Welcome to psychological first aid PFA training.

Training objectives. When you’ve successfully completed this training, you should be able to do the following. Explain what psychological first aid PFA is. Describe the who, when, and where of PFA. List the PFA action principles. Recognize the people and groups who may need special attention and know how to care for yourself and your team members.

In the resources section at the top of the screen, you’ll find a printable psychological first aid kit PDF to help you remember important concepts from this training. You will want to keep this document open or save it or print it out so you can access it later.

Before continuing, it is important to start with care for yourself. As helpers in crisis situations, we need to take extra care of our own well-being so we can best take care of others. Please take a moment to reflect upon the following questions. What do you do to take care of yourself and manage your stress? How does your team, colleagues, family, etc. take care of each other? Open your psychological first aid kit from the resources section of this training and record your responses on the self-care assessment. We will come back to your responses at the end of this training.

Let’s talk about what psychological first aid PFA is.

What PFA is? Psychological first aid is a way to provide humane, supportive, and practical assistance for people experiencing distress in ways that respect their dignity, culture, and abilities.

We do this through non-intrusive practical care and support. Assessing needs and concerns, helping people to address basic needs. Listening but not pressuring people to talk. Comforting people and helping them to feel calm, helping people connect to information, services, and social supports and protecting people from future harm.

What PFA is not. It is important to remember that PFA is not something only professionals can do. Is not professional counseling. Is not psychological debriefing. This term refers to a specific type of intervention in which people who have recently suffered a crisis event are asked to briefly but systematically recount their perceptions, thoughts, and emotional reactions to the event. Is not asking people to analyze what happened or put time and events in order. Although PFA involves listening to people, it is important not to pressure people to talk or tell their experiences if they do not want to.

The IASC mental health and psychosocial support pyramid adapted with permission shows the place of PFA in the framework of overall mental health and psychosocial response after a crisis event.

The bottom layer of the pyramid shows the need for basic services and security which need to be delivered in a safe and socially appropriate way so as not to undermine people’s dignity or wellbeing.

On the next layer above, many people will likely need interventions that strengthen community and family supports.

As we move up the pyramid, some people will need focused non-specialized support. This includes basic mental health care and basic emotional and practical support such as PFA.

As we go to the top of the pyramid, a small minority of people will need clinical support which may consist of medicines or psychotherapy and which typically involves care by a primary healthcare clinician or a mental health professional.

Describe the who, when, and where of psychological first aid.

Who appropriate to receive PFA. PFA is appropriate for the following. Distressed people who were recently exposed to or triggered by a serious stressful event, adults or children. Note, PFA can be offered to anyone regardless of age, gender, social status, etc., but not everyone will want or need PFA. It is important never to force help on anyone who doesn’t need it and also to make the best use of the resources you have. You may not be able to help everyone. PFA is intended for people who are in distress.

Not appropriate to receive PFA. PFA is not an appropriate intervention for people with serious life-threatening injuries who are so upset they cannot care for themselves or their children, who may hurt themselves, or who may hurt or endanger the lives of others.

When PFA can be administered. Upon contact with a person who is in distress, which can be immediately after a crisis or traumatic event, a few days or even weeks after an event, and even much later on when someone is triggered or affected by a crisis or traumatic event.

Where PFA can be administered. Anywhere safe enough for you to be. The most important issue in terms of where to offer PFA is safety for yourself and the person you are helping. You don’t want to get hurt yourself by going into an unsafe area to offer assistance, nor do you want to put anyone you are helping in any further danger. In certain situations, it may be helpful to have some privacy when offering PFA. Privacy can be important for the dignity of the person. An example might be if you are talking to someone who has experienced a sexual assault where it may be difficult and possibly unsafe to share details in a crowded space. However, there may be ethical or cultural reasons to be careful about talking with someone alone in a private space. Be careful about real or perceived exploitation or abuse of anyone, especially children in a private space.

List the PFA action principles. PFA is designed to meet the needs of people in crisis, including needs for practical help, emotional support, and connection with information and services. It is also designed for helpers to have a framework to be prepared to help and to have the necessary skills and resources to best support anyone who may be in distress.

In this section, we will learn about PFA action principles. Prepare, look, listen, and link.

Step one, prepare. If someone comes to you in distress, it can be a lot to manage. It is helpful to refresh yourself on PFA principles and potential referral resources.

Step two, look. Common distress reactions include weeping, grief and sadness, anxiety, fear, physical symptoms such as shaking, headaches, fatigue, loss of appetite, aches and pains, anger, irritability, and being on guard or jumpy. Less common distress reactions include being immobile, withdrawn, feeling confused or emotionally numb, disoriented, and not responding to others or not speaking. While less common, these reactions are generally more concerning and may warrant professional psychological or medical care.

Most people experiencing distress recover well, especially if their basic needs are met and they receive support. However, people with severe or long-lasting distress may require additional support. In those situations, try to stay with the person and calmly refer the individual to services.

Step three, listen. Here are key steps of good listening in PFA. Make contact. Introduce yourself by name and organization. Ask the person if you can provide help. Help them feel comfortable and ensure you are talking in a safe and appropriate setting. Ask about needs and concerns. Even if needs and concerns are obvious, it is best to ask the person what they need. If someone has multiple needs and concerns, understand which are most important to address.

Listen and help the person feel calm. Listen openly and do not pressure them to talk. If the person is very distressed, consider referring them to a qualified provider. If someone is feeling overwhelmed, ground or reorient them to themselves, their surroundings, or their breath.

Good communication includes finding a quiet place to talk and minimizing distractions, respecting privacy and confidentiality when appropriate, staying near the person while keeping an appropriate distance based on age, gender, and culture, letting them know you are listening, being patient and calm, providing factual information if available, being honest about what you do and do not know, giving information simply, acknowledging how they are feeling, acknowledging their strengths, and allowing silence.

Bad communication includes pressuring someone to tell their story, interrupting or rushing, touching without knowing if it is appropriate, judging what they have or haven’t done or how they feel, making up information, using overly technical terms, telling someone else’s story, talking about your own troubles, making false promises or reassurances, or speaking about the person in negative terms.

Step four, link. A helper’s role is not to solve the problems presented but to help the person address their own needs. This includes linking them with information, services, and social supports. Help people address basic needs by asking what they need and identifying referral resources. Help people cope with distress by prioritizing urgent needs, identifying supports in their life, offering practical suggestions, and reminding them of past coping strategies. Give accurate, up-to-date information and referrals if requested. Connect people with social support when needed. Conclude PFA by explaining you are leaving and sharing relevant referral information.

Positive coping strategies should be culturally appropriate and include getting enough rest, eating nutritious food and drinking water, spending time with family and friends, discussing problems with someone trusted, enjoying relaxing hobbies, avoiding drugs and alcohol, exercising, and attending to personal hygiene.

Recognize people and groups who may need special attention. These include children and adolescents, people with health conditions or disabilities, and people at risk of discrimination or violence.

Children and adolescents, especially those separated from caregivers and girl children, are particularly at risk. In crises they may lose routines, environments, and people that make them feel safe and may be unable to meet basic needs or protect themselves. Separated children are at risk of trafficking, sexual exploitation, or recruitment into armed forces.

Things you can do for children and adolescents include connecting unaccompanied children with child protection agencies, keeping them safe from distressing scenes or media, and listening, talking, and playing with them using calm language at their eye level.

Know how to care for yourself and your team members. Self and team care are essential responsibilities of helpers. Reflect on stresses you have experienced or might experience while providing PFA and review your self-care responses from the beginning of the training. Update your self-care follow-up in your psychological first aid kit.

Helpers should be connected with an organization or agency for safety and coordination. Check in with fellow helpers and allow them to check in on you. When your role ends, take time for rest and reflection and talk with someone you trust.

Providing psychological first aid can take a toll. Helpers should recognize when they need PFA themselves. If experiencing upsetting thoughts, persistent sadness, sleep problems, or reliance on drugs or alcohol more than one month after support ends, seek additional help.

Resources include the National Alliance on Mental Illness, NAMI Helpline, National Suicide Support Hotline, National Human Trafficking Hotline, Domestic Violence Support Hotline, and LGBTQA+ Suicide Prevention Hotline.

Congratulations, you have completed this training.