Overview of TOT Training on

Psychological First Aid

Objective of the Session

• To share the knowledge and experiences of TOT training on

Psychological First Aid
Outline of the Session
• Background of Training

• Overview of Content of Training

• Reflection of Training
 Background of Training
• Training Period: 16-19 August, 2018
• Venue: Maharajgunj Nursing Campus
• Trainers: Kusala Wettesinghe & Felician Fransis (Psychosocial Practitioner, The
good practice group)
• Facilitators: Shubhanga Pyakurel and Radhika Bharati
• Organizer of Training: JISP, Isra AID Nepal, People of Japan, TPO Nepal
• Participants: 41, in two groups, Nursing educators and service providers with
varied background
 Background of Training continued

Objective of the training

• To develop participant’ knowledge on PFA and develop

their skills to use and deliver training on PFA.
Overview of the Content of
Training
Introduction of PFA

• PFA is a humane, supportive & practical assistance to fellow human

beings who recently suffered a serious stressor
What PFA is

• Non-intrusive, practical care and support

• Assessing needs and concerns
• Helping people to address basic needs (food, water)
• Listening, but not pressuring people to talk
• Comforting people and helping them to feel calm
• Helping people connect to information, services and social supports
• Protecting people from further harm
What PFA is NOT

• NOT something only professionals can do

• NOT professional counselling
• NOT a clinical or psychiatric intervention (although can be part of
good clinical care)
• NOT “psychological debriefing”
• NOT asking people to analyze what happened or put time and
events in order
• NOT pressuring people to tell you their story, or asking details
about how they feel or what happened
 History of PFA
 The term Psychological First Aid was coined by Drayer, Cameron,
Woodward, and Glass (1954) in a manuscript they wrote for the American
Psychiatric Association.
 In 1970s, crisis (psychological) intervention was utilized in disaster work
with adults.
 In mid 1980s, the practice of psychological debriefing became popular.

 Debriefing was found to be ineffective and sometimes, harmful too.

 PFA was developed by the National Center for Post Traumatic Stress
Disorder (NC-PTSD), a section of the United States Department of Veterans
Affairs, in 2006.
PFA: Indications
• Very distressed people who were recently exposed to a serious
stressful event

• Adults and children of all ages

• Not everyone who experiences a crisis event will need or want PFA
• Don’t force help on those who don’t want it, but make yourself available and
easily accessible to those who may want support
• Like adults, some children cope very well with difficult experiences.
Who needs more advanced support than PFA
alone?
• People with serious life-threatening
injuries
• People so upset they cannot care
for themselves or their children

• People with suicidal ideas

• People with homicidal ideas
• People who may need special attention: For
example children, people with disabilities,
people having pre-existing mental and
physical illness
PFA: When?
• Upon first contact with a very distressed adult or child, usually
immediately following an event, or sometimes a few days or weeks
after.
PFA: Where?

• Wherever it is safe enough for self to

be there

• Ideally with some privacy (as appropriate) to protect confidentiality

and dignity of the affected person
 Purpose of PFA?

People do better over the long-term if they…

oFeel safe, connected to others, calm & hopeful

oHave access to social, physical & emotional support

oRegain a sense of control by being able to help themselves

PFA Action Principles
Prepare
-------------------
Look Listen Link
 PFA Action Principles
Prepare • Learn about the crisis event
• Learn about available services and supports
• Learn about safety and security concerns
Look • Observe for safety
• Observe for people for obvious urgent basic needs.
• Observe for people with serious distress reactions
Listen • Make contact with people who need support.
• Ask about people’s needs and concerns.
• Listen to people and help them feel calm.
Link • Help people address basic needs and access services
• Help people cope with problems
• Give information
• Connect people with people with loved one and social
support.
 GOOD COMMUNICATION
• Try to find a quiet place to talk and minimize outside
distractions.

• Stay near the person but keep an appropriate distance

depending on their age, gender and culture.

• Let them know you hear them, for example, node your
head and say… ‘hmmm’

• Be patient and calm

 Good Communication contd..
• Provide factual information IF you have it. Be what you don’t
know. “ I don’t know but I will try to find out about that for
you.” Give information in a way the person can understand-
keep it simple

• Acknowledge how they are feeling, and any losses or important

events they share with you, such as loss of home or death of
loved one. .. ‘I’m so sorry’.

• Respect privacy. Keep the person’s story confidential, especially

when they disclose very private events.
• Acknowledge the person’s strengths and how they have helped
themselves.
 Good Communication
Things NOT to Say and DO
• Don’t pressure someone to tell their story
• Don’t interrupt or rush to someone’s story
• Don’t give your opinion of the person’s situation, just listen.
• Don’t touch the person if you are not sure it is appropriate to
do so.
• Don’t judge what they have or haven’t done, or how they are
feeling. Don’t say .. ‘ you shouldn’t feel that way..’ or ‘You
should feel lucky that you survived.’
• Don’t make up things you don’t know.
 Things NOT to Say and DO Contd….

• Don’t use too technical terms.

• Don’t tell them someone else’s story.
• Don’t give false promises or false reassurances
• Don’t feel you have to try to solve all the problems for them.
• Don’t take away the person’s strength and sense of being able to care
for themselves.
SELF CARE AND TEAM CARE
 Self Care : Some Useful Tips
(consider cultural context)
• Set aside some time to relax- (for eg. Beginning or ending of the
day, before starting on a new task, whatever that works for you
and is appropriate to you and the context)
• As much as possible, take your meals on time and sufficient
sleep
• Maintain personal hygiene and healthy practices
• Spend time/ maintain close contact with the family/loved ones.
• Talk over your issues or stress with a trusted and capable
colleague/s.
• Maintain a positive outlook-remind yourself of the limitation of
your role
 Self care contd…

• Be considerate of your team mates who seems stressed . Take time to

talk with them/ be with them.
• Be safe and help other to be safe
• Organizational support- Maintain organizational systems that are
helpful. Eg. Ensuring availability of due leave/managing workload.
Supportive and caring management/supportive communication
Ending your assistance
• Use your best judgment of
person’s needs and your own
needs.
• Explain you are leaving and, if
possible, introduce them to
someone else who can help.
• If you linked them with services,
be sure they have contact details
and know what to expect.
• No matter what your
experience, say goodbye in a
good way, wish them well.
Training Skills
• Neil Fleming’s Styles of Learning
(VARK)
• Check the venue

• Developing Training Schedule

• Keep to general schedule of breaks and
lunch
• Don’t let role plays go on too long
• Discussing and role playing crisis events can touch on personal
experiences and memories to the past events-be supportive
Summary: Ethical Guidelines
Do’s
• Be honest and trustworthy
• Respect a person’s right to make
their own decisions
• Be aware of and set aside your
own biases and prejudices
• Make it clear to people that even
if they refuse help now, they can
still access help in the future
• Respect privacy and keep the
person’s story confidential, as
appropriate
• Behave appropriately according
to the person’s culture, age and
gender
Don’ts
• Don’t exploit your relationship
as a helper
• Don’t ask the person for any money
or favour for helping them
• Don’t make false promises or give
false information
• Don’t exaggerate your skills
• Don’t force help on people, and
don’t be intrusive or pushy
• Don’t pressure people to tell you
their story
• Don’t share the person’s story
with others
• Don’t judge the person for their
actions or feelings
Reflection
• PFA is Simple, basic but important approach of helping people in
need.

• Realized that simulation is really effective way of teaching especially –

attitude

• Happy to train 30 more participants regarding PFA during roll out

session