Psychological First Aid

Psychological First Aid 1. Supportive intervention

2. Evidence-informed
3. Modular approach
4. Acute intervention of choice
A Presentation :
Lucille A. Montes, M.D., Ph.D.
Based on: National Child Traumatic Stress Network and National Center for PTSD, Psychological
5. To reduce the initial distress caused
First Aid: Field Operations Guide, 2nd Ed. , July 2006.
www.nctsm.org and www.ncptsd.va.gov by traumatic events
Compiled by Ptr. Rimalyn Siriban
UPLOADED by BEREAN GUIDE
For Educational Purposes only
6. Foster short- and long-term
adaptive functioning and coping

For whom For whom

1. Children
2. Adolescents 1. First responders
3. Parents/caretakers 2. Other disaster relief workers
4. Families
5. Adults
who are exposed to
disaster or terrorism

When and where should it be used?

Who delivers it?
IN THE IMMEDIATE AFTERMATH OF
 Mental health workers DISASTERS AND TERRORISM
 Other disaster response workers Diverse settings:
who provide early assistance as part 1. General shelters, Special Needs
shelters
of an organized disaster response
2. Field hospitals and medical triage
effort areas
3. Staging areas or respite areas for
first responders and other relief
IMPORTANT: PROVIDERS SHOULD BE PART OF workers
RESPONSE UNITS 4. Assistance centers
5. Feeding locations
 GENERAL GUIDELINES
in delivering Psychological First Aid
PROFESSIONAL BEHAVIOR
1. Operate within framework of
authorized disaster response system
2. Model healthy responses: calm,
courteous, organized, helpful
3. Be visible and available
4. Maintain confidentiality when
appropriate
GENERAL GUIDELINES
in delivering Psychological First Aid
1. Politely observe first, don’t intrude.
Then ask simple respectful questions to
determine how you may help
2. Often, the best way to make contact is to
offer practical assistance (food, water,
blankets)
3. Initiate contact only after you have observed
the situation and the person or family, and
have determined that contact will not be
intrusive or disruptive.
GENERAL GUIDELINES
in delivering Psychological First Aid
8. Acknowledge what survivor has done
to keep safe
9. Give info that directly addresses the
survivors immediate goals
 clarify answers repeatedly as needed
10. Give info that is accurate and age-
appropriate
11. When communicating through
interpreter, look at and talk to person
you are addressing, not at interpreter
GENERAL GUIDELINES
in delivering Psychological First Aid
PROFESSIONAL BEHAVIOR
6. Remain within scope of your expertise
and your designated role
7. Make referrals when needed or
requested
8. Be culture-sensitive
9. Be self aware of own physical and
emotional reactions and practice self-
care
GENERAL GUIDELINES
in delivering Psychological First Aid
4. Survivors will either avoid you or flood
you with contact
5. Speak calmly.
 Be patient, responsive, and sensitive
6. Speak slowly in simple, concrete
terms.
 Don’t use acronyms or jargon
7. If survivors want to talk, be prepared
to listen.
 Focus on what they want to tell you and
how you can be of help
GENERAL GUIDELINES
in delivering Psychological First Aid
Remember the overall goal of PFA
is to
1. reduce distress
2. assist with current needs
3. promote adaptive functioning
NOT to elicit details of traumatic
experiences and losses
 Some dont’s
1. Do not make assumptions about
what the survivors are experiencing
or what they have been through
2. Don’t assume that everyone is
traumatized
3. Don’t pathologize
 don’t label reactions as “symptoms”,
 don’t speak in terms of “diagnoses”, “disorders”,
“pathologies”
Preparation
1. Consider your capability, comfort
level, health etc
2. Know the organizational structure
where you are imbedded: the
people, services, sop’s
3. Have important numbers on hand
4. Decide with team how to provide
your service:
 Designated areas
 Circulating around the facility
 Both
Preparation
Classify: be alert to at-risk groups
1. Children, especially those separated from
parents or caregivers, or whose family
members have died or been injured
2. Those with injuries
3. Medically frail
4. Those with serious mental illnesses
Some dont’s
4. Do not talk down or patronize the survivor
 Don’t focus on his weakness, helplessness,
mistakes or disability
 Focus on what person has done that is effective or
helpful during the disaster and currently
5. Do not assume that all survivors want to talk
or need to talk to you
 Often simple physical presence is enough
6. Don’t “debrief” by asking for details of what
happened
7. Don’t speculate or offer inaccurate info. If
you can’t answer a question, do your best to
learn the facts
Preparation
Mentally have a classification system
(triage) as this is probably not done in a
systematic, organized way. Those who
need more assistance are:
1. Disoriented
2. Confused
3. Frantic or agitated
4. Panicky
5. Extremely withdrawn, apathetic or “shut
down”
6. Extremely irritable or angry
7. Exceedingly worried
Preparation
Classify: be alert to at-risk groups
5. Adolescents who may be risk-takers
6. Pregnant women
7. Mothers with babies and small children
8. Those with significant losses of
possessions
9. Those exposed first hand to grotesque
scenes or extreme life threat
 8 Core Actions 8 Core Actions:
1. Within days or weeks following an event
2. Be flexible Core Action 1
3. Base the amount of time spent on each
action on the survivor’s specific needs Contact and Engagement
and concerns Goal: To respond to contacts initiated
4. Not sequential by survivors, or initiate contact in a
– sometimes may happen simultaneously, or non-intrusive, compassionate and
have to backtrack
helpful manner
Note: it may be helpful to provide some training to
community leaders if the setting is a natural grouping

CORE ACTION 1: CONTACT AND ENGAGEMENT CORE ACTION 1: CONTACT AND ENGAGEMENT

3. Introduce yourself, title, role

1. Ask permission to talk
1. Prioritize those who seek you out 2. Addressing person using cultural practice
2. If several people approach you 3. Invite person to sit, ensure some privacy
4. Avoid being distracted
simultaneously, make contact 5. Find out if there is a pressing problem that need
with as many as you can immediate attention

 Even a brief look of interest and 4. Confidentiality when appropriate

calm can be helpful

CORE ACTION 2: SAFETY AND COMFORT

CORE ACTION 2: SAFETY AND COMFORT

1. Make sure there is physical safety, e.g.

– Find officials who can address issues
Goal: To enhance immediate on weapons, etc.
and ongoing safety, and – Remove broken glass, sharp objects,
spilled liquids, etc
provide physical and
– Make sure children have safe area to
emotional comfort. play and are supervised
– Containment of threat of harm to self
or others
 CORE ACTION 2: SAFETY AND COMFORT
1. Make sure there is physical safety, e.g.
– Find officials who can address issues on weapons,
etc.
– Remove broken glass, sharp objects, spilled liquids,
etc
– Make sure children have safe area to play and are
supervised
– Containment of threat of harm to self or others
2. Comfort, e.g.
– Lighting, noise, temperature
– Health-related needs: eyeglasses, medicines,
assistance in daily functioning
– Immediate medical attention: shock, serious
emergencies
CORE ACTION 2: SAFETY AND COMFORT
5. Protect from additional traumatic
experiences and trauma reminders
– Shield survivors from reporters
– Avoid excessive viewing of coverage of
the disaster
– Remind parents to be careful what they
say in front of the children and clarify
things that may be upsetting
CORE ACTION 3: STABILIZATION (IF NEEDED)
Goal: To calm and orient
emotionally overwhelmed or
disoriented survivors.
CORE ACTION 2: SAFETY AND COMFORT
3. Do
not reassure people that they are safe
unless you have definite factual
information that that this is the case
4. Promote Social Engagement
– Facilitate group and social interaction if possible
and appropriate
• soothing to be near people who are coping
well, encourage them to talk to others who
are distressed
• engage children in activities
– Attend to children who are separated from their
caregivers
• may need to designate child-friendly space
CORE ACTION 2: SAFETY AND COMFORT
6. Help survivors who have a
missing family member
7. Help survivors when a family
member or close friend has died
1. Traumatic grief
2. Funeral arrangements
3. Body identification
8. Attend to spiritual needs
CORE ACTION 3: STABILIZATION
1. Identify those with intense and
persistent reactions that interfere
with functioning
– Remain calm, quiet and be close by; give
him a few minutes before you intervene
– Help them understand their reactions:
intense emotions come and go, fight or
flight mechanism, calming routines help,
family and friends can help calm down
– Grounding
– If above strategies have no effect, refer to
psychiatrist

CORE ACTION 4: INFORMATION GATHERING:
CURRENT NEEDS AND CONCERNS
Goal: To identify immediate needs
and concerns, gather additional
information, and tailor PFA
interventions
CORE ACTION 4: INFORMATION GATHERING:
CURRENT NEEDS AND CONCERNS
6) Losses
7) Feelings of guilt and shame
8) Thoughts about harming self or others
9) Availability of social support
10) Prior alcohol or drug use
11) Prior exposure to trauma or death of loved ones
12) Specific concerns and developmental impact
CORE ACTION 5: PRACTICAL ASSISTANCE
1. Central focus of PFA
2. Let survivors participate in
problem-solving:
empowerment facilitates
recovery
– Identify the most immediate needs
– Clarify the need
– Discuss an action plan
– Act to address the need
CORE ACTION 4: INFORMATION GATHERING:
CURRENT NEEDS AND CONCERNS
1. From moment of engagement and thru
the 8 actions
2. Find out
a) Nature and severity of experiences (avoid
asking in-depth descriptions, just basic info)
b) Death of loved one
c) Separations
d) Concerns about ongoing threat
e) Illnesses, need for medication
CORE ACTION 5: PRACTICAL ASSISTANCE
Goal: To offer practical help to
survivors in addressing
immediate needs and concerns
CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS
Goal: To help establish brief or ongoing
contacts with primary support persons or
other sources of support , including family
members, friends, and community helping
resources
 CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS

1. Fosters well-being and recovery 1. Enhance access to primary support

2. Many forms persons
a) Emotional support 2. Encourage use of immediately available
support persons
b) Social connection 1. Shared activity: games, singing, etc.
c) Feeling needed 2. Older people can be cared for by
d) Reassurance of self-worth adolescents
e) Reliable support 3. Etc.
3. Discuss support seeking and giving
f) Advice and information
1. Reasons why some don’t want to seek
g) Physical assistance support, etc.
h) Material assistance 4. Be role model of a supportive person

CORE ACTION 7: INFORMATION AND COPING

CORE ACTION 7: INFORMATION AND COPING

1. Review basic information about stress reactions

2. Review common psychological reactions to
Goal: To provide information about traumatic experiences and losses
stress reactions and coping to a. Intrusive reactions
reduce distress and promote b. Avoidance and withdrawal reactions
c. Physical arousal reactions
adaptive functioning.
3. Teach simple relaxation techniques
4. Help families cope

CORE ACTION 7: INFORMATION AND COPING CORE ACTION 8: LINKAGE WITH COLLABORATIVE SERVICES

6. Assist with developmental issues

1. Children need different approaches Goal: To link survivors with
7. Assist in anger management available services needed at the
8. Address highly negative emotions (guilt and
shame)
time or in the future
9. Help with sleep problems
10. Address alcohol and substance use
 CORE ACTION 8: LINKAGE WITH COLLABORATIVE SERVICES

1. Refer for additional needed services

2. Promote continuity in helping
relationships
a. Give names and contact info on local
public health and public mental health
service providers in the community JESUS LOVES YOU.
b. Introduce the survivor to other service
providers so s/he knows other helpers by
name
c. If you are leaving, let the survivor know
and if possible endorse personally to the
next provider and provide an introduction