Psychological First Aid (PFA)

Practical Lesson from the Field

Adib Asrori, M. Psi, PsikologClinical Psychologist – United Nation Certified Stress Counselor

Definition

•A compassionate and supportive presence designed tomitigate acute distress and assess the need for continuedmental health care (Everly and Flynn, 2005)• Compassionate : welas asih, penuh kasih sayangà empati•Mitigate Acute Distress : mengurangi, meminimalisir,meredakan• PFA is not a treatment for PTSD (post-traumatic stressdisorder)

PFA After Disaster

• Needs (psychological assistants)• Over 160 empirical studies (Norris, 2006) 41% studies revealed evidencesevere to very severe impairment among survivor.• Demand : 15-25% Population Directly Affected• Enhance Surge Capacity : The ability to response ”surge”• Surge : Increasing demand for services (healthàMH)• Surge Capacity : The ability to provide those kind of services whenneeded.• Goal PFA : to STABILIZE & Mitigate Acute Distress, not long termpsychotherapeutic growth.

Recent Evidence Suggest…

• Best Way : Build Community Surge Capacity / CommunityResilience• First Responder• They know the Culture, Geographic location, etc

• Psychological Crisis Intervention is superior to multisessionpsychotherapy post disaster, for reducing acute distress• Traditional mental health interventions may be problematicwhen applied in disaster settings

RAPID PFA Model : 5 Core Elements

1. Rapport & Reflective Listening (RL) / Active Listening 2. Assessment 3. Prioritization 4. Intervention 5. Disposition & Follow Up

1. Rapport & RL / Active Listening

• Goal : • Make contact• Provide an introduction • Establish Rapport • Use specific Active Listening Technique : Paraphrase, to establish some degree of

empathy • Not only technique, but RL is ongoing process used throughout the entire

interaction with a person who is in Crisis • ”if you understand me, I’ll trust you. If I trust you, I’ll be more compliance”.

Beginning the Conversation

• Establishing rapport as quickly as possible is essential • Disaster à People in Acute Distress • PFA à Acute Assistance • How à Observe & Listen • What to say (depend on the situation) :

• Introduce our self • Explain what you are doing • Ask an initial question (closed-ended & Open-ended)

• Henry Murray ”There is nothing so powerful as the well phrased question”. • Skillfully asked questions can also convey a sense of support.

Remember

• Be “present” • Listen • Allow Catharsis : express emotion, grief & lost • Don’t rush to solve complicated problem with a simplistic

solution • Don’t try to make the person feel better by diminishing,

trivializing her/his concern • Don’t Argue

2. Assessment

• Assessment of basic physical and psychological status/ needs • Conversation involving the survivor’s own narrative • Specific questions regarding details of the event and specific

reactions to the event, so we can clarify ambiguous aspects of personal reactions • To formulate our intervention, we must listen to the story

Assessment…

60 - 90% 5 - 49%

Example :

Dimension Distress Dysfunction

Cognitive Reaction Temporary Confusion, Overwhelmed, Nightmares

Hopelessness, Suicidal Thought, Hallucination

Emotional Reaction Fear, Sadness, Irritability, Anger, Anxiety, Frustration. Agitate

Panic Attacks, Affective Numbing, PTSD, Depression

Behavior Reaction Temporary phobic reaction, sleep disturbance, eating disturbance

Persistent avoidance, Aggression/ Violence, Self Medication (drugs)

Spiritual Reaction Questioning Faith, Questioning God’s Action

Cessation of faith-related practices, Projecting faith

Physiological Reaction

Psychogenic Headache, Psychogenic Muscle Tension, Decrease Immunity

Chess pain, Dizziness, Unconsciousness, Change in cardiac function

Seek medical advice for further investigation by physician

3. Prioritization

Maslow: Meet Basic Medical and Physical Needs First!

Two Approaches to Triage

• Evidence-based• Cognitive Capabilities (insight, problem solving)

à ability to understand the consequences of one’s actions • An impulsive urge to act in a self-defeating, self-injurious manner, feeling of

helplessness, hopelessness • Functional Capacity: inability to perform necessary functions of living

(self- care, caring for others, working, personal hygiene)

• Risk-based• Death • Dislocation : family separation, place to stay• Disabling Impact : physical injury, immediate medical assistant

• Key : Recognizing and prioritizing dysfunctional behaviours

4. Intervention

• Based upon the assessment and prioritization of needs to address, an acute intervention is implemented and designed to : • Attend to basic needs• Mitigate acute psychological distress • Restore acute functional capacity (if possible)

• Simple Structure : 4 Steps 1. Introduce our self2. Ask what happened3. Ask personal well-being 4. Clarify ambiguous descriptors

Types of Intervention

Stabilize • Encourage a task focus• Allow catharsis • Delay impulsive actions • Use distractions

Mitigate Acute Distress• Educate • Normalize • Delay impulsive actions • Stress management technique • Correct misunderstanding or

false information

5. Disposition

• If the person seems more capable of taking care of him- or herself and/or capable of discharging his or her responsibilities, then our intervention has ended • Recommended Follow Up with the person at some point deemed

most appropriate • Sometimes a second follow-up may be useful • However, if a third follow-up seems indicated, it’s probably time to

facilitate access to another level of care

Psychological Awareness Refugees Camp - Aceh

q Karakteristik Rohingnyaq Lack of Psychological Awarenessq Lack of Hygieneq Violence & Aggression (Mongdo vs Sitwe)q Child Abused & Domestic Violence

q Mengelompokkan berdasar homogenitas, ex:perempuan single, suami/ istri, remaja.

q Memberikan informasi umum tentangpsychological awareness dan dampak psikologispaska trauma.

q Diskusi tentang kondisi psikologis mereka &masalah emosi yang dirasakan selama tinggal dicamp pengungsian.

q Activity Daily Living.q Intervention Plan : Individual / Group (Khusus

atau Umum)à IAT (Integrated ADAPT Therapy).

Self Care

• Question to ask before deployment : • Reporting when? • Duration? • Transportation? • Reporting where? • Reporting to whom? contact information? • Authority? • Specific duties? • Safety? • How to handle violence, suicide, acute psychosis

• Remember : • Primary civilian victims experience adverse reactions to disaster, but ... • First responders and others in the helping professions may also be vulnerable to similar

adverse reactions!

Poor Self Care

1. “Burnout” 2. “Compassion fatigue” / Secondary Traumatic Stress (STS)3. Get sick or injured 4. Substance abuse 5. Risk taking/impulsive actions 6. Can’t function effectively7. Guilt (doing something, not doing something)

Burnout Symptom

1. Procrastination 2. Chronic fatigue 3. Cynicism 4. Chronic lateness 5. Difficulty experiencing happiness 6. Pessimism 7. Loss of satisfaction in one’s career or life 8. Questioning one’s own faith

Vicarious Trauma

• Psychological trauma may be contagious • Compassion Fatigue / Secondary Traumatic Stress (STS)• Responders can experience many of same symptoms as survivors:

• Depression • Difficulty sleeping• Startle, hyper-vigilance• Nightmares• Anxiety• Obsessive thoughts of the trauma • Post-traumatic stress disorder• Other symptoms of burnout

Stress Management

•Relaxation • Interpersonal support •Positive attitude •Faith •Self Awareness

PFA Training -PMI Volunteers

1. Basic Mental Health 2. Eustress vs Distress3. Common Reaction After

Disaster 4. PFA 5. Role Play 6. Psychoeducation