PSYCHOLOGICAL

FIRST AID (PFA)

ORIENTATION
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 OBJECTIVES
At the end of the session, participants should
be able to:
• Differentiate Psychological First Aid (PFA), Critical
Incident Stress Debriefing (CISD)and Psychosocial
Support and Understand the Process of Grief;
• Demonstrate the core actions of PFA and skills of
PFA facilitators; and,
• Practice self-care.
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GRIEF
•Is a process not a state
•It takes time to work through
•Is a natural response to a
significant loss
Causes of grief
• Death of Loved ones
• Annulment/separation
• abortion/miscarriage
• Loss of job
• Change of lifestyle
• Lost of properties
 Grief and loss curve

Shock New Beginnings

Denial
Planning
Bargaining/
Guilt

Anger Acceptance

Depression
 Emotional Response

Physical Response
Common
Response to Thinking Response
Grief
Confusion

Behavioral Response
EMOTIONAL RESPONSE

Shock
 disbelief at what happened feeling numb, as if
things are unreal
EMOTIONAL RESPONSE

• Fear
• of one’s own mortality
• for the safety of oneself or one’s family
• apparently unrelated fears
 EMOTIONAL RESPONSE

• Anger
• at the injustice and senselessness of it all
• generalized anger and irritability
• how this could happen to such a good person
EMOTIONAL RESPONSE
• Sadness
• about the loss both personally and
professionally
• flash backs or triggers to previous grief and loss
• about the loss of feeling safe and secure
• feeling depressed or “flat” for no reason
EMOTIONAL RESPONSE
• Guilt
• for having appeared helpless or emotional
• for not behaving as you would have liked
• for unresolved issues or conflict with the person
• for not doing upon reflection what you feel
might have made a different
PHYSICAL
RESPONSE
Sleep Problem

•difficulty getting off to sleep

because of intrusive thoughts
•restless and disturbed sleep
•feeling tired and fatigued
Physical Problem

•general agitation and muscle tension

• headaches or general aches and pains
• feeling generally unwell
•other physical signs and symptoms
THINKING
RESPONSE
Memories

• frequent thoughts or images of the person

• flashbacks or feelings of “reliving” past grief and loss
experiences
• attempts to shut-out the painful memories
• real or imagined pictures of what happened “jumping” into
your head
Dreams

• dreams and nightmares about what

happened
• unpleasant dreams of other frightening
thoughts
 Confusion

• difficulty making simple decisions

• inability to concentrate and memory problems
• not being able to express yourself fluently verbally
• feeling confused generally
BEHAVIORAL
RESPONSE
Social

• withdrawal from others and a need to be alone

• easily irritated by other people
• feelings of detachment from others
• loss of interest in normal activities and hobbies
Work

• not wanting to go to work, poor motivation

• poor concentration and attention
• sense of lost purpose in your work
Habits

• increased use of alcohol, cigarettes or other drugs

• loss of appetite or increased eating
• loss of interest in enjoyable activities
 To feel support

To face reality
Moving
forward to To express feelings
grief process
To move toward the
Re-establishment of
self
• DO
Allow the person to grieve
Encourage the griever to express
emotion and to work through the
grief
Remember that many who give
support immediately after a death
may be delayed in working through
their own grief
• DO
 recognize the intensity of grief that
will be experienced at certain
significant times
Encourage those who have a
common grief to support one
another if they can
• Don’t prevent the person from
expressing their guilt or anger if they
need to
• Don’t stifle the person’s desire to talk
about the deceased
• Don’t personalize knock-backs to your
efforts to assist
• Don’t give trite answers to the “Why”
question
 Be Aware

Be there
What you
should do to Be sensitive and be human
help?
Be ready

Be patient
 WHAT IS PSYCHOLOGICAL
FIRST AID (PFA)?
It is designed to help individuals feel:
1) SAFE
2) CALM
3) CONNECTED
4) SUPPORTED
5) HOPEFUL
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 Critical Incident Stress Debriefing (CISD) and
Psychological First Aid (PFA)
CISD PFA
Introduction Contact
Fact details of events Safety and Comfort
Thoughts Information Gathering
Reactions Stabilize
Symptoms Practical Assistance
Teaching Coping
Re-entry Linking with Services

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 PSYCHOLOGICAL FIRST AID
WHEN? WHY?
reduce initial distress
to be delivered caused by emergencies
during or
foster short- and long-
immediately after the
term adaptive
Emergency Phase
functioning and coping

Where?
• In a safe location
• Can be in the health center, shelter camp, school or
evacuation center
• Ideally, where is privacy 14
For whom?
• Very distressed people who were recently exposed to a serious
stressful event.
• Can be provided to adults and children.
• Not everyone who experience 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.
 WHY DO WE NEED TO
PROVIDE PFA TO OUR PUPILS?
1. Schools are typically the first government
agencies to resume operations after disaster or
an emergency. It can become a primary source of
community support during and after the
incident.
2. It is important for school staff to be prepared for
emergencies.
3. Emergencies affect students academic and social
achievement.
4. Trauma-related distress can have a long-term
impact if left untreated.
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 WHO NEEDS MORE ADVANCED
SUPPORT THAN PFA ALONE?

 People with serious life-­threatening

injuries
 People so upset that they cannot care for
themselves or their children
 People who may hurt themselves
 People who may hurt or endanger the lives
of others

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PFA PROCESS

PREPARE

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Before Conducting PFA you must:
Whenever possible, BEFORE you enter a
crisis site, try to obtain accurate information
so you can be safe and effective.
 Learn about the crisis event.
 Learn about available services and
support.
 Learn about safety and security
concerns.

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 Principles in Providing PFA
• Respect safety, dignity and rights

• Adapt what you do to take account into

culture

• Be aware of other emergency response

measures

• Look after yourself

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 3 Actions Principles in PFA
1. Ensure safety 2. Contact 6. Practical
& engagement assistance

7. Connect
to social
support
8. Link with
services
3. Stabilize 4. Gather information
regarding current needs and
concerns 5. and Support efforts to
coping
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 1. LOOK
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. Try to obtain
obvious • Does anyone need rescue? help for people who need
urgent basic • Does anyone have obvious needs special assistance.
needs (e.g., torn clothing)? Refer critically injured people
• Who may need help to access for care and proper
services or to be protected? management.
• Who else is available to help?

People with • How many & where are they? Consider who may benefit from
serious • Is anyone extremely upset, PFA and how best to help.
distress immobile, not responding to others
or in shock?

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Who are the people that we need to
prioritize looking?
• Children and
adolescents
particularly those alone or
separated from caregivers.
 Girls are especially at
risk. Unaccompanied
children and adolescents
for special assistance, as
they are at high risk of
abuse and exploitation.
• People with health
conditions or disabilities
pregnant women, blind or
deaf people, people who
may be immobile and in
need of help to get to a
safe place

people with severe

mental disorders and
people on medication for
chronic health conditions.
• People at risk of
discrimination or
violence
• this includes women or
people of certain ethnic
groups who may need
protection or extra
assistance in accessing
services due to the
possible risk of
discrimination or
violence.
• LEARNING
STOP:

• It is also important
to LOOK for people
who are in serious
distress.
 2. 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

about ask
needs & • Find out person’s priorities – what is most
concerns important to them.

Listen • Stay close to the person

and help • Do not pressure them to talk
people • Listen in case they want to talk
feel calm • If very distressed, help them feel calm &
make sure they are not alone.

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Do not say:
x I know how you feel.
x It was probably for the best.
x It was her time to go.
x Lets talk about something else.
x Its good that you are alive.
x You need to grieve.
x You need to relax.
x You are the man/woman in the house now. (said to a child)
x You should work towards getting over this.
EMPATHIC LISTENING
• also called reflective/ active listening
• ability to put yourself in the shoes of another to truly where they are
coming from
• through empathic listening, you are also able to convey the message
that you are interested in what the person has to say, are not judging
them and understand what they are saying.

• Two components:
1. Verbal skills
2. Non verbal skills
• Giving psychological attention
• positive face and head movements
• Open hand and arms movements
• non-distracting body movements
• eye contact
• proper orientation and spacing of the body
• Encouragers: nods, uh-huh, I see.., Ahh..
• Pay attention to non verbal behaviors
EMPATHIC LISTENING SKILLS
• Mirroring
Repeating back what the child is saying
• Paraphrasing(listening for content)
Restating what the child said in your own words
• Clarifying
Requests for more information to gain understanding of content (what
do you mean when you said?)
• Summarizing
Synthesizing what the child is saying
MIRRORING
Ayoko pang pumunta sa skwela.
Nakita ko po kasi sa tv na yong
ibang mga bata nawalan ng
magulang. Ayoko na pag-uwi ko
galing school, wala na ang nanay
at tatay ko. Takot na takot po ako.

“Ah… Takot na
takot ka…”
CLARIFYING

Ayoko pong pumunta sa

eskwela. Wag nyo po akong
pilitin na pumunta sa
eskwela!

“Ano ang ayaw mo sa

eskwela?”
PARAPHRASING

Ayoko pang pumunta sa skwela. Nakita ko po kasi

sa tv na yong ibang mga bata nawalan ng
magulang. Ayoko na pag-uwi ko galing school,
wala na ang nanay at tatay ko. Natatakot po ako.

“Natatakot ka na mawala
ang nanay at tatay mo…”
 REFLECTING FEELINGS

I don’t want to go to school. I saw on TV people died.

What if when I get home, mommy and daddy won’t
be there anymore?

“ You’re scared that you will lose your

mommy and daddy…”
 CONNECT WITH OTHER HELPERS
 When pastoral counseling is desired
 Ongoing difficulties with coping (4 weeks or more after the
event)
 Significant developmental concerns about children or
adolescents
 An acute medical or mental problem that needs immediate
attention
 Worsening of a pre-existing medical, emotional or behavioral
problem
 Threat of harm to self or others
 Cases involving domestic, child, or elder abuse (be aware of
reporting laws) 29
Referral

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 When Making Referral
Give the person a brief summary of your
understanding of his/her needs and
concerns.
Describe the option of referral, including
how this may help and what will take place if
the individual goes for further help.
Ask about the person’s reaction to the
suggested referral.
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 When to refer to mental health professionals?

• If symptoms that are considered normal

reactions following a traumatic event
persist for several months and/or are
disruptive of the student’s social,
mental, or physical functioning, referral
is recommended.

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 Consider referring if he/she:
• Is unable to give his/her own name, town and the
date
• Complains of significant memory gaps
• Is despondent and shows agitation,
restlessness and pacing
• Is severely depressed and withdrawn
• Mutilates self/uses drugs or alcohol
excessively 34
 Consider referring if he/she:

• Is unable to care for self

• Repeats ritualistic acts
• States his/her body feels unreal and expresses
fears that he/she is going crazy
• Is excessively preoccupied with one idea or
thought
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 Consider referring if he/she:

• Believes that someone or something is out to

get him/her and his/her family
• Is afraid he/she will kill self or another
• Is unable to make simple decisions or carry out
everyday functions
• Shows extreme pressure of speech – talk
overflows

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SELF-CARE

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 Self-Care
- is the ability to engage in
helping others without
sacrificing other important
parts of one’s life.

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3 Basic Aspects of Self-care
1. AWARENESS
This requires you to slow down and focus
inwardly to determine how you are feeling,
what your stress level is, what types of
thoughts are going through your head, and
whether your behaviors and actions are
consistent with the who you want to be.

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3 Basic Aspects of Self-care
2. BALANCE
The second step is to seek balance in all
areas of your life including work, personal
and family life, rest, and leisure. You will
be more productive when you’ve had
opportunities to rest and relax. Becoming
aware of when you are losing balance in
your life gives you an opportunity to
change.
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3 Basic Aspects of Self-care
3. CONNECTION
The final step is connection. It involves
building connections and supportive
relationships with your co-workers,
friends, family, and community. One of the
most powerful stress reducers is social
connection.

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 “In dealing with those who are
undergoing a great suffering, if you feel
burnout, setting in. If you feel
demoralized and exhausted, it is best for
the sake of everyone to withdraw and
restore yourself. The point is to have a
long term perspective.”

Dalai Lama
 Self-Care Checklist
There are several ways you can find balance, be aware of
your needs, and make connections. Use this list to help
you decide which self-care strategies will work for you.
Make every effort to:
 Seek out and give social support
 Check in with other colleagues to discuss the
response to the emergency
 Schedule time for a vacation or gradual reintegration
into your normal life
 Prepare for worldview changes that may not be
mirrored by others in your life
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 Self-Care Checklist
 Participate in formal help if extreme stress persists
for greater than two to three weeks
 Increase leisure activities, stress management, and
exercise
 Pay extra attention to health and nutrition
 Self-monitor and pace your efforts
 Maintain boundaries: delegate, say “no,” and avoid
getting overloaded with work
 Pay extra attention to rekindling close interpersonal
relationships
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 Self-Care Checklist
 Practice good sleep routines
 Make time for self-reflection
 Find things that you enjoy or make you laugh
 Try at times not to be in charge or the “expert”
 Increase experiences that have spiritual or
philosophical meaning to you
 Access supervision routinely to share concerns,
identify difficult experiences, and strategize to solve
problems

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 Self-Care Checklist
 Anticipate that you will experience recurring
thoughts or dreams, and that they will decrease over
time
 Keep a journal to get worries off your mind
 Ask for help in parenting, if you feel irritable or are
having difficulties adjusting back to your routine
 Plan for family/home safety, including making child
care and pet care plans
 Practice brief relaxation techniques during the
workday
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 Self-Care Checklist
 Use a buddy system to share upsetting emotional
responses
 Stay aware of limitations and needs
 Recognize when one is Hungry, Angry, Lonely, or
Tired (HALT), and take the appropriate self-care
measures
 Increase activities that are positive
 Practice religious faith, philosophy, spirituality

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 Self-Care Checklist
 Spend time with family and friends
 Learn how to “put stress away”
 Write, draw, paint
 Limit caffeine, cigarettes, and substance use

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 Things to Avoid

• Extended periods of solo work without

colleagues or working “round the clock”
with few breaks
• Negative self-talk that reinforces feelings of
inadequacy or incompetency

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 Things to Avoid

• Common attitudinal obstacles to self-care

(e.g., “It would be selfish to take time to
rest.”)
• Negatively assessing your contribution
• Use of excessive use of alcohol, illicit
drugs, or excessive amounts of
prescription drugs

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I EXPECT TO PASS THROUGH
THIS WORLD BUT ONCE. ANY GOOD
THEREFORE, THAT I CAN DO OR
ANY KINDNESS I CAN SHOW TO ANY
FELLOW CREATURE, LET ME DO IT
NOW. LET ME NOT DEFER OR NEGLECT
IT FOR I SHALL NOT PASS THIS WAY 80