Psychological First Aid 101: Everything You Need to Know

PFA is focused on providing safety, social support, and promotion of adaptive functioning. Image courtesy of internationalmedicalcorps.org.uk

PFA is focused on providing safety, social support, and promotion of adaptive functioning. Image courtesy of internationalmedicalcorps.org.uk

With the onslaught of typhoon Haiyan (Yolanda) to East Visayan region of the Philippines, many are left victims of the vast destruction to surroundings, family, and self. There is a need for an immediate prevention of distressful sequelae to these events. The Psychological Association of the Philippines is recently tasked by the Department of Health to respond to the psychological needs of the victims of typhoon Haiyan. This article describes Psychological First Aid (PFA) and provide useful links for a those who want to know more about PFA. It is my hope that most of you will be inspired and empowered to perform PFA after reading this.

What is Psychological First Aid

Psychological First Aid (PFA) are helping actions aimed at reducing initial post-trauma distress and supporting short and long-term adaptive functioning. It is humane, supportive response to a fellow human being who is suffering and who may need support. It can be given immediately after a stressful incident and forms part of a wider disaster/trauma response.

PFA is an alternative to “psychological debriefing” which has been found to be ineffective in most studies (WHO, 2011; Ruzek et al., 2007). PFA is NOT debriefing nor counseling because PFA does NOT necessarily involve a detailed discussion of the event that caused the distress. It is not asking someone to analyse what happened to them or to put time and events in order. Although PFA involves being available to listen to people’s stories, it is not about pressuring people to tell you their feelings and reactions to an event.

PFA is inspired by the following empirically-supported intervention principles for disaster and mass-violence namely:

  • promoting sense of safety
  • promoting calmness
  • promoting sense of self-efficacy and community-efficacy
  • promoting connectedness
  • instilling hope

Therefore, the goals of PFA are focused on the “here and now” concerns of victims distressed by their situation. Deeper processing of events are reserved on the Secondary Psychological Assistance and other specialised intervention to be done later after the initial PFA (Ruzek et al., 2007).

What’s the difference between PFA and Critical Incident Stress Debriefing (CISD)?

When disasters or stressful events happen, there are various initiatives to do interventions for mental health. Commonly you hear the terms “psychological debriefing”, “stress debriefing”, “grief interventions”, “crisis intervention”, Critical Incident Stress Debriefing (CISD), brief cognitive behavioral therapy amongst others. ALL of these are not done in PFA. As previously mentioned, PFA does not involved processing of events and perceptions but is more focused on providing safety, social support, and promotion of adaptive functioning.

Current researches suggest that CISD does not decrease long-term negative effects on post-trauma clients. It may even have negative outcomes by agitating victims because they can be reminded of the pain experienced from disasters (Ruzek et al., 2007; McEvoy, 2005). On the other hand, brief cognitive behavioral therapy may not be effective to some victims because the chaotic and stressful post-event environment may reduce the energy and effort needed to participate in CBT treatments. Other counseling and psychotherapeutic interventions may need multiple sessions which is impractical in disaster situations. Therefore, PFA serves as an immediate intervention within hours/days after the incident.

Who needs PFA?

Children are at-risk on developing distress during disasters. PFA can also be applied and adapted for children. Image courtesy of Philstar.com

Children are at-risk on developing distress during disasters. PFA can also be applied and adapted for children. Image courtesy of Philstar.com

Anyone who experienced a stressful situation like disasters and mass destabilizations needs psychological first aid. Focus should be given to those showing signs of acute distress including but not limited to disorientation, confusion, agitation, extremely withdrawn or “shutdown”, panicky, and extremely worried (NTCSN, 2006).

Moreover, World Health Organization (2011) identified vulnerable groups who might be prioritised for PFA namely (1) people with serious medical concerns, (2) people with problems on self-care, and (3) people who are violent to themselves or others. In addition, The National Child Traumatic Stress Network of United States also included children, adolescents, pregnant women, and mothers caring for babies/small children as special-risk population. These considerations should guide groups who will conduct PFA in disaster-stricken community for proper triage and referrals.

Who can perform PFA?

PFA can be done by both professionals and lay persons after necessary training. PFA is not only for counselors or psychologists. Allied health professionals can also conduct PFA and may already have similar preparations of “first aid”, for example nurses are taught of crisis intervention and disaster nursing even in undergraduate courses. Typically, trainings for PFA can be done in 1-2 day sessions. In one study, paraprofessionals have success on learning how to do PFA after a 1-day workshop (McCabe et al., 2011).

Do we need to be a licensed professional to perform PFA? Specifically for the Philippines, mental health programs including those for disaster and emergency situation are regulated by the law (Sec III, B3, IRR of RA 10029). However, PFA does not involve processing of psychological processes and focuses more on the immediate needs. It is arguably not the same with other psychological interventions and therefore can be done by lay persons with proper training. It is for the Psychology Regulatory Board to decide on this matter legally in the future.

When and Where should PFA be done?

Image courtesy of teamasia.com

Image courtesy of teamasia.com

PFA is a supportive intervention for use immediately after a disaster and mass human destabilization. Practical limitations on conducting PFA will be the immediate physical needs of the persons involved in a disaster. After providing physical safety and security, PFA can follow next. PFA is also designed to be used in diverse settings. It has been used in settings such as shelters, evacuation sites, emergency settings and clinics, homes, and even via phone. Since most of the victims are within the vicinity of the disaster environment, risks and benefits of conducting PFA on-site or on other venue should be considered. It might also be strategic for the PFA team to be near with the Incident Command System for coordination within the larger disaster management program.

What are the preparations/training needed for PFA?

Different organizations may offer trainings and workshops for PFA. Currently, the Psychological Association of the Philippines is spearheading these trainings together with partner schools such as Ateneo De Manila University and Miriam College. The World Health Organization also released a manual on how to conduct PFA and can be downloaded on their website for free. The National Child Traumatic Stress Network website also offers an online course for PFA and a mobile app for field workers. Recently, the Red Cross under the IFRC also offered a diploma course on Disaster Management which may partly cover PFA in one of their modules.

In the undergraduate curriculum, mental health professionals such as psychologists, counselors, psychiatrist, nurses, and social workers may have their own intervention programs that parallels with the goals of PFA. Social workers and nurses are already oriented on crisis intervention and how to deal with acute distress during disasters. Therefore, training people for PFA may come easier for mental health professionals who already have prior experience/knowledge about mental health programs and interventions.

It is also practical to note that most organizations and teams that conduct PFA also do trainings/workshops for PFA. However, there should be a one unified movement when it comes to coordinating efforts of different people to conduct PFA and disaster management in general (IASC, 2006).

I want to learn more about Psychological First Aid!

That’s good to hear! Here are some useful links for you to read more about PFA:

WHO Psychological First Aid: Guide to Field Workers: http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf
– Provides an easy to read yet very informative discussion about PFA

National Child Traumatic Stress Network PFA manual: http://www.nctsn.org/content/psychological-first-aid
– Provides a useful framework and step-by-step procedure on how to do PFA. It also include sample dialogues to victims and worksheets for field workers.

Psychological First Aid by Ruzek et. al. (2007): http://www.academia.edu/966163/Ruzek_Brymer_Jacobs_Layne_Vernberg_and_Watson_2007_._Psychological_First_Aid
– Research article that discusses the eight core actions that forms the framework in conducting PFA. Also discusses the empirical findings of PFA, CISD, and other psychotrauma interventions.

Inter-Agency Standing Committee: http://www.humanitarianinfo.org/iasc/
– Provides general guidelines on how to respond to disasters. They also have specific guidelines for mental health and psychosocial support in emergency settings.

Psychological Association of the Philippines: https://www.facebook.com/pages/Psychological-Association-of-the-Philippines/148851815387
– If you are interested to undergo training and/or provide PFA, you may contact them or update yourself with their latest announcements in their official FB page.

NCTSN PFA Mobile app for Apple and Android devices: http://www.nctsn.org/content/pfa-mobile

I want to be trained and volunteer!

Here are the updated links and information about PFA opportunities for training and volunteering (as of Nov 25, 2013):

PAP PFA Training for Villamor at Ateneo De Manila University: http://www.signupgenius.com/go/10C0E44ACA72AA7FB6-pappfa

PAP PFA Volunteers for Villamor Airbase: http://www.signupgenius.com/go/10C0E44ACA72AA7FB6-pappfa2


References:

Inter-Agency Standing Committee. (2006). PROTECTING PERSONS AFFECTED BY NATURAL DISASTERS: IASC Operational Guidelines on Human Rights and Natural Disasters. Retrieved from http://www.humanitarianinfo.org/iasc/
McCabe, O. L., Perry, C., Azur, M., Taylor, H. G., Bailey, M., & Links, J. M. (2011). Psychological First-Aid Training for Paraprofessionals: A Systems-Based Model for Enhancing Capacity of Rural Emergency Responses. Prehospital and Disaster Medicine, 26(4), 251–8. doi:http://dx.doi.org/10.1017/S1049023X11006297
McEvoy, M. (2005, December). Psychological First Aid: Replacement for Critical Incident Stress Debriefing? Fire Engineering, 158(12), 63–66.
McMillan, I. (2005). Give psychological “first aid” to tsunami survivors. Mental Health Practice, 8(5), 40–40.
Nagara, B. (2003). “Psychological First Aid.” UN Chronicle, 40(4), 53–54.
National Child Traumatic Stress Network. (2006). Psychological First Aid—Field Operations Manual (2nd ed.). Retrieved from http://www.nctsn.org/content/psychological-first-aid
Plummer, C. A., Cain, D. S., Fisher, R. M., & Bankston, T. Q. (2008). Practice Challenges in Using Psychological First Aid in a Group Format with Children: A Pilot Study. Brief Treatment and Crisis Intervention, 8(4), 313–326. doi:http://dx.doi.org/10.1093/brief-treatment/mhn019
Psychological First Aid. (1952, April). Journal of Clinical Psychology, pp. 210–211.
Ruzek, J. I., Brymer, M. J., Jacobs, A. K., Layne, C. M., Vernberg, E. M., & Watson, P. J. (2007). Psychological First Aid. Journal of Mental Health Counseling, 29(1), 17–49.
Schafer, A., Snider, L., & van Ommeren, M. (2010). Psychological first aid pilot: Haiti emergency response. Intervention, 8(3), 245–254.
Shibley, H. (2010). Psychological first aid: Helping children overcome disasters. Brown University Child & Adolescent Behavior Letter, 26(4), 1–6.
Snider, L., World Health Organization, War Trauma Foundation, & World Vision International. (2011). Psychological first aid: guide for field workers. Geneva, Switzerland: World Health Organization.
Taylor, A. J. W. (2002). Coping with catastrophe: Organising psychological first-aiders. New Zealand Journal of Psychology, 31(2), 104.
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