Psychological First Aid

Supporting People in
the Aftermath of
Crisis Events
 Different kinds of
Crisis
NATURAL DISASTER

VIOLENCE &
DISPLACEMENT

ACCIDENT
What comes to mind when you
hear…

“Psychological First Aid”

 What is PFA?
• Humane, supportive and practical assistance to
fellow human beings who recently suffered exposure
to serious stressors, and involves:
– 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?
• It is NOT something only professionals can do
• It is NOT professional counseling
• It is NOT “psychological debriefing”
– No detailed discussion of the distressing event
• It is NOT asking people to analyze what happened or
put time and events in order
• Although PFA involves being available to listen to
people’s stories, it is NOT pressuring people to tell
you their feelings or reactions to an event
 Responses to Crisis Events
• People may have very different reactions to an event.
• What factors influence how someone responds?
 Why PFA?
• People do better over
the long-term if they…
– Feel safe, connected to
others, calm & hopeful
– Have access to social,
physical & emotional
support
– Regain a sense of
control by being able to
help themselves
 Group Exercise (5 minutes)
Following a crisis event…

• WHO may benefit from PFA?

• WHO may need more advanced support?
• WHEN should PFA be provided?
• WHERE should PFA be provided?
 PFA: Who?
• Very distressed people who were recently
exposed to a serious stressful event
• Can be provided to adults and children
• 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
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
Who needs more advanced support
than PFA alone?

• People who may hurt

themselves
• People who may hurt or endanger the lives of others
 PFA: When?

• Upon first contact with very distressed

people, usually immediately following an
event, or sometimes a few days or weeks
after
 PFA: Where?
• Wherever it is safe enough for you to be
there
• Ideally with some privacy (as appropriate)
to protect confidentiality and dignity of
the affected person
 Activity – What if I lost…
 You have been given three cards each of three
different colors:
Blue Card - write the name of a person close to
you on each card
White Card - write down one of your favorite
belongings
Pink Card - write down something you enjoy, an
activity, or hobby.

 After you have written on each card, place

them face down on the table and shuffle them
around. Close your eyes and pick three cards.
 Activity – What if I lost…
 These are the three things you will
have lost in a disaster.

 Discuss with the group how you feel

about losing these things or people
 If this crisis happened…
• What would you need
as a SURVIVOR?

• What would you need

as a HELPER?
 Full Day Orientation
Frequent Needs of People After Crisis Event
• Basic needs: shelter, food, water, sanitation
• Health services for injuries or help with chronic
medical conditions
• Understandable and correct information about event,
loved ones and available services
• Being able to contact loved ones
• Access to specific support related to one’s culture or
religion
• Being consulted and involved in important decisions
 PSYCHOLOGICAL FIRST AID
Action Principles
 Learn about the crisis event.
PREPARE Learn about available services and supports.
Learn about safety and security concerns.

 Observe for safety.

LOOK  Observe for people with obvious urgent basic needs.
 Observe for people with serious distress reactions.

 Make contact with people who may need support.

LISTEN  Ask about people’s needs and concerns.
 Listen to people and help then feel calm.

 Help people address basic needs and access services.

LINK  Help people cope with problems.
 Connect people with loved ones and social support.
Prepare •Learn about the crisis event.
•Learn about available services and supports.
•Learn about safety and security concerns.

• Crisis situations
can be chaotic
• They often require
urgent action

Wherever possible BEFORE you enter a crisis site,

try to obtain accurate information
so you can be safe and effective
Prepare Before you enter a crisis site, try to learn about…

The Crisis •What happened?

Event •Where?
•When?
•How many and who are affected?

Available •Who is providing for basic needs (emergency medical care, food,
Services shelter)?
•When and where can people access services?
•Who is helping, including community members?

Safety and •Is the crisis over or ongoing (aftershocks, fighting)?

Security •What dangers may be in the environment?
•Are there places to avoid due to insecurity or because it is not
permitted to be there?
Look •Observe for safety.
QuickTime™ and a
•Observe for people with obvious urgent basic needs.
decompressor
are needed to see this picture.

•Observe for people with serious distress reactions.

• Crisis situations can change rapidly

• What you encounter may be different from
what you learned before entering
• Take time - even a quick scan - to LOOK
around before offering help
Be calm
Be safe
Think before you act
Look •Observe for safety.
•Observe for people with obvious urgent basic needs.
•Observe for people with serious distress reactions.

Safety •What dangers can you observe? If you’re not certain about
•Can you be there without harm to safety…DO NOT GO!
yourself or others? Seek help from others
Communicate from a safe
distance

People with •Is anyone critically injured Know your role

obvious urgent •Does anyone need rescue? Try to obtain help for
basic needs •Obvious needs (e.g., torn clothing)? people who need special
•Who may need help to access assistance
services or to be protected? Refer critically injured
•Who else is available to help? people for care

People with •How many & where are they? Consider who may benefit
serious •Is anyone extremely upset, immobile, from PFA and how best to
distress not responding to others or in shock? help
 People who Likely Need Special Attention
( To be safe. . . . To access services )
 Children and adolescents
- Especially those separated from caregivers.
 People with health conditions and disabilities.
- People who are non- mobile , or who have no
chronic
illnesses , hearing/ visual impairments ( deaf or
blind ),
or severe mental disorders.
- Frail elderly people , pregnant or nursing women.
 People at risk of discrimination or violence.
- women , people of certain ethnic or religions
groups
, people with mental disabilities.
 Distress Reactions To Crisis
Physical symptoms ( shaking,
headaches, fatigue, loss of appetite,
aches & pains )
 Anxiety and fear
 Weeping, grief and sadness
 Guilt , shame ( for having survived, or
for not saving others)’  Immobile, withdrawn
 Elation for having survived  Disoriented- not knowing one’s name ,
 Being on guard, jumpy where one is from or what happened.
 Anger, irritability  Not responding to others , not speaking
at all.
 Feeling confused , emotionally numb,
feeling unreal or in a daze.
 Unable to care for oneself or one’s
children ( not eating or drinking, not able to
make simple decisions.)
 LISTEN
Make  Approach respectfully
Contact  Introduce yourself by name & organization.
 Ask if you can provide help. Find safe & quiet place.
 Help person feel comfortable . ( water, blanket )
 Try to keep them safe.

Ask  Although some needs are obvious, always ask .

About  Find out person’s priorities. ( What is most important to them )
Needs
and
Concern

Listen &  Stay close to the person.

Help  Do not pressure them to talk.
People  Listen in case they want to talk.
Feel Calm  If every distressed, help them feel calm & make sure they are
not alone.
 Help People Feel Calm

 Keep your tone of voice soft and calm.

 Maintain some eye contact.
 Reassure them they are safe and that you are there
to help.
 If someone feels “ unreal” help them to make
contact with:

-- Themselves ( feel feet on the floor, tap hands on

top.)
-- Their surroundings ( notice things around them )
-- Their breath ( focus on breath & breathe slowly)
  Make contact with people who may need support.
LISTEN  Ask about people’s needs and concerns.
 Listen to people and help them feel calm.

Listen with compassion by using your:

Eyes – Giving the person your undivided attention

Ears- hearing carefully their concern.
Heart- with caring and showing respect.
 Good Communication: Things to say
and do.
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 nod
your head and say “ hmmm.”
Be patient and calm.
Provide factual information if you have it. Be
honest what you know . Say “ I don’t know but I
will try to find out about that for you.”
 Good Communication: Things To Say
And do
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 a loved one. Say “ I’m
sorry.”
Respect privacy. Keep the person’s story
confidential, especially when they disclosed 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 someone’s story.
Don’t give your own opinion’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 you survived.”
Don’t make up things you don’t know.
Don’t use too technical terms.
Don’t tell them someone’s else story.
Good communication: Things NOT to
say and do.
Don’t talk about your own troubles.
Don’t feel you have to try to solve all the
person’s problem for them.
Don’t give false promises or false
reassurances.
Don’t take away the person’s strength and
sense of being able to care for themselves.
  Help people address basic needs and access services.
LINK  Help people cope with problems.
 Give information
 Connect people with loved ones and social support.

Help people to help themselves and regain control

of their situation
 LINK- BASIC NEEDS

 What needs do they request ?

 What services are available ?
 Don’t overlook the needs of
vulnerable marginalized people.
 Follow up if you promise to do
so.
 Link- help people cope with
problems.

Distressed people may feel overwhelmed

with worries. . . . . .
 Help them prioritize urgent needs ( what to do first )
 Help them identify supports in their life.
 Give practical suggestion how they can meet their
needs ( e.g. registering for food aid )
 Help them remember how they coped in the past what
helps them feel better.
 Link- Social Support
 Social support is very important to
recovery.
 Keep families together & children with
caregivers.
 Help people contact friends and love
ones.
 Give access to religious support.
 Affected people may be able to help
each other – bring them together.
 Make sure people know about how to
access services ( especially vulnerable
people .)
 Ending your assistance
• Use your best judgment of the
person’s needs and your own
needs

• Explain you are leaving and, if

possible, introduce them to
someone else who can help
 Ending your assistance
• 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
 Summary: Ethical Guidelines
Do’s Don’ts
• Be honest and trustworthy • Don’t exploit your relationship as a
helper
• Respect a person’s right to make
their own decisions • Don’t ask the person for any money
or favor for helping them
• Be aware of and set aside your
own biases and prejudices • Don’t make false promises or give
false information
• Make it clear to people that even
if they refuse help now, they can • Don’t exaggerate your skills
still access help in the future
• Don’t force help on people, and
don’t be intrusive or pushy
 Summary: Ethical Guidelines
Do’s Don’ts
• Respect privacy and keep the • Don’t pressure people to tell you
person’s story confidential, as their story
appropriate
• Don’t share the person’s story with
• Behave appropriately according to others
the person’s culture, age and
gender • Don’t judge the person for their
actions or feelings
Starting and Ending With Care For Ourselves

• How do I take care of myself ?

• How does my team take care of each other
?

Be responsible to yourself and others by

paying attention to self care on a daily
basis.
 Practice Self And Team CAre
• Before
- Are you ready to help ?
 During
- How can you stay physically and emotionaly
healthy?
- How can you support colleagues ?
 After
- How can you take time to rest, recover and reflect
?
Seek support from someone you trust when
you . . .
• Have upsetting thoughts or memories about the
crisis event.
• Feel very nervous or extremely sad.
• Have trouble sleeping
• Drink a lot of alcohol or take drugs to cope with
your experience

Consult a professional if these difficulties persist

more than one month.
 Self and Team Care

• It is best for helpers to be connected with an

agency or group to ensure safety and good
coordination.
• Check in with fellow helpers to see how they are
doing, and have them check in with you.
• When your helping role in the crisis is over be
sure to take time for rest and reflection.
• Talk about your experience with a supervisor,
collegues or someone else you trust.
 Positive coping strategies
(adjust for culture)
Help people use their natural coping mechanisms to
regain a sense of control:
– Get enough rest
– Eat as regularly as possible and drink water
– Talk and spend time with family and friends
– Discuss problems with someone you trust
– Relax: walk, sing, pray, play with children
 Positive coping strategies
(adjust for culture)
Help people use their natural coping mechanisms to
regain a sense of control:
– Exercise
– Avoid alcohol or drugs, caffeine, nicotine
– Attend to personal hygiene
– Find safe ways to help others
 Ice-Breaker Exercise
• This exercise uses questions about participants’ experiences
with crisis situations along with more light-hearted questions.
• Stand up and Clap if you. . . . .”
 Travelled more than 5 minutes today to come here.
 Have ever worked in a crisis setting.
 Your favorite color is blue.
 Have ever lived in a place where there was crisis
 Are a good singer/dancer
 Have you ever helped someone emotionally in a crisis situation
 Slept well last night
Evaluation

• Please say…
– What went well?
– What could have been better?
– What did you learn (one thing) that you will use in
offering PFA?

THANK YOU & GOOD LUCK!