Operational Teachers Training for Tsunami Affected Area

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OPERATIONAL TEACHERS TRAINING FOR TSUNAMI AFFECTEDAREA

SCHOOL BASED PSYCHOLOGICAL SUPPORT TRAINING FOR TEACHERS

Dr. Joseph O. Prewitt DiazMs. Anjana Rajesh

Dr. Satyabrata DashGraphics and designing: Manasi Mewari

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FOUNDER OF RED CROSS: JEAN HENRY DUNANT (8th May, 1828 to 30th to

October, 1910)

History The history of the International Committee for Red Cross began on a battlefield atSolferino on June 1859. Henry Dunant, a 31 year- old businessman from Geneva, was

travelling to meet the French Emperor Napoleon III; while the latters armed forces werefighting the Austrian troops. In this battle, more than 40,000 soldiers were dead or wounded.Dunant improvised first aid methods with the women of neighboring villages and providedboth medical and psychological help. He returned to Geneva a few days later but remainedhaunted by what he saw on the battlefield. In 1862, he published a book A Memory ofSolferino, in which he launched two proposals: that an international treaty be adopted torecognize the immunity and neutrality of the medical personnel bringing aid to the woundedsoldiers, that in all countries relief societies be formed to assist the wounded soldiers inwartime. The book proved an immense success and travelled throughout Europe to gainfurther support for his proposals.On 17 February 1863, with the support of four prominent citizens of Geneva, he founded the

International Committee for Relief to the wounded, which was to become the ICRC in 1875.

The Seven Fundamental Principles of Red Cross

Humanity

Impartiality

Neutrality

Independence

Voluntary service

Unity

Universality

The Red Cross EmblemIt is an emblem, which is used by those belonging to the Red Cross Movement and Army

Medical Services who are involved in humanitarian work mainly in times of armed conflicts andnatural disasters. It is not the emblem of medical professions and its use is regulated byinternational and national laws. It has been universally accepted. Unauthorized use of theemblem in India is a punishable offence.National Red Cross and Red Crescent Societies represent the work and principles of theInternational Red Cross and Red Crescent Movement in more than 176countries. Red Cross andRed Crescent Societies also offer psychological support and social welfare services to the needy intheir communities

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ACKNOWLEDGEMENTS

This manual has been produced with technical and financial contribution of the American RedCross. The authors are responsible for the views expressed herein. The first edition of this manual

was produced in 2003. The second edition has been developed based on the lessons learnt and

experiences of the people who used the formal edition. We hope that this American Red Cross

Manual is to be used for preparedness of teachers, students, and parents so that crises may be

dealt with in a timely manner and wisely.

For further information about the Indian Red Cross Societys (IRCS) efforts to develop psychological

support programs, contact:

This manual is dedicated to the millions of people of India who have experienced crises and have

overcome their grief and losses. They have moved from victims to victors.

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CONTENTS

TITLE Page No.

Introduction: 5

How to use the manual? 6Lesson plans for Module I: Disasters, crises and Emergencies 8

Types of disaster 11The elements of crisis 13Psychosocial needs 16Preparing schools for disaster, crisis and emergencies 17Risk and resources mapping 18What is risk reduction 22Session Guidelines for Module II 28Lesson Plan for Module II: 30Common stress reactions in children 31Recognizing the ability of children and adolescents to deal with crisis 35Helping children and adolescents to become resilient in school 40Session Guidelines for Module III 47Lesson Plan for MODULE III: PSYCHOLOGICAL FIRST AID 49Relevance of PFA for disaster, emergency and crisis 50The concept of distress and stress 53Importance of non-verbal communication 57Implementation of PFA 62

Guidelines for accepting the feelings of the survivor 66General principles of PFA 67Organization of emotional support brigade 72Roles of a brigade before the disaster 74Session Guidelines for Module IV 76Lesson Plan for Module IV 78

Stress Management and self care for Teachers 79Self-care for teachers and volunteers 80Spiritual self-care 82Importance of self-care 84

References 86

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INTRODUCTION

GOAL OF THE COURSE:Develop the capacity to prepare for crisis, emergencies and disasters in the school and prevent theemotional damages caused.OBJECTIVES:

Describe crisis, disasters and emergencies.

Promote resilience in children and adolescents.

Plan classroom activities that can develop resilience in children.

Teach basic skills to deliver psychological first aid.

COMPONENTS:

MODULE I: DISASTERS, CRISES AND EMERGENCIES IN SCHOOLS

MODULE III: PSYCHOLOGICAL FIRST AID FOR TEACHERS

EXPECTED OUTCOMES:After attending the workshop, participants will be able to:

1. Distinguish with examples between crises, disasters and emergencies2. Recognize at least five symptoms that show emotional distress in children3. Adopt at least two participatory methods to help childrens self-expression4. Identify and carry out at least three psychological support activities in the school.5. Enumerate at least five principles of PFA.

6. Deliver the five steps of PFA.

In each of the expected outcomes, the participants should reach a performance level of atleast 70% in the posttests.

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HOW TO USE THE MANUAL ?

The methodology used in the modules is participative and interactive, with more emphasis on

brainstorming, group work, role-plays and the workshop method rather than lectures and

presentations. Energizers are activities that are meant to recharge the group when they might be

tired or losing concentration.Procedures are given as a guideline to conduct each of the activities.

Suggestions for making the Training more effective.

Read each module carefully before implementation.

Keep number of participants for each session from 10 to 15, ideally.

The method adopted to present the module is based on experiential learning, which encouragesparticipation and interaction and creates a relationship within the group. The process facilitates

discussion on the topic and aims to establish a participatory process of work between the facilitator

and the participants.

The planned duration of the three modules in Phase I is 16 hours.

Phase II which consists of three modules should be covered within two months. It need not be a

Module a day. Lesson plans to be made by the instructor as per the requirements of the class.

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LESSON PLAN FOR ALL MODULES

OBJECTIVE OF THE SESSION:

SUGGESTED TIME : 8 HOURS (including lunch and tea break)

SUGGESTED TECHNIQUES- Brainstorming- Lecture- Group work- Role plays- Exercises

MATERIALS TO USE:Pens, paper, pencil, eraser, slide, flip charts, participants handbook.

PRELIMINARY DETAILS- Greet the participants and introduce yourself and your colleague.- Distribute the material (notebooks, pens, handouts) to participants.- Ask the participants to introduce themselves.- Ask the participants to write down their expectations about the course.- Give the pre-test to the participants- Give an introduction about the objectives of the course.

- Start the presentation- At the end give the post-test to the participants.

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Lesson plan

MODULE IDISASTERS, CRISES AND EMERGENCIES

INTRODUCTION:

Elaborate on the objectives.

(1) Define disaster and crises

(2) Outline the cycle of disasters

(3) Assess and prepare a map of risks and resources in the school

(4) Discuss the risk reduction steps in each phase of a disaster

Expected outcome:

The participants will be able to

1. Define disasters, crises and emergencies with examples2. Describe the stages of the cycle of disasters3. Prepare a map of five risks and resources of a selected school4. Name at least two risk reduction activities to be undertaken in each stage of a disaster.

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1. WHAT is a DISASTER, CRISIS or EMERGENCY?

Define a disaster, crisis and emergencyProcedure:

1. Give three cards to each of the participants and ask them to write a definition ofcrisis, disaster and emergency in each.

2. Put a large poster on the board with a man, a woman and a child saying adisaster is, a crisis is, and an emergency is.

3. Put up each of the definitions that the participants came up with under the figures.4. Put up the definitions provided by you.5. Brainstorm on the examples of each of them and write them on individual cards.6. Stick the cards under the def of each term.

EMERGENCY DISASTER CRISIS

Def: A sudden unforeseen

event (usually involvingdanger), which requiresimmediate action.

Def: An occurrence

disrupting the normalconditions of existence andcausing a level of sufferingthat exceeds the capacity ofadjustment of the affectedcommunity (WHO, 2002).

Def: A crisis can be

defined as an eventthat exceeds apersons ability tocope with the presenttime.

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Activity 1:


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Examples:FiresDust storms

Examples:EpidemicsRiots

Examples:A child losing one ofhis/her parents or family

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Exercise on disaster, crisis, and emergency 1. Divide participants into two groups.

2. Make cards with the following examples written on them1. Earthquake

2. Floods3. Fires4. Dust storms5. Food poisoning in the school6. Snake bites or other insect bites and stings7. Epidemics8. Riots9. A child losing one of his/her parents or

family members10. Physical injuries while playing11. A child suffering from an illness or disability

12. Cyclones13. Bomb blasts14. A child belonging to a poor family15. Road, rail and industrial accidents16. A child being punished at school17. A child not able to make friends18. Pollution19. Family Problems20. Heavy rains

3. Shuffle the cards and distribute 10 cards to each group. As them to identify which

is a disaster, which a crisis and which an emergency..

Activity 2.


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Heavy rainsFood poisoningSnake bites or other insectbites and stingPhysical injuries whileplaying

EarthquakesFloodsCycloneBomb blastRoad, rail and industrialaccidentsPollution

membersA child suffering from anillness or disabilityA child belonging to apoor familyA child being punished atschool

A child not able to makefriendsFamily problems

1.1. Types of Disaster:Disasters can occur by a natural phenomenon or be caused by human beings.

-- Natural disaster. Events, which are unexpected and unavoidable because they occur withoutwarning and are caused by natural forces are called natural disasters. They are threats that cannotbe practically controlled. However, floods, droughts and landslides can be controlled or reduced bycivil works, such as dams, planting of trees and preparing for disasters in the school and the

community.

Examples of natural disaster are:

Disasters caused by human beings. Events, which cause seriousDamage to life and property and occur due to human negligence or

Carelessness.

Examples of human made disasters are:

- Bomb blasts- Fires

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- Road, rail and industrial accidents- Pollution- Riots

Fire in the school building is an emergency

1.2 Common reactions to a crisis:

Experience sharing1. Give each participant 5 minutes to think about an event in their life, which

they see as a crisis.2. Let each member share the following:

a) How did you feel?b) What did you do?c) Who or what helped you cope?

3. Explain that crisis is a personal event. It affects the individual in differentways. Anyone can have a crisis. It is not necessarily a mental illness.

1. Shock , disbelief and denial - I cannot believe this is happening to me.2. Fear I am scared of the dark.

Anger Nobody is doing anything for us.3. Confusion- I dont know what to do 4. Guilt If only I was at home when it happened, I could have saved.5. Anxiety is expressed by headaches, stomachaches, excessive sweating.)

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Activity 3:


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Survivor mother/father next to dead child

2. Disaster Mental Health and Psychosocial Care

2.1 What is Disaster Mental Health ?

A field of practice designed to help the survivors (and the relief workers who rush to theiraid) learn to effectively cope with the extreme stresses they will face during and in theaftermath of a disaster. (Weaver, 1996)

Disaster Mental Health is helping people to come together and respond collectively to a crisis ordisaster event.

2.2. What is Psychosocial Care ?

Role Play:Scenario: A child sees his father mistreating his wife one morning. He goes toschool. How will the child behave in school?Guidelines:

1. Ask three volunteers to come forward.2. Two of the volunteers will play the child and his classmate. The child will be

aggressive and fight with the other. He will not listen to the teacher.3. The third will be the teacher.

Guidelines for discussion:1. How did the child feel ?

2. Why did the child behave that way ?3. Do you think the thoughts and feelings of the child are a cause for his

behaviour in school ?

PSYCHO refers to the inner person his or her feelings, thoughts, values and beliefs.

SOCIAL refers to the persons external relationships with the people in his/her environment.

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The internal (Psycho) and the external (Social) interact and influence eachother(Annan, Castelli, Devreux, Locatelli, 2003).

For example, the child in the role play is aggressive and rebellious in school because he isangry with his parents. He has possibly seen violence at home. He needs to express hisanger towards his parents. The teacher can allow him to ventilate his feelings. The

psychosocial support he needs is to receive comfort from his teacher.The cycle of support

2.3. Psychosocial Needs:

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Exercise on Needs :On the basis of the following questions -1. What needs do we have in our daily life ?2. What are the things that we need to become healthy, functioning and

happy human beings ?3. What needs do children and adolescents have ?4. What needs do adults have ?

The participants will be divided into 3 groups.. One member from eachgroup will present the important needs of a person according to theirstage of life. After the presentations of each group leader, the instructorwill discuss the relevance of the needs as per the different categories.

Guidelines for discussion:1. Are your needs the same as your desires? For example, Food is a need,

to own a house is a desire based on the need to have independence, self-respect.

2. Can you differentiate between your material, social and psychologicalneeds ?

3. Do you tend to forget about your emotional needs ?

We can differentiate our needs in the following categories:

Material

Food

ShelterClothingMedical CareSecurity/protectionMoney/assets

Social

Family

Friends/neighborsSchoolReligious groupsCultural groupsCommunity activities

Psychological

Parental love and care

Values/beliefsSpiritual guidanceSense of belongingRecognitionRespectIndependenceLove/companionshipResponsibilitiesPeaceUnityFreedom

(Adapted from Annan, Castelli, Devreux, Locatelli (2003). Handbook for Teachers. AVSI:Uganda)To be happy, every individual needs love and care as much as food and a house to live in.A child grows up and is influenced by the interactions s/he has with peers, familymembers, teachers, and neighbors. Her/his needs of love, affection, acceptance are metthrough these interactions.

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Activity 5:


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Psychosocial needs of a child are dependent on the way s/he communicates the need,the way it is received and the response s/he gets. This can influence his/her behavior andthe way the childs inner strengths are developed.

For example,

Friends Trying to do small things for Given small tasks and Social skills Teachers and friends responsibilities Confidence

Brainstorm1. Can you share some experience where children have expressed a

need?2. What was the behavior, which expressed the need?

3. Do you think you have been able to identify psychosocial needs in anyof your students?4. What are some of the psychosocial needs that you as a teacher have?

4. PREPARING SCHOOLS for Disasters, Crises and emergencies

Gunjan (name changed) was the brightest student in the school. She was

asked to hoist the Indian flag on Independence Day in the assembly. As she

stood at the dais, there was a terrible noise and a big piece of the school roof

fell on Gunjan. The entire school, all her friends and classmates watched

Gunjan die under that piece of concrete and metal.

To this day, two years after the Gujarat earthquake, the children in the school

have not been able to forget the incident.

Disasters, Crises and emergencies can affect a school at anytime. Preparedness in school is veryimportant because children need a supportive and protected environment in school wherein theyare able to feel safe. A protective environment comprises a positive, secure interaction with othechildren, parents and teachers, access to education and health services and the space to expressfeelings.Preparedness would develop the schools capacity to (1) support the children who have faced acrisis situation (2) respond to the situation with planned immediate steps (3) minimize the losses ordamage caused.

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Needs Communication Positive Response Inner


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The culture of preparing can be developed if the school community accepts the fact thatemergencies, crises and disasters are inevitable.

Risk and Resource Mapping

3.1. What are risks and resources?

Risks and resources are some physical and psychological factors, which exist inThe school and make it more vulnerable or help it in responding better during and

After a crisis/disaster situation. The damages caused by a crisis event can be greatlyReduced or avoided if the school has knowledge about the risks and resources, whichIt can control before the event.

RISKS -Risks are elements in the school and in its immediate external environment, which cancause a crisis or emergency in the school or reduce its ability to respond to the event.

For example, If the school is located near a ocean, it is a risk for small children.The risk has the scope of becoming a crisis if a child gets hurt while some

Preparedness CHECKLIST

Risk and resource mapping

Planning

Response Teams

Warning and alert systems

Resource base

Communication and Information

Rehearsals and mock drills

Public education and training

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accident near the ocean.

Threatsare external factors of risk, represented by the potential occurrence of a natural or humanmade crisis in a given place, at a given time.

For example, teachers who are not regular in coming to school and attending to the children are athreat.

Vulnerabilityis an internal factor of risk, which makes an individual orcommunity more exposed to athreat situation.

For example, buildings with large cracks or broken walls are vulnerability in areas whereearthquakes are a threat.

RISK = THREAT + VULNERABILITY

RESOURCES -Resources are elements in the school, which increase or contribute to the schools capacity torespond physically and emotionally to an emergency or to adapt to its aftermath.For example, existence of trained psychological first aid volunteers in the school are a resourceduring an emergency.

- Knowledge about risks and resources is important because:

It will prepare the school community in dealing with crisis events.

The school community can define what efforts should be made to improve and increase

existing resources. The school community can make elaborate plans to reduce risks in schools by knowing

what resources to rely on.

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Prepare forcrisis,

disasters and

emergencies

Respond to

crisis,

disaster and

emergenciesimmediatel

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1.1. Some examples of risks and resources in the school :

Exercise on Risks and ResourcesProcedure: Participants will be divided into small groups. They will be

given flipcharts to prepare the risks and resources of their school. Groups willselect a member who will make a presentation of their school.

Guidelines for discussion:

a) What are the resources in your school?b) Identify five threats in your school.c) Identify five vulnerabilities in your school.d) Develop an assessment of risks and resources in your schoole) What suggestions do you have to reduce the risks?f) Make a note of the suggestions on a flip chart.

Resources

Risks

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Reduce

damages,losses caused

by disaster,

crisis andemergencies

Manage

availableschool

resources and

generate

newresources

Activity 6 :


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Physical and material factors related to psychological distress

Strong building without cracks. Cracks in the building.

Availability of emergency crisisresponse kits.

Absence of emergency crisis responsekits.

Trained Physical first aiders. Absence of physical first aider.

Trained Psychological first aiders. Absence of psychological first aiders.Identifying safe place for rescue andevacuation. For example, a cornerwithin the school compound which isopen.

Absence of a safe place for rescue andevacuation.

Geographical location. For example, isthe location of school prone toearthquakes, distance from epicenter,open field, canal.

Geographical location. For example,close to the epicenter, rivers, deserts,and other danger points.

Availability of a vehicle and conditionof roads connecting to nearest village,

or health post.

Absence of vehicles or proper roads tothe nearest village or health post.

Past experience in dealing withcrisis/disaster situations. For example,how well has the schooladaptedafterthe crisis.

Lack of experience in preparedness,planning and response.

Personal factors related to psychological distress

Teachers positive interaction withchildren and their parents.

Less teachers compared to number ofstudents

Participatory method of teaching andlearning

Directive method of teaching andlearning

Children who have a support systemof guardians, friends and family

Children who have experiencedtraumatic life events such as loss of aparent, major disasters.

Children brought up in a secure,protected home environment

Children who have been abusedphysically or sexually.

Children who are physically healthyand have not suffered any majorillness prior to the disaster.

Children who have been physicallyinjured, ill or lost a limb.

Children brought up in a protected,

nurturing environment

Children who have witnessed

violence between adults at home orin the community.

Children who had a normal lifestylebefore the disaster

Children who had mental healthproblems (anxiety, depression)before the disaster.

3.2. What is Risk Reduction?

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Risk reduction is a set of activities or steps, which will prevent the extent of damages caused bycrises. Risk reduction in schools depends on the level of information about threats, vulnerabilityand the resources available in the school.

There cannot be a useful strategy to reduce, prevent or mitigate disasters,crises or emergencies in the school unless it is based on an assessment of

risks and resources.

1.2. RISK REDUCTION according to the Cycle of disasters:

Before:

Prevention

Mitigation

Preparation

Warning

During:

Response

After:

Rehabilitation

Reconstruction

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1. Warning: The process of monitoring the threats in high-risk areas. It is the state of alertwhen the disaster is imminent. This is the period when prior preparedness plans have to beput into practice to offer timely support, relief and minimize loss.

2. Event: This period is the first twenty-four (24) hours when the disaster is occurring.

3. Response: This period is between 0-96 hours after the disaster has occurred. This period is

when relief such as food, shelter, water, medicines and psychological support are provided.

4. Rehabilitation: This period extends up to 1 year after the disaster has occurred. In thisphase, the relief is stopped and emphasis is on rebuilding the community and school life toits pre-disaster situation.

5. Reconstruction: This period extends from 3-5 years after the disaster has occurredHowever,psychological reconstruction of individuals who have suffered in disasters is a lifelong process. This phase lays emphasis on building the capacity of the school andcommunity to withstand and face crises and disasters.

6. Prevention: This is a long-term process, which involves activities that reduce the risks andpsychological vulnerability of the community and school and strengthen the existingresources.

7. Mitigation: This phase includes long-term preparedness and risk reduction measures takenprior to the occurrence of a disaster.

8. Preparedness: Activities carried out to minimize loss of life and damage, organize thetemporary removal of people and property from a threatened location and facilitate timelyrescues, relief and rehabilitation.

3.4. Risk reduction steps to be taken in each stage:

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Exercise on WarningResources Two ropes, spacious room

Procedure Divide the participants into two groups. Two groups will stand in twolines facing each other and maintaining some space in between. Two ropes will beplaced in that space on the ground parallel to each other. The area between onerope and the participant group on that side, will be known as Hall the correspondingspace on the other side will be known as Playground. The participants are to rushto the place as per the command given by the instructor.

Continue the activity for 20 minutes at least. Till all are fully alert and follow thewarning.

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RESPONSE

Riskreductionactivities

1. Search and rescue of persons affected.

2. Evacuation from unsafe zones.

3. Psychological First Aid hand in hand with Physical FirstAid.

4. Temporary accommodation and supply of food andclothing.

5. Transfer of survivors to safe area.

6. Assessment of damages.

WARNING


1. Define signals to be used as an alert.Signals shouldbe:

Clear, a simple and precise information

Within reach, it should be spread by all the availablemedia and understood by the school community. Forexample, the school bell can be used as an alarm.

Immediate, The information should be given outwithout delay as soon as the crisis event hasoccurred or news of it is received.

Coherent, It should be easy to understand. The

volunteers, staff and students should immediatelyknow what to do.

Official, should be given by authorized or reliablesources.

2. Monitor threats and control rumours about the disasters

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REHABILITATION

Risk

reductionactivities

1. Repair of damaged school structure or renovation ofexisting school structure.

2. Resume schooling activities.3. Use non-formal methods of education such as games and

art to help children express themselves.

RECONSTRUCTION


1. Establish a structure of school crisis preparation andresponse at the district and local levels.

2. Promote resilience through classroom based activities

3. Generate awareness about stress and stress reactionsamong school community

4. Have functioning crisis response teams in place with well-defined roles and responsibilities of the members.

5. Develop a long-term crisis preparation and response plan.

6. Include psychological support training module into teachertraining programs

7. Include crisis response planning and response into schoolcurriculum

PREVENTION

Riskreduction

activities

1. Repair of damaged classrooms.

2. Set up guidelines for response activities

3. Generate awareness among the school communityon preparedness, immediate response activities

4. Promote resilience through classroom basedactivities

5. Generate awareness about stress and stressreactions among school community

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school.

Feedback/Homework:

1. Ask one of the participants to revise the days topics in brief2. Welcome participants to share any comments, feedback or raise any doubts and

questions on the topics discussed.Distribute the reading materials. Suggest that participants read Module One of the Teachers training

manual.

SESSION GUIDELINES TO MODULE II

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Demonstration on Search and Rescue by the Competent persons ( Civil defence) to give the teachers practica

knowledge on how to handle school crises or emergencies


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CONTENT ACTIVITY RESOURCES TIME

WelcomeIntroduction ofparticipantsIntroduction tomodule I

Delivery of materialsPresentation

Pens, paper,pencils

20 minutes10 minutes10 minutes

Pre test Test Sheets Annex 1.1 20 minutesWhat isdisaster,crisis andemergency ?

Lecture/Branstorm Activity 1Activity 2

20 minutes20 minutes

Type of disastersCommonreactions to crisisElements of crisis

Lecture/demostrationBrainstrom

Activity 3 20 minutes20 minutes20 minutes

Disaster MentalHealth &Psychosocial

Care

Lecture/Brainstorm Activity 4Activity 5

20 minutes20 minutes

Preparing Schoolsfor disaster, crisisand emergenciesWhat ispreparedness?What are risksand resources ?Examples of riskand resources .What is risk

reduction?Risk reductionsteps in eachstage.

Lecture/Brainstorm

Exercise

Exercise

Activity 6

Activity 7

20 minutes

20 minutes

30minutes

30minutes

Demonstration onSearch andRescue

Demonstration 120 minutes

Post Test Test sheets Annex 1.1 20 minutes

Total 7 hrs.20 mnts

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MODULE-IIResiliency in Children:

Role of Teachers

LESSON PLAN

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STRESS REACTIONS TO CRISIS PSYCHOLOGICAL FIRST AID

1) Inactive. Not able to follow daily routine. 1) Provide support, rest, comfort, food,Opportunity to play or draw.

2) Fear of the dark, fear of being alone. 2) Provide sense of security

3) Not able to speak. 3) Help to share feelings throughtalking, listening, drawings.

4) Disturbed sleep (nightmares, fear ofgoing to sleep, fear of being alone at night)

4) Encourage talking about thedreams with teachers and parents.

5) Clinging, not wanting to be away fromparent or teacher, bed-wetting.

5) Provide sense of security byholding the child often.

6) Anxieties about the dead person thats/he will return.

6) Explain the physical reality aboutdeath.

Clinging Opportunity to play

(b) Children from 8-12 years

STRESS REACTIONS TO CRISIS PSYCHOLOGICAL FIRST AID

1) Issues of responsibility and guilt. 1) Help to express their feelings.

2) Fears triggered by the event. 2) Help to identify feelings about theevent.

3) Retelling and replaying of the event. 3) Permit them to talk; addressfeelings and assure that they arenormal reactions to an abnormalsituation.

4) Feeling disturbed, confused andfrightened by their responses, fear ofghosts.

4) Encourage expression of feelings.Help to retain positive memories.

5) Difficulty in concentration and learning 5) Encourage them to talk to teachersabout the thoughts that are interferingwith learning.

6) Disturbed sleep (bad dreams, fear of 6) Support them in talking about the

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sleeping alone) dreams, provide information aboutwhy we have bad dreams.

7) Change in behavior (excessive anger oraggressive behavior)

7) Help to cope with the change intheir behavior by accepting it andtalking about it. (For example, it mustbe difficult to feel so angry)

Fear triggered by event Encourage expression of feelings

(c) Adolescents (13 - 18 years)

STRESS REACTIONS TO CRISIS PSYCHOLOGICAL FIRST AID1) Shame and guilt 1) Encourage discussion of the event,

feelings about it and expectations of whatcould have been done.

2) Sense of vulnerability about theirfeelings, fear of being labeledabnormal.

2) Help them understand that theirfeelings are normal in the situation.Encourage understanding among eachother and people of the same age group.

3) Drug use, anti-social behaviour, andsexual misbehavior.

3) Help to understand that the behavioursare an effort to forget about the feelings.Help to ventilate anger, frustration over

the event.4) Accident prone behaviour,recklessness.

4) Address the impulse toward recklessbehaviour. Help to understand that thisbehaviour can lead to violence, which canhave fatal consequences.

5) Changes in relationship withparents, friends and other people.

5) Discuss the changes in relationshipand why they might be happening.

6) Feeling that one has grown up too 6) Encourage focus on ones life ahead,

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soon (for example, leaving school,getting married)

allow them to be involved in otheractivities of interest.

7) Thoughts of revenge. 7) Discuss about the actual thoughts of revenge, the possible consequences ofthe act and encourage constructivealternatives that will have long-termbenefits.

Aggressive Engage in recreation activities

Exercise on Stress reactions: Participants will be given some cards. Someof them will be on stress reactions. Their task is to identify them. They then have toelaborate on the stress condition and the facilitator will describe it further. Afterfinding out the stress reactions, the participants in groups will present one or twointerventions to relieve stress. Each group will carefully observe the other group

and give feedback.

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Activity 1:

ctivity 2:

Case study- First, the instructor will describe a crisis situation in a school . Theparticipants will be divided into two or three groups. The task of each group is todevelop a plan of action to assist the child under stress. Each group will presenttheir case.Guidelines-

a. Divide participants into smaller groups.b. Each group will be given a case study of a child with two of the above

signs of stress.c. The task for each group is to develop a plan of action to assist the

child in not less than 5 steps.Each group will present their case.

ctivity 2: Activity 2:


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2. Recognizing the ability of children and adolescents to deal with crisis:

Resilience is the capacity to transform oneself in positive way after a difficult event.(Annan, Castelli, Devreux, Locatelli, 2003)

Human growth and development:

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When a child attends a school he will begin to learn how to read and write? He often comes homewith his school work and show it proudly to his mother. However small his accomplishments maybe, he wants them to be recognized. He will become more aware of himself and those around him.As he interacts with the family, friends, teacher, and others, he develops more inner resources.

Discussion on the physical and psychological needs of humanbeings:The participants will share from their knowledge and experience. Finally, theinstructor will sum up the ideas.

What is important in the life of a human being ? Think about your life and reflecton the things that are important to you.

1. What is most important to you?- Relationships- Work

2. What gives you a purpose in life?3. What values are important to you?4. What are your beliefs?

Through RELATIONSHIPS I HAVE I BUILD

ParentsFamilyFriendsTeachersReligious leadersCommunity

TrustLoveIdentitySense of Belonging

Through ACTIVITIES I CAN I BUILD

School

WorkEveryday activities

Competence

ConfidenceInitiative

Through SPIRITUALITY I AM I BUILD

ValuesBeliefsCulture

Self esteemPurpose in lifeIdentityResponsibility

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What I HAVE, CAN and AM can help me to face difficult situations and recover with renewedenergy and strength.

Just as the way the bamboo springs back after pressure, the resilient individuals recoverafter a difficult time or a crisis.

The ability to spring back from and successfully adapt to adversity isResiliency (Henderson, 2001).

Children and adolescents have tremendous capacity to bounce back after a crisis event if theyare provided with a supportive environment. The ways in which children and adolescents behaveand respond to adults after a crisis situation are indications of their ability to deal with what hashappened. The role of adults is to provide children with positive ways by which they will becomemore resilient.

2.1. Recognizing resilience in children:A childs resilience is built by the coping skills s/he adapts, his/her behaviour with friends and

family, his/her performance at school and the way that s/he follows his/her daily routines.

(a) If a child is coping well, s/he is:- Happy and interested in his/her surroundings.- Will make friends and enjoy playing with them.- Offer and accept affection.- Will want to learn, be happy at school.

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On resiliency.Call for 2 volunteers. Give one a wooden stick. Give the other a bamboo cane.Ask each one to bend one side of the stick/cane. The wooden one breaks, whilethe bamboo one springs back.

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Offers and accepts affection(b) If a child is not coping well, then s/he would show the following signs at school:

Very quiet and unresponsive to questions asked.

Does not participate in the class or play with friends. Is irritable and fights with other children.

Cries and shows regressive behaviour such as thumb sucking or clinging to the teacher. Gets scared easily. Always feels fearful and nervous.

Physical problems. For example, headaches and backaches.

No visual contact. The child does not look into the eyes of the other person.

Very low achievement in school. The child does not understand what the teacher explains.

Very quiet and unresponsive

2.2. Recognizing resilience in adolescents: In case of adolescents, adults need to realize that itis a time when s/he is growing from a child to an adult and can no longer be treated as smallchildren. Adolescents usually have an innate capacity to deal with crisis in a positive way althoughat times they might adopt negative ways. Because of the crucial time that they are in, they have toconstantly adjust and recreate the way they deal with crisis and can some times be confused or

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misled. It is important for adults to provide them the support and encouragement that will help themto become resilient.

Increase in Substance use/Abuse Engage in Community activities

Brainstorm:

a. Have you ever wished you were of the opposite sex? Why ?b. Do you think there was a difference in the way you and your brotheror sister was brought up?

c. Do you think boys and girls are different? Why ?d. Do you think there is a difference in resilience among boys and girls ?

(a) Coping power of adolescent boys and girls:In India, adolescent girls and boys are brought up with different roles. Expectations from boys andgirls are very different. Most of the time boys are not expected to carry out household activities, asare girls. In rural India schooling activities are also discontinued for girls as soon as they attainpuberty while there are expectations from boys to finish education and start earning for the family.

Such differences influence their coping mechanisms.

Table 3.2 (a)

Coping mechanisms Adolescent boys Adolescent girls

1. Ask for help They will usually find iteasier to seek adultguidance and assistancebecause they have morefreedom in the house.

They usually dont havemuch freedom or support inthe house to feelcomfortable enough to askfor adult assistance.

2. Care for others and

accept affection fromothers

They may not feel very

comfortable with thisbecause society teachesthem to hide their emotions.

They find it easier to give

and receive affection ifgiven the opportunity andencouragement.

3. Have friends andenjoy doing things ofinterest

They usually have thefreedom to step out of thehouse and meet people oftheir own age.

In rural India, they areburdened with householdresponsibilities. They maynot be allowed to step out to

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meet friends because ofsafety and societalconstraints.

4. Attempt to learn newthings

They have the interest tolearn new things andwould do so if given theopportunity.

They have the interest tolearn new things and woulddo so if given theopportunity.

5. Make plans for his/her future

They enjoy more freedomto make plans becausethey are usually allowedto pursue education ifthere are no financialdifficulties in the family.

Social expectation fromthem is to get married.Education is also secondaryfor them because of socialnorms in the villages.

6. Participate incommunity activities

They are able toparticipate in activitiesbecause there are noconstraints on theirmovement.

They are not able toparticipate so actively incommunity activitiesbecause of householdtasks, security and social

norms.7. Undertake things ofinterest

They usually have moretime on their hands to doso because they are notexpected to help in thehouse.

They usually have less timeto do so because of household responsibilities.

As Table 3.2(a) shows, girls and boys in some parts of India are brought up under differentconditions. It is important to be aware of such differences to be able to recognize their ability tocope with a crisis situation.

(b) If an adolescent is not coping well, s/he will generally: Be aggressive and argue with family members and friends

Be idle and refuse to help in the house.

Refuse to engage in any creative or community activity.

Refuse to go to school or to work and will sit and waste his/her time.

Start smoking and drinking alcohol (mostly boys).

3. HELPING CHILDREN AND ADOLESCENTS TO BECOME RESILIENT IN SCHOOLChildren and adolescents learn and adopt coping mechanisms from the environment they live

in. It is very important that they receive an environment from which they can learn and which

builds their ability to cope. Children and adolescents are very sensitive to the positive or negativeenforcements received from their family, peers or community members.

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Exercise of self expressionGive the group 10 minutes to think about a significant

person in each ones life between the ages of 7-16 years. Draw that person.

Ask members to share:1. Who was that person ?2. What was so significant about the person ?

3. How did they feel thinking back so many years ?Learning:Some childhood memories remain in our minds very clearly and certainpeople play a very significant role. The teachers role is also as significant ina childs life.

Even the smallest incident in our childhood can impact us.

People we remember, who we liked are not always parents or

family members. They can be our neighbors, teachers, andfriends parents.

Children also feel bad when things are not all right. They express

it differently.

Children need to share their feelings about an experience.

Our experiences of childhood influence the way we are as adults

For example, if a child is constantly criticized for his/her actions at home, s/he mightGrow up to lack confidence in him/herself. Such a child or adolescent would be moreProne to stress during a crisis event.

3.1. Age specific interventions in the classroom (adapted from Center for Mental Health atUCLA (2000). A response aid packet on responding to crisis at a school):

(a) Children between 4-7 years

Physical contact: Children need lots of physical contact during times of stress to regain asense of security. Games involving physical touch can help meet this need.

Physical activity: Children feel restless and anxious after a crisis event and activitiesinvolving physical movement can help them. For example, games like skipping or chainchain.

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(b) Children between 8-12 years

Share your own experience: Stimulate group discussion about crisis experiences bysharing your own fears and experiences. It helps children to feel less isolated and alone.

Reading: Read aloud or have children read stories or books that talk about children orfamilies dealing with difficult situations, pulling together during those times and similastories.

Discussion groups Facilitate discussion on topics such as what happened in youneighborhood (school name or home) when the event occurred? This is recommended withsmall groups with discussion afterward. This can help children feel less isolated and to venttheir feelings. Have the children draw individual pictures and share them with the class. Thegroup discussion should end on a positive note (recognizing that the children and theirfamilies were able to pull together through the difficult situation).

Visualization and relaxation : Children are restless and crisis events can further hampertheir ability to concentrate. Visualization and relaxation exercises help them to relax and thinkabout the nice things that they want in life.

Crisis response plans: Have the children discuss their own family or classroom crisis planWhat do they do if they have to evacuate? How would they contact parents? How should thefamily be prepared? How could they help the family?

Tension breakers: Students feel restless after a crisis. Conduct tension-breaking activitiessuch as co-listening exercise, dancing to music. Organize games such as kabaddi, cricket orantaakshari.

Playacting: In small groups, play the game, if you were an animal, what would yoube? if you were that animal, what would you do if a crisis occurred? Have thechildren act out it out in front of the class and have the rest of the class guess whatthe feeling is and why the student might feel that way.

(c) 13 18 years (Adolescents):

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Expression of feelings during class: Relate the crisis event to the course that is beingtaught in class. Help students express their experiences and observations. For example,during a science class let them prepare projects on stress, what they feel and how to deawith it. Facilitate discussion on each project.

Listening and validating: Adolescents have their own understanding of things happening

around them and their reactions to the event could be different from children or adults. Donot criticize the way they think or feel. If you validate what they are saying they would beencouraged to share more. Telling their story will help them to understand and eventuallyaccept the event.

Visualization and relaxation: Children are restless and crisis events can further hampertheir ability to concentrate. Visualization and relaxation exercises.(Refer Module-V) help themto relax and think about the nice things that they want in life.

Organizing community events: Holding community events like cricket match, projecwork, picnic or drama. Playing together is very helpful. It fosters teamwork and unity. It is

also a good exercise that helps the children to manage their stress. When children would dothings together, it will facilitate sharing of feelings.

Turning survival skills into leadership: Help them recognize their strengths and abilitiesand to see that they can make very valuable contributions to the community. They can initiateactivities in the community and become leaders in mobilizing their peers.

Skills development: Develop their technical skills in vocational activities such as PhysicaFirst Aid or Psychological First Aid. This would help them to assist others and themselves.Techniques to manage their stress would facilitate better adaptation to new conditions after acrisis.

4. ACTIVITIES FOR CHILDREN AND ADOLESCENTS

Clay Activity1. Give each participant some plasticine.2. Ask them to make something that was dear to them as a child and

which they have lost.3. Ask them to share their feelings while making the object.Guidelines for discussion:

1. How did you feel ?2. Why was this object dear to you ?

Learning:5. Sharing our feelings makes us feel better.6. The most insignificant thing can be very dear to a little child.

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7. The loss of toys also impacts children after a disaster.8. It is important for children to express loss and sadness.

Activities that help children express themselves:Children cannot express themselves with words so well. TheyExpress in other ways. There are some ways or activities by which we can helpChildren to express their feelings, emotions, their views and their expectations.

4.1. Drawing method: Drawing method is one of the ways by which expression of feelings canbe facilitated. Asking a child to draw a picture can be a good way to find out what the childis feeling.

- Guidelines to use the drawing method:a) Tell the children to close their eyes for five minutes and try to draw whateve

comes to their mind.b) Give them specific themes such as

a. What do you remember of the time when the crisis occurred?b. What did the village look like at the time when the crisis occurred?

c. Can you draw a picture of something you lost?c) Ask each child to describe or explain what s/he has drawn.d) Do not grade the drawings or hold a competition.e) Put all the drawings together and put them up on the school walls.

4.2. Story-telling method: Stories fire a childs imagination. Story telling is a very effectivemethod by which children are able to express feelings in a simple manner.

- Guidelines to use the story telling method:(a) Tell them a story about the crisis. For example, a story about a little boy/girl,

who lived in a village and suddenly one day a crisis came upon the village andso on(b) After the story is over, discuss the story by asking questions like:

- How do you think the little boy or girl must have felt?- What do you think the little boy or girl would have done?- Do you think you will be able to face a crisis like that?

(c) Encourage the children to talk about their own experiences as you talk aboutthe characters in the story.

(d) Encourage them to share similar stories.

4.3. Creative writing method: Sometimes children do not want to or may not know how to

share feelings. Some children like to express their feelings by writing about it. The creativewriting method can help them to form a story or a poem. Its notnecessary for them toshare what they have written if they dont want to.

- Guidelines to use the creative writing method:(a) Show them pictures of a family and a crisis site. Ask them to

Write something on what they feel about the pictures.(b) Encourage them to read out what they have written one by one.

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However if a child does not want to then s/he should not be forced.(c) Encourage them to explain what they wrote and what they thought of the picture.

4.4. School Drama method:Theatre is a very effective way of not only helping children to express their feelings but also todeal with the emotional losses and pain that they might be feeling after a crisis. Theatre includesactivities like writing, singing, dancing, acting and sharing of ideas. These activities help the child

to feel good about working in a team and contributing to it, showing their talents in dance, musicor acting and finding an interest in things other than studies.- Guidelines to use school drama:

a) Divide the children into groups who will be responsible for the songs and music, thecostumes and props, the writing of the play and direction and advertising about the play(where it will be performed, what time, what date).

b) In developing the script for the play, use the creative writing method. Let the childrencome up with the story for the play. The teacher can only guide them on how to do it.

c) Encourage them to express their feelings as they write the story so that some of theirexperiences are also reflected in it.

d) Encourage a lot of discussion and participation from all the children to decide the story,the costumes, the songs and the overall planning of the play.

Prepare Guidelines for the skit:- First of all the participants would decide a theme for the

skit.

- All the participants would share ideas for 10 minutes.- One of the participants can write them down.- The roles of each member will also be decided.- The group will present the skit.

Each group will be asked to give a five-minute presentation on the processthrough which the skit evolved. For example, how did they decide on thetheme?What stepsdid they follow to decide who will play what role? Theperson who makes notes should share his/her observations. Interpersonalcommunication gets strengthened.

Or

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THEMES FOR CLASSROOM BASED ACTIVITIES

Pre-disaster

Knowledge about the village

Knowledge about disasters

Understand the importance ofpreparation

Fears people experience

Fears about disasters

How to prepare for a disaster

Understand that its okay to feelbad, cared, sad

Issues related to loss and death

Importance of relaxation and selfcare

What will happen in a crisis The role of students in a crisis

situation

Finding solutions to issues

Post disaster

Grieving

Losing people we loved

Losing our pets

Losing things we loved

Coping with the changed living

Feeling good

Relaxation

Dealing with illnesses

Having fun

Memories

Coping with stress reactions

Returning to routines

Seeking help and comfort

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BACHON KI RAILDuration: Two and Half hoursProcedure: Participants will be divided into small groups. Each group will

prepare activities for children [Station-I FUN (Dance, play and songs),Station-IIdrawing, Station-III clay activity or role play of different characters, Station-IVfood and sweets, in nearby schools.]Resources : School children, pencil, rubber, colour pencils, drawing sheets,ta e recorder, biscuits and chocolates etc .

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SESSION GUIDLINE TO THE MODULE-III

CONTENT ACTIVITY RESOURCES TIMERecap of theprevious dayssessionIntroduction tomodule-V

Discussion

Presentation

Materials asrequired

20 minutes

10 minutes

Pre test Test sheets Annex 5.1 20 minutes

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1. Stressmanagement forteacher andvolunteers.1.1What is

stress ?1.2Common

causes andsigns of stress.1.3Stress in

school

Lecture

Demonstration

Brainstorm

Exercise

Activity 1

15 minutes

30 minutes

20 minutes

15 minutes

2. Self-care forteacher andvolunteers.2.1 Techniques ofself-care.2.2 Ways to dealwith stress.

LectureDemonstrationPracticeExercise

LectureDemonstration

Practice

Activity 2

Activity 3

Activity 4Activity 5

30 minutes

30 minutes20 minutes20 minutes

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MODULE-III

PSYCHOLOGICAL FIRST AID

LESSON PLANThe purpose of the Psychological First Aid module is to give Red Cross Volunteers and CommunityBased First Responders certain familiarity about how to deliver psychological first aid to survivors ofa disaster or a daily life crisis ?

Module Length:

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Psychological first aid module is designed to be taught in approximately eight (8) hours. The modulecan be presented as an add-on module to the Community Based First Aid course, or it can bepresented as stand alone session.

Module Material:

For the instructor:Flip chartsPensName cardsTrifold

For the participants:Psychological first aid bookletNotebooksPens

Goal:Community Based Volunteers and First Responders will become familiar with Psychological FirstAid.

Objectives:1. Understand the significance of Psychological First Aid.2. Explain the importance of stress.3. Learn basic skills to deliver Psychological First Aid.

Expected outcome:By the end of the session the participants will be able to:

1. Recognize at least five principles of Psychological First Aid.2. Identify at least two kinds of stress reactions.3. Deliver the five steps of Psychological First Aid.

1.Introduction to Psychological First Aid (PFA)

Remembering events of past

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The participants will be asked to write about a sad event of their past.

The participants will be asked to write about the first time they brushedtheir teeth or wore their clothes themselves.

Inference:

You remember the sad events.

You do not remember the insignificant events.

1. Introduction:To offer a cure, one must know the ailment. Psychological First Aid is a common cure for people indistress. But first one must understand what kind of distress it is. Then the relevance of thepsychological first aid can be understood.Psychological first aid is as important as physical first aid. When someone is bleeding, you dontimmediately take the person to the Emergency room; you do something to stop the bleeding, andthen take him/her to the Emergency Room. Likewise, you do not offer a person in need ofimmediate psychological assistance, trauma counseling, or take them for psychotherapy. Firstly

because in India, there are very few psychiatrists and psychologists to assist such a vast populationand secondly, not all psychological problems require professional intervention. There are simpleways of assisting people in distress, which the fellow human beings can offer. These simple waysconstitute Psychological First Aid.

2. Relevance of Psychological First Aid for a disaster, emergency, and crisis.Almost every person faces difficult times in life. But some people face problems of greatemagnitude and severity like disasters/ crises.

2.1 What is a disaster ?

A disaster is a serious disruption of the functioning of a society, causing widespread humanmaterial, or environment losses, which exceed the ability of the affected society to cope with, usingonly its own resources. Disasters are often classified according to the speed of onset (sudden orslow), or according to their cause (natural or manmade).An overview of Disaster Management, 2nd Edition, (1992), UNDP, Disaster Management TrainingProgram, Wisconsin Disaster Management Center.

Disaster is an event that exceeds the communitys capacity to respond. Disaster can be classifiedas

Natural disasters such as cyclone, earthquake and drought.

Man-made disasters such as communal riots, industrial accidents and fire.

A Disaster affects us in many ways:

We may lose the social structure such as family, neighbours, and other groups. The size andthe range of the disaster will determine the disruption in the workplace, schools, and locainfrastructure such as light, water, and communications. There are some preconditions which wilimpact the magnitude of the disasters. These are poverty, unemployment, lack of information, andnot having a support network. During this period the community has some specific needs

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sometimes referred to as basic needs, which include water, food and shelter. A disaster is classifieddepending on the speed and the cause.

2.2 What is an emergency ?

An emergency is an unforeseen event that is marked by a clear deterioration in the coping abilities

of a group or community. Emergencies are reflections of normal life. For example a person knowsthat the brake shoe of the car is worn out. The person has earned his/her weekly salary. A decisionhas to be made on whether to fix the brakes or buy food, so the person buys food. As a result of thisdecision he/she loses the brakes while driving and has an accident.An emergency has three components (1) an underlying cause (poverty), (2) dynamic pressures

(how to spend money), and an unsafe condition (car is unsafe to drive).

2.3 What is a crisis ?

It is an event that exceeds the capacity of an individual to respond.A crisis is an event that precipitates social readjustment. A crisis is an event caused by traumatic

stimuli such as loss of life, injury, sudden illness, change in environment, winning a lottery, or simplya promotion at work. How a person faces the crisis, whether it is perceived as a problem or as anopportunity, results in the behavioral reaction.

3. Psychological first aid.Psychological first aid is a first order response, of short duration, to a person who is experiencing

distress as a result of a disaster, an emergency or a crisis. The SPHERE 2004 manual definespsychological first aid saying itentails basic non-intrusive, pragmatic care with a focus on listeningbut not forcing to talk; assessing needs and ensuring that basic needs are met, encouraging but notforcing company from significant others; and protecting from further harm.

Based on the SPHERE standards psychological first aid proposes five steps. (1) Provide forbasic needs, (2) listen to the survivors distress, (3) accept the feelings and understanding thatthese are normal reactions to abnormal situations, (4) assist with next steps by reuniting with lovedones or providing timely and accurate information, and (5) refer to appropriate support systems (formedical needs to the health post, for spiritual needs to the appropriate spiritual guide, for a loneperson to a support network).

Figure 1: Illustrations below show an example of a crisis and the necessity of emotionasupport beyond physical first aid.

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Motorcycle accident needing physical first aid.

Though physically fit, victim needs psychological healingThe illustration depicts how the physical wound gets healed after physical first aid is given but thefear for motorcycle persists. Thus, emphasizing some kind of additional assistance in a situation ofdisaster/ crisis is needed i.e.

Psychological First Aid.

Psychological First Aid is a brief, first order intervention for a person facing a disaster or acrisis in order to prevent persistence of deeper psychological impact.

3.1 What are the conditions that will cause a reaction of distress ?

The following conditions during the disaster, emergency or crisis will serve as an indication for

psychological first aid.

(1.) Physical proximity to the disaster.(2.) Emotional proximity to an event.(3.) Whether or not there are secondary events such as a disruption of daily routines through theloss of shelter, work place, or transportation.

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(4.) Whether or not a disaster has occurred by natural causes, such as hurricane or flood, or iscaused by an act of another person known or unknown. Gods Will is more readily accepted thanaccidental or premeditated harm caused by another human being.3.2 Individual Factors:

Many individual factors can affect the way a person responds to a disaster. These include geneticvulnerabilities and capacities, prior history of constant stress or exposure to past disasters, history

or presence of a psychiatric disorder, having lower education and income, lower IQ, being divorcedor widowed, health issues or psychopathology within the family, the presence or absence of familyand social support structures, the age and developmental level of the individual. Children representa particularly vulnerable population.

When a disaster, an emergency or a crisis occurs, the survivors depending on the level of exposurewill require emotional support along with other relief material. By alleviating stress,psychologicafirst aid will help the survivors to sustain mental/physical performance during routine activities, underextremely adverse conditions and in hostile environments.Three main things need to be done when caring for these survivors.

1) Provide information about normal behavioral responses to a disaster. Most people want to

know they are not abnormal.2) Provide for the survivors basic needs. Some survivors will have no access to money, foodor shelter.

3) Refer the acute distress reactions to mental health professionals.

2.The Concept of distress and stress

4. Introduction

There are many definitions of psychological distress; most of them include some type of

overwhelming, unanticipated danger from which one cannot escape and for which there appears tobe no method of either decreasing the danger or the individuals anxiety.

The disaster survivor may almost instantaneously develop distress symptoms including a feelingthat ones heart is about to burst, difficulty in breathing (so that one feels smothered), trembling,muscular tension, perspiration, nausea, mild diarrhoea, and anxiety.

These responses are complex and include biological defenses against the threat, the activation ofmechanisms related to past learning and adaptation in similar situations, response to social cues(i.e. Behavior is shaped by the behavior of those around us running or going into a building as aresult of a loud noise), reactions to immediate loss or separation from a loved one and the effects of

the cognitive disarray that can occur from experiencing chaos all around. Hysterical reactions areuncommon during a disaster or a crisis.

4.1 Factors that can affect a persons response to a disaster, an emergency or a crisis.There are a number of factors that increase the distress of people experiencing a disaster. Theyinclude:

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(1.) Being a direct victim as opposed to a witness (e.g. Seeing it live on television).(2.) Having a daily routine disrupted (e.g. Loss of shelter).(3.) Whether the disaster is natural or manmade.(4 ).Socio-economic status (poverty, caste, religion, gender).(5.)Support systems (family and friends).(6.)Level of emotional developmental (e.g. Children often respond to disasters just like thei

parents do).

Illustrations to show how stress affects individuals with help of rock example:

With a small rock the bridge with a little bigger rock, the

is intact. Bridge develops cracks

With a even bigger rock, the bridge collapses

The effect of stressful life events on a person:

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Small events, adult copes Bigger events, adult has difficulty in coping

Develops symptoms of stress

Still bigger events, adult unable to cope and breaks down

4.2 What is stress?

Stress is the bodys response to situations that pose demands, constraints or opportunities.

In day-to-day life any one can experience stress but it depends on person to person how stresseds/he feels in one situation. For example, a boy who has to take his exams might either feelextremely stressed and fall ill or he might feel moderately stressed and concentrate on studies.

Stress is not always negative. Some amount of stress is required to give optimum performance. It isthe chronic stress that can have a negative impact on a person.

Stress reactions are divided into four categories i.e. Physical, emotional, cognitive andbehavioral. Though the most common stress reactions are simply inefficient performances, such as:

Slow thinking (or reaction time).

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Difficulty sorting out the important tasks from extraneous activities and seeing what needs tobe done.

Difficulty getting started.

Indecisiveness, trouble-focusing attention.

Exercise on stress.0.0.0.1 Brainstorm

Guidelines for discussion:

Have you witnessed a disaster?

What were your reactions to the disaster?

What was the behavior of other survivors?

The facilitator will write all the reaction and behavior on the flip chart.

Physical reactions:

Fatigue, exhaustion

Appetite change

Tightening in throat, chest or stomach

Worsening of chronic conditions (high blood pressure, asthma, diabetes, or heart condition).

Somatic complaints

Behavioral reactions:

Sleep problems

Crying easily Avoiding reminders

Excessive activity level

Increased conflicts with family

Hyper vigilance, startling reactions

Isolation or social withdrawal

Disaster Mental Health Response Handbook (July 2000). Center for Mental Health, North SydneyNSWAlthough the behaviour described above usually diminish with time, some do not.

A person, who has not improved somewhat within a day, even though he or she has been givenwarm food, time for sleep, and opportunity to ventilate, or who becomes worse, deservesspecialized medical/psychiatric care. Do not wait to see if what he is experiencing will get better withtime.

Factors involved in Stress Tolerance:There are three factors involved in tolerance of stress. They are:

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The environment (the stressor).

The way the person perceives the environment.

The way a person judges his/her emotional resources.

As shown in the bridge and stone picture the capacity of the bridge depends on the load that is put

on it, the material with which it is built and the engineering design with which it is built to take theload. Similarly in an individual the tolerance to stress depends on the emotional load of the event,the perception of the event by the individual and the use of the emotional resources by theindividual to cope with the stress.

Example1. Take an ordinary rubber band. Stretch it from both the sides. It stretches up to a pointand then it breaks. This breaking point is when the stretching power of the rubber band gives way.This demonstrates that a person can cope up to a point but not beyond.

3.Importance of Non-verbal Communication

Nonverbal communication is a mode of expression exclusive of verbal communication:

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ROLE PLAYA participant is asked to hide behind any large object or cover himself. He/she isthen instructed without others knowledge to relate a sad story with verbalmodulationsParticipants are asked to give their thoughts on the verbal message.

ctivity 3:

The same participant is then asked to express sadness without using words

The participants are asked about their observation.Inference:

Feelings can be conveyed non verbally.Non-verbal communication can be as powerful as verbal communication.

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Some illustrative examples are given below:

1. Anxiety

Trembling of hands.

Constantly changing body posture.

Acute voice.

Clearing throat.

Vague look.

2. Lack of interest:

Vague look

Looking around.

Monotone voice.

Moving the feet.

Yawning

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3. Confidentiality:

Looking to all sides.

Eyes half shut.

Mouth is covered.

Low voice.

Mumbling.

4. Not caring:

Hands on the waist.

Extended legs.

Looking the other way.

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6. Irritated

Red face.

High tone of voice.

Pointing with finger.

Cold stare

Forehead wrinkled.

A listener should follow the below mentioned guidelines to be an effective listener:

1. Sit in front of the individual with open hands.2. Do not fold arms.

3. Maintain direct visual contact.

4. Interpret the total message (words, body language, facial expressions)5. Encourage the speaker to express all their feelings without repressing.6. Pay attention. Looking at a person and moving head freely confirms that you are willing to

establish contact and are paying attention.7. Listen carefully and retain information received to be able to use it in the future.8. Do not speak out your ideas. Be careful with what you say.

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4.Implementation of Psychological First Aid

Brainstorm Guidelines for discussion:

When an individual is in crisis what do you do to make him feel better ?

First aid can be applied to stress reactions of the mind as well as to physical injuries of thebody. You must know how to give psychological first aid to be able to, help yourself, yourfriends and family, and the community in times of a disaster or of a personal crisis.

Psychological first aid measures are simple and easy to understand. Improvisation is inorder, just as it is in splinting a fracture. Your decision of what to do depends upon yourability to observe the survivor and understand his/her needs. Time is on your side, and soare the emotional resources of the survivor you are helping. Making the best use of

resources requires ingenuity.If psychological first aid is offered early to survivors during the immediate response periodthe survivors stand a good chance of recovering early and of becoming an effective memberof the community recovery efforts.

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Open palm ListeningProcedure:

Divide the participants into pairs

They can occupy any part of the room or area they feel comfortable They can sit on a chair or on the floor wherever they feel comfortable

Give them five minutes to share an event with the other

Mention that the listener will keep his/her palm facing upward and bodyleaning forward

Facilitator can demonstrate the Open Palm techniqueGuidelines for discussion:

How did you feel ?

Did the persons posture make you feel less or more comfortable?

Did you feel that the person was really listening to you? If yes, why ?If not, why not ?

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.1.1.1.1.1.1.1EXERCISE:

Two balloons are inflated and kept on the floor.

Two participants are asked to walk around trying to stamp theballoons. (Secretly instructed not to burst the balloons)

Two more participants are asked to protect the balloons andkeep it safe for future use.

Others are to observe the activity and reflect on it.

Expected outcome: Emphasize the steps of Psychological First Aid in the contextof the balloon. (See illustrations below)

Illustrations below show simple ways of remembering the steps:

Balloon needs to be provided immediate Balloon needs to be deflated so that protectionand care from danger possibility of bursting is decreased

Plan to keep the balloon at a safe place If there are holes in the balloon, it needs to so that ithas a secure future be repaired

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Guidelines for accepting the feelings of the survivor:

Accept the survivors you are trying to help without censorship or ridicule.

Accept the survivors right to their own feelings. Even though your feelings, beliefs,and behavior are different.

Do not blame or make light of the way the survivor feels or acts. Your purpose is tohelp the survivor in this tough situation, not to be critical.

A survivor does not want to be upset and worried; the survivors would "snap out of it"if they could.

When a survivor seeks help, he or she needs and expects consideration of their fearsnot abrupt dismissal or accusations.

Realize that people are the products of a wide variety of factors. All persons may reactin different ways to the same situations. Each individual has complex needs andmotivations, both conscious and unconscious that are uniquely his/her own.

Often, the "straw that breaks the camel's back" the one thing that finally causes theperson to be overloaded by the stressful situation is not the stressor itself, but someother problem. Thus, an injury or an emotional catastrophe will have a personameaning for each individual.

Even though you may not share the reactions or feelings of another person, and eventhough the reactions seem foolish or peculiar, you must realize that the person feelsas he does, for areason.

You can help the person most by accepting the person, and by doing what you can forthe survivor during this difficult time.

Understand that the survivor is doing the best he can under the circumstances.Your positive assistance and trust may be what the survivor needs, to do better.

Who require Psychological First Aid ?Any person who is in a crisis requires Psychological First Aid. During a disaster it is not just the

survivors who require Psychological First Aid but also their relatives and the people who come toassist the survivors.

Disaster Mental Response Handbook, NSW HEALTH, 2002.

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Person who requires Psychological First Aid in context of a disaster would be:

Survivors

First Responders (rescue and recovery personnel and helpers)

Secondary Survivors (friends and relatives of survivors, incidental others upset by theevent and indirectly involved persons)

General principles of Psychological First Aid

1. Intervene immediately (be direct, active and authoritative). The sooner the survivor isassisted in coping with the disaster or an emergency or a crisis situation, the better are thechances of restoring the pre-disaster situation. The longer the survivor remains in a state ofconfusion, unable to take some sort of action to address the situation, the more difficult itwill be to intervene.

2. Keep the focus of the intervention on the precipitating situation . Help the survivor toaccept that the crisis situation has occurred by encouraging the survivor to express the factsof the situation as well as his/her feelings.

3. Provide accurate information about the situation. Give a realistic orientation about whahas occurred, and what might be the expected outcomes.

4. Do not give false assurances. Always remain truthful and realistic. Recognize thestress reactions and provide some sense of hope and reassurance that the person willultimately overcome the crisis. However, let the survivor know that things may never be thesame as they were before the crisis.

5. Recognize the importance of taking action. Every psychological first aid interventionshould have an ultimate outcome or some action that the individual is able to takeRestoring the person to the position of victor rather than victim is critical to success.

6. Assist in developing networks for survivors. Find a group of peers, family memberscommunity members or church members that can provide both support and temporaryassistance during the crisis. Implement a buddy system so that the survivor is not left alone.

7. Focus on personal coping ability. Emphasize how the survivor has coped with thesituation so far and how the survivor has already begun to use strategies for movingforward. Encourage the survivor to implement solutions or strategies, which have a highprobability of success.

8. Encourage resilience. Provide constructive activities that the survivor can do to assist withthe situation, such as helping to put up tents, or distributing food and water in the camp.

Reinforce whatever problem solving the individual has demonstrated till this point in time.

9. Be concerned and competent. The more Red Cross volunteers can present themselvesas a model of a competent, problem solving individual, and demonstrate the process oftaking in information, choosing between alternatives, and then taking action, the moresurvivors will be able to function adequately. Therefore, it is important that Red Crossvolunteers establish their own support systems so that they can adequately cope with thesituation.

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4.1 Dos and Donts of Psychological First Aid

Do Dont

1. Contact Listen carefullyCommunicateacceptance.

Tell your own story yet.Ignore either facts orfeelings.Judge or take sides

2. Dimensions of problem

Ask open-endedquestions.Ask person to be specific

Rely on yes/noquestions.Allow continuedabstractions.Ignore danger signs.

3. Possible solutions Encouragebrainstorming.Deal directly withimmediate problems.

Set priorities

Allow tunnel vision.Leaveobstacles unexplored.Tolerate a jumble ofneeds.

4. Concrete action Take one step at a time.Set specific short-termgoals.Give directions, only ifthe person needs to go tothe health post.

Attempt to solve it allnow.Make binding long-termdecisions.Be timid.Retreat from takingresponsibility whennecessary.

5. Follow-up Make a contract for re-

contact.Evaluate action steps.

Leave details up in the

air, or assume that clientwill follow through onplan by her/himself.Leave evaluation tosomeone else.

Slaikeu, Karl A. (1990). Crisis Intervention: A Handbook for practice and research Allyn and Bacon. (pg. 90)

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How to use the Psychological First Aid Trifolds ?

The PFA trifold is a tool that helps the community-based worker to learn PFA for the peopleat the community level. It has simple words and is illustrated with bright colors. In the front, idepicts a happy family that undergoes a disaster/ crisis. The first fold shows the stressreactions of the husband. In the second and third fold, the five simple steps are given toguide the helper to deliver psychological first aid to the distressed husband.

Demonstration and Practice Guidelines:

Facilitator demonstrates use of Trifold in the form of a story.

Participants are asked to use similar method to present the Trifold.

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Documents

Operational Teachers Training for Tsunami Affected Area