Introduction to Psychological First Aid

Introduction to Psychological First Aid

I was reading some older posts within the Temple’s forum and someone wanted a lesson on Psychological First Aid (PFA). For this lesson, I’ll cover just the basics in order to bring awareness to the topic and not burden the reader with information overload.
First and foremost, I am certified to perform Psychological First Aid, not to teach and certify. I would suggest that if you are interested in learning more about the program to visit the link to the National Child Traumatic Stress Network where you can participate in an interactive 6 hour training at no cost.

So, what is Psychological First Aid? We are familiar with First Aid training offered through the Red Cross or the American Heart Association that deals with minor trauma to our physical body, but PFA offers immediate assistance through the implementation of specific services to individuals who have undergone a recent form of disaster. Disasters can be thought of events in our lives that throw us off center balance and can arise from a loss of physical property (such as flooding, terroristic damages, fire damages), life, feelings of connectedness, or a depreciated sense of hope. It is important to understand that we are unique social creatures and that our ways of grieving range from person to person; so what works for one individual might be different for another.

For the purposes of this training, let’s focus on the event of a tornado destroying a large portion of the town you are living in, and you are called to provide basic PFA for the survivors. What would you say? How would you approach the situation? Who do you offer your assistance to first? These are difficult questions to ask yourself. Reflect back on a time in your life when you experienced a serious traumatic event; how did you respond to your grief?

Basically, the PFA model through the NCTSN teaches us there are 8 core actions or services that we can provide to those in need in order to help them maintain balance with 5 basic principles.

The 8 core actions are:
1.) Contact/Engagement 2.) Safety/Comfort 3.) Stabilization 4.) Information Gathering
5.) Practical Assistance 6.) Connections with Social Support 7.) Information on Coping
8.) Link with Collaborative Support

The 5 basic principles are:

1.) Safety 2.) Calmness 3.) Correctedness 4.) Hope 5.) Self/Community Efficacy

This may seem like a lot at first, but as we go a bit further into each of the actions and principles you will begin to see how they both interconnect.

Contact/Engagement

As PFA responders, it is important to understand that the way that we approach an individual sets the tone to how we are received. A general rule for our approach is to identify an individual in crisis and walk towards them with a diagonally or from the side. It is talked against to approach someone from behind or directly from the front because it has the potential to exacerbate their current mental state. If we walk up to them from behind, they could be in such a state of trauma that we “spook” them and cause another crisis to occur. If we go about it from the front, we risk coming off as too aggressive and the individual might not be as receptive to receive the help from you.

As we approach from the side, it is important to introduce yourself to the person with you name and title, and ask them if they would like your assistance. We do this for 2 reasons. Firstly, it allows the person to choose to have our help. People who have just experienced a crisis often are under the illusion that they have lost their ability to control what happens to them. Offering them the choice to accept services may be the first thing they feel they have the power to do, so don’t be too disparaged if they are not willing in the beginning. And the second reason goes back to the concept that some people grieve differently. We don’t want to automatically assume that this individual needs our help immediately. Again, if we over impose our willingness to help, we risk the person not willing to participate with us.

Safety/Comfort

Now I know the thought of providing therapy and counseling to those who are grieving is the first thought that comes to your mind when you think of PFA; psychological means in the mind, so that’s what we do first, right? Not quite, before we offer any sort of services to the individual, it is important to address immediate needs of safety and comfort. We do this by providing the access to food, clean water, a place to shower, and a bed to sleep on, even though it may be temporary. Let’s say you approach an individual and say, “Hi, my name is Thomas, I am trained to provide Psychological First Aid, are you interested in speaking with me to see if there is anything I can assist you with today?” and the person tells you, “No, I just want to be left alone for right now.” What do you do next?

This happens quite often while offering PFA services to people in distress so don’t feel too discouraged. Before walking off, make sure to inform the individual of the available resources around them that meet their basic needs of survival (food, clothing, shelter, clean water) and ask them if it would be alright if you stopped by at a later time to check up on them. Again, it is important to give the person the ability to choose to request your assistance.

Stabilization

Stabilization involves utilizing both breathing and grounding techniques to assist victims of disasters who do not have the ability to stabilize their emotional reaction to the situation. I will not go over much of these techniques because there is a wealth of resources on TOTJO’s forum and library that discuss this in detail. After asking and receiving permission from the person to administer services and we visually see the individual isn’t able to breathe properly or is pacing back and forth, we can assist them by walking them through guided techniques to lower the heart rate and bring their attention to the here and now. For the breathing techniques, a simple hand on the belly as they breathe slowly in and out (especially out!!!) of their mouth/nose will help to slow the heart beat and regulate their body to a less elated state of hyperactivity.

If the person still has difficulty stabilizing after the breathing techniques, the PFA can also choose to help ground the individual to the present moment by having them sit down, breath in and out slowly and asking them to name as many non-distressing things they can see, then hear, and then feel. This should help the person begin to feel a bit more relaxed after the traumatic event and they will be more receptive to your help. Note, this step is vital before proceeding to offering other types of assistance. If the individual cannot come down from their reactive state, they will not be able to truly participate in the planning of their treatment plan. We will see in the next few sections why this is important.

Information Gathering

Now that your client has stabilized their emotions, it is now time to move on to the information gathering stage. This is important when providing treatment because it is tailored specifically to the needs of the individual and is not “cookie cut” out of a generic plan. If you are familiar with counseling in general, you might have heard the term, Person-Centered Services. This is the idea that the person and the professional work together in collaboration to find out what best suits the needs of the client. As a PFA professional, you want to ask the person open-ended questions to understand the depth of their needs and offer assistance where they need it most. In the practical assistance stage (in which we will discuss in the next section), you don’t want to focus on items that the client does not have an immediate need for. For instance, we don’t need to make a plan for the client to visit vocational services or apply for food stamps if the disaster did not dislocate him/her from the workforce. It is vital for the PFA professional to actively listen to the person and identify their needs. The PFAP should also use supportive comments to actively portray to the individual that they are listening. Phrases such as, “no wonder you feel…”, “I am really sorry that this is so tough…”, “am I right when I am saying…” or “What have you done in the past?”

Practical Assistance

The goal of practical assistance should be to restore optimism, confidence, and the individual’s ability to obtain resources. Think of practical in terms of relevant. As we stated in the previous section, the assistance that we provide should be relevant to the individual and should address their needs. But how do you go about understand which needs to address first? This is an important questions that PFAP should put some consideration on. For starters, the PFAP should address any immediate needs first. How is a person expected to go back to their normal routines if they no longer have their house, or they have no means of transportation? Addressing these needs first will restore the person’s confidence and they will be more willing to “buy into” your advice on how to fill their other needs. After you identify their initial needs, you should clarify with the individual that you are both understand each other and come up with a sort of action plan to address the needs. What types of services will you offer this individual? Are there any community resources that you can turn to in order to help this person regain control over their life? Finally the last step of practical assistance is to act. Take that first step with the person and see that they are moving forward from their crisis.

Connections with Social Support

This portion of the 8 core actions ties into the acting portion of the previous step. What types of services are available? Aside from the training, it is good to have a copy of the list of resources available within your community in case you are in need of providing reference to these services. It is better to plan ahead and become familiar with the types of social supports/programs in your local area before disaster strikes to eliminate the worry of having to start from scratch to find help. Typically there are 8 different types of support that an individual can receive. I will provide examples of what people in crisis can do with you in order to refocus their mind outside of the trauma.

1.) Physical Assistance (having people help you do tasks)
2.) Advice/Information (you can have them show you how to do something or vice versa)
3.) Reliable Support (reassure or build support from a peer/community group)
4.) Material Assistance (give people things they need; food, housing, clothing, money)
5.) Emotional Support (hugs, listening ears, empathy, love, etc.)
6.) Social Connection (feelings that you fit in)
7.) Feeling Needs (feelings of being important to others)
8.) Reassurance of Self-worth (other people can restore your confidence in yourself and your abilities.)

It is important to tailor the needs to your client. Not everyone is going to want to receive hugs, but some require it. Our ability to gather information on the client will provide us with how receptive the person will be to the types of services that we will offer.

Information on Coping

When I first stumbled upon PFA, I thought that teaching coping skills was the only part to being effective at stabilizing a person after their disaster; but I didn’t understand that it was so much more. Coping, in its most basic definition, is a manner in which we deal with stressful or complicated ideas or situations. Think about the psychological stressors that can alter our thoughts, patterns and actions after we experience a traumatic event. Firstly, there is intrusive actions/thoughts which are the mind recalling the events of the disaster. In hopes of your ability to cope well, try to bring yourself to remember a tragedy that occurred in your life. Can you recall all of the details? Do these thoughts still impede your daily life? Do these events live in your dreams? These thoughts will often plague our ability to positively cope with the traumatic event and will lead us to become avoidant, to become physically agitated, and to experience immense grief.

Now, it is important to understand your role as a PFAP. You are not providing counseling services or therapy to the clients. Your job is to stabilize the person and provide them with information on coping and resources within the community to cope with their grief. Focus on what you can do to help the person in this current moment and allow other professionals to continue with a continuity of care.

But as I stated before, different people will interpret grief differently. Some people might experience disturbances in their sleep and become frustrated easier, while others will experience shame, avoidance, or even exhibit signs of depression. Parents might often become stricter with their children after the events of a disaster which can cause issues within the family structure and their individual roles within. If you are working with a child or teenage, make sure to instruct them that these restrictions are more than likely only going to be temporary and they were only placed for their safety. It is best to also emphasize that all roles within the family system are open and honest to each other about their feelings and encourage open conversations.

Some key things to remember when providing information on coping

1.) It is best to reestablish family routines as quickly as possible.
2.) Encourage journaling of emotions and participation in community events
3.) Avoid overworking to cope with the pain
4.) Name it to tame it approach (I feel mad right now, because of “X”, but I am okay to feel this way. Feelings are normal, and this feeling will pass in time.)
5.) Avoid bottling up or suppressing how you feel
6.) Practice Self Care by attending to yourself.

Link with collaborative supports

The idea is to think globally, but act locally. As PFA professional, we do not have the capability to do everything for those in need. We need to partner with others and form a continuity of care in order to ensure the maximum success for our efforts. Being in the Jedi community, we understand the interdependence we share will all beings and non-beings. If the option remains available and the client is willing, keep in touch and form that lasting relationship. Psychological First Aid professionals need to perpetuate the individual’s sense of self-worth and empower them to continue to seek resources within the community to prevent the relapse of grieve.

In closing this entry (knowing beforehand I wished to make short, but instead is now 5 pages long), Psychological First Aid professionals are quite often the first person the individual meets after experiencing a life changing disaster. Preplanning and being aware of community resources will set the precedence of the interaction, and given the severity of the disaster, could mean the life or death difference between those we work with.

I strongly encourage everybody to follow the link that I posted above in order to learn a bit more about the benefits of being a PFA responder. Not to mention the fact that it is free training that literally could save a life.

Thank you for reading, and May the force be with you, always.

I'm a certified Crisis Incident Peer Supporter.

While I understand the need to educate people on things that are available and tell them to seek out the services they can put people in contact with, the truth is they need to learn how to communicate with people in a crisis first. How to recognize signs of distress, so they can build a rapport with the victim.

You touch briefly on approach. But here's the thing- that's not the most likely scenario for the Clergy here, they will be approached. Given this simple fact- instead of using a Disaster scenario go directly to defining what a crisis is.

Things online I keep seeing in the community as a whole are the constant use of improper language which turns the victim off. It makes them feel like you're less interested in them and more interested in feeling like you accomplished something.

(random note: Before anyone asks me to write this course, I offered it to ToTJO twice since 2012. For reasons I'm not willing to discuss atm beyond "it's going through revisions", the offer is off the table.)

Alethea,

Thank you for your input. I totally agree with you in regards to approaching crisis online is very different than applying it in the real world. Emotions, body language, empathy, and intent are a bit harder to display in your messages, and have the potential to be misconstrued if taken out of context. This is why it is important to choose the words to the message we want received effectively, and quite often, it proves to be difficult to do given the variations between culture, genders, and individualistic lifestyles. Perhaps approach is a bit easier online than it is in-person, because of the way an individual in asks for assistance, or due to the barrier of protection they feel as if they have behind the screen of a computer, rather than feeling pressured to have a face-to-face contact with someone after an immediate disaster. (Thus giving the individual the power of choice and control over what they want to say.)

With that being said, this post was aligned to teach the principles of the PFA program offered under my certification that is primarily applicable to the use in the real world, but flexible enough to have applications online as well. As I am sure your aware with your experience on the delegation of information, the person is less likely to be receptive with an overload of information in a single setting. Thus, I kept to the basics of the PFA program to grab the reader's attention to (hopefully) motivate them to pursue the knowledge of approach on their own. By reading this, the reader should not be under the impression they are going to be SME on the topic, but more familiar with the concepts should they choose to become certified at a later date.

If you'd ever change your mind about writing your piece, I would love to read it. I feel teaching the material both reinforces better practice while the learners gain insight another piece to the puzzle from another's perspective. That's the beauty of studying/working with human behavior; it is never static.