Enhanced SECURE STAIRS team

COVID-19 guide – psychological first aid for children and

young people
Since the onset of the COVID-19 global pandemic, the world has been going through a frightening
and stressful time. Life is very different from usual and we are all in the process of adjusting to and
making sense of our new circumstances.

We know from studies of previous global or large-scale infectious outbreaks1 (HIV/AIDS, SARS2,
H1N13, Ebola, MERS and Zika virus) that the fear and uncertainty associated with them can affect
both our emotional wellbeing and our behavioural responses. There is no right or wrong way to feel.

Many people (at least half) feel more anxious than usual. Most of us will recover naturally from the
shock of such health crises and will not need formal psychological assistance to do so. Every person
has strengths and abilities that can help them cope with life’s challenges.

However, some people are particularly vulnerable in a crisis and may need extra help. This includes
those who may be at risk or need support because of their age (children, older people), they have a
mental or physical disability, or they belong to groups who may be marginalised or targeted for
violence.

Psychological first aid (PFA) describes a humane, supportive response to a fellow human being who
is suffering and who may need support.4 It is an evidence-based intervention shown to support
anyone caught up in a crisis,5 including pandemics and large-scale infectious outbreaks, to recover.

PFA may be a useful tool for staff supporting children and young people in the children and young
people secure estate. This is a guide to using it with this group.

What is psychological first aid? What psychological first aid is NOT

 It is a resilience-focused, supportive five-  It is not something that only professionals

step framework (see next page). The World can deliver.
Health Organization recommends it as the
most appropriate way to help people  It is not professional counselling.
recently affected by a traumatic crisis or
event. 6  It is not ‘psychological debriefing’ in that
PFA does not necessarily involve a detailed
 It is suitable for use with everyone in the discussion of the event that caused the
first days, weeks and months after a crisis. distress.

 It can be delivered by anyone in a support  It is not asking someone to analyse what

role and is comparable to providing first aid happened to them or to put time and events
for physical wounds. in order.

 It involves comforting and listening to  Although PFA involves being available to

people, but not pressurising them to talk, listen to people’s stories, it is not about
and helping them to feel calm and connect pressurising them to tell you their feelings
to information. and reactions to an event.

1
 Delivering psychological first aid

Children and young people will reflect the emotional responses of those around them. Before you
start, take a moment ‘to check in with yourself’ and ensure that you feel calm and clear about what
you want to achieve with this intervention. Taking a few slow deep breaths and reminding yourself of
the key messages you need to deliver will help you provide PFA effectively.

Getting Started - CONNECT

Staff can incorporate PFA in a typical one-to-one session with a child or young person to review how
they are and offer support. Phrases such as “I want to check in with you/see how you are doing/see if
you have any questions” may be useful openers.

Some children and young people will spontaneously share their feelings with staff; others may be
more reluctant to do so. Either is fine. PFA does not require a person to share their feelings.

However, if they do start to express how they feel, listen but do not offer your opinions or rush to try
and problem solve. Listen empathically, asking questions if necessary to clarify what you are being
told, and let them express what they want. It may not feel as though you are ‘doing’ much, but by
listening in this way you will be promoting a feeling of safety and connection for the child or young
person.

Psychological first aid: Five-step framework

This guide outlines the framework to deliver PFA, along with information and practical examples to show
how it can be used in the secure estate.

1
PROVIDE SAFETY
To keep safe at a time of crisis, an individual needs access to accurate and timely
information pitched at the correct level for the individual, explained where possible and
delivered in an acceptable dose.

2
ACCEPT AND CALM
Create calm by first ensuring you are calm. Emphasise the present, the practical and the
possible.

3
INCREASE SENSE OF SELF-CONTROL
Find opportunities for meaningful activity to try to move the focus away from what the
individual must NOT/can NOT do.

4
CONNECT
Help the individual connect with friends, family and, as a therapeutic parent within the
secure estate, provide meaningful contact with them at every opportunity.

5
PROVIDE HOPE / OPTIMISM / POSITIVITY
Create hope by reflecting positive facts, and predictable, realistic steps that can be taken
now. Personally maintain hope and communicate this to the child or young person.

2
1. PROVIDE SAFETY
To keep safe at a time of crisis, the child or young person needs access to accurate and timely
information pitched at the correct level, explained where possible and delivered in an acceptable
dose. This information should help individuals explore answers to three key questions:

 What has happened?

 What is happening now?
 What is going to happen next?
Many young people will have heard a lot of information about the COVID-19 outbreak. However, this
may not all be accurate, and some of the beliefs they have may be causing unnecessary worry or
distress. Checking that the child or young person has an accurate understanding of the situation
and, where necessary, correcting any misapprehensions is an important intervention.

SIMPLE EXPLANATION EXAMPLE

What has happened? What is happening now? What will happen next?

• Humans are being To stop it spreading, • Hospital staff are helping

infected by a new virus government has told us to: people who have
called COVID-19 (Why is become very ill with the
• wash our hands using
it called this? virus to get better.
COronaVIrus Disease soap and warm water for
2019). It has spread 20 seconds, most
• Those with symptoms of
rapidly around the world, importantly after handling
COVID-19, and some
things others have
causing a lot of people to key workers, are being
get ill. touched
tested for the virus.
• catch coughs and
• An illness that spreads to • Scientists around the
many different countries sneezes with a tissue,
world are trying to
is called a pandemic. which should then be
develop a vaccine for
thrown away and then
COVID-19. This could
wash our hands
• People who catch the take 1-2 years.
virus may develop a high
• stay 2m apart from each
temperature, a cough or • Government is trying to
have a change to their other (this is referred to
work out when it can
as ‘physical/social
sense of smell or taste. safely end the lockdown.
They can be quite unwell distancing’)
It reviews the situation
for a few days, but most every 3 weeks.
make a full recovery. • people are staying inside
except to shop for • Government announces
• However, not everyone essentials, attend latest developments
will get better and some medical appointments
each afternoon around
will die. and exercise once a day.
5pm.

•
ACCURACY – Help the child or young person develop a plan for ongoing connection with
accurate resources such as BBC news reports or government briefings. Social media is not a source
of accurate information and tends to focus on subjects that can trigger alarm or anger.

TIMELINESS – Help the child or young person to balance their requirement for reliable
information with the amount of distress that information can generate. Checking the news once a day
is likely to be sufficient to keep up to date enough to stay safe and avoid undue distress.
Alternatively, a child or young person could choose ask staff to keep them up to date with important
information.

3
2. ACCEPT AND CALM
At a time of crisis, people may experience unfamiliar feelings, thoughts and physical sensations.
These are normal reactions to abnormal events and are the body’s reaction to stress. They are likely
to change over time and may include the six reactions outlined below.

RE-EXPERIENCING
CHANGES IN MOOD HYPERAROUSAL TRAUMA
(numb, anxious,
irritable) (jumpy, panicky) (nightmares, intrusive
images)

PHYSICAL
RUMINATING ON DEPERSONALISATION SYMPTOMS OF
NEGATIVE THOUGHTS (feel as if in a film, in a ANXIETY
(eg 'what if...?') dream) (racing heart, sweating,
distractibility, insomnia)

Promote good self-care including adequate sleep, nutrition, hydration, exercise and fresh air. Advise
against excessive consumption of dietary stimulants such as caffeine and sugar.
Keeping up with personal hygiene and changing clothes every day helps to maintain self-esteem.
Encourage interventions other than medication that increase a child or young person’s sense of being
able to manage their bodies and emotions. Breathing exercises, muscle relaxation exercises and
yoga promote a sense of calmness and improve sleep.
Following a routine is soothing for most people and provides certainty in uncertain times.

3. INCREASE SENSE OF SELF-CONTROL

Find opportunities for meaningful activity to try to move the focus away from what the individual must
NOT/ can NOT do. This could include:

 education

 reading

 arts and crafts

 creative writing

 keeping a diary

 learning a new skill

 building knowledge of a subject

 assigned roles and responsibilities.


4
4. CONNECT

Help children and young people to stay in touch with their loved ones. Maintain and support
connectedness through supporting children and young people as therapeutic parents in the children
and young people secure estate. Ensure all contact with children and young people is meaningful.
Normalise the COVID-19 lockdown experience and re-inforce the message that we are all (staff,
children and young people) in this together and will get through it together. Positive affirmations such
as “We can do this” may be helpful.

Have shared routines, maintain social connection and consider what shared activities could be run
place while maintaining physical distancing. REFLECT on:

 Daily shared discussions.

 If thought helpful and unlikely to increase distress, a daily COVID-themed discussion could
explore:
o What have you heard today about COVID-19?
o What is the source for that?
o How are people feeling about that?
o Do you have any questions about that?
 Shared activities, eg decorating the unit with rainbow-themed art work, games and quizzes,
watching a DVD or listening to music together.
 Themed meals or days.
 Shared fitness challenges.
Consider having a ‘joke of the day’, ‘good news story of the day’ or ‘inspirational quotation of the day’
to refocus attention on positive aspects of life.

5. PROVIDE HOPE / OPTIMISM / POSITIVITY

Regularly remind the child or young person that:

• this WILL end, not tomorrow, but in a matter of months.
• the vast majority of people who contract COVID-19 get better and return to their normal level
of functioning
• they have coped with difficult situations before and succeeded, they can draw on the positive
skills and resilience developed in those situations and use them now

1. Bults M, Beaujean DJ, Richardus JH & Voeten HA (2015) Perceptions and behavioural responses
of the general public during the 2009 influenza A (H1N1) pandemic: A systematic review. Disaster
Medicine and Public Health Preparedness, 9, 207-219
2. McAlonen GM, Lee AM, Cheung V, Wong JW & Chua SE (2005) Psychological morbidity related
to the SARS outbreak in Hong Kong. Psychological Medicine, 35, 459-460
3. Gu J, Zhong Y, Hao Y, Zhou D, Tsui H, Hao C et al (2015) Preventative behaviours and mental
distress in response to H1N1 among university students in Guangzhou, China. Asia-Pacific
Journal of Public Health, 27,1867-1879
4. Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in
Humanitarian Response, fourth edition, Geneva, Switzerland, 2018.
www.spherestandards.org/handbook
5. Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., et al. (2007).
Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence.
Psychiatry, 70, 283-315
6. World Health Organization, War Trauma Foundation and World Vision International (2011).
Psychological first aid: Guide for field workers. WHO: Geneva.