Psychological First Aid
Psychological First Aid
Psychological First Aid
PFA GUIDE
FOREWORD
When terrible things happen in our communities, countries and the world, we want to reach out a helping hand to those who are affected. This guide covers psychological rst aid which involves humane, supportive and practical help to fellow human beings suffering serious crisis events. It is written for people in a position to help others who have experienced an extremely distressing event. It gives a framework for supporting people in ways that respect their dignity, culture and abilities. Despite its name, psychological rst aid covers both social and psychological support. Perhaps you are called upon as a staff member or volunteer to help in a major disaster, or you nd yourself at the scene of an accident where people are hurt. Perhaps you are a teacher or health worker talking with someone from your community who has just witnessed the violent death of a loved one. This guide will help you to know the most supportive things to say and do for people who are very distressed. It will also give you information on how to approach a new situation safely for yourself and others, and not to cause harm by your actions. Psychological rst aid has been recommended by many international and national expert groups, including the Inter-Agency Standing Committee (IASC) and the Sphere Project. Psychological rst aid is an alternative to psychological debrieng. In 2009, the World Health Organizations (WHO) mhGAP Guidelines Development Group evaluated the evidence for psychological rst aid and psychological debrieng. They concluded that psychological rst aid, rather than psychological debrieng, should be offered to people in severe distress after being recently exposed to a traumatic event. This guide was developed in order to have widely agreed upon psychological rst aid materials for use in low and middle income countries. The information we have given here is a model only. You will need to adapt it appropriately to the local context and the culture of the people you will help. This guide endorsed by many international agencies reects the emerging science and international consensus on how to support people in the immediate aftermath of extremely stressful events.
Shekhar Saxena
Director
Department of Mental Health and Substance Abuse World Health Organization
Stefan Germann
Director
Learning and Partnerships, Global Health Team World Vision International
Marieke Schouten
Director
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ACKNOWLEDGEmENTs
Writing and Editorial Team
Leslie Snider (War Trauma Foundation, WTF), Mark van Ommeren (World Health Organization, WHO) and Alison Schafer (World Vision International, WVI).
Artwork Team
Illustrations by Julie Smith (PD Consulting). Artwork and design by Adrian Soriano (WVI). Artwork coordination by Andrew Wadey (WVI).
Funding
World Vision International
Endorsement
This document has been endorsed by 23 international agencies (see names with logos on front and back cover) as well as Mdecins Sans Frontires (MSF).
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CONTENTs
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CHAPTER 1
UNDERsTANDING PFA
CHAPTER 1
Different kinds of distressing events happen in the world, such as war, natural disasters, accidents, res and interpersonal violence (for example, sexual violence). Individuals, families or entire communities may be affected. People may lose their homes or loved ones, be separated from family and community, or may witness violence, destruction or death. Although everyone is affected in some way by these events, there are a wide range of reactions and feelings each person can have. Many people may feel overwhelmed, confused or very uncertain about what is happening. They can feel very fearful or anxious, or numb and detached. Some people may have mild reactions, whereas others may have more severe reactions. How someone reacts depends on many factors, including: the nature and severity of the event(s) they experience; their experience with previous distressing events; the support they have in their life from others; their physical health; their personal and family history of mental health problems; their cultural background and traditions; their age (for example, children of different age groups react differently).
Psychological first aid: Guide for eld workers 2
Every person has strengths and abilities to help them cope with life challenges. However, some people are particularly vulnerable in a crisis situation and may need extra help. This includes people who may be at risk or need additional support because of their age (children, elderly), because they have a mental or physical disability, or because they belong to groups who may be marginalized or targeted for violence. Section 3.5 provides guidance for helping vulnerable people.
WHO (2010) and Sphere (2011) describe psychological debrieng as promoting ventilation by asking a person to briey but systematically recount their perceptions, thoughts and emotional reactions during a recent stressful event. This intervention is not recommended. This is distinct from routine operational debrieng of aid workers used by some organizations at the end of a mission or work task.
PFA is an alternative to psychological debrieng which has been found to be ineffective. In contrast, PFA involves factors that seem to be most helpful to peoples long-term recovery (according to various studies and the consensus of many crisis helpers2). These include: feeling safe, connected to others, calm and hopeful; having access to social, physical and emotional support; and feeling able to help themselves, as individuals and communities.
CHAPTER 1
See Hobfoll, et al. (2007) and Bisson & Lewis (2009) in References and Resources
There may be situations when someone needs much more advanced support than PFA alone. Know your limits and get help from others, such as medical personnel (if available), your colleagues or other people in the area, local authorities, or community and religious leaders. In the following box we have listed people who need more immediate advanced support. People in these situations need medical or other help as a priority to save life.
CHAPTER 1
CHAPTER 2
CHAPTER 2
REsPECT PEOPLEs
Safety
Avoid putting people at further risk of harm as a result of your actions. Make sure, to the best of your ability, that the adults and children you help are safe and protect them from physical or psychological harm. Treat people with respect and according to their cultural and social norms. Make sure people can access help fairly and without discrimination. Help people to claim their rights and access available support. Act only in the best interest of any person you encounter.
Dignity Rights
Keep these principles in mind in all of your actions and with all people you encounter, whatever their age, gender or ethnic background. Consider what these principles mean in terms of your cultural context. Know and follow your agency codes of conduct at all times if you work or volunteer for an agency that has these codes. We offer the following Ethical Dos and Donts as guidance to avoid causing further harm to the person, to provide the best care possible, and to act only in their best interest.
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For more information, see the Sphere Protection Chapter, Sphere Project (2011).
Be honest and trustworthy. Respect peoples right to make their own decisions. Be aware of and set aside your own biases and prejudices. Make it clear to people that even if they refuse help now, they can still access help in the future. Respect privacy and keep the persons story condential, if this is appropriate. Behave appropriately by considering the persons culture, age and gender.
Dont exploit your relationship as a helper. Dont ask the person for any money or favour for helping them. Dont make false promises or give false information. Dont exaggerate your skills. Dont force help on people, and dont be intrusive or pushy. Dont pressure people to tell you their story. Dont share the persons story with others. Dont judge the person for their actions or feelings.
CHAPTER 2
CONsIDER THE FOLLOWING QUEsTIONs As YOU PREPARE TO OFFER PFA IN DIFFERENT CULTUREs:
Dress
Do I need to dress a certain way to be respectful? Will impacted people be in need of certain clothing items to keep their dignity and customs? What is the customary way of greeting people in this culture? What language do they speak? Should affected women only be approached by women helpers? Who may I approach? (In other words, the head of the family or community?) What are the usual customs around touching people? Is it all right to hold someones hand or touch their shoulder? Are there special things to consider in terms of behaviour around the elderly, children, women or others? Who are the different ethnic and religious groups among the affected people? What beliefs or practices are important to the people affected? How might they understand or explain what has happened?
Language
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PFA is part of a broader response to large humanitarian emergencies (IASC, 2007). When hundreds or thousands of people are affected, different types of emergency response measures take place, such as search-and-rescue operations, emergency health care, shelter, food distribution, and family tracing and child protection activities. Often it is challenging for aid workers and volunteers to know exactly what services are available where. This is true during mass disasters and in places which do not already have a functioning infrastructure for health and other services. Try to be aware of what services and supports may be available so you can share information with people you are helping and tell them how to access practical help.
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CHAPTER 2
It is not necessary to have a psychosocial background in order to offer PFA. However, if you want to help in crisis settings, we recommend that you work through an organization or community group. If you act on your own, you may put yourself at risk, it may have a negative effect on coordination efforts, and you are unlikely to be able to link affected people with the resources and support they need.
For more information, see the Sphere Protection Chapter, Sphere Project (2011).
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CHAPTER 3
PROVIDING PFA
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CHAPTER 3
Below are suggestions for things to say and do, and what not to say and do. Most importantly, be yourself, be genuine and be sincere in offering your help and care.
Try to nd a quiet place to talk, and minimize outside distractions. Respect privacy and keep the persons story condential, if this is appropriate. Stay near the person but keep an appropriate distance depending on their age, gender and culture. Let them know you are listening; for example, nod your head or say hmmmm. Be patient and calm. Provide factual information, if you have it. Be honest about what you know and dont know. I dont know, but I will try to nd out about that for you. Give information in a way the person can understand keep it simple. Acknowledge how they are feeling and any losses or important events they tell you about, such as loss of their home or death of a loved one. Im so sorry. I can imagine this is very sad for you. Acknowledge the persons strengths and how they have helped themselves. Allow for silence.
Dont pressure someone to tell their story. Dont interrupt or rush someones story (for example, dont look at your watch or speak too rapidly). Dont touch the person if youre not sure it is appropriate to do so. Dont judge what they have or havent done, or how they are feeling. Dont say: You shouldnt feel that way, or You should feel lucky you survived. Dont make up things you dont know. Dont use terms that are too technical. Dont tell them someone elses story. Dont talk about your own troubles. Dont give false promises or false reassurances. Dont think and act as if you must solve all the persons problems for them. Dont take away the persons strength and sense of being able to care for themselves. Dont talk about people in negative terms (for example, dont call them crazy or mad).
Keep good communication in mind as you look, listen and link the action principles of PFA covered in the following pages.
15 Psychological first aid: Guide for eld workers
PREPARE
Learn about the crisis event. Learn about available services and supports. Learn about safety and security concerns.
CHAPTER 3
Crisis situations can be chaotic and often need urgent action. However, wherever possible before entering a crisis site, try to get accurate information about the situation. Consider the following questions:
Psychological first aid: Guide for eld workers 16
These important preparation questions can help you to understand the situation you are entering, to offer PFA more effectively and to be more aware of your safety.
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LOOK
Check for safety. Check for people with obvious urgent basic needs. Check for people with serious distress reactions.
CHAPTER 3
LIsTEN
Approach people who may need support. Ask about peoples needs and concerns. Listen to people, and help them to feel calm.
LINK
Help people address basic needs and access services. Help people cope with problems. Give information. Connect people with loved ones and social support.
LOOK
Check for safety. Check for people with obvious urgent basic needs. Check for people with serious distress reactions.
Crisis situations can change rapidly. What you nd at the scene may be different from what you learned before entering the crisis situation. Therefore, it is important to take time even
Psychological first aid: Guide for eld workers 18
a few moments to look around you before offering help. If you suddenly nd yourself in a crisis situation without time to prepare, this may be just a quick scan. These moments will give you a chance to be calm, be safe and think before you act. See the following table for questions to consider and important messages as you look around you.
LOOK
Safety
QUEsTIONs
What dangers can you see in the environment, such as active conict, damaged roads, unstable buildings, re or ooding? Can you be there without likely harm to yourself or others?
ImPORTANT mEssAGE
If you are not certain about the safety of the crisis site, then do not go. Try to get help for people in need. If possible, communicate with people in distress from a safe distance. Know your role and try to get help for people who need special assistance or who have obvious urgent basic needs. Refer critically injured people to medical personnel or others trained in physical rst aid.
Does anyone appear to be critically injured and in need of emergency medical help? Does anyone seem to need rescuing, such as people trapped or in immediate danger? Does anyone have obvious urgent basic needs, such as protection from the weather, torn clothing? Which people may need help in terms of accessing basic services and special attention to be protected from discrimination and violence? Who else is available around me to help? Are there people who appear extremely upset, not able to move on their own, not responding to others, or in shock? Where and who are the most distressed people?
Consider who may benet from PFA and how you can best help.
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People may react in various ways to a crisis. Some examples of distress responses to crisis are listed below: physical symptoms (for example, shaking, headaches, feeling very tired, loss of appetite, aches and pains) crying, sadness, depressed mood, grief anxiety, fear being on guard or jumpy worry that something really bad is going to happen insomnia, nightmares irritability, anger guilt, shame (for example, for having survived, or for not helping or saving others) confused, emotionally numb, or feeling unreal or in a daze appearing withdrawn or very still (not moving) not responding to others, not speaking at all disorientation (for example, not knowing their own name, where they are from, or what happened) not being able to care for themselves or their children (for example, not eating or drinking, not able to make simple decisions)
CHAPTER 3
Some people may only be mildly distressed or not distressed at all. Most people will recover well over time, especially if they can restore their basic needs and receive support such as help from those around them and/or PFA. However, people with either severe or long-lasting distress reactions may need more support than PFA alone, particularly if they cannot function in their daily life or if they are a danger to themselves or others. Make sure that severely distressed people are not left alone and try to keep them safe until the reaction passes or until you can nd help from health personnel, local leaders or other community members in the area. Also, look for people among the affected population who are likely to need special attention for their care and safety:
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PEOPLE WHO ARE LIKELY TO NEED sPECIAL ATTENTION IN A CRIsIs (sEE SECTION 3.5):
Children including adolescents especially those separated from their caregivers, may need protection from abuse and exploitation. They will also likely need care from those around them and help to meet their basic needs. People with health conditions or physical and mental disabilities may need special help to get to a safe place, to be protected from abuse and to access medical care and other services. This may include frail elderly people, pregnant women, people with severe mental disorders, or people with visual or hearing difculties. People at risk of discrimination or violence, such as women or people of certain ethnic groups, may need special protection to be safe in the crisis setting and support to access available help.
LIsTEN
Approach people who may need support. Ask about peoples needs and concerns. Listen to people, and help them to feel calm.
Listening properly to people you are helping is essential to understand their situation and needs, to help them to feel calm, and to be able to offer appropriate help. Learn to listen with your:
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yes giving the person your undivided attention E Ears truly hearing their concerns Heart with caring and showing respect
Psychological first aid: Guide for eld workers
CHAPTER 3
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LINK
Help people address basic needs and access services. Help people cope with problems. Give information. Connect people with loved ones and social support.
Although each crisis situation is unique, people who are affected often need the things listed in the following box.
FREQUENT NEEDs:
Basic needs, such as shelter, food, and water and sanitation. Health services for injuries or help with chronic (long-term) medical conditions. Understandable and correct information about the event, loved ones and available services. Being able to contact loved ones, friends and other social supports. Access to specic support related to ones culture or religion. Being consulted and involved in important decisions.
CHAPTER 3
People may feel vulnerable, isolated or powerless after a distressing event. In some situations, their daily life is disrupted. They may be unable to access their usual supports, or they may nd themselves suddenly living in stressful conditions. Linking people with practical support is a major part of PFA. Remember that PFA is often a one-time intervention and you may only be there to help for a short time. Affected people will need to use their own coping skills to recover in the long term. Help people to help themselves and to regain control of their situation.
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A person in distress can feel overwhelmed with worries and fears. Help them to consider their most urgent needs, and how to prioritize and address them. For example, you can ask them to think about what they need to address now, and what can wait for later. Being able to manage a few issues will give the person a greater sense of control in the situation and strengthen their own ability to cope. Remember to: help people identify supports in their life, such as friends or family, who can help them in the current situation; give practical suggestions for people to meet their own needs (for example, explain how the person can register to receive food aid or material assistance); ask the person to consider how they coped with difcult situations in the past, and afrm their ability to cope with the current situation; ask the person what helps them to feel better. Encourage them to use positive coping strategies and avoid negative coping strategies (see the following table).
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COPING
Everyone has natural ways of coping. Encourage people to use their own positive coping strategies, while avoiding negative strategies. This will help them feel stronger and regain a sense of control. You will need to adapt the following suggestions to take account of the persons culture and what is possible in the particular crisis situation.
Get enough rest. Eat as regularly as possible and drink water. Talk and spend time with family and friends. Discuss problems with someone you trust. Do activities that help you relax (walk, sing, pray, play with children). Do physical exercise. Find safe ways to help others in the crisis and get involved in community activities.
CHAPTER 3
Dont take drugs, smoke or drink alcohol. Dont sleep all day. Dont work all the time without any rest or relaxation. Dont isolate yourself from friends and loved ones. Dont neglect basic personal hygiene. Dont be violent.
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3. GIVE INFORmATION
People affected by a crisis event will want accurate information about: the event loved ones or others who are impacted their safety their rights how to access the services and things they need
Getting accurate information after a crisis event may be difcult. The situation may change as information about the crisis event becomes known and relief measures are put in place. Rumours may be common. You may not have all the answers in any given moment, but wherever possible: nd out where to get correct information, and when and where to get updates; try to get as much information as you can before you approach people to offer support; try to keep updated about the state of the crisis, safety issues, available services, and the whereabouts and condition of missing or injured people; make sure people are told what is happening and about any plans; if services are available (health services, family tracing, shelter, food distribution), make sure people know about them and can access them; provide people contact details for services, or refer them directly; make sure vulnerable people also know about existing services (see Section 3.5).
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In giving information to affected people: explain the source of the information you are providing and how reliable it is; only say what you know do not make up information or give false reassurances; keep messages simple and accurate, and repeat the message to be sure people hear and understand the information; it may be useful to give information to groups of affected people, so that everyone hears the same message; let people know if you will keep them updated on new developments, including where and when.
When giving information, be aware that the helper can become a target of the frustration and anger people may feel when their expectations of help have not been met by you or others. In these situations, try to remain calm and be understanding.
CHAPTER 3
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PEOPLE WHO mAY BE VULNERABLE AND NEED sPECIAL HELP IN A CRIsIs INCLUDE:
1. Children, including adolescents. 2. People with health conditions or disabilities. 3. People at risk of discrimination or violence.
CHAPTER 3
Remember that all people have resources to cope, including those who are vulnerable. Help vulnerable people to use their own coping resources and strategies.
age and developmental stage. It also depends on the ways their caregivers and other adults interact with them. For example, young children may not fully understand what is happening around them, and are especially in need of support from caregivers. In general, children cope better when they have a stable, calm adult around them.
Children and young people may experience similar distress reactions as adults do (see Section 3.3). They may also have some of the following specic distress reactions 4: Young children may return to earlier behaviours (for example, bedwetting or thumb-sucking), they may cling to caregivers, and reduce their play or use repetitive play related to the distressing event. School-age children may believe they caused bad things to happen, develop new fears, may be less affectionate, feel alone and be preoccupied with protecting or rescuing people in the crisis. Adolescents may feel nothing, feel different from or isolated from their friends, or they may display risk-taking behaviour and negative attitudes.
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Family and other caregivers are important sources of protection and emotional support for children. Those separated from caregivers may nd themselves in unfamiliar places and around unfamiliar people during a crisis event. They may be very fearful and may not be able to properly judge the risks and danger around them. An important rst step is to reunite separated children including adolescents with their families or caregivers. Do not try to do this on your own. If you make mistakes, it will make the childs situation worse. Instead, try to link immediately with a trustworthy child protection agency that can begin the process of registering the child and ensuring they are cared for. When children are with their caregivers, try to support the caregivers in taking care of their own children. The following box gives suggestions for how they can support children of different ages and developmental stages.
CHAPTER 3
Young children
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If the caregiver is injured, extremely upset or otherwise cannot care for their children, you can arrange to get help for the caregiver and care for the children. Involve a trustworthy child protection agency or network, whenever possible. Keep children and their caregivers together, and try not to let them get separated. For example, if the caregiver is being transported somewhere for medical care, try to keep the children with them or take down the details of where the caregiver is being taken so they can be reunited. Also keep in mind that children may gather around a crisis setting and may witness horric events, even if they or their caregivers are not directly affected by the event. In the chaos of a crisis, adults are often busy and may not be watching closely what children in the area are doing or what they see or hear. Try to shield them from upsetting scenes or stories.
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Keep safe
CHAPTER 3
Be calm, talk softly and be kind. Listen to childrens views on their situation. Try to talk with them on their eye level, and use words and explanations they can understand. Introduce yourself by name and let them know you are there to help. Find out their name, where they are from, and any information you can in order to help find their caregivers and other family members. When they are with their caregivers, support the caregivers in taking care of their own children. If passing time with children, try to involve them in play activities or simple conversation about their interests, according to their age.
Remember that children also have their own resources for coping. Learn what these are and support positive coping strategies, while helping them to avoid negative coping strategies. Older children and adolescents can often help in crisis situations. Finding safe ways for them to contribute in the situation may help them to feel more in control.
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People with chronic (long-term) health conditions, with physical or mental disabilities (including severe mental disorder), or who are elderly may need special help. This may include help to get to a safe place, to connect with basic support and health care, or to take care of themselves. The experience of a crisis event can make different types of health conditions worse, such as high blood pressure, heart conditions, asthma, anxiety and other health and mental disorders. Pregnant and nursing women may experience severe stress from the crisis that can affect their pregnancy, or their own and their infants health. People who cannot move on their own, or who have problems seeing or hearing, may have difculty nding loved ones or accessing the services available. Here are some things you can do to help people with health conditions or disabilities: Help them to get to a safe place. Help them to meet their basic needs, such as being able to eat, drink, get clean water, care for themselves, or to build shelter from materials handed out by agencies. Ask people if they have any health conditions, or if they regularly take medication for a health problem. Try to help people get their medication or access medical services, when available. Stay with the person or try to make sure they have someone to help them if you need to leave. Consider linking the person with a protection agency or other relevant support, to help them in the longer term. Give them information on how to access any services available.
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People at risk of discrimination or violence may need special protection to be safe in a crisis situation, and may need extra help to address their basic needs and access available services. Be aware of these people and assist them by: helping them to nd safe places to stay; helping them to connect with their loved ones and other trusted people; and providing them with information on available services and helping them to link directly with those services when necessary.
CHAPTER 3
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CHAPTER 4
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You or your family may be directly affected by the crisis situation. Even if you are not directly involved, you may be affected by what you see or hear while helping. As a helper, it is important to pay extra attention to your own wellbeing. Take care of yourself, so you can best take care of others!
CHAPTER 4
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A main source of stress for helpers is day-to-day job stress, particularly during a crisis. Long working hours, overwhelming responsibilities, lack of a clear job description, poor communication or management, and working in areas which are not secure are examples of job-related stress that can affect helpers. As a helper, you may feel responsible for peoples safety and care. You may witness or even directly experience terrible things, such as destruction, injury, death or violence. You may also hear stories of other peoples pain and suffering. All of these experiences can affect you and your fellow helpers. Consider how you can best manage your own stress, to support and be supported by your fellow helpers. The following suggestions may be helpful in managing your stress. Think about what has helped you cope in the past and what you can do to stay strong. Try to take time to eat, rest and relax, even for short periods. Try to keep reasonable working hours so you do not become too exhausted. Consider, for example, dividing the workload among helpers, working in shifts during the acute phase of the crisis and taking regular rest periods. People may have many problems after a crisis event. You may feel inadequate or frustrated when you cannot help people with all of their problems. Remember that you are not responsible for solving all of peoples problems. Do what you can to help people help themselves. Minimize your intake of alcohol, caffeine or nicotine and avoid nonprescription drugs. Check in with fellow helpers to see how they are doing, and have them check in with you. Find ways to support each other. Talk with friends, loved ones or other people you trust for support.
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If you nd yourself with upsetting thoughts or memories about the event, feel very nervous or extremely sad, have trouble sleeping, or drink a lot of alcohol or take drugs, it is important to get support from someone you trust. Speak to a health care professional or, if available, a mental health specialist if these difculties continue for more than one month.
CHAPTER 4
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CHAPTER 5
THE FOLLOWING CAsE sCENARIOs ARE EXAmPLEs OF CRIsIs EVENTs YOU mAY DEAL WITH IN YOUR ROLE As A HELPER. As YOU READ THEsE sCENARIOs, ImAGINE:
1. What would you need most urgently if something like this happened to you? 2. What would you nd most helpful? Keep in mind the PFA action principles of look, listen and link as you imagine how you would respond to people in each scenario. We have included some important questions to help you think through what to consider and ways to respond.
CHAPTER 5
You hear that a large earthquake has suddenly hit the centre of the city in the middle of the working day. Many people have been affected and buildings have fallen. You and your colleagues felt the shaking, but are okay. The extent of the damage is unclear. The agency you work for has asked you and your colleagues to help survivors, and to support any severely affected people you encounter.
Psychological first aid: Guide for eld workers 42
As you prepare to help, ask yourself the following questions: Am I ready to help? What personal concerns might be important? What information do I have about the crisis situation? Will I travel alone or together with colleagues? Why or why not?
THINGs TO CONsIDER:
When going to help in a crisis situation particularly immediately after a mass disaster consider the advantages of working in a team or in pairs. Working in teams will help you to have support and back-up in difcult situations and is important for your safety. You can also be more effective in a team. For example, one person can stay with someone who is distressed while the other person can focus on nding special help such as medical care, if needed. If possible, try to have a buddy system where you and a fellow helper can check in with each other for support and help. Some agencies may be able to give you support, such as supplies, transportation, communication equipment, updated information about the situation or security issues, and coordination with other team members or services.
As you move about the city, what should you look for? Is it safe enough to be at the crisis site? What services and supports are available? Are there people with obvious urgent basic needs? Are there people with obvious serious emotional reactions? Who may likely be in need of special help? Where can I provide PFA?
As you approach people, how can you best listen to their concerns and give comfort?
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What basic needs may affected people have? How will I identify and introduce myself to offer support? What does it mean in this situation to help keep affected people safe from harm? How will I ask people about their needs and concerns? How can I best support and comfort affected people?
Psychological first aid: Guide for eld workers
CHAPTER 5
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[The conversation continues for another 10 minutes with you listening to the womans story and asking for her needs and concerns. The conversation wraps up as follows:] Woman: I need to nd out if my family is all right, but I lost my phone when the shaking started, and I dont know how to get home. You: I can help you call your family, and then we can gure out together how you can get to them. Woman: Thank you. That would help a lot.
In this sample conversation, notice that you: introduced yourself by name and told the person the agency you work for; asked the person if they would like to talk; addressed the person by their name, respectfully using the last name; protected the distressed person from further harm by moving to a safer place; offered the distressed person some comfort (for example, some water); listened and stayed near the person, without forcing them to talk; reected back to the person ways they had acted appropriately; took the time to listen; identied the persons needs and concerns; acknowledged the persons worry over the possible loss of colleagues; offered to help connect the person with their family members.
What can you do to link people with information and practical support? What challenges might there be in this situation to nding out about available resources (food, shelter, water) or services for affected people? What worries and concerns may be on peoples minds? What practical suggestions could I give to help them address their problems? What information will affected people want? Where will I nd updated and reliable information about the crisis event? What can I do to connect people with their loved ones or services? What challenges might there be? What may children and adolescents or people with health conditions need? How can I help link vulnerable people with loved ones and services?
Psychological first aid: Guide for eld workers
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Refugees are being brought to a new location in trucks and told that they will be living in this new place. They were moved because of the war in their previous area. As they get off the trucks, some of them are crying, some appear very fearful, some seem disoriented, while others are sighing with relief. Most are afraid and doubtful of this new place, and have no idea where they will sleep, eat or receive health care. Some seem scared when they hear any loud noise, thinking they are hearing gunre again. You are a volunteer with an agency that distributes food items and have been asked to help out at distribution sites. As you prepare to help, consider what you would like to know about this situation: Who are the people I will be helping? What is their cultural background? Are there any rules of conduct or customs I need to follow? For example, is it more appropriate for women helpers to speak with women refugees? How far have they travelled? What do I know about the conict they have experienced? What services are being provided in the place the refugees are being received? If I am working in a team, how will we organize ourselves to help in this situation? What tasks will each person take on? How will we coordinate with each other and with other groups of helpers who may be there?
Psychological first aid: Guide for eld workers 46
CHAPTER 5
As you encounter the group of refugees, what should you look for? What will most of the refugees need? Will they be hungry, thirsty or tired? Is anyone injured or ill? Are there families or people from the same village within the refugee group? Are there any unaccompanied children or adolescents? Who else may need special help? Individuals in the refugee group seem to be having different types of reactions to the crisis. What kinds of serious emotional responses do you see?
As you approach people among the refugee group, how can you best listen to their concerns and give comfort? How will I introduce myself to offer support? People who experienced or witnessed violence may be very frightened and feel unsafe. How can I support them and help them feel calm? How can I nd out the needs and concerns of people who may need special help, such as women? How will I approach and help unaccompanied children and adolescents?
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You: Thank you, Adam. When is the last time you saw your family? Child: My older sister was there when the trucks came to bring us here. But now I cant nd her. You: How old is your sister? What is her name? Child: Her name is Rose. Shes 15. You: I will try to help you nd your sister. Where are your parents? Child: We all ran from the village when we heard the gunre. We got lost from my parents. [crying] You: Im sorry, Adam. That must have been scary for you, but youre safe now. Child: I am scared! You [in a warm, natural manner]: I understand. I would like to help you. Child: What should I do? You: I can stay with you for a while, and we can try to nd your sister. Would you like that? Child: Yes, thank you. You: Is there anything else worrying you or anything that you need? Child: No. You: Adam, it is important that we talk with the people over there who can help nd your sister or other family. I will go with you to talk to them. [It is essential to help the child to register with a reputable family tracing or child protection organization, if available.]
CHAPTER 5
saw an unaccompanied child in the crowd of refugees; got down on one knee to speak with the child on his eye level; spoke calmly and kindly to the child; found out information about the childs family, including the name of his sister; stayed with the child while identifying a trustworthy family tracing organization that could organize a safe place for the child to stay until his family is found.
Psychological first aid: Guide for eld workers 48
What can you do to link people with information and practical support? What basic needs might people have? What services do I know are available? How can people access them? What accurate information do I have about the plans for caring for these refugees? When and where can people nd more information about what is happening? How can I help to protect vulnerable people, such as women or unaccompanied children, from further harm? How can I help link vulnerable people with loved ones and services? What special needs might people have, including those who have been exposed to violence? What can I do to connect people with their loved ones or services?
You are travelling on a busy village road in a safe part of the country when up ahead you see an accident. It appears a man who was crossing the road with his wife and young daughter was hit by a passing car. The man is lying on the ground, bleeding and not moving. His wife and daughter are near him. His wife is crying and shaking, while his daughter is standing motionless and silent. Some villagers are gathering on the road near the scene of the accident. You need to react quickly in this situation, but take a moment to stay calm and consider the following as you prepare to help:
49 Psychological first aid: Guide for eld workers
Are there any safety concerns for me or others? How can I address the situation? What needs to be done urgently, particularly for the man who is seriously injured?
What is important to look for? Who needs assistance? What kind of assistance do they need? What assistance can I provide myself and what special help is needed? Who can I ask to help me? What help could the people who are gathering around the site provide? In what ways might they interfere or not be helpful?
As you make contact with the people involved in the accident, how can you best listen and provide comfort? How will I identify and introduce myself to offer support? How can I help to keep people safe from further harm? Are there special concerns for the daughter who has witnessed her fathers injury and appears dazed and shocked? Can her mother care for and comfort her at this time? Where can I provide PFA that is safe and relatively quiet? How will I ask people about their needs and concerns? How can I give affected people comfort and help them to feel calm?
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Villagers: No. You [to a nearby villager]: Could you please call for an ambulance right away? Villager: Yes, I will!
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You [to other onlookers]: We need to try to redirect the trafc. Can you please help with this? [Some villagers go to ag down the passing cars and redirect trafc.] [As you approach the affected people, you notice one of the villagers is about to move the injured man.] You: Please dont move him! He may have an injury to his neck. An ambulance has been called. [If you or someone nearby is trained to do so, give physical rst aid to the injured man. Check or ask someone around you to help make sure the wife and daughter are not injured. Once the injured man is attended to appropriately, and you are sure the other affected people are not seriously injured, provide PFA.] You [to the wife]: My name is ___. An ambulance has been called. Are you or your daughter injured? Wife [sobbing and shaking]: No, Im not hurt. You [to the wife, calmly and warmly]: What is your name? Wife [crying]: Hanna, you can call me HannaOh, my husband! My husband! You: Hanna, I understand that you are very frightened. An ambulance has been called to help your husband. I will stay with you for a while. Do you and your daughter have any other needs or concerns right now? Wife: Is my daughter OK? You: Your daughter does not seem to be injured. Can you tell me her name so I can talk to her? Wife [reaching out to take her daughters hand]: This is Sarah. You [warmly and on the eye level of the child]: Hi Sarah. My name is ___. Im here to help you and your mom. [The conversation continues and you learn that the daughter is not talking. The mother says this is unusual for her daughter, but stays focused on her husband. The mother also says she wants to go with the father to the hospital to stay with him. The daughter is at risk of spending the evening alone at home.]
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You: Hanna, it would be much better if your daughter stays with you or someone you trust. She seems to be very frightened by what happened and it is best for her not to be left alone right now. Is there someone you trust who could stay with her? Wife: Yes, my sister could help. Sarah likes her very much. You: Can I help you to call your sister? Wife: Yes, please! [You help the wife to contact her sister and it is arranged that the daughter will be with her aunt for the evening. You also advise the mother to bring the daughter to a health clinic if she stays silent over the coming days.] You: When the ambulance arrives, I will nd out where they will take your husband and let you know if you and your daughter can go with them. [When the ambulance arrives, you nd out how the family can be kept together when the injured man is taken to hospital.]
In this sample conversation and actions, notice that you: rst quickly scanned the crisis situation to be sure it was safe to enter and to see who was seriously injured; made sure an ambulance was called immediately for the injured man, and prevented him from being moved and possibly injured further; tried to work in a way that prevented further harm or danger to others (for example, being careful of the trafc in the road); spoke respectfully and warmly to the wife and daughter; addressed the child on her eye level; helped the wife to make appropriate arrangements to look after her daughter; took steps to help the family stay together when the injured man was taken to hospital.
CHAPTER 5
What can you do to link people with information and practical support? What basic needs may the non-injured, distressed people in this crisis situation have? What worries and concerns may be on the minds of the different people in this scenario? What information will they want? What can I do to connect people with their loved ones who may help to support them?
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PREPARE
Learn about the crisis event. Learn about available services and supports. Learn about safety and security concerns.
LOOK
LIsTEN
LINK
ETHICs:
Ethical dos and donts are offered as guidance to avoid causing further harm to the person, to provide the best care possible and to act only in their best interest. Offer help in ways that are most appropriate and comfortable to the people you are supporting. Consider what this ethical guidance means in terms of your cultural context.
Be honest and trustworthy. Respect peoples right to make their own decisions. Be aware of and set aside your own biases and prejudices. Make it clear to people that even if they refuse help now, they can still access help in the future. Respect privacy and keep the persons story condential, if this is appropriate. Behave appropriately by considering the persons culture, age and gender.
Dont exploit your relationship as a helper. Dont ask the person for any money or favour for helping them. Dont make false promises or give false information. Dont exaggerate your skills. Dont force help on people, and dont be intrusive or pushy. Dont pressure people to tell you their story. Dont share the persons story with others. Dont judge the person for their actions or feelings.
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NOTEs
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