INTRODUCTION

A disaster is a severe disruption, ecological and psychosocial, which greatly

exceeds the coping capacity of the affected community. 1 Children may
experience a spectrum of psychological effects across the disaster timeline.
Their reactions vary from normal stress reactions to manifest psychiatric
disorders.
Disasters that occur in any time and place brings subsequent cascade of
secondary stressors and adversities occurring in the aftermath. Psychological
sequelae occur across a timeline generally conceptualized as pre-impact,
impact, and post-impact phases.2
The preimpact phase provides
opportunities to prepare, organize, and train mental health personnel; to
work with community leaders to identify the needs of children and their
families; and to evolve strategies for rapid and effective intervention. The
impact phase occurs when the force of the disaster creates the maximum
likelihood of bodily injury and death. The post-impact phase spans the time
period from the immediate aftermath when rescue and recovery efforts
predominate and when early interventions such as psychological first aid are
administered, through an intermediate phase and the subsequent long-term
recovery period when more intensive psychosocial interventions are
delivered3.
Psychological first aid is a component of the public health, mental health,
medical, and emergency response systems which recognizes that the
foremost concerns during the impact phase and in the immediate aftermath
of a disaster are safety, security, and triage. 4 Psychological first aid can be
administered by non-clinicians to address emotional stress until professional
intervention is available.5

1
2Training Manual Designed to help trainees to help reduce the initial
distress of children by empowering with skills and knowledge of
psychological first aid (PFA)for children. PFA for children can be given
during an emergency situation or immediately after a critical event.
3
4What we will cover in the training What PFA is and is not
Place of PFA in overall response Who, when and where of PFA
Ac&on principles: Prepare, Look, Listen and Link Good
5communica&on skills People who likely need special aQen&on
Adap&ng PFA to the local context Caring for yourself and your
team members(BASED on WHO )
6
7Module 1. Introduction of Psychological first aid (PFA) for children.
8
9Objective: To introduce psychological first aid for children to the
participants
10Materials required: PowerPoint slides.
11
12There are six sessions in training:
13
14Resources:
15
161.This training draws on the Psychological First Aid Field Operations
Guide by the National
17Child Traumatic Stress Network3 and on the Psychological first aid:
Guide for field workers,
18developed by the World Health Organization (WHO), together with
World Vision and
19the War Trauma Foundation4.
20The WHO guide is based on the guidelines presented in The Sphere
Handbook: Humanitarian
21Charter and Minimum Standards in Humanitarian Response5 and the
IASC Guidelines on
22Mental Health and Psychosocial support in Emergency settings6.
National Child Traumatic Stress Network National Center for PTSD
(2006). Psychological First Aid Field Operations Guide. 2nd
23Edition. http://resourcecentre.savethechildren.se/library/psychologicalfirst-aid-field-operations-guide-2nd-edition
244 WHO, World Vision and War Trauma Foundation (2011). Psychological
first
aid:
Guide
for
field
workers
http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf
25
265 The Sphere Project (2011). The Sphere Handbook: Humanitarian
Charter and Minimum Standards in Humanitarian Response. http://
27www.sphereproject.org/handbook/

286 Inter-Agency Standing Committee (2007). IASC Guidelines on Mental

Health and Psychosocial support in Emergency settings. http://
29www.who.int/mental_health/emergencies/guidelines_iasc_mental_healt
h_psychosocial_june_2007.pdf
30
312. Psychological First Aid Training Manual for Child Practitioners: Save
the Children
32

33
Topics to be covered in the training
Session 1 Introduction: PFA

What PFA is and is not

Place of PFA in overall response
Who, when and where of PFA
Session 2: Children's reaction to crisis
Session 3
Action principles: Prepare, Look, Listen and link
Good communication skills
People who likely need special attention
Adapting PFA to the local context
Caring for yourself and your team members

34
35
36
37
38
39
40
41Session 1
42
43
44
45
46Slide: What is Psychological First Aid (PFA) for children?
47
48According to Sphere (2011) and IASC (2007), psychological first aid
(PFA) describes a humane, supportive response to a fellow human
being who is suffering and who may need support. One of the goals of
PFA is to encourage and make the survivors feel able to help
themselves. Since 2002, psychological first aid has been
recommended as a key part of the provision of psychosocial support
following disasters (APS, 2013)6 Psychological First Aid will contribute
to preventing short- and long-term psychological
49problems after traumatic incidents by fostering adaptive functioning
and coping. Psychological first aid covers both psychological and social
support.
50
51
52

53
54Slide: PFA involves the following themes (WHO, 2013):
1. Providing practical care and support, which does not intrude
2. Assess needs and concerns of the survivors
3. Helps people to address basic needs (e.g., food, water,
information)
4. Listens to people but does not pressure people to talk about
traumatic events
5. Comforts and help them to feel calm
6. Helps in connecting people to information, services available,
and social supports
7. Protects people from further harm
55Slide: Psychological first involves factors that seem to be most helpful
to peoples long-term recovery, according to various studies and the
consensus of many crisis helpers7.
56These factors include:
57 Feeling safe, connected to others, calm and hopeful.
58 Having access to social, physical and emotional support.
59 Feeling able to help themselves, as individuals and communities.
60
61Slide Psychological first aid is not:
62
63 Something only professionals can give.
64 Professional counseling.
65 A clinical or psychiatric intervention, although it can be part of good
clinical care.
66 Psychological debriefing.
67 Asking someone to analyze what happened to them or to put time
and events in order.
68 Pressing people to tell you their story.
69 Asking people details about how they feel or what happened.
70
71
72

73Slide: When do Psychological first aid for children provided?

74
75 During an emergency situation or immediately after a crisis event:
76
77 -as part of an immediate response or as part of capacity building
activity in disaster preparedness
78in emergency prone areas, as well as preparation for staff on the global
emergency response list.
79-during or after a crisis affecting a small group of children, such as a fire
at a school, or a robbery.
80- as a first and immediate intervention with vulnerable children in a
non-emergency context, for example with children who have been
sexually or physically abused or neglected, as well as children in
conflict with the law or after accidents.
81
82Slide: Why PFA for children
83 In crisis events, children
84- react and think differently to adults.
85-have specific needs according to their ages
86-and are vulnerable to adverse effects due to their physical sizes and
social and emotional attachments to care-givers.
87Therefore, children need psychological first aid developed especially for
children.
88
89Slide: which children need PFA?
90 Not all children need psychological first aid. Like adults, some children
cope very well with difficult experiences. we need to explore how
children react to stressful events and how to identify children who are
in distress and may need psychological first aid.
91
92Slide: Who can provide PFA
93
94 Basically, all adults who work directly with children can give
psychological first aid.
95These adults include psycho social workers, psychologists and those
who
96work directly with children such as teachers, educators and social
workers, and all others
97who work to support children in a crisis situation.
98
99
100Slide: Where can you provide PFA?
101
-Anywhere specially wherever it is safe enough for yourself and
people you are helping
102
- Preferably with some privacy to protect confidentiality and
dignity of the affected person.

103
104
105Session 2
106
107Session 2: Children's reaction to crisis (Resources: Psychological First aid
training manual for child practitioners_ Save the children)
108Objective: to familiarize and acquaint the trainees with children's
reactions to crisis based on their developmental level.
109Materials: Slides
110Children's common Reactions to disasters
111
112Children will react differently to an earthquake and its aftermath
depending on their age, developmental level, and prior experiences.
Some will withdraw, while others will have angry outbursts. Still others
will become agitated or irritable. We should be sensitive to each
child's coping style. The following are typical reactions children exhibit
following an earthquake or other natural disaster:

Fear and worry about their safety and the safety of others, including
pets
Fear of separation from family members
Clinging to parents, siblings, or teachers
Worry that another earthquake will come
Increase in activity level
Trouble concentrating or paying attention
Withdrawal from others
Angry outbursts or tantrums
Aggression toward parents, siblings, or friends
Increase in physical complaints, such as headaches and stomachaches
Change in school performance
Long-lasting focus on the earthquake, such as talking repeatedly about
it or acting out the event in play
Increased sensitivity to aftershocks, creaking sounds, things falling or
crashing, buildings swaying slightly in the wind, or trembling that occurs
when a big truck drives by
Changes in sleep patterns
Changes in appetite
Lack of interest in usual activities, even playing with friends
Returning to earlier behaviors, such as baby talk, bedwetting, or
tantrums
Increase in teens' risky behaviors, such as drinking alcohol, using
substances, harming themselves, or engaging in dangerous activities
113

114We can summarize that there are some concerns that most children of
all ages have. Most children will show signs of fear that the event will
take place again, and they will worry that their loved ones or they
themselves will be hurt or they will be separated from loved ones. Most
children also react to seeing their community destroyed. All children
react to separation from parents and siblings, and all age groups may
experience changes in sleep patterns or difficulties sleeping, as well as
crying. Children of different age groups, react differently in a crisis
situation.
115
116
117Note that potentially all children have these thoughts, even if they
dont show or share their thoughts and emotions. Children do not
always ask the questions they are thinking about. Perhaps they are
protecting their care-givers from distress. Perhaps they are shy. Maybe
they do not have the capacity to express these thoughts. Be alert to
underlying questions.
118
119
120
121 Slides: Cognitive development describes what kind of development
children have reached in terms of thinking, communicating with others
and understanding of the world around them.
122
123 Childrens cognitive development affects how they react to crises and
difficult experiences.
124
125 Slide: Cognitive development of Children aged 0 to 3 years
126
127 They have no or limited language, so communicate with body
language. They have very little or no understanding of an emergency
or event. Physical contact means comfort to them. The greatest
threat to an infant is to be abandoned. Why?
128
129
130Slide: common reactions for children aged 0 to 3 years:
131
They cling more to their parents.
They regress to younger behaviour.
There are changes in their sleep and eating patterns.
They cry more or are more irritable
They are afraid of things that did not frighten them before.
They display hyperactivity and poor concentration.
There are changes in their play activity:

132- Less or no interest in playing or only playing for short periods,

repetitive play. They may play aggressively and in a violent way.
They can be more opposing and demanding than before.
They can be very sensitive to how others react.
133
134Therefore it is important to be aware of changes in young childrens
behaviour.
135
136
137 Slide: Cognitive development of Children aged 4-6 yrs
138
139A child aged 4 to 6 years has a language, but a narrow understanding
of the world, as everything is centred on the childs personal
experiences. The child does not understand the consequences of
emergencies. Although it is preoccupied with death, it doesnt
understand that, when you are dead, you will never come back.
140The child understands the world through its parents reactions, but at
the same time it hasa vivid inner life. Sometimes the boundaries
between imagination and reality are blurred. Magical or imaginative
thinking is typical.
141
142Slide Cognitive development of Children aged 4-6 yrs condt
143
144The child may think that he or she is the cause of events, and think
that an emergency was his or her fault. The child is seeking the
purpose and reason for why things happen, and sometimes s/he fills in
the blanks with his or her own imagination. This has nothing to do with
lying. It is simply the way a 4-to-6-year-old child makes reason of and
understands the world. At this age, children may remember many
details, but not in the correct order, or the correct places. Active
listening is helpful to understand the childs experiences.
145
146
147Slide: common reactions for children aged 4-6
148

Start clinging to parents or other adults.

Regress to younger behaviour such as thumb-sucking.
Stop talking.
Become inactive or hyperactive.
Stop playing, or start playing repetitive games.
Feel anxious and worry that bad things are going to happen.
Experience sleep disturbances, including nightmares.
Changes in eating patterns.

Become easily confused.

Be unable to concentrate well.
At times take on adult roles.
Feel irritability.

149
150Slide Cognitive development of Children aged 7-12 yrs
151

Still thinking concrete, but also some abstract and logical thinking
Deeper understanding of how things are linked together, such as cause
and effect,risks and vulnerabilities
Interested in facts

Understand that death is for ever

Understand loss

They struggle with change,

divide the world into good-evil, right-wrong, reward-punishment etc.

They still practice magical thinking sometimes.

152
153Slide: Common reactions for children aged 7-12 yrs
154

Their level of physical activity changes.

They feel and behave confused.
They withdraw from social contact.
They talk about the event in a repetitive manner.
They may be reluctant to go to school.
They feel and express fear.
They experience a negative impact on memory, concentration and
attention.
They have sleep and appetite disturbances.
They show aggression, irritability or restlessness.
They have somatic complaints (physical symptoms related to
emotional stress).
They are concerned about other affected people.

They experience self-blame and guilt feelings.

155

156Slide Cognitive development of Teens: Transition from child to

adult
157
158Children are often preoccupied with wanting to define themselves in
relation to others during the transitional teen years. Even though the
child is still attached to the family, peers play a very important role as
the child gradually gets engaged in social life. They have a growing
understanding of others perspectives, even if they are different to
their own, and they understand the seriousness of an emergency
situation from their own viewpoint as well as from others viewpoints.
Teens start to feel a strong sense of responsibility for the family, and
some are already family breadwinners. Guilt and shame are also
common feelings during this period.
159
160Slide: Common reactions for teens
161
Feel intense grief
Feel self-conscious or guilt and shame that they were unable to help
those who were hurt
Show excessive concern about other affected persons
May become self-absorbed and feel self-pity
Changes in interpersonal relationships
Teenagers may also start taking risks, engage in self-destructive
behaviour, have avoidant
162
behaviour, and become aggressive.
Experience major shifts in their view of the world,
a sense of hopelessness about the present and the future.
Become defiant of authorities and parents, while they start relying on
peers for socializing.
163
164Slide :( Summarize) How children react depends on...
165
Age, developmental stage
How others, especially parents and care-givers, react
What they have experienced
Past experiences such as abuse, family violence and neglect
166Remember that children understand events differently than
adults.
167

1 World Health Organization. Psychosocial Consequences of Disasters: Prevention and Management. Geneva, Switzerland:
World Health Organization, Division of Mental Health; 1992, page 7.

2 Shaw JA, Espinel Z, Shultz JM. Care of Children Exposed to the Traumatic Effects of Disaster. Washington DC:
American Psychiatric Press; 2012.

3 Practice Parameter on Disaster Preparedness Betty Pfefferbaum, M.D., J.D., Jon A. Shaw, M.D., and the American
Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) JOURNAL OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRYVOLUME 52 NUMBER 11 NOVEMBER 2013

4 National Institute of Mental Health. Mental Health and Mass Violence: Evidence-Based Early
Psychological Intervention for Victims/Survivors of Mass Violence. A Workshop to Reach Consensus
on Best Practices. NIH Publication No. 02-5138. Washington, DC: United States Government
Printing Office; 2002.

5 Reyes G, Elhai JD. Psychosocial interventions in the early phases of disasters. Psychotherapy: Theory,
Research, Practice, Training. 2004;41(4):399-411
6 aaaaaaaaaaaaaaau
7

WHO, World Vision and War Trauma Foundation (2011). Psychological first aid: Guide for field workers
http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf