FIRST AID

PSYCHOLOGICAL

THELMA SINGSON – BARRERA, RN

National Center for Mental Health

Definition• Psychological First Aid – is simply a “first-

aid” response aimed to *stabilize, *reduce symptoms and *return the survivor to functional capacity in the aftermath of a critical incident.

It refers to any effort that

reduces the victims’ feeling of

helplessness and promotes their

sense of control

PSYCHOLOGICAL FIRST AID

Practical assistance for basic human comfort and compassion

What is Emotional First Aid™(EFA)?

"Emotional First Aid™ is the initial response given to a person experiencing emotional distress before specific professional help is sought and obtained."

National Center for Mental Health(Nice-to-know-term)

Some examples of critical incidents :

Mass disasters : natural & human-induced Multiple injuries/fatalities Death or injury to a child Serious injury or line of duty death Excessive media attention Outsiders or family members interfering with

operations Any incident grotesque by sight, smell or other

circumstance likely to produce an emotional (memory) input

WHO is PFA for?

PFA is intended for PEOPLE EXPOSED TO DISASTER

(children, adults, first responders, disaster relief workers)

WHO delivers PFA?

•Mental Health Workers

•Other disaster response workers

WHEN should PFA be used?

IMMEDIATE aftermath of the disaster/ critical

WHERE should PFA be used?

Shelters, hospitals, medical triage areas, acute care facilities,

feeding locations, family reception & assistance centers, home,

business & community settings, crisis hotlines

• PFA aims to help persons to mobilize their own abilities and resources to RECOVER & REBUILD by responding to basic needs, showing concern & care, and respecting the wishes & capabilities of the person.

• PFA aims to offer both safe & effective help for persons after a critical event.

3 Goals of Providing PFA

1. Relieve both emotional & physical suffering

2. Improve people’s short term functioning

3. Accelerate the individual’s course of recovery

ELEMENTS OF PFA

• Feeling safe, calm & hopeful and connected to others

• Having access to social, physical & emotional support

• Being ABLE TO HELP THEMSELVES as individuals & communities

HOW PFA IS OFFERED?

• By your presence

• Your willingness to listen

• Providing practical things & information the person may need right in that moment

• Connecting them with services & people that can assist them as they recover in the long term

How to Approach PFA responsibly?

• YOU CAN BEST HELP IF YOU ARE:– CALM– FOCUSED– PREPARED

DO NO HARM;

- respect the person

- Protect the person from harm

- Act only in the BEST INTEREST of the person

Considerations in PROVIDING PFA

• Do no HARM

• SAFETY of yourself & others

• ETHICAL principles

ATTRIBUTES OF A GOOD HELPER

• Personal readiness to help in crisis

• Ability to stay CALM & FOCUSED

• Ability to learn the basic principles & DO’S & DON’Ts

• Warmth & empathy with others

Examples of Psychological First Aid

Family Support Services involve assisting the affected family with their particular and specific needs during and shortly following a crisis. (helping them with their activities of daily living, making arrangements for them (including phone calls).

- provision of warm blanket, clothing, tents, etc.

- food assistance – provision of a cup of noodles,

- warm broth, etc.

Examples of Psychological First Aid

• Information Support Services – provision of appropriate

information

• Tracing Services – helps locate missing relatives

Examples of PFA

●Reassurance – statement that help is forthcoming (if

indeed coming), provide sense of security

•Presence of crisis workers – human service

providers especially if they are in uniform with clear identification i.e. NCMH-DOH

Examples of PFA

•Rituals•i.e. allowing victims to go through grieving rituals

• Other support structures - this usually involves provision of a support structure to help the victims/survivors go through the different phases of a critical incident.

E.g. Cebu Pacific plane crash, MV Princess of the Stars Sea tragedy

Examples of PFA

• Defusing - an early-intervention strategy that is activated while the traumatic memories are more successfully dealt with, before they are 'cemented in' and perhaps distorted

• Defusing is a shortened version of a debriefing (PSP), lasting 20-45 minutes, and must be held within 8 hours of the incident (1-2 hours is preferable). The groups usually have 6-8 participants, and the defusing works with only three stages (introduction, exploration and information).

Defusing

• provides a structure whereby the members may support and encourage each other

• exchange information, and enjoy a sense of group caring.

• The group also provides a forum whereby the myth of uniqueness is dispelled, as many of the members will express similar feelings

Crisis Management Briefings

• large-scale crisis interventions. They are usually held for large groups (up to 300 members at a time)

• It lasts about 45-75 minutes, and provides information and rumor control about the crisis.

Crisis Management Briefings

• Reduce the sense of chaos, provide information about resources, assess the group for additional needs, help to restore the group to adaptive functioning, and facilitate follow up care.

• A community leader or allied representative associated with the crisis may be on hand with the CIS Team member to facilitate information dissemination.

WHEN IS PFA EFFECTIVE?

• It is COMFORTING to someone in distress

• It is PRACTICAL SUPPORT – helping people w/ basic needs

• It is TAILORED to the NEEDS & CONCERNS of the affected persons & the situation

WHEN IS PFA EFFECTIVE?

• It is IMMEDIATE & Intended to help those who recently experienced a very distressing event

• It is CONNECTED to other supports (services & people) who can help in the long term

WHAT PFA IS NOT?

• It is not something that only professionals can do

• It is not counselling or debriefing

• It is not asking people to analyze what happened to them, or to put time & events in order

WHAT PFA IS NOT?

• Although PFA involves being available to listen to people’s stories, PFA IS NOT ABOUT PRESSING people to tell you all their feelings & reactions to an event

• It is not something that every person who experience a crisis will need.

PFA Core Actions

1. Contact & Engagement – initiate non-intrusive, compassionate & helpful manner

2. Safety & Comfort – enhance ongoing safety, provide physical & emotional comfort

3. Stabilization – calm & orient emotionally overwhelmed / disoriented survivors

4. Information Gathering – identify immediate needs & concerns – tailor PFA interventions

5. Practical Assistance - identify/ clarify the need, discuss action plan, act to address the need

6. Connection w/ social supports – enhance access, encourage use, discuss support-seeking & giving, modeling support

7. Information of Coping – give basic info about stress rxns, teach relaxation techniques, address (-) emotions

8. Linkage w/ collaborative Services – provide link to add’l. services, promote continuity of care

PFA Core Actions

Delivering PFA

• Professional Behavior:– Operate only within the framework of an

authorized disaster response system.– Model healthy responses: calm, courteous, organized,

helpful

– Be visible & available– Maintain confidentiality– Remain within the scope of your expertise &

designated role

Do’s

Delivering PFA

• Professional Behavior:

– Make appropriate REFERRALS– Be knowledgeable & sensitive (Culture & diversity)

– Pay attention to your own emotional & physical reactions.

– Practice SELF-CARE

Do’s

• Do not make assumptions (about what the survivors are experiencing or what they have gone through)

• Do not assume that everyone exposed to a disaster will be traumatized.

• Do not pathologize (do not label “reactions” as “symptoms”

• Do not talk down to or patronize the survivor, or focus on his helplessness/weaknesses, mistakes, disability. FOCUS on what he has done EFFECTIVELY to help others

Delivering PFADont’s

Delivering PFA

• Do not assume that all survivors want to talk or need to talk to you. (Being physically present in a supportive, calm way helps survivors feel safer & more able to cope)

• Do not “debrief” by asking details of what happened.

• Do not speculate or offer possibly inaccurate information. Know the facts before answering their questions.

Dont’s

Guidelines for Delivering PFA

• Politely observe first, don’t intrude. (ask simple respectful ?s to know how you may help)

• Provide practical assistance to make contact (food, water, blankets)

• Initiate contact only after you have observed the situation, the person, the family

• Be prepared that survivors will either AVOID you or FLOOD YOU w/ contact

• Speak calmly. Be patient, responsive & sensitive.

• Speak slowly, in simple concrete terms. Don’t use acronyms.

• Be prepared to listen. (Focus on hearing what they want to tell you, and how you can be of help)

• Acknowledge the positive features of what the survivor has done to keep safe.

• Give information that addresses directly the survivor’s immediate goals & clarify answers

• Give accurate & age- appropriate information • When communicating w/ a translator, look &

talk to the client, not the translator.

• Remember the GOAL of PFA ( to reduce stress, assist w/ current needs, promote adaptive functioning, not to elicit details of traumatic experiences & losses)

When you are approaching a CRISIS SITUATION to assist others, think of these BASIC

ACTION PRINCIPLES

A = ASSESS

B = BE

C = COMFORT/COPING

D = DO

E = END/ EXIT STRATEGY

Basic Action Principles

Explanation

A = Assess Know the situation so you will know what to do!Assess for: Safety, obvious urgent physical needs, persons w/ serious reactions, Ask for: Person’s NEEDS & CONCERNS

B = Be Know yourself well, so you can…BE attentive, BE respectful, BE aware

C = Comfort/ Coping

Give COMFORT & help people begin using their own COPING resourcesCOMFORT thru your presence, thru good COMMUNICATION & helping people to COPE

D = Do Act to help persons with their basic practical needs.Do address practical needs, Do help problem solve, Do link people w/ loved ones & other supports

E = End/ Exit Strategy

Leave persons w/ connections to supports, & take time for your own self-careEnd your assistance – refer to other supportsEnd for yourself – take time for self-care.

When To Refer?

WHEN TO REFER?

• REFERRAL - the act of recommending that a person speak to a professional who is more competent to handle the difficulties and complexities of his/her needs.

• Referral may be necessary when the stress reactions of individuals affected by disasters are causing impairments (inability to take care of self or inability to work)

WHEN TO REFER?

• When a person hints or talks openly of suicide

• If there is a possibility of child abuse or any criminal activity

• The problem is beyond your training

• The problem is beyond your capability.

• The problem does not fit the purpose of the community responder program

WHEN TO REFER?

• The person seems to be socially isolated.,

• You have difficulty maintaining real contact with the person

• You become aware of dependency on alcohol and drugs

• When the person is engaging in risky or threatening behavior.

WHEN TO REFER?

• When you yourself become:

– Restless– Confused– Have negative recurring thoughts– Dream about the case– Feel you are the only one who can help

Client

• Assessment if PSS is needed

• By SERVICE PROVIDERS: MSW, BHW, Midwife,

• PHN, MD

PSP needed

MHPSS/ Psychosocial

Intervention by MHPSS

Service Providers

MH Specialist(Psychiatrist)

Improved

MHPSS REFERRAL FLOW CHART

When, Where & How to REFER

INTERVENTION/ REFERRAL FLOWCHART

Select Activity

For Help

CHILD• Talk• Play - Support - Educate

FAMILY• Talk a. Support b. educate -Child rearing Practices - communication styles

COMMUNITY• Talk• Suggest Activities a. Day care b. sportfest c. disaster preparedness

SCHOOL• Talk• Suggest Activities a. Sportfest b. Disaster preparedness c. Family day d. Art contest

IMPROVED FOLLOW-UP

NOTIMPROVED

COUNSELINGSERVICE

SOCIALSERVICE

MEDICALSERVICE

• Contact people • Agency and Address (DSWD, WCPU)

FIRST AID

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