INTRODUCTION TO PSYCHOLOGICAL FIRST AID

A. BACKGROUND

What is PFA?

The Inter-Agency Standing Committee (IASC) defines Psychological First Aid (PFA) as a humane
and non-intrusive way of treating another individual who may be suffering from post-traumatic
stress symptoms and therefore is needing support. It consists of the following systematic steps of
helping actions which aid in developing adaptive ways of coping with the stressful event:
-Asking about the individual needs at the moment
-Making him/her feel safe and calm
-Addressing his/her basic needs
-Connecting them with services and social support
-Protecting them from harm

It is best to remember that PFA is NOT counseling, psychological debriefing, nor Critical
Incidence Stress Debriefing (CISD). It is NOT a practice limited to professionals, NOT a session
where individuals are asked to discuss details of the event nor to analyze what had happened to
them. There should be no pressure to tell others about how they feel or react to the event. It is a
supportive intervention for use in the immediate aftermath of disasters. It is designed to reduce
the initial distress caused by traumatic events and to foster short- and long-term adaptive
functioning and coping, NOT to elicit details of the traumatic experiences and losses.

What are the core actions in PFA?

There are 3 core actions in delivering PFA:

1. LOOK – Ensure safety, Contact & engagement
The goal is to initiate contacts or to respond to contacts by students and staff in a non-
intrusive, compassionate and helpful manner, to enhance immediate and on-going safety,
and provide physical and emotional comfort.
REMINDERS for small group format:
-It is preferred that you conduct the group with another provider, preferably someone who
is familiar to the students/staff.
-Introduce yourself and the purpose of the meeting.
-Acknowledge to group members that, while they have had similar experiences, their
responses may be very different.
-Create a comforting

2. LISTEN – Stabilize, Gather information regarding current needs and concerns, and Support
efforts to coping
The goal is to calm and orient emotionally overwhelmed or disoriented students and staff,
to identify immediate needs and concerns and tailor PFA interventions to meet these needs,
to provide information about stress reactions and coping to reduce distress and promote
adaptive functioning and to support the positive coping mechanisms they have already
adapted.
3. LINK – Practical assistance, Connect to social support, and Link with services
 The goal is to offer practical help to students and staff in addressing immediate needs and
concerns, to help establish brief or ongoing contacts with primary support persons or other
sources of support including family, friends, teachers and other school/community
resources, and to link students and staff with available services needed at the time or in the
future.

Who delivers PFA?

Because it is not psychotherapy, an extended “treatment,” or a stand-alone mental health

intervention, any staff member, regardless of whether he/she has had mental health training, can
deliver aspects of PFA-S and can contribute to the school recovery by functioning within the PFA
framework. Similarly, trained members of community emergency response agencies and mental
health professionals may provide PFA-S. During and after an emergency, teachers and other staff
are a critical link in promoting resilience, in recognizing the signs of traumatic stress, and in
helping students and their families regain a sense of normalcy.

B. CONCEPTS YOU NEED TO KNOW ABOUT

I. SELF-CARE
Self-care is the ability to engage in helping others without sacrificing other important parts of one’s
life. It’s taking responsibility for job functions you have control over, the ability to maintain a
positive attitude towards the work despite challenges, and your right to be well, safe, and fulfilled.
It’s important to remember that self-care is not an emergency response plan to be activated when
stress becomes overwhelming or that having a good self-care plan means you are acting selfishly.
Healthy self-care can renew our spirits and help us become more resilient. Think of self-care as
having three basic aspects:
1. Awareness. The first step is to seek 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
who you want to be.
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.
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.

PFA PROVIDERS’ REACTIONS TO STRESSFUL EVENTS

Providing support in the immediate aftermath of crisis can be an enriching professional and
personal experience that enhances satisfaction through helping others. It can also be physically
and emotionally exhausting. The following provides information to consider when responding to
an emergency at a school.
A. COMMON REACTIONS
- Increase/decrease in activity level
- Difficulty in sleeping
- Substance use
 - Disconnection and numbing
- Irritability, anger and frustration
- Vicarious traumatization: shock, fearfulness, horror or helplessness
- Confusion, lack of attention, and difficulty in decision-making
- Physical reactions: headaches, stomachaches and is easily startled
- Depressive or anxiety reactions
- Decreased social activities
- Diminished self-care
B. EXTREME STRESS REACTIONS THAT WARRANT REFERRAL (RISK FACTORS):
You may experience more serious stress responses that warrant seeking professional support or
monitoring by a supervisor. These include:
- Sense of helplessness
- Preoccupation or compulsive re-experiencing of trauma experienced either directly or
indirectly
- attempts to over-control in professional or personal situations, or act out a “rescuer
complex”
- social withdrawal and isolation
- chronic exhaustion
- survival coping strategies like relying on substances, overly preoccupied by work, or
drastic changes in sleeping or eating patterns
- Serious difficulties in interpersonal relationships, including domestic violence
- Depression accompanied by hopelessness Suicidal ideation or attempts
- Unnecessary risk-taking Illness or an increase in levels of pain
- Changes in memory and perception Disruption in your perceptions of safety, trust, and
independence

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
- 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
- Practice good sleep routines „ o 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
 - 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
- 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
- Spend time with family and friends
- Learn how to “put stress away”
- Write, draw, paint
- Limit caffeine, cigarettes, and substance use

School administration and leadership can help support providers by reducing the risk of extreme
stress through implementing procedures and policies. Consider:
- Encouraging work breaks
- Rotating of providers from the most highly exposed assignments to lesser levels of
exposure
- Identifying enough supports to meet the needs of administration, staff, students, and
families
- Encouraging peer partners and peer consultation
- Monitoring providers who meet certain high risk criteria, such as: those who have been
directly exposed to the event, those having regular exposure to severely affected
individuals or families, those with multiple stresses (e.g., family changes, health problems)
- Ensuring regular supervision, case conferencing, staff appreciation events
- Conducting trainings on stress management practices and encourage the use of such
practices
- Supporting open communication

Be careful of engaging in activities that can hinder your attempts at good self-care. 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
- 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

II. Grief
Apart from learning more about PFA, it is also essential for teachers to have a background
knowledge on grief as a natural process. This is because grief, death, and loss can affect anyone.
Reactions vary depending on the circumstances of death. Anyone who have lost a relative or
someone close to them will need particular attention and support. It is important for people working
closely/living with the person to understand the reaction they may observe and to identify those
who require support. However, they must also understand how their own grief responses and
reactions to loss may impact the experiences of a grieving person.

The General Stages of the Grief Process (Kubler-Ross, 1969) are:

• Denial - Unwillingness to discuss the loss
• Anger - Blaming others for the loss
• Bargaining - Attempts to regain control by making promises or changes in one’s life
• Depression - Loss of energy, appetite, or interest in activities
• Acceptance - Acceptance that loss is final, real, significant, and painful

For teachers, just in case there are students who are still grieving in class, it is best to schedule a
one-on-one session with the student. A guidance counselor would be the best person to handle this.
In the absence of a counselor, the class adviser and/or teacher should read through this in order to
maximize the manner by which you can help the student.

Facilitating
Anyone (teachers, guidance counselors, and people who are willing to be trained in PFA) with
skills, competencies and an empowering attitude, can guide the survivors in empowering
themselves to self-reflect and learn. The role of facilitators is to provide the opportunity and guide
the process of self-reflection and learning.

The following skills are needed for the facilitation of a PFA session:
1. Emphatic and active listening – reflecting back what the speaker had said, clarifying what was
said, and being able to interpret what the person might be feeling even if it was not specifically
mentioned
2. Proficiency with the local language or dialect
3. Creating an atmosphere of unconditional acceptance and support-setting ground rules (respect
others’ opinions and having no right or wrong answer), encouraging participation using verbal
and nonverbal communication
MORE GUIDELINES:
1. Speak calmly. Be patient, responsive, and sensitive.
2. Speak slowly, in simple concrete terms; don’t use acronyms or jargon.
3. Give information that is accurate and age-appropriate for your audience.
4. Let people know that you are interested in how they are feeling.
5. Understand that people have all different kinds of feelings after a traumatic event. There is no
right or wrong way to react. Some people cry when they are sad; other people may feel sad, but
respond by being quiet, laughing, or seeming angry.
For young children and adolescents:
6. Listen to the other person, respect his/her feelings, never make fun of the person, and encourage
friends to seek support from adults when you think it might help. It always helps to be a good
friend.
7. Sit or crouch at the child’s eye level.
 8. Help school-age children verbalize their feelings, concerns and questions; provide simple labels
for common emotional reactions (for example, mad, sad, scared and worried). Do not use extreme
words like “horrified” or “petrified” because this may increase their distress.
9. Use direct and simple language as much as possible.
10. Listen carefully and check in with the child to make sure you understand him/her.
11. Talk to adolescents “adult to adult” so you give the message that you respect their feelings,
concerns, and questions.

KEY MESSAGES:
1. The PSS discussed in the sessions focus on Psychological First Aid (PFA), which is delivered
in the emergency phase (1-day to 6 months) of a disaster.
2. These sessions are conducted to build resiliency in personnel and learner survivors of disasters
and to mitigate the impact of the disastrous event in their life.
3. As a facilitator, it is important to assure those who are affected of their safety before starting
the PFA. Be knowledgeable about the nature of the event, current circumstances, and the type
and availability of relief and support services. As a PFA provider, make sure to practice self-
care.
4. The participants’ take home message consists of the following ideas:
 My reactions to the disaster are valid and normal.
 I can calm down and control my emotions.
 I know whom to approach for support in addressing my needs.
 I have multiple sources of strength.

REFERENCES:
Brymer M., Jacobs A., Layne C., Pynoos R., Ruzek J., Steinberg A., Vernberg E., and Watson P.
Psychological First Aid for Schools: Field Operations Guide, 2nd Edition. (2008). Los Angeles:
National Child Traumatic Stress Network & National Center for PTSD.

Ramos, P., Hechanova M., Caligner E., Bersamin A. Supporting Enabling and Empowering
Students: Manual on Psychosocial Interventions for Secondary School-Aged Students During
Disasters and Emergency Situations. (2015). UNESCO in partnership with Philippines’
Department of Education and Psychological Association of the Philippines.