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Psychological First Aid Training Guide

This document provides an overview of Psychological First Aid (PFA) for schools. It acknowledges authorities in the field of disaster behavioral health and PFA. The agenda outlines introducing PFA concepts and skills. PFA is described as an evidence-informed approach to assist students, families, and staff in the aftermath of a school crisis or disaster. It aims to limit distress and promote recovery through listening, protecting, connecting, modeling, and teaching coping skills. The document compares PFA to medical first aid and outlines when PFA should be used.

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0% found this document useful (0 votes)

207 views186 pages

Psychological First Aid Training Guide

Uploaded by

Ana Chicas

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

Nicci Spinazzola, Ed.S.

, LMFT, LPC, ACS

NJ-DRCC
spinazzola@[Link]
Acknowledgements
 This training program is based upon the best practices in Psychological
First Aid (PFA) identified by several leading international authorities,
such as:

 National Center for Posttraumatic Stress Disorder;;

Disaster Branch of the National Child Traumatic Stress Network.

 The International Federation of Red Cross and Red Crescent

Societies.

 National Academies of Science-Institute of Medicine.

 Drs. George Everly & Brian Flynn.

 Zagurski, R., Bulling, D., Chang, R. (2005). Nebraska Psychological

First Aid Curriculum. Lincoln, NE: University of Nebraska Public Policy
Center.
2
National Child Traumatic Stress Network
National Center for PTSD

 Psychological First
Aid for Schools

 PFA-S

 Field Operations
Guide
Our Agenda
 Introduction
 Foundations of Disaster Behavioral Health
 What is Psychological First Aid (PFA)?
 Key Concepts in PFA
 Delivering PFA
 Core Actions in PFA
 PFA Skills Tool Kit
 PFA Do’s & Don’ts
 Self-Care

4
5
What is PFA?

 Psychological First Aid is an evidence-

informed approach for assisting children,
adolescents, adults, and families in the
aftermath of a school crisis, disaster, or
terrorism event.
Psychological First Aid—
 developed in response to a series of school shootings in the
1990s

 strategies guide teachers and staff in helping traumatized

students deal with the aftermath of traumatic events

 helps educational staff support students through the process

of recovery, especially when encountering traumatic
reminders of…
 being in danger
 experiencing loss or trauma
Overview
 Listen — Let your students know you are available to listen to their
concerns and talk about the event. Listen attentively and pay attention
to what students say.

 Protect — Help students feel protected by continuing to listen to their
concerns. Talk to them about what is being done in the school and
community to keep them safe.

 Connect — Reach out to your students regularly. Communicate with

others involved in your students' lives, such as parents, grandparents,
or other teachers. Restore school clubs and activities.

 Model — Be mindful of your verbal and non-verbal cues. Commit to your
own self-care. Acknowledge the difficulty of the situation.

 Teach — Help your students reach and achieve small goals and applaud
these achievements. Remind students that time will help.
A Working Definition

“Psychological first aid (PFA) refers to

a set of skills identified to limit the
distress and negative behaviors that
can increase fear and arousal.”

(National Academy of Sciences, 2003)

9
Psychological First Aid is….
 Psychological first aid (PFA) is as natural, necessary and
accessible as medical first aid.

 Psychological first aid means nothing more complicated

than assisting people with emotional distress resulting
from an accident, injury or sudden shocking event.

 Like medical first aid skills, you don't need to be a doctor,
nurse or highly trained professional to provide
immediate care to those in need.

10
Psychological First Aid is Not…
 Debriefing
 Counseling
 Psychotherapy
 Mental Health Treatment

Fill in the blank:

“The purpose of psychotherapy is to create _______________.”
“The purpose of disaster mental health
intervention is to prevent _____________.”
11
a comparison…

Medical First Aid

 early assistance provided by those first on-scene
 initial assessment of the physical impact of the event
 stabilization of immediate physical wounds
 prevention of further physical exposure or injury
 maintenance of medical status until professional medical
care is available
 facilitate transition to trained medical professional when
needed
 promotes quicker and better physical recovery
A comparison
Psychological First Aid
 early assistance provided by those first on-scene
 initial assessment of emotional impact of event
 stabilization of immediate emotional wounds
 prevention of further exposure or emotional injury
 maintenance of emotional status until professional mental
health care is available
 facilitate transition to trained mental health professional
when necessary
 promotes quicker and better emotional recovery
A Distinction:
Psychological First Aid
vs.
Mental Health First

PFA is intended for MHFA is intended

anyone experiencing primarily for
an overwhelming individuals with a
emotional response pre-existing
to a disaster or psychiatric
emergency, with or conditions
experiencing a
without a pre-existing psychiatric
condition. emergency.
ABC’s of First Aid

Medical
 Airway
 Breathing Psychological
 Circulation
 Arousal (Reduce)
 Behavior (Limit)
 Cognition (Improve)
Strengths of PFA
• PFA includes basic information-gathering
techniques for rapid assessment of the
survivor’s immediate concerns.
• PFA relies on field-tested, evidence-informed
strategies that can be applied in a variety of
disasters and crisis situations.
• PFA is appropriate across ages and cultures.
• PFA includes the use of handouts to provide
important information for dealing with post-
disaster reactions and adversities.
16
Psychological First Aid for Schools (PFA-S)

 designed to reduce initial distress caused by

emergencies
 foster short- and long-term adaptive functioning and
coping
 principles and techniques meet five basic standards:
 consistent with research on risk and resilience following trauma
 respectful of and consistent with the administration of the:
○ academic setting
○ school culture
○ behavior (code of conduct) of students
 applicable and practical in field settings
 appropriate for developmental levels across the lifespan
 delivered in a culturally-informed and flexible manner
PFA-S
 assumes that students and staff may experience a
range of early reactions (physical, cognitive,
psychological, behavioral, spiritual)

 reactions can cause distress that interferes with

adaptive coping

 getting support from informed, compassionate and

caring professionals help in the recovery

 has the potential to mitigate development of severe

MH problems or long-term difficulty in recovery by:
○ identifying individuals who may need additional services
○ linking them to services as needed
Why us?
 schools are typically first to resume operations after a
disaster
 primary source of community support during and after
 when people are trained in emergency protocols (including
students, when appropriate) and have knowledge of
techniques to reduce anxiety and establish calm, they
are better able to handle the emergency and be of help
 when students’ psychosocial and mental health needs are
addressed in a developmental, systematic, and
comprehensive manner, they achieve at higher levels
 trauma-related distress has long-term impact if left untreated
 unaddressed mental health needs increase dropout rates,
lowers academic achievement, disrupts relationships,
and impacts overall well-being
When should PFA be used?

 most effective immediately following the incident

(one hour to a couple of weeks after an
event)

 in some circumstances, assuming the safety of

students and staff has been ensured PFA
can be started while an incident is still
occurring, such as in sheltered-in-place or
lockdown
Who is PFA for?

 intended for students, school personnel, and

their families

 whether emergency occurs on school grounds

or in community, schools serve as a central
location for professionals to assist children,
families, school personnel, and school
partners
when should PFA be used?
 immediate aftermath of disasters or terrorism
 typically 0 to 48 hours of the event.
PFA by Phone

23
Who delivers PFA?
 any staff member, regardless of whether having
had mental health training, can deliver aspects
of PFA and contribute to the school recovery

 trained members of community emergency

response agencies and mental health
professionals may provide PFA

 during and after emergency teachers and staff are

critical links in:
 promoting resilience
 recognizing the signs of traumatic stress
 helping students and their families regain a sense of
normalcy
traits of effective PFA responders

 capacity to connect with wide range of

individuals
 tolerance for symptomatic behavior and
strong expressions of feelings
 capacity to rapidly assess survivors
 provide clear, concrete information
 capacity for self-care
 know yourself, your abilities and limits

25
essential attributes and skills for
responders

 Good Listening Skills

 Patient
 Caring Attitude
 Trustworthy
 Approachable
 Culturally Competent
 Empathetic
Essential Attributes and Skills (Cont.)

 Non-judgmental approach
 Kind
 Committed
 Flexible
 Able to tolerate chaos and
uncertainty

27
28
basic objectives of the PFA provider

 establish positive connections with students and staff in a

non-intrusive, compassionate manner
 enhance immediate and ongoing safety and provide
physical/emotional comfort
 calm and orient emotionally overwhelmed or distraught
students and staff
 help students and staff identify their immediate needs and
concerns
 offer practical assistance and information to help address
those identified immediate needs and concerns
 connect as soon as possible to social support networks,
including family members, friends, coaches, other
school or community groups
basic objectives of the PFA provider
 empower all to take an active role in their recovery, by
acknowledging their efforts and strengths, and supporting
adaptive coping

 make clear your availability

 Protect: From further

exposure and media.
 Direct: Be kind, gentle,
clear.
 Connect: With loved ones
and information and
support.
Early Psychological Support
 relieves suffering,
both emotional and
physical

 improves short
term functioning

 accelerates
recovery
Principles
of Psychological Support
 Do no harm  Encourages
 Peer-based organizational
approach participation
 Recognizes and  Exercises care with
uses terminology
indigenous  Encourages active
healing involvement
networks and  Values early
practices intervention
 Uses trained  Uses viable
volunteers interventions
 Empowers
Empowerment
 over-helping can be humiliating and/or create
passivity
 quality relief and assistance is based on
helping others to gain self-respect and
autonomy (empowerment)
 abilities and strengths of the recipient are as
important as their problems
 high degree of organizational participation
enhances empowerment
Active Involvement
 focus on strengths rather than symptoms and
deficits
 identify and strengthen coping mechanisms
 actively involve the person in helping to sort
out their problems

 Remember: “Action Binds Anxiety!”

35
Slow It Down

Sit
Think
Observe
Plan
Interpersonal Communication
Skills

 Non-verbal communication

 Listening and responding

 Giving feedback
Projecting Warmth

 Soft tone
 Smile
 Interested facial expression
 Open/welcoming gestures
 Allow the person you are talking with to
dictate the spatial distance between y
 NOTE: This can vary according to cultural or
personal differences
Increasing Trust and Confidence
 General behaviors (depending on
culture) to increase trust and
confidence:
 Face the speaker
 Display an open posture
 Keep an appropriate distance
 Frequent and soft eye contact
 Appear calm and relaxed
Communicating Warmth
 SOLER
• S it squarely
• O pen Posture
• L ean Forward
• E ye Contact
• R elax
Communication and Empathy
(and Safety!)

 L-Shaped Stance:

 Demonstrates respect

 Decreases confrontation
Listening and Responding
 Seek to understand first, then to be understood

 Concentrate on what is being said

 Be an active listener (nod, affirm)

 Be aware of your own biases/values

 Listen and look for feelings

 Do not rehearse your answers

A Good Practice: “Ask before you tell.”

Listening and Responding
(cont)

 Pause to think before answering

 Do not judge

 Use clarifying questions and statements

 Avoid expressions of approval or disapproval

 Do not insist on the last word

 Ask for additional details

Benefits of Active Listening
 Shows empathy

 Builds relationships

 Helps people acknowledge their emotions

and to talk about them instead of
negatively acting on them

 Clears up misunderstandings between people

Guidelines for Responding
 Give subtle signals that you are listening

 Ask questions sparingly

 Never appear to interview the person

 Address the content (especially feelings) of what

you hear without judging

 Focus on responding to what the person is really

saying or asking
Non-Verbal Communication
 Non-verbal can include:
 Personal Space
 Posture
 Body language

 Para-verbal communications refers to :

 Voice Tone
 Volume
 Rate of speech

 Para-verbal communication is how we say

something, not what we say
Congruence

 Matching words and actions

 Denotes trustworthiness
 Shows others that we care
 Shows we are in control

 Incongruence
 Interpreted as being untrustworthy or
inauthentic

48
Resolving Cultural Conflicts
1. Be aware that culture may be a factor

2. Be willing to work on the cultural issues

3. Be willing to talk about how the other person's

culture would address this problem

4. Develop a solution together

5. If there is confusion or a misunderstanding…talk

about it and learn from each other
Seek Assistance

 Loss of control

 Becoming threatening

 If the person becomes threatening or

intimidating and does not respond to your
attempts to calm them, seek immediate
assistance
Personal Safety in PFA
 Observe safe practices by
showing concern for your
own safety
 Remain calm and appear
relaxed, confident and non-
threatening
 Three rules for personal safety:
 Never sacrifice safety for rapport
 Leaving too soon, always better than
too late
 If you have to run, don’t run from
danger, run toward safety!
51
52
Guidelines for Delivering PFA
 Politely observe first;; Don’t intrude

 Ask simple, respectful questions to

determine how you can help

 Offering practical assistance (food,

water, blankets, etc.) can create
the PFA opportunity

 Be prepared for survivors to either

avoid you or flood you with contact

53
Guidelines for Delivering PFA
 Speak calmly. Be patient, responsive and
sensitive.
 Speak slowly, in concrete terms;; avoid
acronyms or jargon.
 Acknowledge whatever positive steps the
survivor has done to keep safe.
 Give information that directly addresses the
survivors immediate needs and goals.
 Provide information that is accurate, timely
and age-appropriate.
54
Guidelines for Delivering PFA
 listen carefully when students or staff want to
talk

 focus on understanding what they want to tell

you and hearing how you can be of help

 children who are too young to speak, or who

may not speak clearly, often express their
feelings and show what they want through
their behaviors (watch their play)
Guidelines for Delivering PFA
 support and reinforce individual strengths and coping
strategies, including the positive things done to stay
safe

 give information that directly addresses the immediate

goals, and clarify answers repeatedly as needed

 give information that is accurate and age

appropriate…even very young children need to know
what has happened

 tell children the truth, but keep it brief and speak to their
developmental level (avoid discussing the details of a
death)
Guidelines for Delivering PFA
 reassure children that the adults are there to protect them
and keep them safe…even when adults do not feel
safe, children need to be assured that everything
possible is being done to keep them safe

 when communicating through an interpreter, look at the

person with whom you are talking, not at the translator
or interpreter

 PFA leaders should reach out to those in positions of
authority (administrators, school resource officers) who
have been equally exposed but who, due to their
position, need to project a sense of calm and control to
those under their care
Guidelines for Delivering PFA
 assist support staff (custodians, bus drivers, food workers,
librarians, secretaries, coaches, instructional aides)

 staff members, who are involved in directing, calming, and

reassuring students and parents, are among the
important stabilizing factors in students’ lives

 remember that the goal of PFA is to reduce distress, assist
with current needs, and promote adaptive functioning,
not to elicit details of traumatic experiences and losses
Guidelines for Delivering PFA
 the goal of schools is to support
academic achievement

 ask students what they need to be able

to attend school every day, to
complete their work, succeed in
school, and to stay safe in their lives
outside of school
Keep in Mind…
 The goal of PFA is to:

 Reduce distress and arousal

 Assist with current needs
 Promote adaptive function

 The goal is NOT to:

 Elicit details of the traumatic

experience or losses.

 Debrief, by asking for

details.
60
Behaviors to Avoid
• Do not make assumptions about what survivors are
experiencing or what they have been through.
• Do not assume that everyone exposed to a disaster will be
traumatized.
• Do not pathologize. Most reactions are understandable and
expectable.
• Do not patronize or talk down to survivors, focus on
helplessness, weakness, mistakes or disabilities.
• Do not assume survivors want to or need to talk to you;; a
“compassionate presence” can be calming, supportive
and help people feel safer and better able to cope.
• Do not speculate or offer possibly inaccurate information.
61
as adults…remember
 students take their cues from how we are reacting

 to demonstrate calm and clear thinking to help

those impacted know they can rely on you

 some may follow your lead and remain focused

even if they don’t feel calm, safe or hopeful

 model a sense of hope that individuals can’t

feel because they are attempting to deal with
the event and the concerns surrounding it
when preparing to deliver PFA
 learn about the school

 take into account the history of the school and

its surrounding community

 following are are some questions for you to

consider:
 Have there been any previous events at the school (threats, violence, deaths,
racism or conflicts with certain ethnic groups)
 Have these adverse events occurred recently and/or frequently?
 Has the school had prior experience with any post-event interventions? If so did
staff find interventions helpful or disruptive?
 Are there any groups functioning within the school community that promote the
strength of the school or that serve as a protective factor for individuals?
 What is the current morale of the school staff and students, and the current
“climate” of the school community as a whole?
 Are there any upcoming events at the school (dances, standardized testing,
graduation, accreditation review, sporting events, anniversaries of past
events) that might positively or negatively affect the recovery of the school
community?
 Are there any recent changes to school staff (a new principal, reduction in nursing
staff time) that may affect response/recovery efforts?
 What is the present relationship of the school to the community?
 What collaborative relationships, coalitions exist that support the school?
 Are there any members of the school staff who have personal trauma histories that
should be taken into consideration by those making decisions related to
emergency response or recovery procedures?
at-risk populations
Students and staff who are at special risk include those who:

 had direct exposure (exposed directly or experienced extreme

life threat)
 have been injured
 have experienced the death or serious injury of a loved one
 had a close personal relationship with any victim(s)
 have a history of depression, suicidal thoughts or attempts
 have a history of anxiety, shyness or low self-confidence
 have a history of risk-taking behavior
 have experienced prior traumatic events and are at current risk:
 those exposed to community violence or domestic violence
 those with a history of abuse and/or neglect
 war or other refugees or political asylees
 members of economically disadvantaged groups
 medically vulnerable individuals
 those from disaster-prone regions
Be Sensitive to Racial and Cultural Diversity
 respect cultural, ethnic, religious, racial, and
language differences

 be aware of your personal values and

prejudices and how these may agree or
conflict with those of the community you are
serving

 students and staff are better able to cope when

they maintain their traditions, rituals, gender
roles, and social bonds
Special needs kids
 design and adapt interventions to their
particular abilities and enlist their
teachers and teaching assistants for
help

 considerations for different disabilities

follow:
Autism Spectrum
 when possible allow them to follow their behavior plans

 may include going to a predetermined “safe place” when

distressed

 respond best to familiar teacher or person in authority

who can calmly reassure them of their safety and set firm
limits on their behaviors

 most helpful intervention will be a return to normal daily routine

 may not be responsive to new people

 attempts to teach them exercises meant to help them cope
may increase their distress
Learning Disabilities
 the nature of the learning disability may affect a
child’s ability to benefit from a specific
exercise

 a student with a language disability may have

difficulty expressing feelings in writing, or
may have difficulty accurately recalling
contact information such as a phone number
and street address

 adapt specific exercises to student’s strengths

speech and language deficits

 may have difficulties with comprehension or

with verbal expression

 these students may respond best to exercises

that include activities and visual cues, such
as artwork, or relaxation strategies that can
be modeled rather than just described
Cognitive Impairment

 students with cognitive delays will do

best after returning to their normal
routines

 higher functioning students in general

education classes may require
simpler, more concrete directions, but
they should respond to most PFA
strategies
Emotional Disturbance
 children identified as having a variety of mood
disorders (depression, anxiety, anger, fear)
and/or behavioral (aggression, withdrawal,
hyperactivity, temper tantrums)

 most serious disturbances include distorted

thinking, excessive anxiety, bizarre motor
acts, abnormal mood swings, or psychosis

 some will have trauma histories and the current

event may bring up reminders of past events
that are unsettling and disruptive
Emotional Disturbance
 most will be responsive to PFA techniques…others resistant
or become distressed

 most will have behavioral intervention plans that include

options for them to follow in certain circumstances

 ex. a child who may become out of control is allowed to visit a
particular adult or engage in a particular activity in order to
self-soothe

 when possible follow the familiar and established routine

 if not possible the teacher, aide, or another familiar member of
the child’s team should explain the new plan
Attention-Deficit/Hyperactivity Disorder (ADHD)

 in a crisis increases their symptoms of

hyperactivity and impulsivity resulting in out
of control behaviors

 benefit from activities that allow for physical

movement

 when giving directions…calmly say

exactly what you expect…avoid directions
with more than one or two steps…give
warnings about specific consequences for
inappropriate behavior
Orthopedic, Hearing, or Visual Impairment
 often experience an increased sense of
vulnerability and distress when the
unexpected happens

 reassure these children that they are safe

 work with their teachers or aides to design or

adapt interventions for their needs

 their teachers and teaching assistants will be

best able to help restore calm
Other Health Impairment

 watch carefully for signs that students are

having physical distress

 ask them if they are physically okay and if they
need any help

 seek appropriate medical attention as needed

Implement PFA in Groups

 can be delivered in various group settings,

such as in classrooms, with a small
group of students or staff

 it is best to run groups with another

provider

 when meeting with groups, keep the

following in mind:
Group Structure
 tailor discussion to the shared needs and concerns of the group
 focus on problem solving and applying coping to immediate issues
 only one person speaks at a time
 answer questions honestly…limit information to what the students can
handle and tolerate
 do not let discussions about concerns lapse into complaints
 redirect discussion if turns to descriptions of gruesome details
 if an answer might be upsetting…tell the individual that the information
would not be helpful to everyone but that you can discuss it
privately
 if you sense individuals are becoming anxious or distressed, interrupt
and lead the group in a relaxation exercise (ask everyone to be
silent and to take a few slow breaths;; then refocus the
conversation)
 if individual needs further support offer to meet after group
 keep focus on creating supportive environment with the overall goal of
having the school return to a healthy learning environment
Core Actions
Core Actions

• core actions of Psychological First Aid for Schools

constitute the basic objectives of providing early
assistance within hours, days, or weeks
following an event

• be flexible and base the amount of time you

spend on each core action on the person’s
specific needs and concerns
PFA Core Actions
1 Contact and Engagement

2 Safety and Comfort

3 Stabilization

4 Information Gathering

5 Practical Assistance

6 Connection with Social Supports

7 Information on Coping

8 Linkage with Collaborative Services

1. Contact and Engagement
 Goal: To initiate contacts or to respond to
contacts by students and staff in a non-
intrusive, compassionate, and helpful manner
Contact and Engagement:
Review
 Introduce yourself.
 Ask about immediate needs.
 Maintain the highest level of confidentiality
possible.
 Use the “active lurking” approach.
To make initial contact, you might say:
 Staff/Family Members Hello. My name is ___________. I work with
__________ and I am part of the school-based mental health recovery
team. I’m checking in with staff/family members to see how they are
doing, and to see if I can help in any way. Is it okay if I talk to you for a
few minutes? May I ask your name? Mrs. Williams, before we talk, is
there something that you need right now?

 Adolescent My name is _. I work with and I

am part of the school-based mental health recovery team. I am touching
base with students to see how they are doing and find out what they
need. Is it okay if I talk to you for a few minutes?

 Child (Get on child’s eye level, smile and greet the child, using her/his
name and speaking calmly.) Hi, Lisa. My name is ___________. I am
working with Mr./Ms./Teacher__________ to help you and your
family/classmates. Is there anything you need right now? Are you warm
enough? Do you want a drink or some food?
Culture Alert
 The type of physical or personal contact considered
appropriate may vary from person to person and across
cultures and social groups (how close to stand next to
someone, how much eye contact to make, whether or not
to touch someone, especially of the opposite sex.)
Do:
 ✔ Look for clues that indicate an individual’s need for
“personal space.”

 ✔ Seek guidance about the most common and important

cultural norms from school or community cultural leaders
who best understand local customs. Also ask about
cultural variations, both between distinctive groups and
within groups, to avoid stereotypes.

 ✔ Ask the person what cultural traditions or rituals are

important to him/her.
Culture Alert (continued)
 Don’t:

 ✘ Use sustained eye contact or stand too close to

an individual unless he/she initiates such
contact.

 ✘ Touch the individual unless you have asked

permission. Only touch in a way that cannot be
misinterpreted by others.

 ✘ Make assumptions about the individual’s culture,

race, nationality, or belief system.

 ✘ Expect all members of a group to be too similar

in their beliefs and behaviors.
setting

 If possible avoid large group settings—

such as an auditorium—when you need
to deliver emotionally sensitive
information, even if it is just limited to
updates on the emergency.
confidentiality
 as a provider of PFA services in a school setting, you likely
belong to a category of mandated reporters and must abide
by state abuse and neglect reporting laws

 be aware of the Health Insurance Portability and Accountability

Act (HIPAA) and the provisions related to disaster and terrorism

 be aware of privacy and information-sharing concerns

associated with the Federal Educational Records
Protection Act (FERPA), particularly as these relate to the
sharing of information about students who are deemed a
potential harm to themselves or others

 if you have questions about releasing information discuss this

with school administration and determine if this needs to be
further reviewed by the school’s legal counsel
2. Safety and Comfort

 Goal: To enhance immediate and

ongoing safety, and provide physical
and emotional comfort
Safety and Comfort Strategies
 Do things that are active (rather than passive), practical (using
available resources), and familiar (drawing on pass
experience), soothing (calming and relaxing, easy on the
nerves)

 When you can give individuals some sense of predictability,

they regain a feeling of security and control.

 Get current, accurate, up to date information, while avoiding

students and staff exposure to information that is inaccurate
or excessively upsetting.

 Get connected to practical resources.

 Get connected with others who have shared similar

experiences.
Ensuring Immediate Physical Safety
 Find appropriate officials who can resolve safety concerns
beyond your control (threats, weapons, etc.)
 Remove hazards from your service area (broken glass,
overturned furniture, spilled liquids, etc.) that could cause
someone to slip or fall.
 Ask students, staff members, or caregivers if there are
special medical concerns, medical devices, or
medications that individuals may need. If yes, contact a
school nurse, medical team leader, or relative
 Make sure children have a safe and supervised area to play.
 Be aware of potential persecution of individuals or groups
due to ethnic, religious or other affiliations or identities.
Ensure Physical Safety (Cont.)

 Keep a list of survivors with special needs to they can be checked on
frequently.

 Threat of harm to self or others – Look for signs that students or
family members may hurt themselves or others (e.g., students
expressing intense anger or agitation). If you need additional
support or are not trained to assess at-risk individuals, get help
by contacting medical or mental health personnel, an EMT or
security to handle the situation.

 Shock – Seek immediate medical support if an individual is

showing signs of shock or has these symptoms: pale, clammy
skin;; weakness or rapid pulse;; dizziness or irregular breathing;;
dull or glassy eyes;; is unresponsive to communication;; lacks
bladder or bowel control;; or shows restlessness, agitation, or
confusion.
Provide Information About Response Activities
To help reorient and comfort survivors, provide information
about:
 What to do next
 The status, if known and safe, of their classmates,
teachers, other school staff, and relatives who may also be
in the school
 What is being done to assist them
 What is currently known about the unfolding event
 The support services available to them and their families
 When and where school services will be resumed
 The best way to get updated information about the
situation in hours/ days ahead
Provide information
 Make sure school authorities have granted permission to share
event-specific information (circumstances of the current
situation, the names of those directly affected by event, and
when school services will resume.)
 Use your judgment as to whether and when to present specific
information.
 Use clear and concise language while avoiding technical jargon.
 Position yourself, when feasible, at eye level with the individual.
 Use a calm, reassuring tone of voice and give the person time and
space to talk.
 Provide accurate information, in easy to understand terms, to
young students about who will be supervising them and what to
expect next.
 Consider using visual cues and materials to illustrate your
information.
Provide information
 Consider when talking to students:
 Is it appropriate to share this information given his/her age?
 Does he/she appear able to comprehend what you are saying?
 Is he/she ready to hear the content of what you are saying?

Remember:
 Address immediate needs and concerns to reduce fears,
answer pressing questions, and support adaptive coping.
 Students, staff, and family members may be getting
information from many sources of technology (texting,
Twitter, Facebook, TV, radio, phone, Internet).
 Ask about what they have heard or read and address any
misinformation or distressing information.
 Do not guess or invent information if you do not know it in
order to provide reassurance. Instead, develop a plan,
with those you are helping, to get them the information.
Promote Social Engagement

• Facilitate group and

social interaction as
appropriate.
• Promote same-
age/near-age peer
interaction with
children and teens.
• Encourage “neighbor-
helping-neighbor”
support to reduce
social isolation.
Address Media and Social Networking Safety Concerns
 Point out that excessive viewing of media coverage may not only
upset them, but may also subtly re-traumatize them.

 Discourage teachers and other staff from ongoing media viewing in
and outside the classroom.

 Remind them that some reports may not be accurate and identify
where they can get reliable and up-to date information.

 Many individuals may use the Internet, texting, and/or social

networking (e.g., Twitter, Facebook) to share information. Be
aware that the amount of emergency information being shared
through these technologies will be out of your control, but it is
important to monitor what is being communicated. For example,
students often develop a “memorial page” on Facebook when a
member of the community is injured or died. Regularly monitor this
page to see if disturbing details or misinformation are being posted.

 Notify the administrator about this site so that he/she can delete any
inappropriate posts.
Address Media and Social Networking Safety Concerns
 Be proactive by encouraging school officials to post accurate
information and psychoeducational material (including
recommendations for where to seek assistance) on these
forums, on other social media sites, and on official websites as
soon as possible.

 Encourage students to ask questions or share information they

have learned from these forums with trusted adults.

 Ask students what they heard or what they know about the situation
to help you start the discussion.

 Shield students from reporters, onlookers, and attorneys, in

order to help protect their privacy. Many schools have a clear
policy not to allow their students to be interviewed by the media
during an emergency. If the policy does allow for interviews,
remind students that they may decline a media interview or
have an adult they trust with them, if they choose to participate.
Address Media and Social Networking Safety Concerns
Provider Alert
It is very natural for students to seek out information through the media. tell
teachers, parents, and other caregivers that:
 They should monitor and limit children’s exposure to the media, and
discuss any concerns the children have.
 They can let children know that they are keeping track of information
and that they should come to them for updates.
 Young children are often confused by repeated media coverage and
assume that the events that they see in the media are happening
over and over again.
 They should be careful about adults watching media reports if children
are in the same or an adjacent room, as children can overhear and
become confused and frightened by what they learn.
 For parents, suggest that they may consider watching or listening to
limited, carefully selected news with their children and then
discussing the information together afterwards.
 This will help children process the event and allow them to see their
family members as protective and supportive.
Children Separated
from Parents/Caregivers
• Reconnect children with
parents/caregivers they may have
been separated from is a priority.
• Ask unaccompanied children for basic
information (name, parent/caregiver
names, sibling names, address,
school, etc.).
• Provide children with accurate, easy
to understand information about who
will be supervising them and what to
expect next.
• Do not make promises that they will
see their caregiver soon.
Attend Funerals and School Memorials to
Monitor Those at Risk
 consider how funerals and school memorials may serve as trauma
reminders for students and staff.

 there are many concerns associated with holding school-wide

functions to memorialize a violent event or accident

 PFA-S provider should always be present at such events.

 the potential for memorial events to re-traumatize is real, particularly
for elementary students.

 take care during the event to monitor those in attendance, engage
them in a sensitive way, and provide psychoeducational materials.

 while it is helpful to provide psychoeducational materials to attendees of
memorials and to high-risk students on anniversary events, it is
never appropriate to do so at funerals.
Attend Funerals and School Memorials to
Monitor Those at Risk
 during funerals and school memorials, some individuals
who were not close to the event but who have
experienced similar loss in their lives or have other risk
factors may become extremely upset. Those at risk may
include those:
 having pervasive fantasies about reuniting with the
individual who has died
 attempted suicide
 substance abuse
 severe depression or other mental illness
 violent behavior, particularly when combined with
access to weapons
 monitor them in the days and weeks following the event.
 reactions may linger and it is important for these individuals
to know that there are supports and resources available
to them.
Attend Funerals and School Memorials to
Monitor Those at Risk
Provider Alert
 Permanent memorials should be avoided. A school
community is a dynamic process, and often the
emotional significance of a memorial is lost over
time.
 Unless the event was of major historical
significance to the community, future
generations of students and staff should not be
constricted, however slightly, by tragedies of the
past.
 Similarly, schools should avoid living memorials,
such as trees or flower gardens, as their
ongoing maintenance or health may become an
issue.
Address Personal Belongings, “Empty Chairs,”
and Temporary Memorials
 allow individuals to grieve at their own pace.
 many well-intentioned adults quickly remove all traces of a
teacher or student who has died;; however, many
students/staff members want to honor the life of the
deceased.
 Do not immediately remove pictures of the deceased
that are displayed in the classroom or school.
 Do not immediately place another student in the
desk/seat of the person who has died.
 Do allow students to talk about their memories of the
person who has died. If a student’s focus on the
deceased persists and later interferes with functioning,
he/she may be encouraged to speak to a family
member or professional outside of the classroom.
Address Personal Belongings, “Empty Chairs,”
and Temporary Memorials
 prior to any emergencies establish procedures for accepting
donations, as well as for removing temporary memorials.
 schools may have a pre-designated, temporary, in-school
memorial site where flowers, poems, cards and
photographs can be collected and displayed.
 schools should clearly communicate from the start that
such memorials are temporary and will be in place for a
limited time, and that after that time the items will be
collected and given to the deceased individual’s family.
 consider having a well-respected representative of the
student body assist in this process, to provide a sense of
closure and respect for the student body as a whole.
 school should work with the family if online memorials are
created in order to monitor these sites for at-risk
individuals.
Help Students/Staff with Grief
Culture Alert
 Beliefs and attitudes about death, funerals, and
expressions of grief are strongly influenced by family,
culture, religious beliefs, and rituals related to mourning.
 Learn about the cultural norms of the student and staff
through the assistance of community cultural and
school leaders who best understand local customs.
 Even within cultural and religious groups, beliefs and
practices can vary widely.
 Do not assume that all individuals in a given group will
believe or behave the same way.
 You should allow individuals to engage in their traditions,
practices, and rituals in order to provide mutual support
for each other, to seek meaning, to manage the range of
emotional responses and death-related adversities they
may experience, and to honor the death appropriately.
Help Students/Staff with Grief
 Acute Grief Reactions are likely to be intense and prevalent
among those who have suffered the death of a loved one or
close friend.

 They may feel shock, disbelief, sadness, and anger;; feel

responsible for not preventing the death;; regret not providing
comfort or having a proper leave-taking;; or miss the
deceased and wish for reunion (including having dreams of
seeing the person again).

 Although painful to experience, grief reactions are healthy

responses that reflect the significance of the death.

 Over time, grief reactions tend to include more pleasant thoughts
and experiences, such as telling positive stories about a
loved one and remembering him/her in comforting ways.
Help Students/Staff with Grief
 Children’s and adolescents’ understanding of death varies
depending on age and prior experience with death, and is
strongly influenced by family, religious, and cultural values.

 Preschool children may not understand that death is

permanent and may believe that if they wish it, the
person will come back.

 They need help to confirm the physical reality of a person’s
death—that he/she is no longer breathing, moving, or
having thoughts, and feels no discomfort or pain.

 They may worry about something bad happening to another

family member.

 It may be helpful to explain death to young children through
the use of storybooks (see [Link] for a list of
commonly used books).
Help Students/Staff with Grief
 School-age children understand the physical
reality of death, but may picture death as a
monster or a skeleton.
 In longing for the loved one’s return, they may
feel an upsetting “ghostlike” presence of the
lost person, but not tell anyone.

 Adolescents generally understand that death is

irreversible.
 losing a family member or friend can trigger rage
and impulsive decisions, such as quitting
school, running away, or abusing substances.
 these issues need prompt attention by the
family and/or school.
When a Family Member or Close Friend Died
When working with acutely bereaved individuals, remember that:
 should be treated with dignity, respect, and compassion.
 grief reactions will vary from person to person.
 what they are experiencing is understandable and expectable,
given the loss.
 there is no “correct” course of grieving;; how a person grieves is
dependent not only on his/her cultural and religious beliefs,
but also on his/her developmental level.
 explain that they will most likely continue to experience periods
of sadness, loneliness, or anger.
 grief puts older children and adults at risk for abuse of over-
the-counter medications, smoking, alcohol, drug usage, and
depression and suicidal thoughts.
 students and staff should be made aware of the above risks,
the importance of self-care, and the availability of professional
help.
Helping Families After a Loss
 Discuss how family and friends will each have their
own reactions.
 Explain that there is no “right” or “wrong” way to
feel or act and there is no “normal” period of
time for grieving.
 Discuss how culture and religious beliefs influence
grieving.
 Explain that children may only show their grief for
short periods of time each day, and otherwise
engage in play and positive activities. This does
not mean their grief is not as strong as other
family members.
Provide Additional Support to Staff

 Take time to meet with staff, either in

groups or individually, in a private space
that is apart from the students.

 Be certain that there is a box of tissues

in the room and, if possible, food
and beverages.

 Update staff about the situation, plans, and

safety of the school community.
Provide Additional Support to Staff

 Promote a sense of safety and provide psychoeducation about

emotional reactions.
 Acknowledge fears and worries about personal safety or
health issues.
 Find out what staff may specifically need and try to provide
it.
 Secure the use of a landline telephone, cell phone, or
email, as much is possible, so that they can contact and
reassure family members that they are safe.
 Demonstrate calming techniques, such as slow breathing,
thought stopping, or grounding.
 Compliment their professionalism, protective instincts, and
fast thinking.
 Recommend limiting “second guessing” or reevaluating
their actions “in hindsight.”
3. Stabilization (if needed)

 Goal: To calm and orient emotionally

overwhelmed or disoriented students and
staff
Emotionally Overwhelmed Survivors

Most individuals affected by disasters will NOT

require stabilization. You should be
concerned about reactions that are intense,
persistent and interfere with the survivor’s
ability to function.
Adults, adolescents, or school-aged children who
need stabilization may be:
 Disoriented: engaging in aimless disorganized behavior
 Disconnected: numb;; startlingly unaffected by the event
 Confused: not able to understand what is happening around
them;; not making sense
 Panicked: extremely anxious;; unable to settle;; their eyes wide
and darting
 Hysterical: sobbing uncontrollably;; hyperventilating;; rocking
 Excessively preoccupied: unable to think about anything else
 In denial: refusing to accept that the event took place
 In physical shock: not being able to move;; frozen
 Glassy-eyed and staring vacantly;; unable to find direction
 Unresponsive to verbal questions or commands
 Exhibiting frantic searching behavior
 Feeling incapacitated by worry
 Engaging in risky activities
Young children who need stabilization may be:

 Staring blankly
 Unresponsive
 Displaying behaviors they had outgrown
 Screaming
 Crying or sobbing uncontrollably
 Hyperventilating
 Moving in an agitated way
 Hiding
 Clinging excessively
Support Distressed Individuals
For adults, adolescents, and school-aged children
 Respect the person’s privacy and give him/her a few minutes before you
intervene. Say you will be available if he/she needs you, or that you will
check back in a few minutes to see how he/she is doing and whether
there is anything you can do to help at that time.
 Remain calm, quiet, and present, rather than trying to talk to him/her
directly, as your questioning may contribute to cognitive and/or
emotional overload.
 Remain available, while giving him/her a few minutes to calm down.
 Stand nearby as you talk to other individuals, do some paperwork, or do
other tasks, watching to see if the person needs or wishes help.
 Offer support and help him/her focus on specific manageable feelings,
thoughts, and goals.
 Give information that orients him/her to the surroundings, such as how
the setting is organized, what will be happening, and what steps he/she
may consider.
 Clarify any misinformation or misunderstanding about what is taking
place, while helping to curtail rumors.
 Attempt to determine what the student or adult is experiencing, so that
you can address the individual’s immediate concern or difficulty.
Support Distressed Individuals
For young children
 Remain calm, quiet, and reassuring. Sit with the child at eye level as
you speak in a low tone and in a reassuring manner.
 Reassure and calm through physical contact, such as a protective arm
across the shoulder, if it appears welcome. Some children may dislike
or have a negative association with being touched.
 If you are unsure, ask them if you may touch them.
 Distract the child from the situation by asking questions about his/her favorite story,
hobby, sport, or song.
 Keep the circumstances in mind so that you do not inadvertently trigger greater
anxiety by asking about a topic that may be related to existing fears (such as
asking, “What is your favorite bedtime story?” when the child is fearful for
his/her caregiver’s safety).
 Give age-appropriate information about what to expect, and always answer
questions in an honest, developmentally appropriate way.
 Do not overwhelm children with too much information. Under stress, a child can
only process so much information, and will likely change the subject or move to a
different activity when feeling overwhelmed.
 Watch for and be respectful of the cues the child gives.
 Reconnect children with their caregivers or staff who know them as soon as
possible.
Use these talking points to help individuals
understand their reactions:
For adults, adolescents, and school-aged children
 You may feel intense emotions coming and going like waves. (You
may also feel emotionally knocked down or dragged under)
 You may find that shocking experiences trigger strong and
upsetting—self-protective “alarm” reactions such as an
adrenaline surge, startling easily, or being on-guard.
 You may feel anxious, upset, and out of control, you wonder if
you’re going crazy. Remember that these are expectable and
understandable reactions to a very upsetting and frightening
event.
 Sometimes the best way to recover is to take a few moments to
do activities that calm you (take a walk, breathe slowly, listen to
music).
 Calm yourself by keeping in mind the family members and friends
who love you and support you.
 Staying busy or helping others can distract you from your thoughts
and feelings.
 There are people here to help you learn more ways to calm
yourself.
Use these talking points to help individuals
understand their reactions:
For young children
 After bad things happen, your body may have strong
feelings that come and go like waves in the ocean. First you’re
feeling sort of okay, but then you feel bad all over again. When
you feel really bad, that’s a good time to talk to your mom
and/or dad to help you calm down. Here at school, there are
teachers or other adults you can talk to. Did you know that
lots of people need help at times like this? See all the people
here with the vests on and all those guys out front with the
yellow jackets? All these people—and many more—are
working together to help keep you and the other children safe,
and to help people feel better. One trick to help you start to feel
a little better is to do something. Just sitting here might be
boring or make you feel even worse. Would you like to play
with the other kids or would you like to draw? Do you know
Mrs. Smith? She’s teaching some kids a breathing game to
help them calm their bodies. Calming your body can help calm
your mind, and that can help you start to feel better.
When People are Overwhelmed

 Enlist available family and/or friends to assist.

 Decrease stimulation: find a quiet place to talk,

speak softly and quietly.

 Ask what the person is experiencing (i.e.-possible

flashbacks, feeling the event is still ongoing,
etc.).

 Address the persons concern, don’t simply try to

convince the person to “calm down” or “feel
safe”.
Steps for Stabilizing

 Respect the person’s privacy;; give them a few minutes before you
intervene.

 Let people know you are available, and that you will stop back. Stay
near by, keep busy.

 Remain quiet, calm and present, rather than adding additional

stimulation.

 Offer support on specific manageable feelings, thoughts or reactions.

 Give information that orients the students and staff to the
surroundings, what will be happening, what steps he or she may
consider.
Stabilization Techniques

If the person is extremely agitated, shows a

rush of speech and appears to be losing
touch with their surroundings or is
experiencing persistent, intense crying, it
may be helpful to employ:
 Grounding techniques
 Relaxation techniques
 Entrainment Techniques
Beginning a Stabilization Technique
Begin each stabilization technique by:
 Asking the person to listen to you and look at you.

 Finding out if the person knows who they are,

where they are and what is happening around them
(are the “oriented”).

 Asking him/her to describe the surroundings, and

say where you both are.

This initial step may be enough to help “ground” and
re-orient the survivor.
Grounding Technique
Introduce the technique by saying:
 After a frightening experience, you can be
very upset or angry or unable to stop thinking
about what happened. I can help you feel less
overwhelmed by teaching you about
something called “grounding.” Grounding
works by having you focus on the things you
see and hear around you, instead of all the
thoughts you’re having.
Would you like to try it?
Grounding Instructions
 Sit in a comfortable position with your legs and arms uncrossed.
 Breathe in and out slowly three times.
 Look around you and name five non-distressing, simple objects that you
can see. For example, you might say, “I see the floor, I see a shoe, I
see a table, I see a chair, I see my friend.”
 Breathe in and out slowly three times.
 Next, name five non-distressing sounds you can hear. For example, you
might say, “I hear a teacher talking, I hear myself breathing, I hear a
door close, I hear kids playing, I hear a cell phone ringing.”
 Breathe in and out slowly three times.
 Next, name five non-distressing things you can feel. For example, you
might say, “I can feel the pen in my hand, I can feel my toes inside my
shoes, I can feel my back pressing against my chair, I can feel my feet
on the floor, I can feel my lips pressed together.”
 Breathe in and out slowly three times.
 If the person selects distressing objects or sounds to name, interrupt
him/her and suggest he/she pick items that are not upsetting.
 You might have a younger student name the colors of objects that he/she
sees around them. For example, you could say, “Next, name five
colors that you can see from where you are sitting. Tell me something
you see that is blue, now something that’s yellow, now something
green.”
Grounding Instructions (Cont.)
Stabilize Students in Group Settings
 While working with a group of students, monitor
how the students are responding to the
discussion.
 If you see that students are getting distressed,
stabilize the situation by conducting a neutral
group activity.
 These activities can be drawing/coloring, a writing
exercise, a breathing exercise, making a
collage, or working together on a mural. If a
student is still having problems calming down,
you or another PFA-S provider should work with
him/her in private.
Relaxation Techniques
 There are several types of relaxation
techniques helpful for deceasing arousal.

 The most useful in the immediate post-disaster

environment are:
 Breathing
 Progressive muscle relation
 Although visual imagery can be an effective
relaxation technique in normal conditions,
survivors who close their eyes and attempt
to picture pleasant or calming images may
find themselves overwhelmed with visual
images of the disaster.
Entrainment Techniques

 Entrainments techniques involve using your

behavior and communications in a way
that influences the survivors behavior.
 This technique can be helpful in calming a
loud, agitated individual or someone who
is frantic and speaking excessively or
uncontrollably fast.
Entrainment
 If the survivor is speaking very loudly, begin by
speaking a little more loudly than you normally
do (not as loud as the survivor);; Slowly and
incrementally, begin to lower your volume in
order to influence the survivor to lower their
volume.

 If the survivor is speaking very quickly, begin by

speaking a little more quickly that you normally
do;; Slowly and incrementally, begin to slow your
pace in order to influence the survivor’s pace of
speech.
4. Information Gathering: Current
Needs and Concerns
 Goal: To identify immediate needs and
concerns gather additional information and
tailor PFA interventions to meet these
needs
Information Gathering
PFA interventions must be flexible and adapted
to the specific individual, their needs and
concern. Although a formal assessment is
not necessary, you may ask about:
 Need for immediate referral.
 Need for additional services.
 Offering a follow-up meeting.
 Using PFA components that may be helpful.
Information Gathering
 1. How are you doing now? What are your immediate
needs and concerns?

 2. What happened to you during the event? How were you
affected?

 Where were you during the emergency?

 Did you feel threatened? Did you get hurt/injured?
 Do you still feel threatened?
 What problems do you have now? Do you have any continuing or
ongoing problems?
 Did a loved one die or suffer severe injury?
 Have you lost contact with, or are you separated from, a loved
one?
 Did you (or your family) lose any personal property?
 Did your pet die or get hurt?
Information Gathering
 3. How has the event impacted you, your family, and
your friends?
 use the names of the individuals that the person has already
mentioned.
 When working with middle or high school students, ask how their
classmates and friends are doing.
 Note whether students are limiting their interactions with others,
delaying important developmental activities (birthday, prom, getting
a driver’s license), or increasing at-risk behaviors (drinking, using
drugs, reckless driving, self-injurious behaviors)
 explore students’ ability to do schoolwork, their sleep habits, and
recent moods.

 4. When you look ahead, do you have any concerns? Is
there anything bothering you about your future?

 5. Is there anything else you would like to share?

See handout Core action 4
Other General Concerns
 It is also useful to ask general open-ended
questions to make sure that you have not
missed any important information. You can ask,

 “Is there anything else we have not covered that you are
concerned about or want to share with me?”

 If the survivor identifies multiple concerns,

summarize these and help to identify which
issues are most pressing. Work with the survivor
to prioritize the order in which concerns should
be addressed.

137
5. Practical Assistance

 Goal: To offer practical help to students and

staff in addressing immediate needs and
concerns
Practical Assistance
 Exposure to disaster, terrorism and post-event adversities is
often accompanied by a loss of hope.

 Those likely to have more favorable outcomes maintain one or
more of the following characteristics:

 Optimism (a belief that things will turn out as well as can be expected)
 Confidence that life is predictable
 Belief that they can achieve the goals they set (self-efficacy)
 Belief that outside sources will act benevolently on one’s behalf ( that the
community is willing to help)
 Positive self-talk or beliefs (“I have gotten through some tough situations in
the past and I can get through this too”)
 Knowledge that they will have the resources they need (such as support from
others, money for essential expenses, the opportunity to receive tutoring
services)
 Providing students, staff, and their families with needed resources can empower
them, help them have hope, and restore their dignity.
 Assisting individuals with current or anticipated problems is a central component
of PFA-S.
Steps in Offering
Practical Assistance

Step 1: Identify the Most Immediate Need

 If a survivor has identified several needs,

focus on one of them at a time.

 Collaborate with the survivor helping them

select the most urgent issues.
Steps in Offering
Practical Assistance (Cont.)

Step 2: Clarify the Need

 Talk with the survivor to specify the problem.

 If the problem is understood and clarified, it

will be easier to identify next steps.
Steps in Offering
Practical Assistance (Cont.)

Step 3: Discuss an Action Plan

 Discuss what can be done to address the
concern or need.

 If the survivor is stuck, you can offer a

suggestion.

 Tell survivors what they can realistically

expect if you are aware of resources and
procedures.
Steps in Offering
Practical Assistance (Cont.)

Step 4: Act to Address the Need

 Help the survivor take action.

 Example: Help the set up an appointment for

needed services or assist him/her in starting
their paperwork.
 Note: Do not do for the survivor, but rather
do with. Avoid creating a dependency.
Promote self-efficacy and empowerment.
6. Connection with Social Supports

 Goal: To help establish brief or ongoing

contacts with primary support persons or
other sources of support, including
family, friends, teachers, and other
school and/or community resources
Forms of Social Support
Social support is related to emotional well-being and
recovery following disasters and terrorism. People
who are well connected to others are more likely to
engage in receiving and giving support.

 Emotional Support  Reliable Support

 Social Connection  Advice and Information
 Feeling needed  Physical Assistance
 Reassurance of Self-Worth  Material Assistance
Fostering Social Support

 Enhance access to primary support persons

(family members, significant others, etc.)

 Encourage use of immediately available

supports persons.

 Discuss both seeking and giving support

 Model support with the survivor.

Barriers to Social Support
If individuals are reluctant to seek support, there may be
reasons, such as:
 Not knowing what they need (feeling that they should)
 Feeling embarrassed or weak.
 Feeling guilty to receive when others are in greater
need.
 Not knowing where to turn for help.
 Thinking, “No one can understand what I am going
through.”
 Fearing that people will be angry or made to feel guilty
if they are asked for help.
Enhance the School Community

 Promote a sense of tolerance by helping students

and staff members understand that everyone
is on their own recovery path.

 Highlight the importance of mutual aid among

the students and staff.

 Brainstorm ways that groups can work together to

address mutual problems.

 Encourage students to watch out for each

other. If they see a change in a peer’s behavior
or mood, they should notify a parent, school
counselor, or other trusted adult.
Discuss Support-Seeking and Giving

If students or staff members are reluctant to seek support, there may be
many reasons, including:
 Not knowing what they need (perhaps feeling that they should
know)
 Feeling embarrassed or weak because they need help
 Feeling guilty about receiving help when others are in greater
need
 Not knowing where to turn for help
 Not knowing how to ask for help
 Worrying that they will be a burden or depress others
 Thinking that since they’ve been helped in the past, they shouldn’t
ask again
 Fearing that they will get so upset that they will lose control
 Doubting that support will be available or helpful
 Thinking, “No one can understand what I’m going through”
 Having tried to get help in the past and finding that help was not
there (feeling let down or betrayed)
 Fearing that the people they ask will be angry or make them feel
guilty for needing help
Discuss Support-Seeking and Giving
 In helping students and staff to appreciate the
value of social support and engaging with
others, you can also help them to:
 Think about the type of support that would be most
helpful
 Think about whom they might approach for that
type of support
 Choose the right time and place to approach the
person
 Talk to the support person and explain how he/she
can be of help
 Thank the support person afterwards for his/her time
and help
Discuss Support-Seeking and Giving
For those who would like to provide support to others, you
can help them to:
 Discover ways that they can help others (tutor
students who missed school, organize fundraisers,
disseminate donations, ask a friend if he/she wants
to talk)
 Identify a person or persons to help
 Find an uninterrupted time and place to talk or to
help
 Show interest, attention, and care
 Offer to talk or spend time together as often as
needed
 Let them know that, instead of discussing the event, it
is better to provide practical assistance and help to
Modeling Support
As a provider of support, you can model positive supportive
responses, such as:

 “From what you’re saying, I can see how you would

be…” (Reflective comment)

 “Am I right when I say that you…” (Clarifying comment)

 “Are there any things that you think would help you to
feel better?” (Empowering comment/question)

 If appropriate, consider passing along the handout,

“Connecting with Others: Seeking Social Support
and Giving Social Support”
7. Information on Coping

 Goal: To provide information about

stress reactions and coping to reduce
distress and promote adaptive
functioning
Providing Information
Various types of information can help survivors
manage their stress reactions and deal more
effectively with problems. Such information
includes:
 What is currently known about the unfolding
event.
 What is being done to assist them.
 What, where, and when services are available.
 Post-disaster reactions and how to manage
them.
 Self-care, family care, and coping.
Provide Basic Information
about Stress Reactions
 Briefly discuss the stress reactions that people commonly experience after a
crisis. You may:
 Highlight that they may be frightened or alarmed by their own response, and
may view their reactions in negative ways ( thinking, “There’s something wrong
with me” or “I’m weak”).
 You can reduce their worry about their own responses by explaining that their
reactions are understandable and expectable.
 Avoid pathologizing stress reactions;; do not use terms like “symptoms” or
“disorder.”
 Make sure you note that there is a range of possible reactions from negative
to positive, including a greater appreciation of life, family, and friends, or a
strengthening of spiritual beliefs and social connections, so as not to give
people the suggestion that they will only be negatively affected by events.
 Indicate that if their stress reactions continue to interfere with their ability to
function adequately for more than a month, they should seek psychological
services or student support staff to help restore their pre-event level of
functioning. (Remember that you may have to refer earlier if the individual is
having major difficulty with sleep, unable to care for oneself, or shows signs of
safety concerns.)
posttraumatic stress and other reactions that you can
discuss with student and staff

 Intrusive Reactions are ways in which the traumatic

experience comes back to mind. These reactions
include distressing thoughts or mental images of the
event (e.g., visualizing what one saw) or dreams about
what happened.
 In children, bad dreams may not be specifically about the
trauma.
 Intrusive reactions also include upsetting emotional or
physical reactions to reminders of the experience.
 Some people may feel and act as if one of their worst
experiences is happening all over again.
 These reactions can interfere with individuals’ attention,
concentration, and overall functioning at school.
PTS
 Avoidance and Withdrawal Reactions are ways
people use to keep away from, or protect against,
intrusive reactions.
 They may try to avoid talking, thinking, and having
feelings about the emergency, and avoid reminders
of the event, including places and people.
 They may restrict or numb their emotions to protect
themselves against distress.
 Their feelings of detachment and estrangement from
others may lead to social withdrawal.
 They may lose interest in formerly pleasurable activities.
 Those experiencing these reactions maymiss school
more frequently, limit their participation in school
activities, or change their peer group.
PTS
 Physical Arousal Reactions are bodily
responses to danger that occur when the danger
is no longer present.
 People may react by constantly being “on the
lookout” for danger, by startling easily or being
jumpy, by being irritable or having outbursts of
anger, having difficulty falling or staying asleep,
and having problems concentrating or paying
attention.
 Those struggling with these reactions can result in
problems with school or work functioning,
completing chores or homework, peers
relationships, and overall health.
Information about Trauma Reminders
 Trauma Reminders can be sights, sounds, places, smells, specific
people, time of day, situations, or even feelings such as being afraid or
anxious. Trauma reminders are related to the specific type of event—
such as a hurricane, shooting, flood, tornado, or fire—and specific
circumstances can evoke upsetting thoughts and feelings about what
happened. Examples include hearing the sound of wind, rain,
helicopters, screaming or shouting, and seeing individuals who were
present at the event. Students reacting to such reminders can cause
them to be distracted, miss teacher instruction, engage in risky
behaviors, and may result in a decline in academic performance.

 Loss Reminders can also be sights, sounds, places, smells, specific
people, time of day, situations, or feelings. Examples include seeing a
picture of a lost loved one or seeing their belongings, such as their
locker or desk. Loss reminders bring to mind the absence of the loved
one. Missing the deceased can evoke strong feelings of sadness,
anxiety, uncertainty about life without him/her, anger, loneliness,
abandonment, or hopelessness. Loss reminders can lead students to
miss school or other activities to avoid experiencing these reminders.
159
Information about Trauma Reminders
 Change Reminders can be people, places, things, activities, or
hardships that remind people of how their lives have changed as the
result of an emergency. Change reminders can be something as simple
as waking up in a different bed in the morning, going to a different
school, or being in a refurbished place. Even nice things can remind
people of how life has changed and make them miss what they had
before.

 Hardships often follow in the wake of disaster and can make it more
difficult to recover. Hardships place additional strains on survivors and
can contribute to feelings of anxiety, depression, irritability, uncertainty,
and mental and physical exhaustion. Hardships can be loss of home or
possessions, lack of money, shortages of food or water, separations
from friends and family, school closures, medical or physical health
problems, the process of obtaining compensation for losses, moving to a
new area, and lack of fun activities. For these types of emergencies, the
response phase may be longer and trauma/grief specific services will be
needed to facilitate the school recovery.
Other Reactions

Other kinds of reactions include:

 Grief Reactions
 Traumatic Grief Reactions
 Depression
 Physical Reactions

Responders should consider using the handout,

“When Terrible Things Happen”, as well as the
“Tips” series (“Parent Tips for Helping Adolescents”)

161
Discussing Positive and
Negative Forms of Coping

The aim of discussing both the positive and negative

forms of coping is to:

 The aim of discussing positive and negative forms of

coping is to:
 Help students and staff consider different coping options
 Identify and acknowledge their personal coping strengths
 Guide students and staff to examine the negative consequences
of maladaptive coping actions
 Encourage students to make conscious, goal-oriented choices
 Enhance a sense of personal control over their coping choices
Information on Ways of Coping
You can discuss a variety of ways to effectively cope
with post-disaster reactions and adversity:
 Talking to others for support.
 Getting needed information.
 Getting adequate rest, nutrition and exercise.
 Engaging in positive distracting activities (i.e.-
hobbies, sports, reading, etc.)
 Trying to maintain a normal schedule to the extent
possible.
 Using the breathing exercises discussed in the
“Stabilization” section.

There are many more.

Maladaptive Coping Actions

There are also ineffective coping actions, including:

 Using drugs or alcohol to cope.
 Withdrawing from activities.
 Withdrawing from friends and family.
 Working too many hours.
 Getting violently angry.
 Overeating or undereating.
 Doing risky or dangerous things.
 Not taking care of yourself.

There are many more.

Other Coping Issues

Survivors may also benefit by addressing

other coping issues, such as:
 Age/Developmental issues.
 Anger Management.
 Highly Negative Emotions (Guilt and
Shame).
 Sleep Problems
 Alcohol and Substance Use
8. Linkage with Collaborative Services

 Goal: To link students and staff with

available services needed at the time or
in the future
Collaborative Services

The goal of this action is to link survivors with
available resources at the time or in the future.
Provide Direct Links
to Needed Services
Responders should do what they can to ensure effective linkage
with needed services. Examples of situations requiring
referral include:
 Acute medical problems that require immediate attention.
 Acute mental health problems the require immediate
attention.
 Worsening of a pre-existing medical, emotional, or behavioral
problem.
 Treat of harm to self or others.
 Cases involving domestic, child, or elder abuse (be aware of
local reporting laws).
 When survivors ask for referrals.
Making a Referral

When making a referral:

 Summarize your discussion with the person
about his/her needs and concerns.
 Check for the accuracy of your summary.
 Ask about the survivor’s reaction to the
suggested referral (“How do you feel
about connecting with Agency A?”).
 Give written referral information, or if possible,
make the appointment right then and there.
Managing Secondary Traumatic
Stress (STS)

170
Crisis Responder
Self-Care

• Compassion Fatigue (Figley, 1992) is an

occupational hazard in trauma intervention
providers

• Additional supervision and attention to

transference and counter transference
issues is advised
• Internal support may be a productive means
of team member ventilation and validation
Vulnerabilities of
Crisis Responders
• Cumulative stress from hearing disaster stories
• Not Understanding how much listening and
talking help
• Feeling overwhelmed by the depth of grief,
anger or frustration expressed by survivors
• Over-identification or enmeshment with
survivors
• Unrealistic expectations of reliving emotional
pain
When Responders
Need Help
• Take on the anger and frustration of the survivor
• Responder begins to take on the system
• Refer anyone who shows strong emotions to higher
levels of care
• Cannot end helping relationship when goals have
been met
• Performing concrete services that the survivor
could or should do for themselves
• Work too much overtime
• Survivors call them at home
Burnout
“A state of extreme dissatisfaction
with one’s clinical work, characterized by:
1) excessive distancing from survivors;;
2) impaired competence;;
3) low energy;;
4) increased irritability;;
5) other signs of impairment and depression
resulting from individual, social, work
environment and societal factors”
Figley, C., 1994
Compassion Fatigue
A state of tension and preoccupation
with the individual or cumulative
trauma of others as manifested in
one or more ways:

1) re-experiencing traumatic events;;

2) avoidance / numbing of reminders;;
and
3) persistent arousal.
Burnout or
Compassion Fatigue?
Unlike burnout, the traumatized professional
experiences:

• Faster onset of symptoms

• Faster recovery from symptoms
• Sense of helplessness and confusion
• Sense of isolation from supporters
• Symptoms disconnected from “real
causes”.
• Symptoms triggered by additional events
Do’s and Don’ts
of Psychological First Aid

177
Do’s & Don’ts
Promote Safety
 Help people meet basic needs for food,
shelter, and obtain emergency medical
attention.

 Provide repeated, simple and accurate

information on how to obtain these.

178
Do’s & Don’ts
Promote Calm
• Listen to people who wish to share their stories and
emotions and remember there is no wrong or right
way to feel.

• Be friendly and compassionate even if people are

being difficult.

• Offer accurate information about the disaster or crisis

event, and the assistance available to help victims
understand their situation.
Do’s & Don’ts

Promote Connectedness
 Help people quickly connect with friends
or loved ones.

 Keep families together. Keep children

and parents or other close relatives
together when ever possible.
Do’s & Don’ts

Promote Self-Efficacy

 Give practical suggestions that steer

people towards helping themselves.

 Engage people in meeting their own

needs.
Do’s & Don’ts

Promote Hope

 Find out the types of help available to people

and direct people to those services.

 Remind people (if you know) that more help

and services are on the way when they
express fear or worry.
Do’s & Don’ts
• Force people to share their stories with
you, especially very personal details (this
may decrease calmness in people who are
not ready to share their experiences).

• Give simple reassurances like “everything will

be OK” or “at least you survived”
(statements like this diminish calmness).

183
Do’s & Don’ts

 Tell people what you think they should be

thinking or feeling or how they should
have acted (this decreases self-efficacy).
 Tell people why you think they have suffered
by alluding to personal behaviors or beliefs
of the victims (this also decreases self-
efficacy).

184
Do’s & Don’ts

 Make promises that may not be kept.

 Criticize existing relief efforts or

existing services in front of people in
need of these services (this
undermines hope and calmness.

185
Closing Activities

 Q & A
 Evaluations
 Certificates

Thank you…Nicci

186

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Psychological First Aid Training Guide

Uploaded by

Psychological First Aid Training Guide

Uploaded by

Nicci Spinazzola, Ed.S.

, LMFT, LPC, ACS

 National Center for Posttraumatic Stress Disorder;;

 The International Federation of Red Cross and Red Crescent

 National Academies of Science-­Institute of Medicine.

 Drs. George Everly & Brian Flynn.

 Zagurski, R., Bulling, D., Chang, R. (2005). Nebraska Psychological

 Psychological First Aid is an evidence-­

 strategies guide teachers and staff in helping traumatized

 helps educational staff support students through the process

 Connect — Reach out to your students regularly. Communicate with

“Psychological first aid (PFA) refers to

(National Academy of Sciences, 2003)

 Psychological first aid means nothing more complicated

Fill in the blank:

Medical First Aid

PFA is intended for MHFA is intended

 designed to reduce initial distress caused by

 reactions can cause distress that interferes with

 getting support from informed, compassionate and

 has the potential to mitigate development of severe

 most effective immediately following the incident

 in some circumstances, assuming the safety of

 intended for students, school personnel, and

 whether emergency occurs on school grounds

 trained members of community emergency

 during and after emergency teachers and staff are

 capacity to connect with wide range of

 Good Listening Skills

 establish positive connections with students and staff in a

 make clear your availability

 when appropriate link to other resources:

 Protect: From further

 Remember: “Action Binds Anxiety!”

 Listening and responding

 Concentrate on what is being said

 Be an active listener (nod, affirm)

 Be aware of your own biases/values

 Listen and look for feelings

 Do not rehearse your answers

A Good Practice: “Ask before you tell.”

 Pause to think before answering

 Use clarifying questions and statements

 Avoid expressions of approval or disapproval

 Do not insist on the last word

 Ask for additional details

 Helps people acknowledge their emotions

 Clears up misunderstandings between people

 Ask questions sparingly

 Never appear to interview the person

 Address the content (especially feelings) of what

 Focus on responding to what the person is really

 Para-­verbal communications refers to :

 Para-­verbal communication is how we say

 Matching words and actions

2. Be willing to work on the cultural issues

3. Be willing to talk about how the other person's

4. Develop a solution together

5. If there is confusion or a misunderstanding…talk

 Loss of control

 If the person becomes threatening or

 Ask simple, respectful questions to

 Offering practical assistance (food,

 Be prepared for survivors to either

 focus on understanding what they want to tell

 children who are too young to speak, or who

 give information that directly addresses the immediate

 give information that is accurate and age

 when communicating through an interpreter, look at the

 staff members, who are involved in directing, calming, and

 ask students what they need to be able

 Reduce distress and arousal

 The goal is NOT to:

 Elicit details of the traumatic

 Debrief, by asking for

 to demonstrate calm and clear thinking to help

 National Center for Posttraumatic Stress Disorder;;

 The International Federation of Red Cross and Red Crescent

 National Academies of Science-Institute of Medicine.

 Drs. George Everly & Brian Flynn.

 Zagurski, R., Bulling, D., Chang, R. (2005). Nebraska Psychological

 Psychological First Aid is an evidence-

 strategies guide teachers and staff in helping traumatized

 helps educational staff support students through the process

 Connect — Reach out to your students regularly. Communicate with

 Psychological first aid means nothing more complicated

 designed to reduce initial distress caused by

 reactions can cause distress that interferes with

 getting support from informed, compassionate and

 has the potential to mitigate development of severe

 most effective immediately following the incident

 in some circumstances, assuming the safety of

 intended for students, school personnel, and

 whether emergency occurs on school grounds

 trained members of community emergency

 during and after emergency teachers and staff are

 capacity to connect with wide range of

 Good Listening Skills

 establish positive connections with students and staff in a

 make clear your availability

 when appropriate link to other resources:

 Protect: From further

 Remember: “Action Binds Anxiety!”

 Listening and responding

 Concentrate on what is being said

 Be an active listener (nod, affirm)

 Be aware of your own biases/values

 Listen and look for feelings

 Do not rehearse your answers

 Pause to think before answering

 Use clarifying questions and statements

 Avoid expressions of approval or disapproval

 Do not insist on the last word

 Ask for additional details

 Helps people acknowledge their emotions

 Clears up misunderstandings between people

 Ask questions sparingly

 Never appear to interview the person

 Address the content (especially feelings) of what

 Focus on responding to what the person is really

 Para-verbal communications refers to :

 Para-verbal communication is how we say

 Matching words and actions

 Loss of control

 If the person becomes threatening or

 Ask simple, respectful questions to

 Offering practical assistance (food,

 Be prepared for survivors to either

 focus on understanding what they want to tell

 children who are too young to speak, or who

 give information that directly addresses the immediate

 give information that is accurate and age

 when communicating through an interpreter, look at the

 staff members, who are involved in directing, calming, and

 ask students what they need to be able

 Reduce distress and arousal

 The goal is NOT to:

 Elicit details of the traumatic

 Debrief, by asking for

 to demonstrate calm and clear thinking to help

 some may follow your lead and remain focused

 model a sense of hope that individuals can’t

 take into account the history of the school and

 following are are some questions for you to

 had direct exposure (exposed directly or experienced extreme

 be aware of your personal values and

 students and staff are better able to cope when

 considerations for different disabilities

 may include going to a predetermined “safe place” when

 respond best to familiar teacher or person in authority

 may not be responsive to new people

 a student with a language disability may have

 adapt specific exercises to student’s strengths

 may have difficulties with comprehension or

 these students may respond best to exercises

 students with cognitive delays will do