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Lin Inverness. Oops. OK. So um what I'm gonna talk to you today is about psychological first aid. But rather what I'm going to talk to you about is the deliverance. Why, why is it important to know about the existence and how you could train to get into delivering psychological state and why? What's the benefit of it? So I'm going to start now by sharing my slides. All right. And I, OK. Now, psychological first aid for Children and young adults. Now, the slides you're seeing here uh by the UK Health uh Security Agency and also safe for Children. And um what we're gonna, I'll try to cover as much as I can. So, what is it? First of all, it's a training that's 4.5 hours stretched on two days. There's role players, there's uh we have breakout rooms and what we're trying to do is that we're trying to empower people with skills and knowledge to give Children and families, psychology, first aid. For any of you, medical students who are interested in psychiatry P fa or psychological fails A is D it's the initial and the, the, the, the most helpful way that we can provide our services to people during humanitarian, in humanitarian medicine. It's the first thing that happens uh by psychiatrists. Now, for example, with the war that happened in Ukraine, with whatever is happening in Sudan and so many more places in the world, there are a lot of doctors now with things online, there are a lot of people who are providing these trainings to people around them. So let's talk about it. So what does it consist of now? The training consists of initially a bit about introductions. We talk about what is PFA for Children, children's reaction to crisis in terms of their develop neurodevelopment and also how they react, how they present symptom wise as a result from those adversities, action principles. What are they a bit about active listening and there's a section finally on looking after yourselves. So if you Google P fa and who psychological first aid and who? There's a lot of material. The latest one is uh the latest edition is from 2011. This has been going on since 2007. It is wh os first uh approach for people who are initially distressed or rather it's teaching the people who are helping those who are distressed and in the position that we uh that, that I I can recommend most of this. Uh most of the students here are this would be uh a lot of benefit. So what does P fa involve? It is all about giving practical care, nonintrusive support. It's something where we assess needs and concern of the people who are distressed, help them with getting access to basic needs, comforting people and helping them to feel calm, helping people to connect to services, social support and protecting people from further harm. Now, this is something that you can train anyone. It doesn't mean you have to be a doctor or a mental health professional. A professional. I was trained by teachers when I, when I started out being fa anybody can do it because we're not teaching people how to give clinical or psychiatric interventions. There's no diagnosis. We're not asking people to psychoanalyze or press people to tell their stories. It's entirely based on, it's really just you common sense teaching people common sense. Now, when do you provide P FA during an emergency situation or immediately after crisis, it's as part of capacity building and disaster preparedness during or after a crisis, affecting small groups of Children and as an immediate intervention with Children who have been sexually or physically abused or neglected or people who are displaced or refugees. Now, why P FA is a big deal? Because so who has come up with um when it comes to mental health, psychosocial support for refugees and people who are displaced, that's a pyramid of action that we go about. The first thing that we do is at the bottom, we provide basic services, security and dignity. So this is where we provide people with food, access, shelter, water, the basics, clothing, that's what we provide with. And then the second thing, what we do in mental health is we try to create a bubble around these people. So what we do is we strengthen family support, community support, integrate the students in schools or like what we are doing right now, that's part of strengthening community support and continuing education. So that's the next level. But then there's a bit higher than that. And that's why we have listening groups, social service support, and psychological first aid. Now this is a group that gives non specialized support that focus attention. What we're doing here is that we're trying to train the people around these group, the people who are displaced refugees, people who are distressed, we're training them to see the red flags, learn how to hear the red red flags. When do you refer to specialist and when do you link them to places that can be of help? So this is where we are training caregivers to have that skill to understand. So why P A for Children? Why is that specific? Now, if you Google wh and psychological first aid, the first thing that comes out is general adults. But only recently, we've realized that that can, that is a separate way of seeing these distressing signs in Children. Because Children react and think differently to adults. They have specific needs according to their age group and they're vulnerable to adverse effects with their physical sizes and social and emotional attachment. So which Children need P fa now, Psychological Fairy, it's all about when we do the program, we are training healthcare workers people around the Children and we are training them how to practice the psychological first aid to Children. Now, not all Children need psychological first aid. That's why there's a PFA program for adults and Children because Children have resilience, resilience factors are very strong, they cope very well with difficult experiences. Yeah. So and they react differently as well. So we'll explore that too. No, in if you're going to teach, if you've completed the training of P FA and you're going to teach people who are your target people to teach the bubble around these Children. So teachers, educators, social workers, you will be amazed at how many people have different perceptions on the word refugee and mental health. And that's what P FA really we're trying to do. Not only do we teach people how to look, listen and, and see those red flags in Children. But we also dispel misconceptions about mental health. I'm going to read to you uh a pro a program that I did training school teachers from the entire highlands. We're talking about a the spice similar to Belgium that, that white uh uh escape uh of school teachers that I was teaching. So there were around, I think 45 school teachers that participated. Now in that 45 in that amount of school teachers, 70% believe that all refugees, all people who are displaced are having mental disorder. Now this is the result of PTSD and that the misconception on PTSD ever since that word came out, we use it lightly. Oh, I have PTSD after, after an exam after war. But now there's this perception that everyone who comes up from an adverse event has PTSD and therefore needs medication and also therefore needs specialized mental health. And close to 40% of people believe that asking these refugees to recount the traumatic events that happen can help them. So there's a lot of misconception here and then telling refugees, telling them story or someone else that helped that, that the teachers help or anyone else that I've helped can help, can help the refugees in turn and giving reassurance is that is easier to, to, to help people feel better even though they are false hope. So saying things like to the Children don't worry, you will go home. Eventually the war will be over, you'll go home, you'll have your own house. All these things can be, can be worse. So that's the misconception that even here in the highlands, in the first world country, people can have. And that beat that to school teachers who have psychological teachers that, that teach psychology in the schools. And yet these perceptions can happen. That's not to say that there's something wrong with Scotland. But what I'm trying to say is this misconception affects us all lay people and even doctors as well. So what P fa what we're trying to do is to dispel that not every refugee needs are having mental disorder, not everyone has to need specialized services. There is such a thing as resilience. There is such a thing that, that they can cope better on their own support. So that's what we're trying to do. So I'll give you a brief description about children's reaction and uh children's development. But before that, uh does anybody know at what age does the brain fully develop? I'm just gonna go to the chat. Does anyone know? Can anyone give a guess of how old does um is your is your brain fully developed 25? That's a, that's a psychiatrist to be, that is true. Your brain is fully developed at the age of 25 and that is the frontal cortex. Yeah. So the frontal cortex is your, your executive thinker, your head master your your your adult that tells you put down the alcohol, you have to work tomorrow. So plan ahead. This is why all of us teenagers when we are teenagers, we are living impulsively. We learn to, to, to I mean, we do things without thinking we party hard, we play hard. There's no consideration for the future because that part of the brain that deals with executive is only fully developed at 25 and guess at what age does it start developing rigorously? When does it start to, to, to develop the frontal lobe, anyone and guest? All right. So I'm just gonna uh say it out then. So it's at the age of 15, at 15 years old, your frontal lobe starts to really develop the network start to form. That's a configuration in the brain and it fully develops at 25. So all these Children are at the age below 18. So you're talking about when it's 16 to 18, it's in between development and anything below uh 15, that's before. So that's what we're going. Uh So that's, that's the difference. Yeah. So I'm going to go back to my slides. See. OK. All right. So what are the common reactions of all age groups now, irrespective of how old you are, there's signs of fear that the event will take place again, the worry that their loved ones or they themselves will be heard or separated. There's reactions to seeing the community destroyed. There's reactions to separation for parents and siblings and there's sleep disturbances and crying. Yeah. So these are all over the age groups. But if you look, if you dissect it, it follows neurodevelopment. So what we're going to talk about, we're going to talk about cognitive development and what are the reactions for each age group? So from 0 to 3 years of old age, there's no, there's limited language they communicate with our body language. There's very little or no understanding of emergency event, physical contact equals comfort. Just a take home message. You need to know if you encounter anybody from 0 to 3 years is the greatest stress is you get abandoning the child. That's the worst thing that you can do. So, what are the reactions of someone who is distressed here? They cling more to parents, attachment is stronger here And there is a common theme here where you would see Children regress to their younger self. What what that means is that we all come out sucking Tums. We all come out with glabellar reflex. We all come out with primitive reflexes when you or, or we come out with where we like to rock ourselves. There's a, there's a comfort in just sitting down, fetal position and rocking to and fro so that when someone regresses to that goes to a development before that they are usually are that regression is often due to shock, trauma, shock and then often, then not across the board, you will see changes in sleep and eating pattern. These are biological figures. Yeah. And then there is crying, irritability, afraid that things, things that did not frighten them before. So these are the things that you look out and because of that uh biological factors, poor food, poor appetite. I sorry, poor appetite and poor sleep that's inactive. There's poor concentration and then there's changes in play they might have less or no interest in playing or they might have repetitive play or they may play aggressively. They're more opposing and demanding than before. How about 4 to 6 years of age? One thing you need to know is that Children or if I have to skip a crude way of explaining all Children are born autistic, that ability to understand another person's mind, another person's world that understanding away from centered uh beliefs comes in after the four years of age, those mirror neurons that that ability to say my mother is angry because she is working hard. You're able to see from another person's perspective that really comes in after four. Yeah. But at this age 4 to 6, they don't understand the consequences of emergency. Uh They still fully dependent on their parents reaction. There is this preoccupation by death, but they do not really understand that deaf people do not come back. Like I said, they can't understand the the perception of another person. There's this magical thinking surrounding themselves. So what can happen to someone who's gone through an adverse event at this age? Again, attachment to press parents regress to younger behavior like Tums are sucking, they stop talking. There's a fear to speak, there's inactive or hyperactive behavior. They do not play or play repetitive games and they're anxious and worried that bad things are going to happen. Also biological factors, sleep and eating difficulties. And because of that, there's physical symptoms of not feeling well, they're not playing. And also what's sad is that you see them take on adult roles. This is usually in Children who start to pick up languages in their host countries, they pick up languages faster. For example, we have seen Children who come from Ukraine or who start to pick up English faster than their parents and then they start taking adult roles, uh being translators for their parents. How about 7 to 12? Again, they are, they still have some magical thinking. Although they are able to think concretely uh a bit, there's a deeper understanding of how things are linked together such as cost and effect. They are interested in facts and they understand that that is forever. Also, they understand laws. There's a struggle with change, there's a divide, they divide the world into opposites, good or evil, right or wrong we want on punishment. That's usually an extremes that they see the world in. And there's still some magical thinking that extremes that seeing the world in extremes is because like I said, the frontal lobe really starts, that's a configuration in the frontal lobe at age 15. And that understanding comes towards that age rather than earlier. So what are the reactions you see level of physical activity changes, s feeling and behave, confused, withdraw from social contact. Talk about the even in a repetitive manner, reluctant to go to school, feel and express fear. Also, they have because of biological issues, like sleeping and appetite, there's memory concentration and attention that are impaired, they become a bit more aggressive, irritable, restless. All this is because of lack of sleep. When there's lack of sleep, your limbic system, which deals with intense emotion, your amygdala, your hippocampus, all these things get hyper and that causes all this aggression and irritability. And also they'll start having somatic complaints. These are psychosomatic, yeah, referred pain, physical symptoms related to emotional stress. Often you, they, you will see them point to their tummy and say pain, pain. Yeah, these are things that you can even see in normal. It's not just restricted to people who are refugees and displaced. Even if you remember if you can see Children before uh uh uh sports they or school exam, they start having stomach aches. These are all normal psychosomatic complaints. Yeah. So, so that's for Children across the board. If you have to get history, taking about someone's mic is on. All right. So, um so across the board, if you have to take mental health um history, the easiest way is to see. Is there any change before and after the, the tragedy before and after the event, was there any change in behavior, personality sleep and appetite. Yeah. And then cognitive development for teens and young adults. This is going to 15 searching for identity. That's a self awareness there, there's a, there's a sense of wanting to belong. So peers are more important. My friends are more important, although they are still attached to their family, understand perspective of others. Those mirror neurons are way developed. They can understand the view of another person. They understand consequences, self and others that executive thinking is there and there's a growing sense of responsibility, of guilt and shame. So that themes now what the reaction feels intense grief, self conscious of guilt and shame that they were unable to help those who were hurt, show excessive concern about others. Affected persons may become self absorbed and feel self pity, changes in interpersonal relationships, which is why also it would be good to know that W recommends among in these patients. What we're trying to do is we're trying to go away from medical treatment, not everyone needs medicine. And in these teams, the most helpful thing is really uh uh uh recommended by W Hr is interpersonal therapy. So that's why you try to help with, with the interpersonal uh uh uh people, the changes around them. So that's why we really target uh uh uh in this group. Another common risk reactions are increase in risk taking behaviors, avoidant aggression. You see them self destructive, self harm, cutting of self hurting self. There's a sense of hopelessness about the present of future, becoming defiant. This is where you start seeing people with conduct disorder. Basically, the criteria is just here becoming defiant to authorities and parents start to rely more on peers for socializing. So if you provide psychological first aid to these Children and young adults, at this point, you can help mitigate uh uh problems in the future. So what are the things you do? The the the the the main principles are prepare before you go, you know a little bit about refugee and mental health. If you're going to teach schoolteachers and anyone teach them about these things, what do you prepare in terms of culture? Understand your role, learning about available services. What are the services available that you can link them with? Right. So the key concept when you teach uh people, psychological first aid, uh eventually or for yourself as well when you're practicing in this stage, as a medical student, understand that if they are severely distressed, then you link them to professional support. Your role is to provide uh um as we will talk later, certain skills that are non intrusive and practical rather than providing uh um um uh specialized services. So when you, so when I talk about service and support, what are the service and supports that you're going to look of? Ok. So there are uh Ukrainian refugees displaced in the UK, what are the support system that I'm going to ask of? First, you look at local authority support, what is social care, housing finances, uh early help that you can have? Then you look at mental health support that in, in that country or in that local region. Uh Are there any mental health support by the uh the NHS for Children and uh uh people's mental health? Then you look at universal NHS services like maternity health care, uh school nurses, health visiting. Then you look at volunteers. There's a gen generous list of NGO S that can help. Ok. In the uh UK, what are the volunteers uh that can provide help mu aid, food banks, child online. And then look at nat National Domestic Abuse helplines. Just so you know, at uh true evidence we have realized, for example, in COVID domestic abuse increased by 10% in war in problems like this domestic abuse should have. So it's always handy to identify what are the helplines that you can help have from this this area. Then local community initiatives, what has been done by college schools or what the program that we are doing right now? CRF by Doctor Sharon Raymond, all these community initiatives, then often they not schools and colleges will have a support system. So these are the things you can find in the internet. University students can provide support, support people, communication tools. What are the tools apps? There are 500 over learning sessions for child and family development. These are things that you can spread to people who are taking care of refugees, try to dispel because when people take in refugees, they don't have a manual, they don't know they're doing a free will but there's a lot of perception through the media and through the experiences. So these online resources can help dispel these uh um uh misconceptions and then wellbeing resources, there's so many online things that you can find in that locality in that language that can help. Another thing when it comes to prepare is to understand culturally specific behavior. Now, I think this would resonate with a lot of people in this group. I'm a Malaysian and I resonate with this as well. English is not my first language. Now, when refugees come here, when you teach P fa to the people around here, if you're after being trained in psychological first aid language is a big, big factor here. You educate the people around. For example, if you see here the list, uh what the British would say in the third row, that's not bad. What the British mean is? That's good. But what other people understand is that's poor. Why is that? That's, that's mainly because of our language. We most languages abroad, we are very direct. There's a lot of nuances here in the UK uh that people speak that we don't understand, they don't say things, they don't mean what they say directly. And that's not a lie. But Children and young adults who come with limited uh capabilities to speak the language, they don't believe that, I mean, they don't know that they see as how it is. If you tell a child from another country who can't speak the language. Well, that's not bad. The child will believe that's poor if you tell them that is, uh, um, um, uh, I almost agree in the last column. I almost agree. The child will believe he's not far from agreement. And when you tell the person, I will see you later, the child believes that the person is going to get back to you later. I will see you soon. The child believes the person is going to be see you uh going to be see soon and that is dangerous. Because if you provide help, if you tell them I'm going to help you soon, you're giving the person hope. And when you break that hope, you break that belief, then only that's recipe for disaster later on in the child's life, you break that trust and that causes problem later on and that's what we're trying to avoid. So, so the action principles. So that's the prepare section. So that's what we in the training we do. We tell people to understand the differences in culture, how to approach them. And then we talk about the three next principles. What do, what do you hear? How do you listen and what do you uh where do you link? So when it comes to looking, that's a safety assessment here, you check for safety. You look for Children with obvious urgent basic needs. You look for Children, parents and caregivers with serious distress reactions how, what do you listen? This is just a summary. Uh uh You listen for you approach Children and parents who may need support. You ask about Children and parents or caregivers needs and concern. You listen to Children and their parents and help them to come. I'll explain a little bit more in detail thinking as well. I'll explain later. But the gist is that you must know Children resilience, they recover well when they are reunited with their parents or caregivers, when they have their basic needs, food, water, shelter, and they feel safe and out of danger when there's a community of bubble around them and when they receive support like p fa by the people around them, that's when things change. So let's look at what is the look assessment uh and other uh as of now, any questions, anybody, is there any questions here? There was one question in the chat, sir. Yes. Um So basically, I think someone said, what is magical thinking? So magical thinking is something Children have that's very beautiful. There's this, they still think like they still believe in Santa Claus, they still believe that fairies unicorns, that's this magical way of seeing things. And if you put, if you teach them religion, they believe that God is God is in the sky and God is looking at them. Therefore, I have to behave differently. Yeah. So that is magical thinking. Children are lucky uh to have that. Uh So that's magical in, in thinking. And, uh, I have seen in the chat someone says, does that mean I'm still a child? I do what others understand. Well, there are certain traits of chocolate that we carry on later. No. All right. Any more questions? Ok. Next, what are the look assessments, identifying Children and young people who needs help? I'm just gonna give the gist of this. Uh, now, as you know, Children react depending on their age developmental stage, how others especially their parents and caregivers react. They mirror their parents. Monkey see monkey do. Yeah, they see they, they feel uh what they've experienced in the past and also history taking what they have uh in terms of their mental health problems, past experiences abuse, family violence, neglect those things play in mind as well. So how does experiences that affect reactions? What are the experiences loss of attachment, family member or friends? Anyone that's attached, seeing seriously injured or dead bodies, family members who remain missing after an event or body has not recovered, becoming hurt or sick because of the disaster, being unable to evacuate quickly in a life threatening situation, feeling trapped, loss of belongings, loss of pets. These are all attachment, attachment to your home, your pets, your belongings, your area around you, the people around you. Any of those loss can cause stress and difficulties. Yeah, because these are the age at this age at at at this age group at after 12. There's a lot of attachments that are being formed. Yeah. And then our Children at high risk of strong reactions. These are people who are separated from their family, caregivers again, attachment, watching people who they are attached to guilt, physically hurt, feeling tra feel guilty about surviving when others die worried and concerned because their parents or caregivers are grieving or concerned. Now this guilt, this grief, all these things can cause them to have core beliefs. Yeah, for example of core beliefs, most of us here we have religions or can identify with people who have religions. For example, um core belief. If you have taught religion when you were young karma, you do good, you get good, you do bad, you get bad. That core belief affects the way you behave later on. And when these Children are affected with guilt at this age that is carried forward later on. So Children with obvious signs of distress, we have spoken about this already. All right. So uh we've spoken about as what are the things you OK. So what are the things you look at basic needs? Are they the? So this is where you have your, your uh mental state examination. MS E This is the key part of psychiatry or mental health. You identify when they come to you are their fingernails clean, are they uh uh uh as they are, are they, are they well nourished? Are they, are they uh hygienic? Are they, well, camp. Are they wearing dirty clothes? These are things you look at, look at medical history and medications. What are they taking? Are they having any learning disability? What are their support? All right. And then do they have someone to speak to someone to engage in meaningful activities? Are they playing with other Children? Approach safe safely? How do you approach? Help the Children feel calm? There's a way we'll talk about that feels later, speak softly calmly. The easiest thing you can do is when you um look uh start a conversation, sit, sit next to them at eye level, same level, maintain eye contact or, or if they have difficulty looking at you, you can look at other places but sit next to them breathe calmly. There is something in and mental health that we recognize as emotional contagion. You know that feeling when you sit beside somebody who's shaking your leg constantly you look at and you get anxious, you see somebody sweating before an exam, you see them, you get anxious. Yeah. So you can also turn the tables around when you breathe calmly. When you are relaxed. Only when you are at peace, you are able to give peace to others emotional contagion. Now, who are the Children who may need extra help? Look for those who are having intellectual disability, autism, uh chromosomal abnormalities. Uh These are where you look at your chromosomal markers down syndromes. Uh uh uh uh what's this thing. Uh There's so many neurological uh uh uh uh issues that uh uh neurological problems a child can have, they can spot out, uh look at the phenotypes, maintain dramatic changes in personality and behavior. You can find that that's a child and needs extra help, cannot function daily in their life. That's the definition of a disorder, mental health, psychological disorders that somebody who can't function in daily life, they feel threatened and risk of doing harm to themselves or others. That's something you obtain in mental health risk, uh mental state examination as well. Those are Children who need extra help. So in these cases, you avoid leaving them alone, uh stay with the child until the reaction have passed or until you can get help from others. This is when you have severe distress. So what about listening? What are the things? So you open the conversation, pay attention, listen actively, accept, acknowledge your feelings come the distress now, these are all just words. But what do you do? That's a video that I will send on the uh chat that you guys can have a look on your own free time. Uh This is an interesting video to look at but let's go into the listening part. So active listening. What are the skills that you are showing the child that you are listening? Actively, validate the child? Uh I remember for all of you who know Oprah free in her last show, I remember her saying of all the interviews she has ever done. The one thing she realized everybody in distress really wants to know is can you validate them? Can you know that they have gone through? So and so they exist? That's the sometimes the best thing you can do is not to just prescribe or immediately find, think of how can I help them? How can I link to them uh services? No, the best thing you can do is really just to validate them to sit down and hear them and hear them say this is where my pattern left. This is where that happened. And this is uh so and so sorry, I'm hearing things on the mic. Anybody has any questions to say? OK, maybe that was just a glip. All right. Uh Other things are um encourage problem solving, improve feeling or safety and hope I'll explain a bit more. So active listening as five components, attentive focus, paraphrasing, encouragement, questioning, and clarifying and summary, summarizing. These are all what psychiatrists do by the way daily and this is how we actively listen. So a uh attentive focus do not talk, just listen open questions. How are your, how's your day? How are you going through? What, what, what are you feeling right now? So don't have any distractions, do not interrupt, be aware of your body language. There is this urge as people who want to help to come up with an agenda. OK? I'm listening uh that they don't have clothes. I'm going to link them to uh uh cloth services. I'm going to link them here, link them. There don't be aware of your body language. When you are aware of your body language, the mind think so realize that you're just there to listen, recognize and control your own listening barriers and emotional triggers, paraphrase, repeat the words when they are speaking. Um OK, so you're saying so and so uh and then Mira, what was said when they are moving their hands, when they are, when they are talking also show that you are listening, show move body language, move words with them and go with the flow describe rather than interpret, don't give inferences. So when the person is talking about uh uh they, they ran through, I want to tell you a story about me running through uh um um this or migrating, walking through long distances, listen to them rather they're interpreting. OK. They've been walking very long. There might be some food problems, there might be some this problem. Just listen. Let me describe, beware of non verbal contradictions and an encouragement. Encourage them to talk. How do you do that? Simple words? Like tell me more, facilitate the conversation. Tell me more if they tell you, oh, I'm feeling sad. Can you tell me more? Expand on the symptoms? I'm feeling uh uh uh uh doctor, I'm feeling troubled. Can you tell me more? Yeah. And then w and non will I noticed pick up on things they are saying, I noticed that you're, you're tearing up. I've noticed that you are, you are very anxious. Why can you tell me more? Open up the conversation and then questions and clarifying uh again, same open questions, normalize and name reactions. Yeah. So people like to, this is a sort of like a general rule of thumb. People like it when others go through the same thing you went through. So normalize, it's uh the person is saying I'm, I'm agitated and I'm stressed because uh I had to leave and I had to stop my schooling, my education normalize. Uh Yes, there are a lot more people who are going through the same thing. There are, there are others who are also going through the same thing. It is normal for people to have these experiences. So normalize, that's how you normalize, put it away or, or the person is cutting themselves. Uh There are they normalize. There are people. So you say there are people who are going through intense severe reaction. It's normal for them to, to, to feel that they want to harm themselves. These are normal reactions. You can't stop a person from being self destructive or, or, or uh uh um uh having all those intense emotions because of the things that they went through. It's normal. But what we are doing here is we're trying to change the, the mala adaptive, the way that they cope by cutting themselves into something that is better like coloring jigsaws playing in the field. So we're just changing coping mechanisms. All the symptoms that we are showing are just coping mechanisms to cope with the problems that they are having. So normalize, reflect what the child has been saying throughout the conversation. So summarizing is a good way, use the person's words. So when the child says things like uh the, the the fairies did not come in. Uh listen to me before. When I was in my town, God listened to me. Now, God is not hearing me use these words in your vocabulary. When you summarize, identify and reflect important key points the child has raised. So a good communication in essence is you do not probe be sensitive and focus. The primary focus is the child. And here what I mean by here is that it's not about what you can provide. It's about letting the child release his tension by talking to you, accept and support emotions, use calm techniques. And if a child does not want to speak, that's OK by you repetitively going and seeing the person. That's when you start to facilitate trust. And these are things that not many people know, especially the lay people. And that's where P fa you teach people to go for it because many people have good intentions, but they don't know how to approach them and how do you manage this stress sometimes when you uh you don't have to read the whole thing. I, I'll explain it to you. So, calming techniques, simple techniques, grounding when the child's mind is array or, or thinking about uh the problems that have gone through, they start crying that can be quite agitating for you when you're seeing a seven year old or a 12 year old crying in front of you. So what you do is you ask the child to ground, focus on the senses. What are the things that they can taste? Smell, hear, see, ask them to be aware when the body is aware of the senses. It is, it starts to pink. The mind starts to pink. Yeah. So that's what we're trying to facilitate. Yeah. And then calming techniques like breathing, breathing. There's a lot of things that can be talked about breathing. But one thing you uh gist of it is for example, when the child is anxious or when somebody is sad yourself included, your breathing becomes hagged, becomes short, fast pace. So you change the breathing. The breathing is the only autonomic function that you can change. Uh um uh uh uh consciously all other autonomic functions. You can't control peristalsis. You can't control your heart rate. You can't control how much you sweat. You can't control your pupils dilation. But breathing, you can, when you change, when you are conscious of your breathing, you're using a different part of your brain, the para facial nerves. So this is what we try to facilitate in Children when they are breathing excessively. There's a different part of their brain in the uh uh in the brain stem that's taking over. So you ask them to be aware, de inhalation, de exhalation. It's all about awareness. What about translators? This is a big thing when it comes to people who are coming from another country, choose people you trust explain how you would like to communicate. Tell the child here is a translator, explain set the scene, ensure that the translator aware of his or her rule that they are not interpreting, they're translating, they're not giving their opinions. Don't criticize be aware of gender issues. Many people, for example, in my country in Malaysia, different genders, Children of the girls will have uh uncomfortability in talking to a group of big male adults. It's culture and we should respect the culture. So find a translator as of the same gender. So these are things that you have to be aware of. And then lastly link link to provide further support and look at how you can support yourself and college uh colleagues. So this is as I said earlier about linking when it comes to linking, learn about what's available in the area, food deliveries. Um What technology zoom that people are using here, teams, financial and employment assistance, childcare, repairs to home or transport when there is a disaster when some in, in, in, in crisis, there's always people who are there to help. The, the issue is finding these people that's when you can try to help. Also part of the program in P FA is teaching people about stress. I'm mindful about time as well. I see we have 12 minutes. Um but the gist of it, these are things that, you know, but it's helpful to, to talk about it, especially when you're going to teach P fa to lay people, school teachers, social workers, whatnot. You tell them the differences between good stress and bad stress. Good stress are when you have fight and flight, bad stress. When you out waste the resource to cope, you're feeling overwhelmed, unable to live up to own and others expectation, you feel out of place. So there's an imbalance when there's a higher source of stress and you can't cope when people can't cope. That's when all these suicidal thinking self harm, harm to others. Aggressive behavior starts to come in. So how does stress affect affects physically behavior, emotionally, spiritually, there's a change in belief in faith and socially. So these are things that you can identify from the history. If the child is having stress types of stress, your basic stress, like what we spoke earlier uh about the fight flight and fight response cumulative over time. Things uh distress, accumulate, burn out, burnout is when you just can't function. Well, you can't function optimally traumatic stress when these are still manifesting as, as um biological symptoms, unable to sleep, unable to eat, uh unable to function. So, burnout is a severe state of emotional and physical exhaustion caused by excessive and prolonged stress. When there are short doses of stress. When it's prolonged, that's where the fight flight and fight part of the brain. The amygdala is constantly being activated. That's when the body just can't cope. So this is when you notice symptoms of chronic physical and emotional extortion, depleted energy, detachment, withdrawal, feeling trapped. These are the key words that you can get from history, taking hopelessness, pessimism, cynicism. These are things when you see people stop believing in religion when they have strong religious background before there's a change in perception. These are easy ways to identify the thing about traumatic stress is you can have critical incidents. This is when you educate people that it's ok to have traumatic stress. It's normal to have traumatic stress after a distressing situation in wars in violence in natural disasters. What we are looking for are things that are secondary trauma, traumatization stress. These are things that happen after a few weeks, few months after the accumulation of all these stress. And these are also people not only just the, the the the the people who are displaced or affected, but the caregivers, caregivers who are exposed to critical incidents, sudden and disruptive people who who are taking care of, of refugees. These are people who can get this secondary stress, sorry, this is critical incident. This is as a direct result from the event and these are your normal uh uh uh reactions to traumatic incidents. Secondary is when somebody has a close relationship with uh these ref refugees or people in need uh who, who are working with them, they start to have concentration and memory difficulties altered outlook, sense of identity change. So another key element in teaching P fa is when we teach people how not to over involve and under involve. So over in involved is when people are like superheroes, savior attitudes, doing everything by themselves, not delegating, exaggerated preoccupations of people's problems. They are compromising their own time and energy for the safety of others, which is noble, sounds noble. But if you are not at peace with yourself, you can't, it's not easy to give peace to others. And how about the other spectrum under involvement, cynicism, less contact, lack of empathy blaming. So the best part, if you look in the middle is to have involve yourself as a helper, ability to register empathy, developing strategies, involvement in different kinds of activities keeping boundaries. So these are all ideal areas that you want to be in ways to reduce stress. These are things in the course we can really talk about about how psychologically we can do uh talk therapies, uh uh personal uh um activities, physical activities, social work related, having supervisors, team leaders. If you are teaching P FA to others or practicing P fa having team leaders to, to talk out whatever you're going gone through that will help. So that's the gist of what P FA did uh P FA is. So basically in a nutshell, the best thing being refugees, being people in the position that you are, you have life experiences of how you would like to be treated and to be spoken and to be heard by others. You're in a fantastic uh position to be teaching P FA to people and educating them. So P fa is great in your position because background story, I'm from Malaysia. I came to this country on a holiday and I got stuck during COVID English is not my first language and I had to stay here. I'm obstetrician by practice in Malaysia, but I had to stay here and I had to learn things, support by myself. I went bankrupt. And uh eventually I studied and I got into the, the, the training program and I'm now I'm in psychiatry. So along the way P FA was practiced on me when I wa I was in a uh a home, a charity home when I was stranded here. So the beauty is what we've know. What I've noticed is people are there to help, there are people who are willing to help, but they don't know how to. And even if they do in giving help in terms of materials, what matters is, is there's someone to hear you, listen to you, talk to you in a way that you would like to be talked. And these are skills and there are people who are just worried to approach because they are worried they might cost an adverse event. So P fa helps teach these people around you. How do you approach people who are distressed? And that's what it really does in the end of the day. And that's the biggest help that we can provide any questions. We have five minutes left. I don't see any questions coming in. I think it was an amazing, beautiful lecture. We really thank you for the lecture today, sir. And if there's no more questions left, I would kindly ask everyone to fill out the feedback form and um have a lovely evening, sir. All right. Thank you, Musa. Thanks everybody. And remember uh the P fa training, you can access it online as well. If you go online. If you type P fa uh uh psychological first aid training, there's so many things, websites that you can be trained in. And then after you start training, if you can practice it under supervision, then you can start training others and it will be helpful. Uh Hello. Yes. Um I have one question. Um some uh like uh extreme reactions can happen to the young Children from age like 7 to 6, then they can talk and like they can um they become like um shocked. So what what can we do in this situation? Like they don't have any response that yes, that that does happen. That does happen. That's a sign uh when somebody is shock and they start becoming mute, you are right. That can happen, especially in Children because there's this fear to speak. And in these events, the best thing we can do is just wait for them to open up. See, there's other distressing signs. Are they still able to function? Are they still able to eat sleep? Are they still able to talk if these people are able to function? Well, the best thing we can do is to wait, give, provide them with an environment that is safe, sit down with them, listen to them just even if they don't want to speak, sit that sit beside show that you're not trapped, breathe calmly yourself, exude, project that emotional contagion and in time that child because Children have high resilience can come back. Yes. If they are unable to function, unable to, to uh harming themselves or harming others. These are seriously disrupted. Uh uh People who are having disorders, these are people that you can refer to tertiary centers. But beyond that Children can have resilience. Does that answer your question? Thank you doctor. That was uh so informative. Thank you so much. All right. Thank you very much, doctor. Um I think there's one more last question. The last question that we're gonna take today, um, in the chat. Would you like me to read it for you or? Oh, I, I can see it. Is it ok for you? Uh, some Children would joke about what they've been through, especially if they are surrounding laugh at the situation. However, when paying close attention to charm and actually be stressed, how do we deal with such Children and how do we make them feel comfortable? So, humor sometimes has a very interesting way. And psychiatry and mental health humor is a very good coping mechanism and you are right. Sometimes Children can laugh about it because everybody is laughing. But what you can do is when everybody is laughing, the child laughs along. But when you sit down with the child alone or with two or three people, when the child is able to trust somebody or the child is able to speak, I'll give you an example. For example, sometimes it's put yourself in university when you're surrounded by a lot of people, everybody behaves collectively laughs in the same approach. But when you sit down with a person, personal time, you get to have a lot of input from a different side of the story. So that's the best way you can do 1 to 1. Uh Did you start studying medicine from the beginning in another country? Um Well, no, I, I completed my studies in Malaysia and I came here on U on a holiday actually as a doctor already. And, uh, doctor is nausea a normal reaction to trauma or is it a sign of physical injury? So, nausea, it depends, you have to take history taking. But, uh, if there's no, uh, blood abnormalities, there's no trauma physically, then nausea is in Children, a normal psychosomatic sign. Uh, they call it but some say butterflies in your stomach before an exam they start, they feel like they want to puke or before an, er, race. So these are normal psychosomatic things. All right. Thank you very much doctor. Really? Thank everyone else for joining and, um, it was a pleasure having a lecture with you and hopefully see you next time and enjoy your weekend, sir. Your weekend. You too. Bye bye.