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

2. 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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. Defusing is a shortened version of a debriefing (PSP), lasting 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

25. 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

26. Crisis Management Briefings
large-scale crisis interventions. They are usually held for large groups (up to 300 members at a time)
It lasts about minutes, and provides information and rumor control about the crisis.
THELMA SINGSON – BARRERA, RN
National Center for Mental Health

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. 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

45. 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.

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

47. 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

48. 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

49. 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

50. 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

51. 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

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

53. 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