1 of 41

Introduction to Psychological First Aid

And Supportive Field Engagement

2 of 41

Psychological First Aid (PFA)

PFA is a supportive and compassionate presence designed to do three things:

Prevent stress from worsening
De-escalate acute distress
Facilitate access to continued supportive care as needed*

2

Listen, Protect and Connect

Models of PFA:

The National Child Traumatic Stress Network and the National Center for PTSD - Second Edition of Psychological First Aid Field Operations Guide

Listen, Protect, and Connect:

Model can be used by community members and other non-clinical helpers

Versions exist for schools/educators, parents/caregivers, displaced populations and others

*Everly, G.S., Jr., & Lating, J.M. (2017). Johns Hopkins guide to psychological first aid. Baltimore: Johns Hopkins Press.

Is accessible - anyone with supports and training can do

Is not professional counseling, psychotherapy or psychiatric intervention

Is not “(psychological) debriefing”

Is not about asking people to analyze what happened or put time and events in order

Is not about pressuring people to tell you their story, or asking details about how they feel or what happened

3 of 41

PFA Basic Assumptions

Emotional Distress ≠ Mental Illness
Emotional Wellness ≠ Lack of Illness
Us = Them
Signs of distress are not universal

3

4 of 41

PFA Basic Assumptions

Distress reactions are:

Common
Expected

While utilizing these techniques:

Don’t expect immediate improvement
Focus on stopping the “flood”

4

5 of 41

Scenario

5

Consider an individual suffering multiple losses of family members and trying to address immediate health and safety needs here on-site.

Please, share - what does a situation typically look like?

6 of 41

Expected Distress Reactions

Trouble sleeping/trouble eating
Sadness, anger, irritation
Trouble listening and concentrating
Trouble or inability to complete tasks

Getting more emotional than usual for that person
Hyper-vigilance
Emotional numbness
Problems at work or school

Others?

6

7 of 41

Strength Based Reactions

People can also respond positively to distress and can become involved in the helping process…

When we do - it’s important to practice regular self-care
Encourage “natural helpers” to take care of themselves

7

8 of 41

8

9 of 41

Psychological First Aid Action Steps

9

Contact and Engagement

Safety and Comfort

Information Gathering: Current Needs and Concerns

Practical Assistance

Connection with Social Supports

Information on Coping

Linkage with Collaborative Services

Stabilization

10 of 41

Contact and Engagement

Goal: Initiate contact and respond in a compassionate and helpful manner

Be on the lookout for those at risk - (isolated, disoriented, what else?)
Start with those that reach out to you
Give your full attention
Introduce yourself with your name, title, and brief description of your role - and ask for immediate needs

Let’s try it!

11 of 41

Contact and Engagement

Find reasons to connect – (water bottle, handouts etc.)
Ask for permission to talk and respect person/culture - think about touch, personal space, eye contact
Respect the decision not to talk
Provide information on when they could speak with someone later on
Listen for more severe or prolonged reactions

Goal: Initiate contact and respond in a compassionate and helpful manner

12 of 41

“Rules” of Engagement

Focus on hearing what someone is saying and how they say it
Pay attention to what is not being said (body language, details that may be left out)
Watch how someone behaves/copes
Listen to and prioritize concerns with those affected

Tip:

Have a partner
“Don’t just do something, stand there” - understand the context

12

13 of 41

Safety and Comfort

Goal: enhance safety and provide physical and emotional comfort

Obtain and provide only up to date information
Incomplete or overly upsetting information should be avoided - unless prepared to deliver it safely and with follow up
Avoid giving false hope

Consider and Practice statements such as:

“I don’t have that answer, but I will work to find out.”
“There are many qualified professionals working to help - let me help connect you to the right person/agency”

14 of 41

Safety and Comfort

Goal: enhance safety and provide physical and emotional comfort

Make the physical environment as safe and comfortable as possible

Offer first aid and medical assistance as appropriate
Food, water, shelter, adequate clothing
Medications and assistive devices (i.e. wheelchair or walker)

Shelter from triggering sights, smells, news, and social media by giving specific advice (“no more than 10 minutes of social media at a time no more than twice a day”)

15 of 41

Stabilization

Goal: Calm and orient emotionally overwhelmed survivors

Strong emotions should be expected in a disaster
Most individuals can calm themselves down

Watch for those that are disoriented, numb, confused, panicked, hysterical, frantic, or frozen
Focus on level of function and assist as needed - calm presence becomes opportunity to model effective behavior

16 of 41

Stabilization

Give some time before engagement
Remain calm, quiet, and present to give help when needed
Give information about the person and his/her surroundings to orient him/her
Clarify misinformation
Explain that intense emotions can be expected and may occur in waves

Goal: Calm and orient emotionally overwhelmed survivors

17 of 41

Information Gathering

Goal: Gather more information, identify immediate needs, and provide targeted support

Begins immediately after initial contact and continues through the entire process
Ask questions informally as you are providing education or assistance
Follow the survivor’s lead about traumatic events
Avoid asking for in-depth descriptions that may traumatize further

18 of 41

Information Gathering

Goal: Gather more information, identify immediate needs, and provide more personalized interventions

Ask only enough questions to determine if they need more support or referral
Examples:

Separation from loved ones and/or death of loved ones
Physical and/or mental illness
Substance use
Need for medications
Thoughts about harming self or others

19 of 41

Information Gathering

Listen for extreme feelings of guilt or shame
Determine availability – or lack – of social supports

Specific concerns about developmental impact and protection of:

Children/youth
Older Adults
Family
Be alert for specifically vulnerable members of the community (LGBTQ+, Domestic Violence, Trafficking)

Goal: Gather more information, identify immediate needs, and provide more personalized interventions

20 of 41

Practical Assistance

Goal: Offer practical help to address immediate needs

Stress can affect ability to think and plan
Ways to assist:

Identify immediate concerns
Clarify the need - “What I am understanding would be helpful for you is…”
Make an action plan with simple, clear steps. Verify understanding
Take action

20

21 of 41

Connect with Social Supports

Goal: establish connection with primary supports and community resources

Assist with access to family, friends, loved ones
Encourage supportive social and group interactions in the immediate environment
Provide information about community resources such as social services, mental health resources, medical resources, addiction services, child care, religious support

22 of 41

Information on Coping

Goal: Provide information about stress reactions, reduce distress, and promote adaptive functioning.

Provide basic information about stress reactions and explain that they are expected/understandable
Identify coping strategies that have worked in the past
Provide additional coping strategies:

Relaxation techniques
Sleep hygiene tools and advice
Ways to manage negative emotions
How to seek out further support

23 of 41

De-escalation and grounding

Box Breathing

Take a deep breath in to the count of 4�Then hold it for 4 seconds�Then release it to the count of 4�Then hold for 4 seconds before you take the next breath in

4x 4x 4x 4

You may also want to think about what you want to put in the box and put away for today; or to help compartmentalize everything you are thinking about.

23

24 of 41

Sleep

https://mobile.va.gov/app/cbt-i-coach

https://www.cstsonline.org/assets/media/documents

https://www.cstsonline.org/assets/media/documents/CSTS_Infographic_MakeSleepAPriority.pdf

25 of 41

Linkage with Collaborative Services

Provide direct links to additional needed services:

Know services that are available and how to connect survivors with them
Collaborate with survivors to choose the services they need
When leaving a response site, let the survivor know and provide a hand-off to the next provider whenever possible

Goal is to promote continuity in helping relationships for long-term recovery

25

26 of 41

Field Interventions

26

27 of 41

Scenario

Continuously build awareness of culture (a.k.a. “cultural humility”), diversity, community resources, community history and traditions - how do you say hello?

Don’t assume compassion if shared community experiences - it’s complicated

What community do you come from?

27

28 of 41

Important Topics

Reactions will vary across disaster/trauma exposures

Domestic Violence
Child Care and Child Abuse - interface with the community resources
Suicide Prevention Lifeline
Disaster Distress Hotline
Ongoing Engagement with Guests and Ongoing Growing of Staff Skillset

28

29 of 41

Risk Factors

Death of a family member or friend
Seeing serious injury or the death of another person
Feeling extreme panic, fearing for one’s life or that of loved ones was in danger
Being unable to evacuate quickly or becoming trapped
Missing family members
Getting hurt or becoming sick due to the disaster
Worrying about becoming sick
Losing one’s home, job and/or belongings
Having to relocate and change neighborhoods, schools, etc.
Dealing with financial burdens
Having past traumatic experiences
Losing a pet

29

30 of 41

Stepping outside of PFA

Current Needs and Concerns

30

31 of 41

Stepping outside of PFA

Suicide Assessment - C-SSRS - anyone can be effective!

31

https://www.youtube.com/watch?v=_XTg8nCDoTo

32 of 41

Psychoeducation and Information on Coping

Provide basic information about coping
Provide techniques for anger management
Address highly negative emotions (use basic CBT approaches - let’s see if the app can help!)

Address alcohol and substance use:

Determine if usage is more or more impactful than before event

Connect to peer and clinical supports as indicated

32

33 of 41

De-escalation and grounding

Mobilizers

Make circles with your hips, if you are seated, move your rib cage. Remember to breathe deeply, move slowly and pay attention to your body. Do 3 circles in one direction, then do circles in the opposite direction

For the next movement, make an arch with your whole body slowly. As you arch back inhale. Then slowly crouch forward and exhale as you crouch.

Inhale slowly, bring your chin-up, push your chest out, arms reach back with your thumbs up and stick your butt out to make an arch.

Then exhale, bring your chin down, chest in, arms come across in front and butt in to curl your body.

Do 5 repetitions. Everyone, move at your own pace. Inhale and exhale as slowly as possible.

33

Grounding techniques for when anxiety overwhelms you

These techniques use your five senses or tangible objects — things you can touch — to help you move through distress.

1. Put your hands in water

Focus on the water’s temperature and how it feels on your fingertips, palms, and the backs of your hands. Does it feel the same in each part of your hand?

Use warm water first, then cold. Next, try cold water first, then warm. Does it feel different to switch from cold to warm water versus warm to cold?

2. Pick up or touch items near you

Are the things you touch soft or hard? Heavy or light? Warm or cool? Focus on the texture and color of each item. Challenge yourself to think of specific colors, such as crimson, burgundy, indigo, or turquoise, instead of simply red or blue.

3. Breathe deeply

Slowly inhale, then exhale. If it helps, you can say or think “in” and “out” with each breath. Feel each breath filling your lungs and note how it feels to push it back out.

4. Savor a food or drink

Take small bites or sips of a food or beverage you enjoy, letting yourself fully taste each bite. Think about how it tastes and smells and the flavors that linger on your tongue.

5. Take a short walk

Concentrate on your steps — you can even count them. Notice the rhythm of your footsteps and how it feels to put your foot on the ground and then lift it again.

6. Hold a piece of ice

What does it feel like at first? How long does it take to start melting? How does the sensation change when the ice begins to melt?

7. Savor a scent

Is there a fragrance that appeals to you? This might be a cup of tea, an herb or spice, a favorite soap, or a scented candle. Inhale the fragrance slowly and deeply and try to note its qualities (sweet, spicy, sharp, citrusy, and so on).

8. Move your body

Do a few exercises or stretches. You could try jumping jacks, jumping up and down, jumping rope, jogging in place, or stretching different muscle groups one by one.

Pay attention to how your body feels with each movement and when your hands or feet touch the floor or move through the air. How does the floor feel against your feet and hands? If you jump rope, listen to the sound of the rope in the air and when it hits the ground.

9. Listen to your surroundings

Take a few moments to listen to the noises around you. Do you hear birds? Dogs barking? Machinery or traffic? If you hear people talking, what are they saying? Do you recognize the language? Let the sounds wash over you and remind you where you are.

10. Feel your body

You can do this sitting or standing. Focus on how your body feels from head to toe, noticing each part.

Can you feel your hair on your shoulders or forehead? Glasses on your ears or nose? The weight of your shirt on your shoulders? Do your arms feel loose or stiff at your sides? Can you feel your heartbeat? Is it rapid or steady? Does your stomach feel full, or are you hungry? Are your legs crossed, or are your feet resting on the floor? Is your back straight?

Curl your fingers and wiggle your toes. Are you barefoot or in shoes? How does the floor feel against your feet?

11. Try the 5-4-3-2-1 method

Working backward from 5, use your senses to list things you notice around you. For example, you might start by listing five things you hear, then four things you see, then three things you can touch from where you’re sitting, two things you can smell, and one thing you can taste.

Make an effort to notice the little things you might not always pay attention to, such as the color of the flecks in the carpet or the hum of your computer.

34 of 41

Be First
Be Right
Be Credible
Express Empathy
Promote Action
Show Respect

34

Risk Communications�Crisis and Emergency Risk Communications (CERC) and Center for Risk Communication

35 of 41

Messaging 27/9/3 Template

35

Introduction: Safety and Security	We work hard to keep everyone in the Village safe. Rules and laws give all rights and obligations. Staff and volunteers are here to help you but we all need to help each other.
1. What do we mean by safety?	2. What are the rules?	3. Who can help me if I don’t feel safe?
1.1 In United States everyone has the right to be safe - both physically and mentally	2.1 Men and women have equal rights and protections even when married.	3.1 Any person in uniform or with an official ID can help
1.2 Caregivers are responsible for children’s safety - even just leaving the child to wonder on their own can be illegal to a certain age	2.2 Children are particularly protected and hitting or abusing children in any way is against the law.	3.2 If you don’t see anyone who can help or can’t explain what you need - go to the Mayor’s Cell immediately to find help or an interpreter
	2.3 Even those who enforce the law have to follow rules and will not hurt you. You do have to follow their directions, however.	3.3 If there is something suspicious or seems out of place - please tell someone immediately to keep everyone safe.

36 of 41

Disaster Distress Hotline

Disaster Distress Helpline

SAMHSA’s Disaster Distress Helpline provides 24/7, 365-day-a-year crisis counseling and support to people experiencing emotional distress related to natural or human-caused disasters.

En Español

The Disaster Distress Helpline, 1-800-985-5990, is a 24/7, 365-day-a-year, national hotline dedicated to providing immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call or text 1-800-985-5990 to connect with a trained crisis counselor.

36

37 of 41

https://www.cstsonline.org/fact-sheet-menu/fact-sheet-list

38 of 41

Self-care

38

39 of 41

40 of 41

41 of 41

Questions?

Sander Koyfman, MD 917-582-2455 sander.koyfman@gmail.com

General Adult Psychiatry, Addiction Medicine; Vibrant Emotional Health Board Member, Co-Chair of Crisis and Emotional Care Team Advisory

Amy Carol Dominguez

Program Director, Crisis Emotional Care Team

ADominguez@vibrant.org

41