Transcript www.bcscrt.org

Advanced School Crisis Response Skills:
Using a Psychological First Aid Approach in Rapid Response Scenarios
Key Concepts
in
Psychological
First Aid
Active
Shooter
Recognition
Active
Shooter
Incident
Response
Active
Shooter
Incident
Recovery
Practical
Crisis
Response
Exercise
Burlington County Schools Crisis Response Team
Presented by
Behavioral Science Applications
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
About Your Instructor
Steve Crimando, MA,
BCETS, CTS, CHS-V

Consultant/Trainer: U.S. Dept. of Homeland Security;
Dept. of Justice; U.S. Postal Service; OSHA;
United Nations; Police and Military, others.

Officer, Board of Directors: International College
of the Behavioral Sciences.

Diplomate, National Center for Crisis Management.

Diplomate, American Academy of Experts in Traumatic Stress.

Board Certified Expert in Traumatic Stress (BCETS).

Certified Trauma Specialist (CTS).

On-scene Responder/Supervisor: ‘93 and
9/11World Trade Center attacks; NJ Anthrax Screening Center;
TWA Flight 800; Unabomber Case; Int’l kidnappings,
hostage negotiation team member; etc.

Qualified Expert: to the courts and media
on violence prevention and response issues.

Author: Many published articles and book chapters
addressing behavioral sciences in violence prevention, disaster
and terrorism response.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Course
Details
Introduction
Psychological
First Aid








Introduction
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 for Crisis Responders
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Foundational Concepts
Psychological
First Aid
Behavior is a Function
of Person and Environment
B = ƒ (P,E)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Three Key Points
Psychological
First Aid
 The human response to crisis events is “phasespecific.”
 The human response to crisis events is “hazardspecific.”
 In some crisis events, the “psychological footprint” will
completely out-size the medical or physical impact of
the event.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Foundational Concepts
3 Basic Behavioral Responses
•
•
•
Type One: Neighbor-helps-neighbor.
Type Two: Neighbor-fears-neighbor.
Type Three: Neighbor-competes-with neighbor.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Foundational Concepts




Psychological
First Aid
Panic is related to the perception of limited
opportunity for escape or availability of critical
supplies.
Panic is a group phenomena
characterized by an intense,
contagious fear.
Panicked individuals think
only of their own needs
or survival.
Panic is not typical in
most disasters.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
What is Psychological First Aid?
Psychological
First Aid
 Evidence-informed
 Modular approach
 Designed to reduce initial
distress
 For immediate aftermath of a
traumatic or threatening
event
 To foster short- and longterm adaptive functioning
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Working Definitions
Psychological
First Aid
“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)
“The provision of a supportive and compassionate
presence designed to enhance natural resilience and
coping, while facilitating access to continued care, if
necessary.”
(Everly & Flynn, 2006; Parker, Barnett, et al., 2006)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
PFA is Not…
Psychological
First Aid




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 ________.”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
An Important Distinction
Psychological First Aid
PFA is intended for
anyone experiencing an
overwhelming emotional
response to a disaster or
emergency, with or
without a pre-existing
condition.
Psychological
First Aid
Mental Health First Aid
MHFA is intended
primarily for
individuals with a preexisting psychiatric
conditions
experiencing a
psychiatric emergency.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
The ABC’s of First Aid
Psychological
First Aid
Medical
 Airway
 Breathing
 Circulation
Psychological
 Arousal (Reduce)
 Behavior (Limit)
 Cognition (Improve)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When & Where Should PFA Be Used
PFA is a “phase-specific” intervention intended for
the 0-48 hours of a sudden, shocking emergency,
disaster or crisis event.
Psychological
First Aid
 Proximity- Go to affected persons, don’t wait for them to
seek assistance.
 Immediacy- Go sooner, rather than later; PFA is typically
used in the 0-48 of the incident.
 Expectancy – Expect that most people will bounce back in
their own time and their own terms. Few will develop last
emotional problems related to an incident.
(T.W. Salmon, 1919)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When & Where Should PFA Be Used
Psychological
First Aid
 On the frontline of a disaster or
crisis.
 Points of Dispensing (POD’s)
medication or supplies.
 ER’s and Field Hospitals.
 Shelters, Disaster Recovery
Centers, Family Assistance
(Reception) Centers.
 Crisis Hot Lines, Phone Banks.
 Other community settings.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Who Should Deliver PFA?
Psychological
First Aid
 Mental Health Professionals.
 Para-professionals (i.e.-heath care, school crisis
teams, CERT and MRC, Faith-based Relief
Workers, etc.)
 Non-professionals (i.e.-community members, coworkers, etc.)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Basic Objectives in PFA
 Establish a human connection in
a non-intrusive, compassionate
manner.
 Enhance immediate and ongoing
safety.
 Provide physical and emotional
comfort.
 Help survivors identify their
immediate needs and concerns.
 Gather information as
appropriate.
 Offer practical assistance and
information.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Basic Objectives in PFA
(cont.)
Psychological
First Aid
 Connect survivors as soon as possible with
family members, friends, neighbors and
community resources (social support network).
 Support adaptive coping; acknowledge coping
efforts and strengths; encourage active
participation in recovery.
 Provide information about coping
strategies/techniques.
 Clarify availability of mental health responders;
Facilitate linkage to other supports.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Guiding Principles
in Providing PFA
 Protect: From further
exposure and media.
 Direct: Be kind, gentle, clear.
 Connect: With loved ones
and information and
support.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Early Psychological Support
Psychological
First Aid
 Relieve suffering, both
emotional and physical.
 Improve people’s short
term functioning.
 Accelerate the
individual’s course of
recovery.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Active Involvement
Psychological
First Aid
 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!”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Interpersonal Communications
Skills

Non-verbal communication
 Listening and responding
 Giving feedback
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Projecting Warmth
Psychological
First Aid





Soft tone
Smile
Interested facial expression
Open/welcoming gestures
Allow the person you are talking with to dictate the
spatial distance between you (This can vary
according to cultural or personal differences)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Increasing Trust & Confidence
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Enhancing Communication &
Safety While Seated
SOLER





S it squarely
O pen Posture
L ean Forward
E ye Contact
R elax
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Communication & Safety
While Standing
L-Shaped Stance:
 Demonstrates respect
 Decreases confrontation
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Listening & Responding
Psychological
First Aid






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.”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Listening & Responding
(cont.)
Psychological
First Aid






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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Listening & Responding
(cont.)
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Guidelines for Responding
Psychological
First Aid




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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Non-verbal Communication
Psychological
First Aid
 Para-verbal communication is how we say something,
not what we say
 Non-verbal can include:
 Personal Space
 Posture
 Body language
 Para-verbal communications refers to :
 Voice Tone
 Volume
 Rate of speech
 Inflection
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Non-verbal Communication
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Non-verbal Communication
 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!
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
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 people to
either avoid you or flood you
with contact.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Guidelines for Delivering PFA
(cont.)
Psychological
First Aid
 Speak calmly. Be patient, responsive and
sensitive.
 Speak slowly, in concrete terms; avoid
acronyms or jargon.
 Give people information that directly addresses
their immediate needs and goals.
 Provide information that is accurate, timely and
age-appropriate.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Contact & Engagement
Psychological
First Aid
The goal of this action, Contact and Engagement,
is to respond to contacts initiated by survivors, or
to initiate contacts in a non-intrusive,
compassionate, and helpful manner. It is about
how a responder approaches and initiates a PFA
contact with a distressed individual.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Contact & Engagement:
Sample Dialog
“Hi. I’m Bob. I’m part of the county school crisis
response team. I’m checking in with people here
at the Family Assistance Center to see how
they’re doing and to see if I can help in any way.
Is it OK if we talk for a few minutes? Can I ask
you name? Can I call you Doris, or would you
prefer Mrs. Williams? Before we talk, is there
any thing you need right now, Mrs. Williams?
Juice or water? Have you had a chance to eat
yet since you arrived at the Center? (Response)
Good. Well, let’s sit for a few minutes and talk.”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Contact & Engagement:
Sample Dialog
 Introduce yourself.
 Ask about immediate needs.
 Maintain the highest level of confidentiality
possible in the crisis response setting.
 Use the “active lurking” approach.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Safety & Comfort
Psychological
First Aid
The goal of this action is to enhance immediate
and ongoing safety, and provide physical and
emotional comfort.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Strategies for Safety & Comfort
 Do things that are active (rather than passive
waiting), practical (using available resources),
and familiar (drawing on pass experience).
 Get current, accurate, up to date information,
while avoiding survivors’ exposure to information
that is inaccurate or excessively upsetting.
 Get connected to practical resources.
 Get connected with others who have shared
similar experiences.
Key Concept: “Action Binds Anxiety”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
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.
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Ensuring Immediate
Physical Safety
 Look, listen and feel (intuitively) for signs that a
person may hurt themselves or others.
 Expressing anger/hatred toward self or others.
 Extreme agitation.
 Seek immediate support for containment and/or
management of risk by medical, EMS, law
enforcement or security personnel.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Recognizing Shock
 Signs of Shock can include:









Pale
Clammy skin
Weak, rapid pulse
Lightheaded, dizzy
Irregular breathing
Dull, glassy eyes
Unresponsive to communication
Lack of bladder/bowel control
Restless, agitated, confused
 Seek immediate medical support.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Recognizing Shock
Psychological
First Aid
To help reorient and comfort survivors, provide
information about:






What to do next.
What is being done to assist them.
What is currently know about an unfolding event.
Available services.
Common stress reactions.
Self-care, family care, and coping.
Use your judgment about whether and when to
present information.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Promote Social Connectedness
Psychological
First Aid
 Facilitate group and social
interaction as appropriate.
 Promote same-age/nearage peer interaction with
children and teens.
 Encourage “neighborhelping-neighbor” support to
reduce social isolation.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When a Loved One is Missing
Psychological
First Aid
 This is one of the most difficult experiences for a
family. Families often experience:






Denial
Worry
Hope
Anger
Shock
Guilt
The American Red Cross has established a “Disaster
Welfare System” to support family communication
and reunification. Their “Safe and Well” website has
tools and services to help locate loved ones during
emergencies. This resources can be access through:
www.redcross.org
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When a Loved One is Missing
Psychological
First Aid
When a loved one is missing:
 Be prepared to spend extra time with worried
family members.
 Use “compassionate presence”, just being there
to listen to hopes and fears.
 Be honest in giving information and answering
questions.
 Inform the appropriate authorities.
 If family members wish to leave the safe area to
search, inform them of the current conditions in
the search area.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When a Loved One is Missing
Psychological
First Aid
 When authorities need additional information,
they may interview the family. It is best to limit
young children from this process.
 Encourage family members to be patient,
understanding and respectful of each other’s
thoughts and feelings until there is more
definite news.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When a Loved One is Missing
Psychological
First Aid
 When authorities need additional information,
they may interview the family. It is best to limit
young children from this process.
 Encourage family members to be patient,
understanding and respectful of each other’s
thoughts and feelings until there is more definite
news.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
When a Loved One is Missing
 Acute grief reactions are likely. Survivors may feel
sadness, anger, guilt over the death. You should
remember:
 Treat bereaved children and adults with dignity,
respect and compassion.
 Grief reactions vary person to person.
 There is no single “correct” way to grieve.
 Grief puts people at risk for substances (legal and
illegal). Make survivors aware of these risks, the
importance of self-care and availability of
professional help.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Stabilization
 The goal of this action is to calm and orient
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Stabilization
 Looking glassy eyed, vacant or lost.
 Unresponsive to verbal questions or commands.
 Disoriented (aimless, confused behavior).
 Uncontrollable crying, hyperventilating, rocking or
regressive behavior.
 Uncontrollable physical reactions (shaking,
trembling).
 Frantic searching behaviors.
 Feeling incapacitated by worry, anxiety.
 Engaging in risky or dangerous behavior.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Stabilization
Psychological
First Aid
 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”.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Stabilization
 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 survivor to the
surroundings, what will be happening, what steps
he or she may consider.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Stabilization
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Grounding Technique
Psychological
First Aid
Introduce the technique by saying:
“After a frightening experience, you can find
yourself overwhelmed with emotions or unable to
stop thinking about or imaging the what
happened. You can use a method called
“grounding” to feel less overwhelmed.
Grounding works by turning your attention back to
the outside world. Here’s what you do…”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Grounding Technique:
Instructions
Psychological
First Aid
1. Sit/stand comfortably with your arms and legs
uncrossed.
2. Breathe in and out slowly and deeply.
3. Look around you and name different objects that
you can see. For example, you could say, “I see
the floor, I see a shoe, I see a table, I see a chair,
I see a person.”
4. Breathe in and out again slowly and deeply.
(Continued)
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Grounding Technique:
Instructions
5. Next, name five non-distressing sounds that you
can hear. For example, “I hear a woman talking,
I hear myself breathing, I hear someone typing,
I hear a door closing, I hear a cell phone
ringing.”
6. Breathe slowly and deeply.
7. Next name five non-distressing things that you
can feel. For example, “I can feel the wooden
armrest of this chair, I can feel my toes inside
my shoes, I can feel my back pressing against
my chair, I can feel the blanket I am holding, I
can feel my lips pressing together.”
8. Breathe in slowly and deeply.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Relaxation Techniques
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Relaxation Techniques
You can use a script like this to guide a survivor
during a breathing exercise:
1.
Picture that you are going around a box or
square, and as you go around the square you will
breathe, or hold your breath or exhale slowly on
the count of three on each of the four sides of the
square.
2.
Begin by following my voice and now taking two
deep breathes, filling your lungs all the way down
to your belly. Do that two times.
3.
Let’s start to go around the square. Breath in, on
my count, “one-thousand-one, one-thousandtwo, one-thousand three.”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Relaxation Techniques
4.
Now hold your breathe, “one-thousand-one,
one-thousand-two, one-thousand three.”
5.
Now breathe out slowly, “one-thousand-one,
one-thousand-two, one-thousand three.”
6.
Now wait, “one-thousand-one, one-thousandtwo, one-thousand three.”
7.
And now repeat, breathe in, “one-thousand-one,
one-thousand-two, one-thousand three.”
Repeat five times, slowly and comfortably.
Do this as many times each day as needed.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Box Breathing Diagram
Psychological
First Aid
Inhale
Box breathing is an
autogenic technique to
calm physiological
arousal.
Hold
Wait
Exhale
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Relaxation Techniques
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Information Gathering
Psychological
First Aid
 The goal of this action is to identify
needs and concerns, gather additional
information, and tailor PFA
interventions.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Information Gathering
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Practical Assistance
Psychological
First Aid
 The goal of this action is to offer practical
help to survivors in addressing immediate
needs and concerns.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
 Providing people with needed resources can
increase a sense of empowerment, hope, and
restored dignity. Therefore, assisting the survivor
with current and anticipated problems is a central
component of Psychological First Aid.
 Survivors often welcome a pragmatic focus and
assistance with problem-solving.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
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.
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Steps in Offering
Practical Assistance
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Steps in Offering
Practical Assistance
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Connection with
Social Supports
 The goal of this action is to help establish
brief or ongoing contacts with primary
support persons or other sources of
support, including family members,
friends, and community helping resources.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Forms of Social Support
Psychological
First Aid
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
Social Connection
Feeling needed
Reassurance of Self-Worth




Reliable Support
Advice and Information
Physical Assistance
Material Assistance
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Core Actions in PFA
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
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”
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Information on Coping
Psychological
First Aid
The goal of this action is to provide
information about stress reactions and coping
to reduce distress and promote adaptive
functioning.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Providing Information
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Discussing Positive & Negative
Forms of Coping
The aim of discussing both the positive and negative
forms of coping is to:
• Help survivors consider different coping options.
• Identify and acknowledge their personal coping
strengths.
• Think through the negative consequences of
maladaptive coping actions.
• Encourage survivors to make conscious goaloriented choices about how to cope.
• Enhance a sense of personal control over coping
and adjustment.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Forms of
Maladaptive Coping
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Core Actions in PFA
Psychological
First Aid
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
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Linkage with
Collaborative Services
The goal of this action is to link survivors
with available resources at the time or in
the future.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Psychological
First Aid
Making a Referral
Psychological
First Aid
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 (ex.- “How do you feel about connecting
with Agency A?”).
 Give written referral information, or if possible,
make the appointment right then and there.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
Promote Self-Efficacy
 Give practical suggestions that steer
people towards helping themselves.
 Engage people in meeting their own needs.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
 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).
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
 Tell people what you think they should
be thinking or feeling or how they should
have acted (this decreases selfefficacy).
 Tell people why you think they have
suffered by alluding to personal
behaviors or beliefs of the victims (this
also decreases self-efficacy).
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.
Do’s & Don’ts
Psychological
First Aid
 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.
Copyright © 2013. Behavioral Science Applications. All Rights Reserved.