety & comfort
3. Stabilization (if necessary)
4. Information gathering: current needs and
concern
5. Practical assistance
6. Connection with social supports
7. Information on coping support
8. Linkage with collaborative services

National Child Traumatic Stress Network & National Center for PTSD
 PPA QUICK GUIDE TO PFA (from WHO - NCPTSD)
1. CONTACT (Pagkilala)

2. SAFETY AND COMFORT (Paniniguro at ____)

Check if they have eaten or if there is something they urgently need

3. STABILIZE (Pagstabilisa)
Affirm reactions
Check for signs - overwhelmed or disoriented

4. INFORMATION GATHERING (Pagkuha ng Impormasyon)

Don’t force them if they don’ want to recount experience!

5. PRACTICAL ASSISTANCE (Pangangailangan) - Identify needs

6. CONNECTION WITH SOCIAL SUPPORT

Connect with primary support persons and other sources of social support

7. COPING (Pagkaya) Obtain information on coping; affirm positive;

provide info if necessary
8. LINKING WITH SERVICES
(Pagkuha ng Angkop na Serbisyo) Obtaining the Help they need 15
 STRESS DEBRIEFING
PFA- WHO (Mitchell CISD)
1. CONTACT 1. INTRO
2. SAFETY AND COMFORT THE WHOLE PROCESS
3. STABILIZE - Affirm reactions; 4. STRESS REACTIONS
Check for signs - overwhelmed or - Teaching
disoriented
4. INFORMATION GATHERING 2. EVENT
(Pagkuha ng Impormasyon) 3. FEELINGS
5. PRACTICAL ASSISTANCE THE WHOLE OBJECTIVE OF STRESS
(Pangangailangan) - Identify needs DEBRIEFING
6. CONNECTION WITH SOCIAL 7. RE-ENTRY PLANNING & SUPPORT
SUPPORT - Connect with primary
support persons and other sources
7. COPING (Pagkaya) Obtain 4. COPING +
information on coping; affirm positive; 5. TEACHING
provide info if ecessary
8. LINKING WITH SERVICES - 7. RE-ENTRY PLANNING,
(Pagkuha ng Angkop na Serbisyo) + SUPPORT (REFERRALS)
Obtaining the Help they need 16
 DO’s DON’T’s
▪•Practice empathic listening •▪ Force people to share their
▪ Respect people’s right to story with you
privacy; keep their story ▪ Tell people what they
confidential should or should not feel
▪ Be aware of your own or think
biases and set them aside ▪ Minimize what they have
▪ Try and speak their gone through
language ▪ Give promises you can’t
▪ Behave appropriately (i.e. keep
respect elders, don’t touch ▪ Automatically assume
people without their they share your religious
permission) beliefs
▪ Preach
▪ Judge
17
 THE FRAMEWORK OF
PSYCHOSOCIAL CARE

IASC Guidelines On
Mental Health And Psychosocial
Support In Emergency Settings
(MHPSS)

- The IASC Pyramid Model

- The RAT (Rapid Assessment Tool)

18
1. ADVOCACY FOR PYSCHOSOCIAL SUPPORT AND ACCESS TO BASIC SERVICES
• (food, shelter, water, hygiene, functioning governance systems, healthcare) into which
psychosocial support needs to be mainstreamed, and the assurance of security in order to
reestablish wellbeing and mitigate further psychosocial harm. Aim to reach many children and
support ways of coping.,Animators or community workers

2. COMMUNITY & FAM SUPPORT

• Care and support provided by caregivers, friends and community members.
Children who have experienced the loss of family and community level supports,
through death,separation and loss of livelihood opportunities will require specific
support to restore the protective factors that these systems provide eg. family
reunion, healing rituals for reconciliation, vocational training. Child protection
officers or social workers

3. FOCUSED & NON SPECIALIZED SUPPORT

• A smaller percentage of the population, with particularly stressful reactions, will require more
focused and specialized support interventions with attention to the individual, family or group
(eg. psychosocial first aid by health workers), Psychologist

4. SPECIALIZED SERVICES
• Children experiencing significant distress that disrupts their ability to
function on a day to day basis will require specialized mental health and
psychosocial support (to be provided by trained professionals including
specialised traditional healers). Psychiatrist or mental health specialist.
20
IMPACT OF EMERGENCIES :
PSYCHO- SOCIAL

22
IMPACT OF EMERGENCIES
IMPACT OF EMERGENCIES - Social
IMPACT OF EMERGENCIES -PSY
GOOD PRACTICE
PRINCIPLES FOR
ASSESSMENT

27
 RAT – MHPSS

RAPID ASSESSMENT TOOL:

MENTAL HEALTH & PSYCHOSOCIAL
SUPPORT IN EMERGENCY SETTING

30
MHPSS – RAT
 RAT
1) BRIEF DESCRIPTION Of The Event Or
Disaster
2) AT-RISK GROUP Or Population Affected
3) INVENTORY OF SERVICES &
INTERVENTIONS Already Provided
4) MENTAL HEALTH RESOURCES &
PSYCHOSOCIAL SUPPORT Available
5) PRIORITY ISSUES, Concerns, & Problem
Areas
6) RECOMMENDATIONS & Suggestions
7) ASSESSOR Details
1
1
2
2
3
3
4
4
1. Coordination
2. Assessment, Monitoring & Evaluation
3. Protection and Human Rights Standards
4. Human Resources
5. Community Mobilization & Support
6. Health Services
7. Education
8. Info Dissemination
9. Food Security & Nutrition
10. Shelter and Site Planning
11. Water & Sanitation
43
 PFA
GUIDE for
FIELD WORKERS

Some strategies

44
(PFA)
a humane, supportive response to a fellow human
being who is suffering and who may need support.

It involves the following themes:

1. providing practical care and support
2. helping people to address basic needs (food,
water, information)
3. listening to people, but not pressuring them to talk
4. comforting people and helping them to feel calm
5. helping people connect to information, services
and social supports
6. protecting people from further harm.
Who is PFA for?
• for distressed people who have been
recently exposed to a serious crisis event.

• both children and adults. However, not

everyone who experiences a crisis event will
need or want PFA. Do not force help on
people who do not want it, but make
yourself easily available to those who may
want support

46
4 MAIN POINTS : Helping Responsibly

1. Respect safety, dignity and rights.

2. Adapt what you do to take account of

the person’s culture.

3. Be aware of other emergency response

measures.

4. Look after yourself.

Preparing to offer PFA in different cultures:

DRESS
Do I need to dress a certain way to be respectful?
Will impacted people be in need of certain clothing items to
keep their dignity and customs?

LANGUAGE
What is the customary way of greeting people in this culture?
What language do they speak?

GENDER, AGE AND POWER

• Should affected women only be approached by women helpers?
• Who may I approach? (the head of the family or community?)

48
Touching and Behaviour
• What are the usual customs around touching
people? Is it all right to hold someone’s hand or
touch their shoulder?
Are there special things to consider in terms of
behaviour around the elderly, children, women or
others?
Beliefs and Religion
• Who are the different ethnic and religious groups among
the affected people?
• What beliefs or practices are important to the people
affected?
• How might they understand or explain what has
happened? 49
SOME POINTERS IN RESPONDING TO A CRISIS
SITUATION:
1. follow the direction of relevant authorities
managing the crisis;

2. learn what emergency responses are being

organized and what resources are available to
help people, if any;

3. don’t get in the way of search-and-rescue or

emergency medical personnel;

4. know your role and the limits of your role.

50
Prepare Yourself
• Learn about the crisis event.

• Learn about available services and

supports.

• Learn about safety and security

concerns

51
 Who need
special attention
in a crisis

At-Risk Populations

52
CHILDREN & ADOLESCENTS
– especially those separated from their caregivers, may need
protection from abuse and exploitation. They will also likely need
care and help to meet their basic needs.

PEOPLE WITH HEALTH CONDITIONS OR PHYSICAL AND

MENTAL DISABILITIES
- special help to get to a safe place
- to be protected from abuse and to access medical care and other
services. This may include frail elderly people, pregnant women,
people with severe mental disorders, or people with visual or
hearing difficulties.

PEOPLE AT RISK OF DISCRIMINATION OR VIOLENCE

- such as women or people of certain ethnic groups, may need
special protection to be safe in the crisis setting and support to
access available help.

53
 Be Aware of At-Risk Populations

Children, especially those:

• Separated from parents/caregivers.

• Whose parents/caregivers, family members, or

friends have died.

• Whose parents/caregivers were significantly

injured or are missing.

• Involved in the foster care system.

54
 MORE … At-Risk Populations
• Those who have been injured .
• Those who have had multiple relocations and
displacements.
• Medically frail children and adults.
• Those with serious mental illness.
• Those with physical disability, illness, or sensory deficit.
• Adolescents who may be risk-takers.
• Adolescents and adults with substance abuse problems.
• Pregnant women.
• Mothers with babies and small children.
• Disaster response personnel .
• Those with significant loss of possessions (for example,
home, pets, family., memorabilia)
• Those exposed first hand to grotesque scenes or extreme
life threat 55
1. What caregivers can do to
help children

Infants
• Keep them warm and safe.
• Keep them away from loud noises and
chaos.
• Give cuddles and hugs.
• Keep a regular feeding and sleeping
schedule, if possible.
• Speak in a calm and soft voice
56
 1. What caregivers can do to help children

Young children

• Give them extra time and attention.

• Remind them often that they are safe.
• Explain to them that they are not to blame for
bad things that happened.
• Avoid separating young children from
caregivers, brothers and sisters, and loved
ones.
• Keep to regular routines and schedules as much
as possible.
57
 1. What caregivers can do to help children
Young children (2)

• Give simple answers about what happened

without scary details.

• Allow them to stay close to you if they are

fearful or clingy.

• Be patient with children who start

demonstrating behaviours they did when they
were younger, such as thumb sucking or bed
wetting

• Provide a chance to play and relax, if

possible 58
 1. What caregivers can do to help children

Older children and adolescents

• Give them your time and attention.
• Help them to keep regular routines.
• Provide facts about what happened and explain what is
going on now.
• Allow them to be sad. Don’t expect them to be tough.
• Listen to their thoughts and fears without being
judgmental.
• Set clear rules and expectations.
• Ask them about the dangers they face, support them
and discuss how they can best avoid being harmed.
• Encourage and allow opportunities for them to be
helpful

59
2. HOW TO HELP
PEOPLE WITH
HEALTH CONDITIONS
OR DISABILITIES

60
 2. HOW TO HELP PEOPLE WITH HEALTH CONDITIONS OR DISABILITIES

• Help them to get to a safe place.

• Help them to meet their basic needs, such as being able to eat,
drink, get clean water, care for themselves, or to build shelter
from materials handed out by agencies.

• Ask people if they have any health conditions, or if they regularly

take medication for a health problem. Try to help people get their
medication or access medical services, when available.

• Stay with the person or try to make sure they have someone to
help them if you need to leave. Consider linking the person with a
protection agency or other relevant support, to help them in the
longer term.

• Give them information on how to access any services available

61
3. PEOPLE AT RISK
OF DISCRIMINATION
OR VIOLENCE

62
 3. PEOPLE AT RISK OF DISCRIMINATION OR VIOLENCE

Include women, people from certain ethnic or religious

groups, and people with mental disabilities.

• They maybe left out when basic services

are being provided;

• May be left out of decisions about aid,

services or where to go;

• May be targeted for violence, including

sexual violence. 63
GETTING READY
TO HELP …

64
 Getting ready to help

1. Learn about crisis situations, and roles and

responsibilities of different kinds of helpers.

2. Consider your own health, and personal or

family issues that may cause severe stress
as you take on a helping role for others.

3. Make an honest decision about whether you

are ready to help in this particular crisis
situation and at this particular time.

65
WHAT SHOULD BE AVOIDED IN PSYCHOSOCIAL
PROGRAMMES IN EMERGENCIES

1. Avoid Counselling or other interventions that focus on single

events or types of reactions, for example, post traumatic stress
symptoms- people have multiple causes of distress and various
reactions.
Unless provision CBT by fully trained clinicians

2. All programmes and staff should be careful not to elicit

emotional material too early until they are in a safe environment
where their basic needs are met

3.Do not allow untrained / unsupervised staff perform diagnostic

assessment / counseling.

4. Avoid inappropriate explorations of the stressful experiences.

However, if the survivor wishes to speak, do not stop him or her
from telling their story. 66
 What should be avoided…
5. Do not pathologize what are likely to be normal
reactions to extremely distressing events.

6. Do not discourage or encourage people from using

traditional and/ or faith based coping mechanisms, it is
up to the individual.

7. Avoid culturally inappropriate investigation and

misuse of diagnostic tools. Do not screen people for
problems without being able to refer the person to a
service which can provide effective support.

8. Do not carry out any interventions that risk further

isolation or stigmatisation of particular vulnerable
groups among the affected population.
Foundation module 7 Psychosocial support , ARC resource pack 2009 ARCModF7StudyMaterial2009
http://www.arconline.org
67
Supplemental notes

More Strat & Activities

MORE PFA Models

68
PFA – More Strat and Activities
1. Referral

2. Networking Based On Cooperation

3. Coordination

4. Provision of Information / Education.

4. Provision of Comfort And Support

5. Group PFA
69
REFERRAL
• We facilitate the process- accessing additional or
further services. It ensures a continuum of care for
clients by helping them to access all the relevant
services available to address their physical,
psychological and social needs

When to refer
• When resources or needs are beyond your / agency’s
capacity
• When client will receive better services/ resources
from another person / agency
• Confused ; agitated ; Panicky
• Extremely withdrawn, apathetic, or “shut down
• Extremely irritable or angry
• Exceedingly worried 70
 PFA: When to refer
1. When a person is unable to handle the
intense feelings / physical symptoms
2. Feeling numb and empty
3. when strong emotions continue to be
distressing or unbearable
4. Persistent sleep problems / nighmares
5. No one to support the person / no one to
share the emotions
6. Relationship problems become worse
7. Increasing use of alcohol / substance
71
PFA: Safety and Comfort

72
PFA: Safety and Comfort
• Ensure Immediate Physical Safety
• Provide Information about Disaster Response Activities and
Services
• Attend to Physical Comfort
• Promote Social Engagement
• Attend to Children Who Are Separated from their Parents /
Caregivers
• Protect from Additional Traumatic Experiences and Trauma
Reminders
• Help Survivors Who Have a Missing Family Member
• Help Survivors When a Family Member or Close Friend has Died
• Attend to Grief and Spiritual Issues
• Provide Information about Casket and Funeral Issues
• Attend to Issues Related to Traumatic Grief
• Support Survivors Who Receive Death Notification
• Support Survivors Involved in Body Identification
• Help Caregivers Confirm Body Identification to a Child or 73
Adolescent
PFA consists of numerous processes :
Raphael (1986)

1. Meeting basic physical needs, such as

a. physical protection,
b. establishing a sense of security,
c. provision of physical necessities.

2. Meeting psychological needs, such as

a. consolation,
b. provision of emotional support,
c. provision of behavioral support,
d. allowing emotional ventilation,
e. fostering constructive behavior.

3. Fostering social support, such as

a. reuniting victims with friends or family,
b. utilization of community support networks. 74
Group-PFA

a. CISD – Jeffrey Mitchell

b. The 6-stage Group-PFA

Everly and Flynn (2005)

75
 Everly’s Group PFA
1. Introduction
2. Provide a review, or short presentation -
To present and acknowledge the facts of the
situation

3. Ask for clarification or correction of the facts as

presented.
4. Teach
5. Support the natural cohesion and resiliency of
the group ; supporting one another

6. Assist in connecting
with informal / informal support systems 76
 RESOURCES

EMERGENCY NURSING: A Guide to Comprehensive Care - Janet Gren Parker

RAT – MHPSS (RAPID ASSESSMENT TOOL: MENTAL HEALTH & PSYCHOSOCIAL

SUPPORT IN EMERGENCY SETTING – IASC, 2007

PSYCH CRISIS MGMT PRESENTATION SLIDES, Sept 2013 – by R.C. Enriquez