PSYCHOLOGICAL FIRST AID THELMA SINGSON – BARRERA, RN National Center for Mental Health PSYCHOLOGICAL FIRST AID

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

PSYCHOLOGICAL FIRST AID Practical assistance for basic human comfort and compassion THELMA SINGSON – BARRERA, RN National Center for Mental Health

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." (Nice-to-know-term) THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

WHO is PFA for? PFA is intended for PEOPLE EXPOSED TO DISASTER (children, adults, first responders, disaster relief workers) THELMA SINGSON – BARRERA, RN National Center for Mental Health

Mental Health Workers Other disaster response workers WHO delivers PFA? Mental Health Workers Other disaster response workers THELMA SINGSON – BARRERA, RN National Center for Mental Health

IMMEDIATE aftermath of the disaster/ critical event WHEN should PFA be used? IMMEDIATE aftermath of the disaster/ critical event THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 Relieve both emotional & physical suffering Improve people’s short term functioning Accelerate the individual’s course of recovery THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

Considerations in PROVIDING PFA Do no HARM SAFETY of yourself & others ETHICAL principles THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

Roles of a Psychological First Aider Provide social support Educate about normal & abnormal stress reactions Teach stress management techniques Mobilize community resources PROMOTE positive emotional health Provide SUPPORT & REASSURANCE THELMA SINGSON – BARRERA, RN National Center for Mental Health

Roles of a Psychological First Aider AID in ACCESSING appropriate services Undertake RISK ASSESSMENT to help PREVENT HARM to SELF or TO/FROM OTHERS Create a PARTNERSHIP and help find SOLUTIONS, (getting through this together) Assist in EARLY DETECTION & INTERVENTION THELMA SINGSON – BARRERA, RN National Center for Mental Health

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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

Examples of Psychological First Aid Information Support Services – provision of appropriate information Tracing Services – helps locate missing relatives THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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). THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

PFA Core Actions Contact & Engagement – initiate non-intrusive, compassionate & helpful manner Safety & Comfort – enhance ongoing safety, provide physical & emotional comfort Stabilization – calm & orient emotionally overwhelmed / disoriented survivors Information Gathering – identify immediate needs & concerns – tailor PFA interventions THELMA SINGSON – BARRERA, RN National Center for Mental Health

PFA Core Actions 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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

General Principles of PFA First protect from danger Focus on the “here & now” situation Provide accurate information about the situation Assist w/ mobilization of resources Do not give false assurances Recognize the importance of taking action Reunite w/ family members Provide & ensure emotional support Focus on strengths & resilience Encourage self-reliance Respect feelings & cultures of others THELMA SINGSON – BARRERA, RN National Center for Mental Health

12 Principles of PFA program American Red Cross 2006 Making a connection Helping people be safe Being kind, calm & compassionate Meeting people’s basic needs Listening Giving realistic assurance THELMA SINGSON – BARRERA, RN National Center for Mental Health

12 Principles of PFA program American Red Cross 2006 7. Encouraging good coping 8. Helping people connect 9. Giving accurate & timely information 10. Making a referral to a Disaster Mental Health Worker 11. Ending the conversation 12. Taking care of yourself These principles allow all responders to focus their “awareness, attitudes & actions” to support survivors and helpers. THELMA SINGSON – BARRERA, RN National Center for Mental Health

Delivering PFA Do’s 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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

Delivering PFA Do’s Professional Behavior: Make appropriate REFERRALS Be knowledgeable & sensitive (Culture & diversity) Pay attention to your own emotional & physical reactions. Practice SELF-CARE THELMA SINGSON – BARRERA, RN National Center for Mental Health

Delivering PFA Dont’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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

Delivering PFA Dont’s 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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

Guidelines for Delivering PFA 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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

Guidelines for Delivering PFA 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) THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 resources COMFORT 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-care End your assistance – refer to other supports End for yourself – take time for self-care.

When To Refer? THELMA SINGSON – BARRERA, RN National Center for Mental Health

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) THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

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. THELMA SINGSON – BARRERA, RN National Center for Mental Health

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 THELMA SINGSON – BARRERA, RN National Center for Mental Health

MHPSS REFERRAL FLOW CHART Client MHPSS REFERRAL FLOW CHART Assessment if PSS is needed By SERVICE PROVIDERS: MSW, BHW, Midwife, PHN, MD HOME PSP needed NO YES MHPSS/ Psychosocial Intervention by MHPSS Service Providers NO MH Specialist (Psychiatrist) Improved YES HOME THELMA SINGSON – BARRERA, RN National Center for Mental Health

When, Where & How to REFER THELMA SINGSON – BARRERA, RN National Center for Mental Health

INTERVENTION/ REFERRAL FLOWCHART CHILD Talk Play - Support - Educate FAMILY a. Support b. educate -Child rearing Practices - communication styles COMMUNITY Suggest Activities a. Day care b. sportfest c. disaster preparedness SCHOOL a. Sportfest b. Disaster preparedness c. Family day d. Art contest FOLLOW-UP IMPROVED REFER Select Activity For Help NOT IMPROVED COUNSELING SERVICE SOCIAL SERVICE MEDICAL SERVICE Contact people Agency and Address (DSWD, WCPU) THELMA SINGSON – BARRERA, RN National Center for Mental Health