Psychological Association of the Phlippines

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WHO publication www.who.int

Collaborative effort: World Health Organization War Trauma Foundation World Vision International

Endorsed by 24 UN/NGO international agencies

Available in several languages

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Situationer in Yolanda MHPSS Response Models PAP’s MHPSS plans Guiding principles in provision of

psychosocial support What Psychological First Aid is and is not Place of PFA in overall response Frequent needs of survivors Key resilience factors Who, when, where and how PFA Do’s and Don’ts

  Mortality InjuriesRegion 4A – Quezon, Batangas 4  2

Region 4B - Palawan 7

Region 5 (Camarines Norte, Masbate) 5 21

Region 6 (Iloilo, Aklan, Capiz, Antique) 191 228

Region 7 (Cebu, Bohol) 74 102

Region 8 (Samar, Leyte, Ormoc,Biliran) 3725 17,821

  3,976 18, 175

Source: National Risk Reduction and Management Council. As of Nov 18, 2013

ALL Have lost home/propertyFinancial concerns

SOMEInjured because of disasterAt risk of losing life during disasterSeparated from their familiesLoved ones missing or deadHas physical disability/ illnessExperienced violenceAre in the wrong placeAssisted with rescue

Goals: To enable delivery of MHPSS in the form of: Public education and information related to coping Psychological First Aid Specialized services Community recovery

by Empowering local psychologists in the region so they can

provide sustained MPSS in affected areas Collaborating with partners and other providers of

MHPSS to ensure systematic and holistic approach to recovery

Building capability, using common principles, approaches, tools, and materials to ensure consistent approach and protection of human rights in delivery of psychosocial support

Creating a coordinating structure to enable synergy and synchronize efforts

MHPSS COORDINATING HUBS

LGU MPSS

GOs (DOH, DSWD, DepEd)

NGOS

PAP MHPSS Committee

Region 6 Region 7Region 5Region 4B Region 8

Training Documentation & Evaluation

Resource Generation& Management

Information & Communication

PAP PARTNERS

Villamor Airbase

Knowledge Management

Special Groups

Psychology Departments, Centers and Clinics

Individual Members

TYPE OF VOLUNTEER

ROLE QUALIFICATION

Team Leader (2 at a time)

Orient volunteersDebriefing of volunteersHandle special cases

Graduate level education in Psychology WITH experience in crisis intervention

PFA Volunteers Conduct PFA Psychology alumni or graduate studentsAllied helping professions (religious, social workers, nurses, counselors, teachers)WITH experience/training in facilitation or counseling

Counselor Assistants

assist the PFA counselors and team leaders in documentation and other logistical and administrative concerns

Junior and Senior undergraduate students.

ENSURE SAFETY Avoid putting people at further risk

PROTECT DIGNITY Respect social norms

UPHOLD RIGHTS Fairness and non-discrimination in

access to services

Primary focus on physical and material care and protection from danger

Immediate intervention: Be direct, active and remain calm

Focus on “here and now”

Provide accurate information on situation

Do not give false assurances

Recognize the importance of taking action

Reunite with family and friends

Provide and ensure emotional support

Focus on strengths and resilience

Encourage self-reliance Respect feelings of

others Psychosocial Interventions; A Handbook. By the International Federation of Red Cross and Red Crescent Societies; Reference Centre for Psychosocial

Disaster response (first two weeks  of the incident)

Focus on: practical, pragmatic needs info on  support and referral systems education of normal responses to  trauma &

coping

Approach recommended by the UN, WHO, Red Cross and those doing Humanitarian Work during Emergency Situations

1. Recreate a sense of safety2. Establish useful connections to their

immediate needs3. Re-establish a sense of efficacy

It is NOT crisis counseling or “psychological debriefing” Requires survivors to re-live distressing event Critical incident stress debriefing (CISD) has

actually found to be harmful for some survivors

It is NOT asking people to analyze what happened or put time and events in order To expect them to have insight at this time is not

realistic

Although PFA involves being available to listen to people’s stories, it is NOT pressuring people to tell you their feelings or reactions to an event

CISD

1. Introduction2. Fact Details of

events3. Thoughts4. Reactions5. Symptoms6. Teaching7. Re-entry

PFA

1. Contact 2. Safety & Comfort3. Information

Gathering4. Stabilize5. Practical

Assistance6. Coping7. Linking with

services NOTE: There is evidence that CISD soon after a disaster may be more harmful and impairs natural recovery because it requires survivors to re-live their experiences before they have even achieved psychological safety!

ALL Have lost home/propertyFinancial concerns

SOMEInjured because of disasterAt risk of losing life during disasterSeparated from their familiesLoved ones missing or deadHas physical disability/ illnessExperienced violenceAre in the wrong placeAssisted with rescue

Basic needs: shelter, food, water, sanitation Health services for injuries or help with chronic

medical conditions Understandable and correct information about

event, loved ones and available services Being able to contact loved ones Access to specific support related to one’s

culture or religion Being consulted and involved in important

decisions

People do better over the long-term if they… Feel safe, connected

to others, calm & hopeful

Have access to social, physical & emotional support

Regain a sense of control by being able to help themselves

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Basic services and security

Community and family supports

Specialisedservices

Focused (person-to-person) non-specialised

supports

Strengthening community and family supports

Social considerations in basic services and security

Advocacy for basic services that are safe, socially appropriate and protect dignity

Activating social networks Communal traditional supports Supportive child-friendly spaces

Basic mental health care by PHC doctors Basic emotional and practical support by community workers(Psychological First Aid)

Mental health care by mental health specialists (psychiatric nurse, psychologist, psychiatrist etc)

The place of PFA

in overall mental health

and psychosocial

response

The place of PFA

in overall mental health

and psychosocial

response

Examples:

Very distressed people who were recently exposed to a serious stressful event.

Can be provided to adults and children Not everyone who experiences a crisis

event will need or want PFA. Don’t force help on those who don’t want

it, but make yourself available and easily accessible to those who may want support

People with serious life-threatening injuries

People so upset they cannot care for themselves or their children

People who may hurt themselves People who may hurt or endager the

lives of others

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Upon first contact with very distressed people, usually immediately following an event, or sometimes a few days or weeks after.

1. Contact 2. Safety & Comfort3. Information Gathering4. Stabilize5. Coping6. Practical Assistance7. Linking with services

Source: Psychological First Aid. Naitonal Center for PTSD

Introduce self & role Ask permission to ask questions so you

can help them

Ako po si ___________. Volunteer po ako mula sa Psychological Association of the Phlippines. Maaari ba akong magtanong para kumuha ng impormayson at matulungan namin kayo?

Check if they have eaten or if there is something they urgently need

Nakakain na po ba kayo? Meron po ba kayong kailangan bago tayo magusap?

Identify nature and severity of experiences. But if survivors would rather not relay experiences - don’t force them!

Gusto niyo bang magkwento sa akin tungkol sa pinagdaanan ninyo dito sa bagyo?

Check for signs they are overwhelmed or disoriented

Kamusta ang pakiramdam ninyo ngayon?

But affirm normal signs of trauma Hindi kakaiba na ito ang inyong

nararamdam. Huwag kayong mag-alala, kahit sino ang nakaranas ng ganitong sitwasyon ay ganoon din ang mararamdaman

ADULTS

Elevated heart rate Elevated blood pressure Elevated blood sugar Stomach upset, nausea Gastrointestinal

problems (diarrhea, cramps)

Sleep difficulties With extended stress,

suppression of immune system functioning

CHILDREN

Headaches Stomachaches Nausea Eating problems Other physical

reactions

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ADULTS

Fear and anxiety Sadness and depression Anger and irritability Feeling, withdrawn Feeling a lack of

involvement or enjoyment in favorite activities

Feeling a sense of emptiness or hopelessness about the future

CHILDREN

Anxiety, fear, vulnerability

Fear of reoccurrence Fear of being left alone

Especially if separated from family during event

May seem like an exaggerated reaction to adults

Loss of “Sense of Safety” Depression Anger Guilt

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ADULTS

Difficulty concentrating Difficulty with memory Intrusive memories Recurring dreams or

nightmares Flashbacks Difficulty

communicating Difficulty following

complicated instructions

CHILDREN

Confusion and disorientation

Difficulty concentrating

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ADULTS

Family challenges (physical, emotional abuse)

Substance abuse Being overprotective of family Keeping excessively busy Isolating self from others Being very alert at times,

startling easily Problems getting to sleep or

staying asleep Avoiding places, activities, or

people that bring back memories

CHILDREN

Childish” or regressive behavior▪ May not be deliberate

acting out

Bedtime problems▪ Sleep onset insomnia

▪ Midnight awakening

▪ Fear of dark

▪ Fear of event reoccurrence during night

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BE MINDFUL OF THE CHILDREN – make sure that you are able to observe and/or ask about how they are doing.

They may not vocalize their needs as adults do; their needs may not be manifested in explicit or “adult” ways.

Reliance upon faithQuestioning values and beliefsLoss of meaningDirecting anger toward GodCynicism

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Looking glassy-eyed and vacant Unresponsive to verbal questions Extreme disorientation Uncontrollable crying, hyperventilation, rocking, or

regressive behavior Uncontrollable physical reactions (trembling,

shaking) Frantic searching behavior Feeling incapacitated by worry Thinking of harming oneself Feeling numb/disconnected Agitation/violent behavior Extreme fear or anxiety

Obtain information on coping Affirm positive strategiesProvide information if necessary

Ano ang ginagawa ninyo para matulungan ang inyong sarili?

Mabuti naman na….Baka gusto ninyo subukan…..

Common Coping Strategies

1.1. Accepting (pinapasa-Diyos)Accepting (pinapasa-Diyos)2.2. Escape (laughing, entertainment)3.3. Reframing Reframing 4.4. PrayingPraying5. Taking Action to Rebuild 5. Taking Action to Rebuild 6. Seeking Social Support 6. Seeking Social Support 7. Deep Breathing/ Relaxation/ Visualization7. Deep Breathing/ Relaxation/ Visualization

Follow a normal routine as much as possible.Be careful not to skip meals.Exercise and stay active. Help other people in your community as a

volunteer. Stay busy. Accept help from family, friends, co-workers,

or clergy. Talk about your feelings with them.Don’t dwell on TV, radio, or newspaper

reports on the tragedy.

DO highlight adaptive coping strategies.“Nakakatuwa na kahit na may trahedya, kaya pa rin natin

makipagtulungan at makipagtawanan.”

DO highlight strengths (positive traits).“Nakikita ko sa’yo na ikaw ay isang taong mabilis bumangon o

mataas ang kakayahan na bumangon sa isang trahedya.”

DO highlight resources.

“Napansin ko sa kwento mo na marami naman ang tumutulong sa’yo, pamilya mo, mga kamag-anak, kapitbahay at kaibigan.”

How do we steer paradigms from victims to SURVIVORS?

Identify needs

Ano ang pinaka-kailangan ninyo sa ngayon?

Thank them. Getting them the help they need –

guide them to specific station

Salamat po sa inyo….Dadalhin ko na po kayo sa….

If you are going to do PFA, make sure you have a network or are working with other organizations who can provide for other needs of individuals

Otherwise, it will just frustrate people if you ask them what their needs are without being able to help them find solutions

Use PFA Framework and Process Practice empathic listening skills Respect people’s right to decide not to

disclose Be aware of your own biases and set

them aside Respect people’s privacy and their

stories Behave appropriately according to

survivor’s age, gender & culture

Force people to share their stories Give simple reassurances or promises

you cannot keep Tell people what they should or should

not think or feel Lecture or preach Pray over/with them without asking if

they want it Criticize service workers/operations in

front of survivors