Psychological First Aid

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

1. First responders
2. Other disaster relief workers
 Who delivers it?
 Mental health workers
 Other disaster response workers
who provide early assistance as part
of an organized disaster response
effort

IMPORTANT: PROVIDERS SHOULD BE PART OF

RESPONSE UNITS
When and where should it be used?

IN THE IMMEDIATE AFTERMATH OF

DISASTERS AND TERRORISM
Diverse settings:
1. General shelters, Special Needs
shelters
2. Field hospitals and medical triage
areas
3. Staging areas or respite areas for
first responders and other relief
workers
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
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

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
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
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
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”
 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
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
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
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
 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
1. Within days or weeks following an event
2. Be flexible
3. Base the amount of time spent on each
action on the survivor’s specific needs
and concerns
4. Not sequential
– sometimes may happen simultaneously, or
have to backtrack

Note: it may be helpful to provide some training to

community leaders if the setting is a natural grouping
 8 Core Actions:

Core Action 1
Contact and Engagement
Goal: To respond to contacts initiated
by survivors, or initiate contact in a
non-intrusive, compassionate and
helpful manner
 CORE ACTION 1: CONTACT AND ENGAGEMENT

1. Prioritize those who seek you out

2. If several people approach you
simultaneously, make contact
with as many as you can
 Even a brief look of interest and
calm can be helpful
 CORE ACTION 1: CONTACT AND ENGAGEMENT

3. Introduce yourself, title, role

1. Ask permission to talk
2. Addressing person using cultural practice
3. Invite person to sit, ensure some privacy
4. Avoid being distracted
5. Find out if there is a pressing problem that need
immediate attention

4. Confidentiality when appropriate

CORE ACTION 2: SAFETY AND COMFORT

Goal: To enhance immediate

and ongoing safety, and
provide physical and
emotional comfort.
 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
 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

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

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 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 (IF NEEDED)

Goal: To calm and orient

emotionally overwhelmed or
disoriented survivors.
 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

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 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

Goal: To offer practical help to

survivors in addressing
immediate needs and concerns
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 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

1. Fosters well-being and recovery

2. Many forms
a) Emotional support
b) Social connection
c) Feeling needed
d) Reassurance of self-worth
e) Reliable support
f) Advice and information
g) Physical assistance
h) Material assistance
CORE ACTION 6: CONNECTION WITH SOCIAL SUPPORTS

1. Enhance access to primary support

persons
2. Encourage use of immediately available
support persons
1. Shared activity: games, singing, etc.
2. Older people can be cared for by
adolescents
3. Etc.
3. Discuss support seeking and giving
1. Reasons why some don’t want to seek
support, etc.
4. Be role model of a supportive person
CORE ACTION 7: INFORMATION AND COPING

Goal: To provide information about

stress reactions and coping to
reduce distress and promote
adaptive functioning.
 CORE ACTION 7: INFORMATION AND COPING

1. Review basic information about stress reactions

2. Review common psychological reactions to
traumatic experiences and losses
a. Intrusive reactions
b. Avoidance and withdrawal reactions
c. Physical arousal reactions
3. Teach simple relaxation techniques
4. Help families cope
 CORE ACTION 7: INFORMATION AND COPING

6. Assist with developmental issues

1. Children need different approaches
7. Assist in anger management
8. Address highly negative emotions (guilt and
shame)
9. Help with sleep problems
10. Address alcohol and substance use
CORE ACTION 8: LINKAGE WITH COLLABORATIVE SERVICES

Goal: To link survivors with

available services needed at the
time or in the future
 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
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
JESUS LOVES YOU.