psychological intervention

1. Definition
• Psychological First Aid – “first-aid” response
aimed to *stabilize, *reduce symptoms and
*return the survivor to functional capacity in
the aftermath of a critical incident.
PFA

2. What is Emotional First Aid™(EFA)?
"Emotional First Aid initial response given
to a person experiencing emotional
distress before specific professional help
is sought and obtained."

3. 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

4. WHO is PFA for?
PFA is intended for PEOPLE
EXPOSED TO DISASTER
(children, adults, first responders,
disaster relief workers)

5. WHO delivers PFA?
•Social Workers / Health Workers
•Other disaster response workers

6. WHEN should PFA be used?
IMMEDIATE
aftermath of the disaster

7. WHERE should PFA be used?
Shelters, hospitals, medical
areas, care facilities, feeding
locations, family reception &
assistance centers, home,
business & community settings

8. 3 Goals of Providing PFA
1. Relieve both emotional & physical
suffering
2. Improve people’s short term functioning
3. Accelerate the individual’s course of
recovery

9. 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

10. • 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
Roles of a Psychological First Aider

11. 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.

12. Examples of Psychological First Aid
• Information Support
Services – provision of appropriate
information
• Tracing Services –
helps locate missing relatives

13. 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

14. 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.

15. Examples of PFA
• Defusing - early-intervention
strategy that is activated while the
traumatic memories are more
successfully dealt with, before they
are 'cemented in' and perhaps
distorted

16. • Defusing shortened version of a
debriefing, lasting 15-30 minutes, and
must be held within 8 hours of the incident
• defusing works with only three stages
(introduction, exploration and information).

17. Defusing
• Provides support and encourage each
other
• exchange information, and enjoy a sense
of group caring.
• provides express similar feelings

18. Crisis Management Briefings
• large-scale crisis interventions
• usually held for large groups (up to 300
members at a time)
• lasts about 45-75 minutes, and provides
information and rumor control about the
crisis.

19. 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.

20. PFA Core Actions
1. Contact & Engagement – initiate non-
intrusive, compassionate & helpful manner
2. Safety & Comfort – enhance ongoing safety,
provide physical & emotional comfort
3. Stabilization – calm & orient emotionally
overwhelmed / disoriented survivors
4. Information Gathering – identify immediate
needs & concerns – tailor PFA interventions

21. 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
PFA Core Actions

22. 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

23. General Principles of PFA
• Reunite w/ family members
• Provide & ensure emotional support
• Focus on strengths & resilience
• Encourage self-reliance
• Respect feelings & cultures of others

24. Delivering PFA
• 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

25. Delivering PFA
• Professional Behavior:
– Make appropriate REFERRALS
– Be knowledgeable & sensitive (Culture & diversity)
– Pay attention to your own emotional &
physical reactions.
– Practice SELF-CARE

26. • 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 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
Delivering PFA

27. Delivering PFA
• 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.

28. 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

29. 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.

30. 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)

31. When To Refer?

32. 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)

33. 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

34. 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.

35. 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

36. Client
• Assessment if PSS is
needed
• By SERVICE PROVIDERS:
MSW, BHW, Midwife,
• PHN, MD
PSP
needed
HOME
MHPSS/
Psychosocial
Intervention by
MHPSS
Service Providers
MH Specialist
(Psychiatrist)
HOM
E
Improved
MHPSS REFERRAL
FLOW CHART
YES
NO
NO
YES

37. When, Where & How
to REFER

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

40. THOUGHT & FEELING RATIO
THOUGHT FEELING
FEELING THOUGHT
NORMAL CRISIS

41. PSYCHOSOCIAL PROCESSING
- most critical of all the stress management
interventions
- Originally designed to reduce stress in
emergency personnel after extremely
traumatic experiences
- Considered as a most important mechanism to
- reduce the potential of
Post Traumatic Stress Disorder
- Designed for events which is in general considered
to be extremely unusual in the range of ordinary
human experience

42. DEBRIEFING DEFINED
• - a group process
• - can best be defined as a group meeting
or discussion, employing both crisis
intervention and intervention processes,
targeted toward mitigating or resolving the
psychological distress associated with a
critical incident (traumatic event)

43. GOALS AND OBEJECTIVES OF
DEBRIEFING
• Primary
1. Mitigates impact of critical incident on
those victims of critical event, be they:
- primary victims (directly traumatized)
- secondary victims (emergency service
personnel who witnessed or managed the
traumatic event
- tertiary victims (family, friends, etc.)

44. • - accelerate normal recovery process in
normal people who are experiencing
normal stress reactions to normal stress
events
• - facilitate the identification of individuals
within the group who might be in need of
additional CISM services or a referral for
therapy

45. • Secondary:
1. Education about stress, stress reactions,
and survival techniques
2. Emotional ventilation
3. Reassurance that the stress response is
controllable and that recovery is likely
4. Forewarning of symptoms which might
show up in the near future
5. Reduction of the fallacy of uniqueness (or
feeling that one is being singled out as a
victim)

46. 6. Reduction of the fallacy of abnormality
7. Establishment of a positive contact with
mental health professionals
8. Enhancement of group cohesiveness
9. Enhancement of inter agency cooperation
10. Prevention or mitigation of post trauma
syndromes and PTSD
11. Screening for people who need
assessment or therapy
12. Referral for counseling or other services as
necessary

47. TEAM MEMBER DEBRIEFING ROLES
• - Team Leader
• - Co-Leader
• - Doorkeeper
• - Clergy
• - Peers

48. THOUGHT THOUGHT
• FEELING

49. SELF-REPORTING QUESTIONNAIRE
1. Do you often have headaches?
2. Is your appetite poor?
3. Do you sleep badly?
4. Are you easily frightened?
5. Do your hands shake?
6. Do you feel nervous, tense, or worried?
7. Is your digestion poor?
8. Do you have trouble thinking clearly?
9. Do you feel unhappy?
10.Do you cry more than usual?
11. Do you find it difficult to enjoy your daily
activities?

50. SELF-REPORTING QUESTIONNAIRE
12. Do you find it difficult to make decisions?
13. Is your daily work suffering?
14. Are you able to play a useful part in life?
15. Have you lost interest in thins?
16. Do you feel that you are a worthless person?
17. Has the thought of ending your life been on
your mind?
18. Do you feel tired all the time?
19. Do you have uncomfortable feelings in your
stomach?
20. Are you easily tired?