Psychological First Aid (PFA)

TRAINORS TRAINING
HELPING you HELP your colleague
and students in times of CRISIS!
As TEACHER-ADVOCATE you are in
an EXCELLENT POSITION …

To help students & community after a

disaster, school crisis, or emergency.
To help students return to school, stay
in school, continue to learn, & return
to their usual school-based activities
after a crisis.
What is Psychological First Aid?

A CRISIS intervention;
a PSYCHOSOCIAL SUPPORT
SERVICE to alleviate human stress
generally encountered due to the
forces: nature-made like super storms
or man-made like enemy attack, etc.
PFA-an evidence-informed modular life-
span approach

To help children, adolescents,

adults, and families in the
immediate aftermath of disaster
and terrorism.
 PFA is designed

to reduce the initial distress

caused by traumatic events,
to foster short and long term
adaptive functioning and coping.
Principles & Techniques of PFA meet
Four Basic Standards

1. Consistent with research evidence on risk &

resilience following trauma
2. Applicable & practical in field settings
3. Appropriate for development levels across
the lifespan
4. Culturally informed & delivered in a
flexible manner
 PFA does not assume

That all survivors will develop

severe Mental Health problems or
long-term difficulties to recovery.
PFA is based on an understanding that disaster survivors &
others affected by such events will experience

a broad range of early reactions (e.g., physical,

psychological, behavioral, spiritual).
Some reactions will cause enough distress to
interfere with adaptive coping, and recovery
may be helped by support from
COMPASSIONATE, CARING, CONSOLING
and COMFORTING disaster responders.
 PFA is INTENDED for

ALL: children, adolescents, adults

(parents, care-takers) and families
expose to disaster or terrorism
Can also be provided for first
responders and other disaster or crisis
relief workers.
 Who delivers PFA?

Designed for delivery by ANYONE

trained in the basics and by Mental
Health professionals who provide
early assistance to affected children,
adolescents, adults, families as part of
an organized disaster response effort.
 When should PFA be used?

IMMEDIATELY after disasters

and or crisis incident as
supportive intervention.
Many researchers & health organizations
have supported

The idea that early BRIEF and

FOCUSED intervention can reduce
the SOCIAL and EMOTIONAL
distress of children, adolescents and
adults after traumatic events.
 YOU can HELP your students
if YOU do the FIVE-STEP MODEL

1. LISTEN
2. PROTECT
3. CONNECT
4. MODEL
5. TEACH
After a disaster, crisis, or emergency.
These steps can help them bounce back and recover
more quickly.
 Let’s GET STARTED:

THINK ABOUT your students’

“EXPERIENCE” of the CRISIS
SITUATION (physical experience
or directly seeing it as it happens or
indirectly seeing it through stories).
 “DIRECT EXPERIENCE”

a FIRST-HAND: a witness
EXPERIENCE of crisis.
In contrast with a
VICARIOUS EXPERIENCE
 AFTER the CRISIS …

 CHANGES can happen in your students’

feelings (Affective), behaviors (Behavioral)
and thoughts (Cognitive) - ABC
 Your students may worry about family
members, classmates, friends, or pets they
care about, or may worry that it will happen
again.
Common STRESS REACTIONS (CSR) to
CRISIS SITUATIONS include:

Trouble sleeping, listening

Troubles at school & with friends,
Trouble concentrating, not finishing work or
assignments.
More irritable, More sad,
More angry, or More worried as they think
about what happened
When students share their experiences, thoughts
& feelings about the event,

LISTEN for RISK FACTORS or adverse

reactions: meaning attending to verbal and
non-verbal language:
 Find out if s/he has a loss of a family member,
schoolmate, or friend
 Observe if s/he has serious injury or emotional
injury due to the death of another person
 OBSERVE if s/he is …

 getting hurt or becoming sick

 home loss, family moves, change in
neighborhoods
 unable to evacuate quickly
 past losses or traumatic experiences
 pet loss
 If a student has had
any of these experiences

CONSIDER referring your

student to your licensed school
psychologist, counselor, social
worker, or psychiatrist in your
local area, if any.
 Now you know what can affect,
Are YOU now READY to:

1. LISTEN,
2. PROTECT,
3. CONNECT,
4. MODEL,
5. TEACH ,
 STEP 1. LISTEN

 LISTEN and PAY CLOSE

ATTENTION to what your student
say (thoughts and feelings) and how
they act (behavior) is the first
important step to help after the crisis.
 REMEMBER
that your students

 May also show their feelings

in NONVERBAL ways, like
increased behavioral problems
or increased social withdrawal.
 LET your students
KNOW and FEEL that you are

 Willing to LISTEN and PAY CLOSE

ATTENTION and TALK about the crisis,
or make referrals to talk to an appropriate
professional, if they prefer it.
 Use the following questions to talk with
your students.
 USE the following QUESTIONS

LISTEN for CLUES that indicate when your students are

having a hard time.
 Write down a few examples that may be helpful to note:
 1. What might be preventing a student from coming or
staying in school?
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 2. What might be preventing a student from paying attention in
class or doing home work?
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 3. What might be preventing a student from returning to other
school-based activities?
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 LISTEN, observe, and note
any changes in the following:

 behavior or mood
 school work performance
 interactions with schoolmates, teachers
 participation in school-based activities
 behaviors at home that parents discuss
with you.
 REVIEW STEP 1: LISTEN

 PROVIDE students opportunity to share their

experiences and express feelings of worry,
anxiety, fear or other concerns.
 TALK to students individually or in small
formal or informal group setting.
 One-on-one can occur if you find a relatively
private place.
 OPEN the DISCUSSION byc
ACKNOWLEDGING what HAPPENED

 LET the students know that it is okay to share

their experiences and that the school is a safe
place to do this.
 BEGIN the discussion with one of the sample
“Listen questions:”
 1. Where were you when this crisis happened?
 2. What do you remember that day?
 WHEN CONDUCTING STEP 1
in GROUP SETTING

 BE AWARE of who is in this group.

 STUDENTS who experienced a direct loss
due to the CRISIS may BENEFIT MORE
from a one-on-one initial listening session or
with a group that also has experienced the
loss.
 Listening continues throughout PFA
 LISTENING can occur

 In a formal setting like classroom or

homeroom, but may also take place in halls,
or outside under shady trees.
 RESPOND with empathy to students self-
expression to convey interest.
 RESPOND supportively to both VERBAL
and NONVERBAL cues.
ACKNOWLEDGE the DIFFICULTY
the students may be having

 AVOID making judgments or predictions, like “You’ll get

over it,” or “Only the strong survive,“ or “You are a ‘hero.’
“
 Importantly VALIDATE the students’ life EXPERIENCES,
FEELINGS, or THOUGHTS.
 DO NOT PROBE students for more details than they are
willing to share.
 RESPECT students’ wish or desire NOT to SHARE
thoughts or feelings because they are ready yet.
 FORCING students to go over
their experiences in much details

 Immediately after the crisis can RE-

TRAUMATIZE the student.
 May cause more emotional and
psychological distress to student and to
others who may hear additional details
about the crisis.
 LET the students KNOW that
YOU are READY to LISTEN

 CONVEY availability with EMPATHY, ACCEPTANCE,

and RESPECT (EAR).
 REASSURE and ENCOURAGE at this point to stay in
school rather than away from school.
 BEING AVAILABLE to LISTEN (with an E.A.R) to
students’ concerns and
 BEING OPEN to DISCUSS the situation serve as examples
to students of how adults deal with CRISIS situations.
WHEN students FEEL and KNOW
that they have a PLACE

Where adults LISTEN (with EAR) it

increases the students’ perception
that school is a place for positive
experience, and facilitates their
return to caring learning
environment.
 STEP 2: PROTECT

 MAKE your students FEEL BETTER

by doing some or all of the following:
 1. ANSWER questions SIMPLY &
HONESTLY to clear up confusion the
students have about what happened.
 STEP 2: PROTECT continued

 2. LET your students KNOW that

they are NOT alone in their reactions
to the event.
 3. PROVIDE opportunities for your
students to talk, draw and play, but
DON’T FORCE it.
 STEP 2: PROTECT continued

 4. WATCH for anything in the

environment that could
RETRAUMATIZE your students.
 5. KEEP your EYES and EARS
OPEN for bullying behaviors.
 STEP 2: PROTECT continued

 6. MAINTAIN daily ROUTINES, activities

and structure with clear expectations, have
consistent rules, or immediate feedback;
limit unnecessary changes.
7. MAKE adjustment to assignments; be
SENSITIVE to students’ current level of
functioning.
 STEP 2: PROTECT continued

 8. Limit access to live television and

the Internet that show disturbing
scenes of the event. REMEMBER,
what is NOT upsetting to you and
other adults may upset and confuse
your students, and vice-versa.
 STEP 2: PROTECT continued

 9. ENCOURAGE students to “take a break”

from the crisis focus to activities unrelated to
crisis.

 10. FIND WAYS for your students to FEEL

HELPFUL to your classroom, school, and
community.
 STEP 2: PROTECT continued

 LIST other things that may help your students FEEL

BETTER.
SHARE list with other teachers to increase ideas to
helping your students.
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REVIEW STEP 2: PROTECT

 REESTABLISH students’ feelings of both physical

and emotional safety.
 HONESTLY INFORM students about the events
surrounding the crisis.
 SHARE INFORMATIOND about what is being done
in the community and school to keep everyone safe.
 INFORMATION should be provided in an age-
appropriate manner .
 .

 MAKE SURE to reestablish routines,

expectations and rules in classroom or around
school as soon as possible like bell schedule.
 TRAUMATIZED students may experience
more confusion when there are CHANGES or
DISRUPTIONS to their schedules, school
routines, including after school activities.
 ‘

 SEPARATION from parents or caregivers are frequently

children’s paramount concern.
 PARENTS can HELP STABILIZE children’s reactions by
resuming mealtime, homework, and bedtime routines,
community or church activities disrupted by the crisis.

 In STEP 2, it is important to protect your students from

further physical harm or psychological trauma.
 Sample QUESTIONS to HELP
what the students fear or worry

 1. What is the most difficult thing to deal

right now?
 2. Are you worried about how you are
reacting?
 3. Are you worried about your safety?
Around other students? Around adults like
teachers at school or outside of school?
 KEEP the environment FREE of anything that could
RETRAUMATIZE students, like showing videos of
similar tragedies or news stories with repeated reminders
of the crisis or disaster, particularly for younger students.

 There is a strong relationship between the amounts of

time spent watching bombing related coverage and the
numbers of PTSD reported after the crisis.
 Be on the look-out for negative or trauma-related
behaviors, which can include repetitive play or talk
involving aspects of the traumatic event being
proliferated in the classroom or around school.
 Other behaviors may include increased irritability,
oppositional and defiant behaviors, withdrawal,
poor attention and concentration, and difficulty
learning new material.
 While some students may become
TARGET of BULLYING

 BE AWARE that others become bullies using the

crisis as fodder for bullying.
 Students need extra patience and attention after a
crisis, so schools can increase students SENSE of
SAFETY and SECURITY when rules and
routines regarding appropriate behavior, including
disciplinary consequences are re-established.
TREAT students FEARS, WORRIES
and other concerns with RESPECT!

 PROVIDE supportive, discreet, benevolent and caring

HELP.
 It is INAPPROPRIATE and a DISRESPECT to announce
to class that “Jimmy is having a hard time getting his work
done; he needs to go to the counselor because he can’t
stop thinking about the crisis.” Or “Jimmy is afraid of the
dark since the crisis occurred.”
 FIND WAYS that preserve their DIGNITY and PRIVACY.
 STEP 3. CONNECT

 CONNECTING and REACHING OUT

to people in school and community
helps your students AFTER a CRISIS.
CONNECTIONS build strength for
everyone in school and community as
well.
MAKE some or all of the following
CONNECTIONS:

 1. “CHECK IN” with students

on a regular basis.
 2. FIND RESOURCES that can
offer support to your students
and classroom,
 STEP 3: CONNECT continued

 3. KEEP COMMUNICATION OPEN with

others involved in your students’ lives like
parents, other teachers, sport coaches, SOS,
SO, among others.
 4. RESTORE interactive school activities,
including sports, club meetings, student-
serviced projects and student government.
 STEP 3: CONNECT continued

 5. ENCOURAGE student activities

with friends, incl. class projects and
extra-curricular activities.
6. EMPATHIZE with your students by
allowing a little more time for them to
learn new materials.
 STEP 3: CONNECT continued

 7. BUILD your students’ strengths by

USING what they learned in the past
to help them deal with CRISIS.
8. REMIND them that major CRISES
are rare; DISCUSS other times and
topics that they have felt safe.
 STEP 3: CONNECT continued

 LIST programs and activities that connect you

and your students with their community.
SHARE list with other teachers to create a larger
list of activities and resources.
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REVIEW STEP 3: CONNECT

 One most common reaction to trauma is emotional-

social isolation with sense of loss of social supports;
 Can occur automatically, without realizing that students
are withdrawing from teachers, or peers, respectively.
 STEP 3: CONNECT helps students reestablish normal
social relationships and stay connected to others to
experience social support.
RESTORING and BUILDING CONNECTIONS
PROMOTES
STABILITY and RECOVERY

 SCHOOL or CLASSROOM is a safe place to begin

restoring normalcy after a crisis.
 IDENTIFY “systems of care” that are part of
students’ everyday life;
 MOVE BEYOND school classroom to the family,
and then to other community anchors including
FAITH, BELIEFS and CULTURE
CONNECTIONS or supports.
 CONNECT
helps the students

 RECONSTITUTE the RELATIONSHIPS between the

key community systems or “anchors” in their lives.
 REACHING OUT and CHECKING IN with students
on regular basis can do this.
 ENCOURAGE students to interact, share activities
and take on team projects with other students, friends,
or teachers.
 If necessary, refer students to counselors.
 Sample “CONNECT” Questions:
not intrusive or probing,
but gentle inquiries:

 1. What can I do to help you right now?

 2. What can your teachers or other
teachers do to help you?
 3. What can your BFFs, SOS, SO friends,
and relatives do to help you?
 4. What can your family do to help you?
KEEP TRACK of WHAT is going on
in your students’ lives:

SHARE positive feedback about your students’ lives

with other students themselves,.
PROVIDE positive boost to students’ feelings of
confidence that they can handle their reactions related
to the CRISIS.
In this type of interaction, students feel the CARING
and CONSISTENT support of teachers in their lives,
even during a difficult time of coping.
 CONNECT

 ENCOURAGES parents to share with school personnel any

concerns they may have about their children’s reactions
after the event.
 Such communication should be a goal – to balance
concerns about students lives.
 SHARES students’ accomplishments and strengths.
 ENGAGES in open communication and sharing
information, teachers can track the progress of students’
recovery.
 STEP 4: MODEL

 As you help your students REGAIN

their lives after a crisis, your efforts
may be MORE SUCCESSFUL and
LESS STRESSFUL – if you keep in
mind the following:
 MODEL TIPS …

 1. BE AWARE of your
thoughts, feelings, and
reactions about the event,
which can be seen, and can
affect your students.
 MODEL TIPS …

 2. HOW YOU DEAL with a CRISIS,

has INFLUENCING EFFECT on how
students cope, deal, and behave in a
crisis situation.
They watch you for both VERBAL
clues and NONVERBAL cues.
 MODEL TIPS …

 3. MONITOR your conversations because

students may hear.

 4. ACKNOWLEDGE the difficulty of the

crisis situation, and DEMONSTRATE how
people can come together to COPE with
STRESS after such an event.
 REVIEW STEP 4: MODEL
“CALM and OPTOMISTIC Behavior”

 Students watch teachers’ reactions to receive clues

and cues on how to confront adversity and crisis.
 STEP 4: MODEL reminds teachers that they are role
models.
 ACKNOWLEDGE distress, and DEMONSTRATE
CALMNESS and OPTOMISTIC behavior;
 SHOW students that constructive actions provide
hope for the future.
 REVIEW STEP 4

 DEMONSTRATE that you can effectively cope

with stress despite the fear or loss that you
experience,
 This type of social support from can be extremely
powerful in student’s recovery from crisis.
 Students follow the EXAMPLE SET by you and
parents; they WATCH how you react and cope with
adversity particularly during and after crisis.
 TEACHERS can MODEL calm and optimistic
behavior in many ways, including the following:

 MAINTAIN level emotions and reactions to help students achieve

balance.
 TAKE CONSTRUCTIVE ACTIONS to assure student safety, like
engaging in a safety drill to remind them how to stay safe, or planning a
project that improves the physical or social climate of the school.
 EXPRESS POSITIVE THOUGHTS, and FEELINGS for the future
like, “Recovery from this disaster may take some time, but we’ll work
on improving the conditions at our school every day.”
 HELP students to cope with day-to-day challenges; THINK ALOUD
with them about the ways they can solve their problems.
 STEP 5. TEACH

 TALK to your students about expected

reactions (emotional, behavioral,
physiological, social, physiological) after
the crisis.
Let them KNOW that these are “NORMAL”
reactions to ABNORMAL events like the ff:
 KNOW that …

 1. Different people may have very

different reactions even within the
same family. After crisis, people
may also have different amounts of
time they need to cope and adjust.
 KNOW how to …

 2.ENCOURAGE your
students to identify and use
positive coping strategies to
help them after the CRISIS.
 HELP your STUDENTS …

 3. To PROBLEM-SOLVE in order to
get through each day successfully.
 4. To SET SMALL but “DOABLE”
GOALS; and SHARE in these
achievements as “wins” for the
students and your classroom.
 REVIEW STEP 4: MODEL

 5.REMIND students that with

time and assistance, things
generally get better. If it does not
and they don’t get better, they
should let a parent or teacher know.
 REVIEW STEP 5: TEACH
It is very IMPORTANT that

 Students UNDERSTAND the range of normal stress

reactions in a crisis situation.
 YOU take this task with the help of counselors, nurses,
psychologists or social workers;
 YOU TEACH students, staff, parents or guardians, and
volunteers about COMMON STRESS REACTIONS to
specific crisis while noting that students may have
more difficulty with learning after a specific crisis.
POSSIBLE REACTIONS: you can help
your students become

 Familiar with the range of normal reactions that can occur

immediately after a traumatic event, crisis or disaster.
 Possible reactions (of children and adolescents) after
Disasters
 1. Physical changes
 2. Emotional changes
 3. Cognitive changes
 4. Changes in spiritual beliefs
Sample “TEACH-able” MOMENTS:
ways of coping

 Practice relaxation breathing.

 Skills that help students get back to
school, stay engaged in learning and
develop new work abilities.
 Different ways to express feelings and
experiences.
ACKNOWLEDGE and KNOW

 A few of common reactions that affect learning and

introduce the need for a HELPING professional to provide
the classroom with more information.
 ENSURE ACCURATE INFORMATION or about new
safety measures, drills, and ways of staying safe for
students.
 Knowledge helps build RESILIENCE and RESILENCE
increases the sense of ABILITY to COPE with all kinds of
ADVERSITIES.
REMIND students & parents that

 That resuming normal routines, including returning

to regular school attendance and activities, is
important to recovery.
 USE your every day teaching skills to help students
develop constructive solutions for returning to
school after a crisis, like how to go to school, stay
in school and do well in school by relying on the
support of friends, family and relatives .
 SELF-CARE: even as a teacher-trainor
it is okay to seek professional help: ;

 1. When you have feelings of being

overwhelmed or overly stressed that
don’t go away over time.
2. When you are NOT SURE about
how to handle a situation with a student
or a family member.
 When to implement PFA–LPC-MT?

 AFTER any CRISIS, disaster, or

emergency.
 BEGIN the LPC-MT immediately
following a CRISIS.
 Importantly, ANTICIPATE students
possible needs.
 PFA requires a mindset that is open to
LISTENING students’ point of view:

 Everyone can play an important role in crisis recovery if you follow the
Five-STEP LPC – Model & Teach process.
 YOU must possess the following qualities:
 1. Ability to establish rapport quickly.
 2. Ability to listen to difficult feelings and experiences of others and
empathize and be supportive.
 3. Ability to keep confidential the sensitive information that students share.
 4. Ability to be aware of limitations, biases, personal thoughts and feelings
about the crisis.
 5. Ability to be aware of the need for self-care.
 Normal Emotional Reactions
to Traumatic Stress

 it’s normal to feel a wide range of intense emotions reactions. They often come and go in waves. At times you
feel anxious, other times you feel disconnected.

 1. Shock & disbelief: you may have a hard time accepting the reality of what happened
 2. Fear: that the same thing will happen again, or that you will lose control or break down
 3. Sadness: particularly if people you know died
 4. Helplessness: the sudden, unpredictable nature of natural disaster and accidents may leave you feeling
vulnerable and helpless.
 5. Guilt: that you survived when others died, or that you could have done more to help or prevent the situation.
 6. Anger: you may be angry at God or others you feel responsible
 7. Shame: especially over feelings or fears you can’t control
 8. Relief: you may feel relieved that the worst is over, and even hopeful that your life will return
 Normal Physical Responses
to Traumatic Events

Symptoms of traumatic stress are also physical. It’s important to know what the
physical symptoms of stress look like, so they don’t scare you. They will go away if
you don’t fight them.

 1. Trembling or shaking
 2. Pounding heart
 3. Rapid breathing
 4. Lump in throat; feeling choked up
 5. Stomach tightening or churning
 6. Feeling dizzy or faint
 7. Cold sweats
 8. Racing thoughts
 Over time …

 YOU, your students and their

families, your classroom can
EXPECT RECOVERY!
GOD BLESS YOU ALL!