MODULE FOR

TEACHERS ON

CREATING A SAFE
AND CARING
ENVIRONMENT FOR
CHILDREN

i
 © February, 2022

ISBN No. 978-93-83807-21-5

Published by HAQ: Centre for Child Rights

Any part of this module may be freely reproduced with appropriate acknowledgement. Permission to
translate all or any part of this module must be obtained from HAQ: Centre for Child Rights, New Delhi

Any parts of this module may be used for non-commercial purposes and distribution with due
acknowledgement and credits to the authors and the publishers.

Supported by: Malala Fund

AUTHORS
Dr. Kavita Mangnani
Ms. Uzma Parveen

RESEARCH TEAM
Ms. Sana Sood

EDITING
Ms. Anishha Aggrawal

ILLUSTRATIONS
Mr. Ashok Kumar

For further information, contact:

HAQ: Centre for Child Rights
E-mail: info@haqcrc.org

Design and Typesetting: Aspire Design

ii
Preface
COVID-19 has taken the whole world by shock and India’s story in this backdrop is no different. Chil-
dren have always been on the margins and the current pandemic has increased their vulnerabilities
multiple fold. While physical safety is the most immediate and imminent concern arising out of sud-
den outbreak of the pandemic, mental well-being has even more long lasting impact on individual
and communities at large. Needless to say, children are among the most vulnerable groups when it
comes to the mental health risks during and post COVID-19. As per mental health experts, numerous
factors around COVID-19 such as social distancing and isolation for longer duration, sudden closure of
schools and disruption in regular studies, fear of unknown and ambiguity around pandemic, restricted
or no opportunities for play and peer interactions etc. may impact children’s mental well-being. As per
the World Health Organisation (WHO), children with mental health issues face major challenges with
stigma, isolation and discrimination, as well as lack of access to health care and education facilities,
in violation of their fundamental human rights. As per WHO’s ‘Mental Health Status of Adolescents in
South-East Asia: Evidence for Action’ Report, published in 2017, a quarter of adolescents in India in
the 13-15 age group suffer from depression. Even the National Mental Health Survey of India, 2015-16
conducted by National Institute of Mental Health and Neuro Sciences (NIMHANS) and supported by
the Ministry of Health and Family Welfare reveal rising mental health concerns among children, both in
rural and urban settings. It is needless to say that the present COVID-19 situation has added to the con-
cerns which were already there and have amplified those in the present circumstances. COVID-19-re-
lated school closures have affected over 1.5 billion children around the world. In India, COVID-19 has
amplified the situation coupled with many socio-economic deprivations for economically weaker fam-
ilies such as loss of livelihood opportunities, greater risk of virus spread etc. This has also resulted in
reverse migration from cities to the native villages or towns. The out-of-school children and drop-outs
have increased multiple folds in the backdrop of the pandemic. Needless to say, girls have suffered
adversely on many counts given the predominant patriarchal social and family structure during the
pandemic and issues ranges from access to technology to non-prioritising the education of girl child.

The safety of children is often construed in terms of physical safety and seldom the mental health con-
cerns are taken into consideration. This module is an attempt to highlight the issue of mental well-be-
ing of children who have continued their school education despite pandemic situation and also of
those children who will start afresh once the normalcy is restored in the schools. The module aims at
equipping the teachers with basic skillset of identifying the mental health concerns among children
and the ways to address those. Therefore, the module aims to creating a safe space for children at
school and expand the meaning and scope of safety beyond conventional though process. The module
has been supported by Malala Fund and provides a practical handbook on bringing the preliminary
mental health services to the remote parts of the country through teachers.

We would truly appreciate a feedback on the handbook and its utility.

iii
iv
Acknowledgements
This module could not have been possible without the guidance and support of Malala Fund Network
Partners:

 Azad India Foundation, Bihar

 Joint Operation for Social Help (JOSH), Uttar Pradesh & Delhi

 Navbharat Samaj Kalyan Samiti (NBSKS), Uttar Pradesh

 Samudaik Kalyan Evam Vikash Sansthan (SKVS), Uttar Pradesh

 North East Research & Social Work Networking (NERSWN), Assam

 Purva Bharati Educational Trust, Assam

We are also thankful to Ms. Anubhuti Patra and Ms. Richa Silakari from Malala Fund India office for
constantly guiding and encouraging the team to keep the focus on mental well-being of children,
especially girls in the times of COVID-19.

In the backdrop of every successful venture are the team members of the organisation, who deserve to
be acknowledged for their cooperation and patience as we steered through the different stages of the
Module and the workshops. In particular, we thank the following colleagues:

Ms. Anuradha

Ms. Khushnoor Bano

Ms. Preeti Singh

Ms. Saine Paul

Ms. Sana Sood

Ms. Sunaina Torungbam

Mr. Tarcitius Baa

Mr. Tekchand

Last but not the least, we are deeply grateful to all the teachers who shared their insights and expe-
riences from the ground to help us make this module a nuanced approach towards addressing the
mental well-being of children.

v
 LIST OF ABBREVIATIONS AND ACRONYMS
PFA Psychological First Aid
COVID-19 Coronavirus disease
LCD Liquid Crystal Display
ADHD Attention Deficit Hyperactivity Disorder
PTSD Post-Traumatic Stress Disorder
CWC Child Welfare Committee
SJPU Special Juvenile Police Unit
CWPO Child Welfare Police Officer
WHO World Health Organization

vi
Table of Contents
Prefaceiii
Acknowledgementsv
List of Abbreviations and Acronymsvi
Table of Contentsvii
Introduction1
How to Use This Training Module 5
Part A. Welcome, Context Setting and Introduction9
A.1. Opening Remarks10
A.2. Purpose and Agenda10
A.3. Ground Rules12
A.4. Ice Breaker14
Part B. Understanding Mental Health and its Components 15
B.1. Myths and Facts about Mental Health17
B.2. Understanding Mental Health20
B.3. Understanding Emotional Well-Being26
B.4. Understanding Psychological Well-being30
B.5. Understanding Social Well-being34
Part C. COVID-19 and Children’s Mental Health 37
C.1. Exploring Factors Affecting Mental Health of Children39
C.2. Understanding the Pandemic Impact on Child Mental Health42
C.3. Recognizing Signs and Symptoms of Mental Health Issues44
Part D. Psychological First Aid 49
D.1. Understanding PFA51
D.2. Delivering PFA53
D.3. Building Skills to Provide PFA57
Part E. Building a Safe and Caring Environment 63
E.1. Building a Safe and Caring Environment64
Annexure 69
Annexure I: Ice-Breaking Activities70
Annexure II: Warning Signs and Symptoms of Mental Illness and Mental Health Issues71
Annexure III: Age-specific Reactions to Trauma76
Annexure IV: Delivery of Psychological First Aid78
Annexure V: Useful Reading Material84
References85

vii
viii
Introduction
This training module is designed for teachers working in government
as well as private schools. It can also be used by school counsellors
and other stakeholders who directly deal with the mental health
issues of children on a regular basis.

Objectives
The main objective of this training module is to enable the participants to become better informed
about mental health of children, to recognise the need for intervention and to deliver Psychological
First Aid (PFA) as needed. This would be accomplished by enabling the participants to:

 Develop an understanding about mental health and its components.

 Identify the factors affecting mental health of children arising out of the COVID-19 pandemic.
 Understand the impact of COVID-19 on the mental health of children.
 Recognize and identify the signs and symptoms of mental health issues in children.
 Understand the concept of Psychological First Aid (PFA) and how it can be used during a crisis.
 Build basic skills to deliver PFA.
 Understand the model and importance of a safe and caring environment for children.|

Expected Outcomes
At the end of this training, it is expected that participants will be able to:

 Understand mental health and its components.

 Assess the factors affecting the mental health of children.
 Assess the impact of COVID-19 on the mental health of children.
 Recognise the signs and symptoms of the mental health issues in children.
 Deliver PFA as needed with the right set of skills.
 Appreciate the importance of a safe and caring environment for children at school setting.

Methodology
This training module uses a combination of facilitative, directive, and participatory methodologies
including presentations, lecture-cum-discussions, group work/activities, role plays, panel/open house
discussions, information sharing on each other’s experiences, case studies, snap polls, etc.

1
 Facilitator
A facilitator is a guide who leads discussion without controlling the process. It is the responsibility
of the facilitator to provide a safe, nurturing, and open environment to discuss various concepts and
relevant information in a manner sensitive to the needs, feelings, and attitude of all the participants.
The term ‘facilitator’ is used since he/she does not provide ready answers or solutions but fosters a
wider understanding of issues through the process of dialogue and discussion.

Training Environment
It is recommended that the training be facilitated by atleast 2-3 persons, and the number of participants
should not exceed 60 in an online mode, and 20-25 in an in-person mode.

It is imperative for a facilitator to promote a conducive and co-operative environment, both, in-person
(in a physical space) and online (in a virtual space), wherein participants are encouraged to put forth
their views.

The facilitator must:

 Welcome every participant and create an atmosphere where each participant feel at ease to
express ideas and respond to those of others.
 Respond positively to questions from participants.
 Mitigate any conflict arising between participants and takes a neutral stand, without hurting
anyone’s feelings.
 Pay attention to responses of all participants to encourage their continued attention and participation.
(It can be done with an encouraging comment, a ‘thank you’ or a nod or by simply acknowledging
the response)
 Provide clarification or ask another participant for a response or suggestion, if a participant seems
to miss a point.
 Create an environment where all points of view are respectfully heard and disagreements, if any,
are gracefully handled.
 Avoid taking sides.
 Use well-placed humour, if possible, to engage participants.

Responsibilities
PRIOR TO THE TRAINING, THE FACILITATOR MUST:

 Read the training module thoroughly and work through the activities in each session to be familiar
with the responses and explanations required.
 Be well prepared on the goals and structure of the training program.
 Practice mock sessions with colleagues before conducting the actual training.
 Be updated on the latest information related to topic in discussion.
 Think of and be prepared with a lot of energizers to be conducted in between sessions.
 Decide on the mode of training beforehand and share the same with each participant prior to the
actual training to give them to for arrangements.
 If the training is done online, then check the setting before starting the session. Check internet
availability, audio and video settings etc.

2
 Share the link for the online session and password at least 24 hours before the training to avoid
any last-minute hassles.
 Choose a sitting area with no or minimum distractions when conducting online session.

DURING THE TRAINING, THE FACILITATOR MUST:

 Dress professionally even during the online session.

 Make the sessions simple and easy to understand.
 Demonstrate enthusiasm for the topics covered in the training and for the work that the participants
are doing.
 Be receptive to each participant’s questions and needs.
 Ensure each participant gets a chance to be heard.
 Ensure everyone takes part in the discussion and encourage participants to go beyond one-word
responses.
 Not cut off discussion because it is uncomfortable to him/her.
 Not let participants ridicule or otherwise not listen to one another.
 Not skip any discussions and questions.
 Not dominate the discussion or lead the participants from their own reference point and
perspective.
 Not be judgmental.
 Not make the participants feel targeted.
 Not raise his/her voice or express negative emotions verbally and/or non-verbally (through facial
expressions or any other gesture) to control the flow of discussions.

AFTER THE TRAINING, THE FACILITATOR MUST:

 Be available to the participants for answering questions/queries.

3
4
How to Use This
Training Module

Purpose
Facilitators can use this training module in an in-person or online mode to:

1. Learn about mental health of children via a facilitated session

2. Learn about mental health of children through self-study of this module
3. Conduct mental health awareness sessions for children using the resources provided
4. Conduct mental health awareness sessions for children’s parents using the resources provided
5. Assess mental health of children using the information and tools provided
6. Deliver PFA using the information and tools provided

Conventions Used
Online and In-person indicate if a particular activity can be carried out online or
in-person.
Optional indicates that the activity is not mandatory or can be substituted with another
one that the facilitator prefers, as long as it meets the stated objectives. Mandatory Indi-
cates it is mandatory.
Facilitators indicates that the activity is for facilitators only. That if a session is being conducted for
children, it is not to be included.

In-person (F) or Online (F) refers to material required by the facilitators.

In-person (P) or Online (P) refers to material required by the participants.

Sequence of Information
The information is provided in the given order:

1. Objectives – why is the information being provided

2. Expected outputs – what the participants must be able to accomplish after the training
3. Methodology – how the facilitator would need to conduct the training
4. Pre-requisites – what must be in place before the training, both, for the facilitator and the
participants

5
 5. Material required – the material that would be needed, both, online and in-person
6. Activities and Tasks – suggestions on the tasks that the facilitator can carry out in each section
and how he/she can engage the participants and introduce the concept; some of these are
optional and can be skipped or substituted with other activities
7. Facilitator Guide – reference material and resources at the end of each activity or task for the
facilitator to explain and reinforce the concept.

Annexures
The annexures contain additional, detailed information on the concepts and supporting documents,
checklists, forms, and other material that may be used by the facilitator.

Suggested Workshop Agenda

The facilitator can refer to the following suggested agenda for conducting the workshop. It may be
modified as per the number of participants, the time available, the mode of training (online or in-per-
son) and number of co-facilitators available.

DAY ONE
Time Topic Duration
10:00 AM – 10:50 AM Welcome and Introduction 50 mins
10:50 AM – 11:20 AM Understanding the Myths around Mental Health 30 mins
11:20 AM – 12:20 PM Understanding Mental Health 60 mins
12:20 PM – 12:30 PM Short Break 10 mins
12:30 PM – 01:30 PM Components of Mental Health 60 mins
01:30 PM – 01:40 PM Reflections and Discussion 10 mins
01:40 PM – 02:00 PM Assignment for Day – 1 and Closing 20 mins

DAY TWO
Time Topic Duration
10:00 AM – 10:20 AM Welcome and Reflection from Day 1 20 mins
10:20 AM – 10:30 AM Discussion on assignment for Day 1 10 mins
10:30 AM -- 11:30 AM Factors Affecting Mental Health of Children 60 mins
Understanding the impact of Pandemic on Mental Health
11:30 AM – 12:20 PM 50 mins
of Children
12:20 PM -- 12:30 PM Short Break 10 mins
12:30 PM – 01:30 PM Recognizing Signs and Symptoms 60 mins
01:30 PM – 01:45 PM Discussions and Reflections 15 mins
01:45 PM – 02:00 PM Assignment for Day – 2 and Closing 15 mins

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DAY THREE
Time Topic Duration
10:00 AM – 10:20 AM Welcome and Reflection from Training 2 20 mins
10:20 AM -- 10:30 AM Discussion on assignment for Day - 2 10 mins
10:30 AM – 11:30 AM Understanding Psychological First Aid (PFA) 60 mins
11:30 AM – 12:30 PM Building Skill to provide Psychological First Aid (PFA) 60 mins
12:30 PM -- 12:40 PM Short Break 10 mins
12:40 PM – 01:30 PM Creating a Safe Environment 50 mins
01:30 PM – 01:45 PM Discussions and Reflections 15 mins
Assignment for Day – 3 and Assessment of the Day – 3
01:45 PM – 01:55 PM 10 mins
assignment*
01:55 PM – 02:00 PM Application of the module and closing 5 mins

7
8
Part A. Welcome,
Context
Setting and
Introduction

9
 Objectives Expected Outputs

� To formally welcome participants � Participants will relax, open up

� To state the purpose of the training and understand and get to know each other
the expectations of the participants from the training � A congenial and safe environ-
� To share the agenda for the workshop ment for the training will be
created
� To familiarise participants with the ground rules
� Participants will be aware about
� To introduce participants with each other and to the objectives of the training and
make them comfortable what is expected from them
� To enthuse and motivate participants to take an ac-
tive role in the training
Methodology Material Required
� Presentation � In-person (F): The training
� Discussion room must be able to accom-
modate 20-25 participants in a
� Activity circular seating setup.
� Online (P): Participants must
Prerequisites
be comfortable with Zoom (or
� In-person (F): A4 size sheets, pens/pencils, flip similar mode for online training)
chart, markers, a small bowl or box, projector and and be seated in a private space
screen or LCD screen, laptop or desktop, audio without external noise and dis-
speakers, thumb pins, stapler and pins, double-sided tractions.
tape, cello tape
� In-person (P): Notebook and pen
� Online (F): Laptop or desktop, online platform such
as Zoom (or similar) with a professional subscription
(including polls, breakout rooms, recording, etc.).
� Online (P): Good internet connection and a smart-
phone with a large screen or a laptop/desktop with
Zoom (or similar) app installed.

A.1. Opening Remarks

Mandatory Online In-person

Prepare opening remarks well in advance and do a mock session prior to the training. Opening
remarks are key as they set the tone and mood for the workshop. There must be high energy
and enthusiasm during the opening remarks. It is a good idea to introduce yourself and your
co-facilitators and to thank the participants for taking out time to attend.

A.2. Purpose and Agenda

Mandatory Online In-person

Every participant comes with certain expectations or pre-conceived notions about the training.
For the smooth transaction of the training program, it is important that the facilitator should
have a fair idea about the expectations of participants from the current training program and
share the objectives of the training and what participants will gain by the end of training.

10
 Facilitator must clearly articulate the purpose of the workshop, seek the expectations of the
participants and what they hope to gain from the workshop. Note the expectations articulat-
ed by the participants on the flipchart or chat window and display visibly during the training.
This is essential to align all stakeholders and remove any misconceptions.

A.2.1. Activity: Listing of Expectation and Sharing of Objectives

Step 1: Ask and encourage the participants to share their expectation from the training.

Step 2: Keep writing down the expectation of the participants on a flip chart/or ask
participants to write them in the chat window.

Step 3: Once all the participants have shared their expectations, integrate the expectations,
and share them with the participants.

Step 4: Afterwards, by using the information given in Facilitator Guide A.2 share objectives
and expected outcomes of the training with participants with the help of a
presentation. Integrate the training objectives and outcomes with expectation of
the participants and set the context for training.

Facilitator Guide A.2

The main objective of this training module is to enable the participants to become better in-
formed about mental health of children, to recognise the need for intervention and to deliver
Psychological First Aid (PFA) as needed. This would be accomplished by enabling the partici-
pants to:
� Develop an understanding about mental health and its components.
� Identify the factors affecting mental health of children arising out of the COVID-19 pandem-
ic.
� Understand the impact of COVID-19 on the mental health of children.
� Recognize and identify the signs and symptoms of mental health issues in children.
� Understand the concept of Psychological First Aid (PFA) and how it can be used during a
crisis.
� Build basic skills to deliver PFA.
� Understand the model and importance of a safe and caring environment for children.

At the end of this training, it is expected that participants will be able to:
� Understand mental health and its components.
� Assess the factors affecting the mental health of children.
� Assess the impact of COVID-19 on the mental health of children.
� Recognise the signs and symptoms of the mental health issues in children.
� Deliver PFA as needed with the right set of skills.
� Appreciate the importance of a safe and caring environment for children at school setting.
This training uses a combination of facilitative, directive, and participatory methodologies includ-
ing presentations, lecture-cum-discussions, group work/activities, role plays, panel/open house
discussions, information sharing on each other’s experiences, case studies, snap polls, etc.

11
 A.3. Ground Rules
Mandatory Online In-person

As a facilitator you must lay out the ground rules. These are mentioned explicitly to guide the
participants towards the desired behaviour expected from all, in order to ensure a mutually
rewarding experience. Depending on the time available, and the nature of the training, these
could be decided in consultation with the participants or independently by the facilitator. If
the former, once the ground rules are unanimously decided, keep them visibly displayed in
the training area (if in-person) or typed in the chat window (if online) for reference.

For this training, there are four basic ground rules. These are:
1. Maintain confidentiality – this is extremely important if people are to be comfortable
revealing personal stories
2. Be respectful – maintaining decorum even if we disagree with each other, is essential
3. Avoid being judgmental – it is imperative to not form premature moralistic judgements
about issues and anything that is being shared during the training
4. Participate actively – the training is designed to elicit active participation; passive
listening will not yield many benefits

Note: Ground rules must always be set with positive statements and action words. Avoid
using a rule as ‘Do not interrupt others when they are speaking’. Instead, word it as, ‘Let the
participant finish speaking before stating your point’.

Some typical ground rules which can be included are:

 Feel encouraged to participate at your own comfort level
 Be fair and sensitive
 Allow everyone to be heard equally
 Ask questions in a positive, open, and accepting atmosphere
 Avoid cross-communication to prevent disturbance
 Respect all views - everyone’s input is valuable
 Respect each other’s right to participate and share thoughts

Some specific ground rules for online training are:

 Mic to be kept turned off at all times.
 Participants who wish to speak must indicate by clicking on the Raise Hand icon, or they
can type in the chat window. Then they must wait for the facilitator to invite them to
speak.
 Each time participants should mention their name when responding or talking so that
others can recognize them.
 Video must be kept on at all times.
 Other apps should not be kept open to save bandwidth and ensure a good connection.

12
EXAMPLE OF GROUND RULES

1. Be respectful

2. Maintain confidentiality

3. Participate actively

4. Avoid being judgmental

13
 A.4. Ice Breaker
Optional Online In-person

Using an ice breaker is essential to get participants to drop their inhibitions, make them com-
fortable with each other and get into the spirit of the training. It will also energize and moti-
vate them to actively participate in the training. However, depending on the time available, it
may not always be feasible to conduct.

Two activities for ice-breaking are provided below. You can choose to do either or none. More
ideas for ice-breaking activities are provided in Annexure I.

A.4.1. Activity: Chitty Chat Introductions

Optional In-person

To introduce participants with each other, the following activity can be done:

Step 1: Count the total number of participants.

Step 2: Prepare same number of chits and write each number twice. For example, if there
are 10 participants then prepare 10 chits and write each number from 1 – 5 twice in
separate chits.

Step 3: Fold every chit in the same order or manner and place them in a small bowl or box.

Step 4: Ask all participants to pick up one chit from the bowl/box.

Step 5: Once all the participants have taken the chits from the bowl/box, ask them to pair
with the participant who has same number chit.

Step 6: Ask participants pairs to collect the following information from each other: Name,
education, place they belong to, occupation, designation, their interest, and an
event from their childhood. Give 2-5 mins.

Step 7: Invite the participants one by one to come forward and introduce their partners.

A.4.2. Activity: Coin Introductions

Optional Online

To introduce participants with each other, the following activity can be done:

Step 1: Count the total number of participants.

Step 2: Ask every participant to find and bring the oldest coin they can find near them and
show it to the facilitator through video.

Step 3: Ask participants to now look at the year mentioned on the coin and think of an
event/memory - sweet or bitter – that happened with them in that year.

Step 4: Ask each participant to introduce themselves with the following information -
Name, education, place they belong to, occupation, designation, their interest, and
life event of the year mentioned in their coin.

14
Part B. Understanding
Mental Health
and its
Components

15
 Objectives Expected Outputs
„ To build understanding about mental health „ Participants will be able to understand
and its components about mental health and how it is
different from mental illness
„ To learn about the components of mental
health - Emotional Well-being, Psychological „ Participants will learn about the
Well-being, and Social Well-being components of mental health -
Emotional Well-being, Psychological
„ To make participants aware about the
Well-being, and Social Well-being
importance of mental health
„ To dispel certain myths and facts about
mental health of children
Methodology Material Required
„ Presentation In-person (F): A4 size sheets, pens/pencils,
flip chart, markers, a small bowl or box,
„ Discussion
projector and screen or LCD screen, laptop
„ Activity or desktop, audio speakers, thumb pins,
„ Case Study stapler and pins, double-sided tape, cello
tape
Prerequisites
In-person (P): Notebook and pen
In-person (F): The training room must be able
to accommodate 20-25 participants in a circular Online (F): Laptop or desktop, online
seating setup. platform such as Zoom (or similar) with a
professional subscription (including polls,
Online (P): Participants must be comfortable breakout rooms, recording, etc.).
with Zoom (or similar online mode) and be
seated in a private space without external noise Online (P): Good internet connection and a
and distractions. smartphone with a large screen or a laptop/
desktop with Zoom (or similar) app installed.

Mental health needs of children and its awareness in the school or among teachers and amongst
parents are largely unseen or unknown. School authorities and parents often find themselves
struggling to understand the behaviour of children who are self-harming, socially isolated, withdrawn
or behaving in a way that may cause distress at school or at home. These outward expressions of
sadness, unhappiness or difficulty affect the well-being and learning of children at school, forcing
children leave studies and drop out from school.
What is required is that the schools should adopt a proactive approach towards the mental health
of children, anticipate, pre-empt, and prevent problems, and undertake early interventions. The
approach should focus on not just helping children deal with the problem at hand, but also help them
build on their strengths. This will act as a buffer in times of crisis or difficult situations.

In this section we will learn about what constitutes mental health and its various components - how
one can identify mental health issues in children, manifested or expressed through their behaviour or
through learning problems or other means.

16
B.1. Myths and Facts about Mental Health
Mandatory Online In-person

You can do either one of the two activities given below.

B.1.1. Activity: Guess the Myth; Guess the Fact

Optional In-person

Prerequisite: Prepare a list of statements on a flip chart related to mental health of children.
The list of myths and facts is given in Facilitator Guide B.1.

Step 1: Show each statement one by one.

Step 2: Ask participants to respond to each statement by raising their hand if they agree
with the statement.

Step 3: Once all the statements (myths) are read out and responses are collected, then
share the facts associated with each statement and hold a brief discussion about it
with the participants.

Note: The presentation of the statements can be done in multiple ways depending
on the mode of training. If the training is being done in-person, then participants
can be given a sheet with all statements written on it and they can respond in
writing with a yes or no.

If the training is being done online, then the statements can be presented via a presentation
and/or an online poll can be conducted. This will enable the facilitator to share the results of
the poll immediately with the group.

B.1.2. Activity: Myths and Facts Brainstorming

Step 1: Divide the participants in equal number of groups.

Step 2: Instruct participants to list down all the myths that they know or have heard about
mental health. Give participants 10 minutes for the discussion.

Step 3: Ask each group to present their list of myths.

Step 4: Once all the presentations are complete, integrate all the myths as per the list given
in Facilitator Guide B.1 and conduct a discussion about the myths.

Note: If this is being done online, use breakout rooms.

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 Facilitator Guide B.1
S. Statement Fact
No.
1 Mental health Mental health problems are not the regular ups and downs
problems are not of life. It creates distress, doesn’t go away on its own and
real problems. are real health problems. It hinders a person’s normal
life functioning. When someone is physically injured,
they see a doctor. Similarly, mental health problems also
require seeing a mental health professional- psychologist/
counsellor/psychiatrist.
2 Mental health It’s true that some people who experience mental illnesses
issues are just an may act in ways that are unexpected or seem strange
excuse for poor to others. For instance, being angry or violent or may
behaviour and start crying suddenly for no apparent reason. We need to
poor academic remember that the illness, not the person, is behind this
performance behaviour.
3 Children do Even very young children may show early warning signs
not experience of mental health concerns. Half of the mental health
Mental Health problems show first signs before a person turns 14 years
problems old.
4 Children show More than a myth, it is a stereotype/bias that adults hold
anger and violent against children. When children are in distress or confused
behaviour due to or feel rejected or experience any mental health issue, they
lack of discipline may express themselves in different ways. Some children
and manners may become withdrawn or isolated whereas others may
show anger or violent behaviour. Also, one must be mindful
of the fact that aggression and violence can be a learned
behaviour. Children who witness aggressive behaviour or
violence at home may adopt this behaviour to cope with
any difficult situations in life.
5 Mental health Mental health problems have nothing to do with being
problems happen weak and many people need help to get better. Many
due to personal factors contribute to mental health problems, including:
weaknesses of � Biological factors, such as genes, physical illness,
children injury, or brain chemistry
� Life experiences, such as trauma or a history of abuse,
� Family history of mental health problems
� People with mental health problems can get better and
many recover completely.

18
 Facilitator Guide B.1
S. Statement Fact
No.
6 Children can Children don’t have the skills and life experience to
manage mental manage conditions as overwhelming as depression,
health problems anxiety, or ADHD. They can benefit profoundly from the
through will right treatment plan, which usually includes a type of
power behavioural therapy, and have their health and happiness
restored.
We can’t expect children and teens to have the tools to
overcome these challenges on their own, but they can
recover with the help of their parents, or other significant
adults in their lives and an effective intervention plan.
7 Children grow On the contrary, children “grow into” deeper or debilitating
out of mental mental health issues if timely interventions are not given.
health issues Most mental health problems, if left untreated in childhood
become more difficult to treat in adulthood. Since we know
that most psychiatric disorders emerge before a child’s 14th
birthday, we should have a huge incentive to screen young
people for emotional and behavioural problems. We can
then coordinate interventions while a child’s brain is most
responsive to change, and treatment is more likely to be
successful.
8 Therapy and Treatment for mental health problems varies depending
counselling on the individual and could include medication, therapy, or
cannot help both. Many individuals gets better with a support system
children with during the healing and recovery process.
mental health
issues
9 There is no hope Studies show that people with mental health problems can
for children get better and many recover completely.
with mental
health problems.
They will never
recover.
10 Mental health Prevention of mental, emotional, and behavioural
problems cannot disorders is possible, if one focuses on addressing the
be prevented known risk factors such as exposure to trauma that can
affect the chances that children, youth, and young adults
will develop mental health problems. Further, promoting
the social-emotional well-being of children and youth
leads to better preparedness to deal in any potential stress
in future.

19
 B.2. Understanding Mental Health
Mandatory Online In-person

It is important to be able to understand the different aspects of mental health. For this pur-
pose, carry out the following activity.

B.2.1. Activity: Understanding Mental Health

Mandatory Online In-person

Step 1: Divide the participants in equal number of groups.

Step 2: Share one case study per group given in Facilitator Guide B.2 – Section 1. Give at-
least 10-15 mins for discussion. Share the following questions as a guide to discus-
sion:
 What do you think about the child in the case study?
 Do you think the child has any mental health issue(s)?
 If yes, what is/are the mental health issue(s) the child is facing?
 If no, provide your reasons.
 Do you think the child needs to be taken to a doctor for treatment?

Step 3: Get everyone back together.

Step 4: Discuss each case study.

Step 5: After the discussion is complete, share and discuss the status of each child men-
tioned in the case studies.

Step 6: Share what encompasses mental health and the three inter-linked components of
mental health using Facilitator Guide B.2 – Section 2.

Note: The message that the participants should get from this activity is that
mental health includes not just helping children to deal with the issue at hand,
but to also help children develop strength; resilience and qualities, which will help
them, deal with any possible stressful/crisis situations in future.

20
 Facilitator Guide B.2 – Section 1
Case Details for Discussion Actual Status
(to be given to participants)
1 5-yr old Danish starts crying whenever his Danish’s mother was a para-medical pro-
mother goes for work. He constantly makes fessional and was on COVID-19 duty at
requests to his mother to not go for work a hospital and her son was very worried
and stay at home with him. When his moth- about her mother going to the hospital
er is at her workplace, he calls her frequent- during lockdown. He was worried that
ly and asks her to come back home. He something will happen to her mother and
complains of stomach pain or body pain and that is why he wanted his mother to stay
requests his mother to take leave from work. at home.
He has stopped attending his online classes
and does not study at all. His mother shared
that when she comes back home from work,
he fights with her. His mother is a healthcare
professional and was stationed in a hospital
duirng the lockdown.
2 16-yr old Sunita is the eldest daughter in Due to the closure of school and lock-
her family. She is a bright child and never down, Sunita being the oldest child had
misses school. She is also very helpful and to share the responsibilities of housework
helps her mother with home chores (does with her mother. Her entire day would go
all the cleaning, cooking, and washing). She in doing home chores, leaving no time for
has younger siblings, but they do not help in her studies or leisure activities and even
home chores at all. Her mother has recently to rest or rebuild her energy. She would
noticed changes in Sunita’s behaviour. Sunita be too tired to attend her classes or finish
has started shouting often and beats-up her her school assignment on time.
younger siblings when they do not listen to
Further her siblings were not helping her
her. Her school teacher too has shared con-
at all in house chores, therefore she was
cerns about Sunita, she shared that Sunita
feeling stressed out and worn out and that
has not been attending her online classes
was the reason for her anger towards her
regularly and if she does, she joins late.
siblings.
3 14-yr old Gayatri’s teacher observed that Gayatri became attracted to her chachi’s
Gayatri has been posting several messages 19-yr old brother who was living with
on her WhatsApp status. Earlier, the messag- them during the lockdown. She started
es were general but moved to being more harbouring feelings of affection but soon
about love, affection, friendship, and now, found herself frustrated at her inability
more recently, about loneliness, rejection, to express her feelings, and also because
lack of trust, and self-harm. She seemed he took no notice of her. Her feelings of
to be demeaning herself very often in the loneliness were compounded by the fact
messages. that she did not attend online classes
and was completely cut off from all her
friends.

21
 4 17-yr old Ram has recently changed his Ram had an experience of bullying in his
school due to his father’s transfer. Their new previous school and no intervention was
house is far from the city and is quieter than done at that time. Later, he developed
the previous one. He likes it here and he social anxiety and would go to any length
likes the new school too. He shares cordial to avoid any kind of social interaction to
relations with his parents and siblings. He avoid humiliation.
is very focused on achieving his goals and
spends most of his time studying. He wants
to get admission in the best business man-
agement college. Ram scored first position
in his mid-term exams. Ram’s teacher
shared with his mother that while Ram is
a bright student, but she has observed that
he stays alone in school or in class, most of
the time. Even after six months of joining,
he has no friends, and she (his teacher) has
never seen him talking to anyone during or
after class. He does not even participate in
any extracurricular activities. Ram’s mother
shared that he never had any friends and
does not like to make friends either, because
he doesn’t feel the need to have friends.
5 8-yr old Pratik’s mother is very concerned Pratik’s head injuries were completely
about him. She feels that there is something unrelated to the current concerns of his
wrong with him. As a child, he had fallen mother. They were superficial and did not
from the bed, stairs and balcony and has got impact his growth from any perspective.
hurt on the head many times. Pratik hardly His mother’s concerns stemmed from
speaks to anyone, at home or during online comparison with the younger sibling. Pra-
class. He doesn’t like to study either and is tik was indeed very quiet, but it was due
inconsistent with his homework. But he has to acute isolation he was experiencing
very good handwriting. His mother works in during lockdown.
an office; she leaves at 8am and return home
at 4pm. Often she finds that Pratik hasn’t
eaten his food. Pratik’s younger sibling, a
2-yr old talks all the time. Unlike Pratik, he
even fights back when other kids hit him.
6 12-yr old Sita’s teacher sees many superficial Sita’s was not hallucinating. She was
cut marks on her left forearm. She asks Sita exhibiting attention seeking behaviour.
how she got hurt. Sita shares that she sees It was a pattern with her as she did not
this chudail all the time who is after her and get adequate attention at home from her
tells her to take a knife and kill her younger parents, especially her mother.
brother and herself. She says that the chudail
wears a white saree, has long, flowing black
hair, and she has blood on her hands. Sita
lives in a 1BHK apartment with her father,
mother and two younger siblings. At night,
they all sleep together next to each other.

22
 Facilitator Guide B.2 – Section 2

What Encompasses Mental Health

Good mental health is more than simply the absence of mental disorder; it includes:
1. A sense of self sufficiency, self-esteem, and self-worth
2. The ability to put one’s trust in others
3. The ability to give and receive friendship, affection, and love
4. The ability to form enduring emotional attachments
5. The ability to experience deep emotions
6. The ability to forgive others and oneself
7. The ability to examine oneself and consider change
8. The ability to learn from experience
9. The ability to tolerate uncertainty and take risks
10. The ability to engage in reverie and fantasy
11. The ability to reach its highest potential

Mental health includes three components:

� Emotional Well-being
� Psychological Well-being
� Social Well-being

All three components are inter-connected and inter-dependent. For instance, when one
experiences negative emotions (emotional well-being) for a long period of time, it may affect
their social interaction (social well-being). Or if one finds it difficult to handle or maintain healthy
social relations (social well-being), then it may affect the person’s self-confidence or self-worth
(psychological well-being).

Social Emotional
well-being well-being

Psychological
well-being

23
 A sense of self sufficiency, self-esteem, The ability to put one’s trust in others
and self-worth

What
Encompasses
Mental
Health?
The ability to form enduring
emotional attachments

The ability to examine oneself and The ability to engage in reverie and
consider change fantasy

24
 The ability to experience The ability to forgive others and oneself
deep emotions

What
Encompasses The ability to give and receive friend-

Mental
ship, affection, and love

Health?

The ability to tolerate uncertainty and

take risks

The ability to learn from experience The ability to reach its highest potential

25
 B.3. Understanding Emotional Well-Being
Mandatory Online In-person
Emotions form an important part of our well-being. What we feel and experience about
ourselves and about others affects our relationships with self and others. At times, it may
seem like we are ruled by these emotions. There are a host of emotions that one experienc-
es - some are pleasant/positive whereas others may be unpleasant/negative. Feeling both
positive and negative emotions is a natural part of being human. Balancing the experience of
both is core to emotional well-being.

We might use the word ‘negative’ to describe more unpleasant emotions, but it doesn’t mean
those emotions are bad or we shouldn’t have them. Still, most people would probably rather
feel positive emotions than negative ones - to feel happy instead of sad, or confident instead
of insecure. But what matters is the quality of our emotions, and how they are balanced
i.e., how much of each type of emotion, positive or negative, we experience in a particular
situation.

Note: It is true that no emotions are bad but the way in which they are expressed can be healthy
or unhealthy. For example, berating or humiliating children when one is feeling frustrated
can affect their mental health. This would be an unhealthy expression of emotions. Unhealthy
feelings can also take the form of self-harm or suicide.

To enable participants to understand emotional well-being, carry out any of the activities
given below.

B.3.1. Activity: Personal Emotions Good vs. Bad

Optional Online In-person

Step 1: Ask participants to write down a list of all the emotions they have ever experienced.
Give 10-12 mins for this.

Step 2: Ask participants to sort the list into two categories – good/positive emotions (those
which gives pleasant experiences) and bad/negative emotions (those which gives
unpleasant experiences). Give 10-12 mins for this.

Step 3: Ask 4-5 participants to share their list of emotions and their reasons why they think
some emotions are good/positive and some are bad/negative.

Step 4: Then use Facilitator Guide B.3 – Section 1 to discuss good/positive emotions vs.
bad/negative emotions and explain the concept of emotional well-being.

B.3.2. Activity: Expression of Emotions – Situational Emotions

Optional Online In-person

Step 1: Share a list of situations provoking emotions. Use Facilitator Guide B.3 – Section 2.

Step 2: Ask participants to brainstorm the emotions that children can experience in such
situations.
Step 3: Once the activity is complete, discuss different ways children may express their
emotions and feelings in different situations. Use Facilitator Guide B.3 – Section 1.

26
B.3.3. Activity: Expression of Emotions: Picture

Optional Online In-person

Children express emotions in different ways. When faced with a difficult situation, some
children may show anger, whereas other may become silent and withdrawn. Or a child may
throw his/her toys out of frustration. Often kids lack the vocabulary to talk about their feel-
ings, and they may act out these feelings in a way that may be problematic. Therefore, it is
important for the adults in their lives to develop the skill to identify their emotions and help
children deal with them.

For this purpose, the following activity can be done.

Step 1: Share a few pictures or images one by one where children are expressing emotions.
Use Facilitator Guide B.3 – Section 3.

Step 2: Ask the participants to identify the emotion or feeling the child may be experienc-
ing in each picture, and what it implies.

Step 3: Once the activity is complete, discuss different ways children may express their
emotions and feelings in different situations. Use Facilitator Guide B.3 – Section 1.

B.3.4. Activity: Expression of Emotions - Movie clip

Optional Online In-person

Step 1: Play parts of a movie named ‘Inside Out’ displaying emotions and their expression
by children.

Step 2: Once the movie ends, discuss different the ways children may express their
emotions and feelings in different situations. Use Facilitator Guide B.3 – Section 1.

B.3.5. Activity: Understanding Hidden Emotions of Children

Optional Online In-person

Do this activity to understand how children express their emotions in different situations. It
will help adults understand the emotions of children and help them identify any child who is
experiencing negative emotions even in apparently pleasant situations. You can then talk to
the child or refer the child for counselling as deemed fit.

Step 1: Share the worksheet outlining different situations. Use Facilitator Guide B.3 – Sec-
tion 4.

Step 2: Ask participants to write down how they might feel in these different situations.

Step 3: Once the activity is complete, collect all the sheets.

Step 4: Then discuss different ways children may express their emotions and feelings in
different situations. Use Facilitator Guide B.3 – Section 1.

27
 Facilitator Guide B.3 – Section 1
Often emotions like anger, sadness, fear are considered negative/bad emotions. But these
emotions warn us against any threat or challenge that we may need to deal with. For instance,
fear can alert us of any possible danger. It is a signal that we might need to protect ourselves.
Angry feelings warn us that someone is stepping on our toes or violating our trust. Hence,
negative emotions help us to focus on a problem so we can deal with it. But experiencing too
many negative emotions for a longer period can make us feel overwhelmed, anxious, exhausted,
or stressed out.
On the other hand, positive emotions help individuals to deal with any situation in a better way.
Positive emotions help us take in more information, open us to new possibilities and enhance
ability to learn new or build on existing skills.
All emotions are valid. Feeling both good/positive and bad/negative emotions are a natural part
of human being. Though it is true that most of the time we would rather feel good or positive
emotions than bad or negative emotions. We use the word bad/negative emotions to describe
more difficult or unpleasant emotions. But both – good/positive or bad/negative emotions are
important to experience and contribute to our emotional well-being, and overall mental well-
being.
Facilitator Guide B.3 – Section 2
Situation Possible emotional expression
When a child fails in an exam angry, withdrawn, refusal to go back to
school
When a child witnesses abuse at home sad, fearful, angry
When a child is scolded by parents, a teacher, or sad, may try to run away from home, hit
any other adult younger siblings
When a child loses something important to him/her upset, guilty, crying
When a child is in a difficult situation confused, fearful
When a child feels let down by adults sad, angry, guilty, feeling worthless
When somebody is abusive or violent with a child spending more time outside home, scared,
guilty, angry

28
Facilitator Guide B.3 – Section 3
Expression of emotions

29
 Facilitator Guide B.3 – Section 4
HOW DO YOU FEEL WHEN…….?
You are praised or appreciated
You are not included in a game
You share anything with a friend
You win a game
You are scolded by your parents or teachers
You are being accused of something you did not do
You are alone at home
You are told that you can never do anything right
You see your parents fight with each other
Your younger siblings do not listen to you
Your friend loses your notebook

B.4. Understanding Psychological Well-being

Mandatory Online In-person

Understanding oneself involves being aware of different aspects of the self, including traits,
behaviours, and feelings. Essentially, it is a psychological state in which oneself becomes the
focus of attention. What we know about ourselves and how we see or perceive ourselves can
affect our psychological well-being.

Do any of the activities below to help participants understand the self.

B.4.1. Activity: Understanding Self

Optional Online In-person

Step 1: Share four different situations with the participants given in Facilitator Guide B.4 –
Section 2. Give 2-4 mins. for the participants to think about the situations.

Step 2: Discuss all the four situations one by one with the participants.

Step 3: Share that the four situations described in the activity were of a single person and
then explain the different aspects of self-awareness using the Johari Window con-
cept. Use Facilitator Guide B.4 – Section 3.

Step 4: Explain the concept of psychological well-being. Use Facilitator Guide B.4 – Sec-
tion 1.

30
B.4.2. Activity: Self-awareness Creation

Optional Online In-person

Step 1: Ask the participants to partner with someone who knows them well.

Step 2: Share the Self-Awareness Worksheet with the participants given in Facilitator Guide
B.4 – Section 4. Give 10-12 mins. for the participants to fill it out.

Step 3: Have a discussion with the participants about their experience of doing the activity.
Following questions can be used as guides:
 Was it an easy or a difficult exercise?
 What was easy and what was difficult?
 Did you discover something that you did not know about yourself?
 How did you feel while filling up the façade section?
 Was it easy to share things that you normally hide from others?
 Do you agree what others said about you in the blind spot section?
 What does this information tell you? How can you use this information?
 Does it give you areas of your life/personality that you would like to work upon?
 Does it tell you your strengths?

Step 4: Explain the different aspects of self-awareness using the Johari Window concept.
Use Facilitator Guide B.4 – Section 3.

Step 5: Explain the concept of psychological well-being. Use Facilitator Guide B.4 –
Section 1.

Facilitator Guide B.4 – Section 1

Psychological Well-being is another component of Mental health which focuses on an
individual’s private and personal criterion for evaluation on one’s life’s functioning. It involves
the development of one’s potential, having a sense of purpose, ability to experience positive
relationships and sense of self-worth. It is a combination of feeling good and functioning
effectively.
Researchers also have found that the absence of distress doesn’t necessarily indicate a person
has high psychological well-being. High psychological well-being is about feeling happy and
doing well on the criterion or standard set by the person itself. People with high psychological
well-being report feeling capable, happy, well-supported, and satisfied with life and experience
fewer social problems.
People with negative/poor psychological well-being often finds it difficult to accept self as they
are, feel less empowered, unable to maintain healthy relationship with others and unable to find
purpose in life. On the other hand, positive/high psychological well-being are more confident,
evaluate self in relations to other in a more rational manner, take criticisms in a constructive
manner and are able to develop skills and achieve goals set for themselves.

31
 Facilitator Guide B.4 – Section 2
Situation 1: ‘A’ is average in academics but is very active in extra-curricular activities. ‘A’ likes
to dance and always participate in all the dance competitions or programs in her
school. ‘A’ is very helpful towards other students in class and enjoys helping others.
Situation 2: ‘B’ has few very close friends. On several occasions, ‘B’s friends have shared that
‘B’ has issues saying no to people. Whoever asks for help, ‘B’always says yes, and at
times goes beyond her capacity to help people. But ‘B’thinks this is not true and that
she does not always say yes to requests for help from others.
Situation 3: ‘C’ fears to be seen as a negative or a bad person. ‘C’s parents have taught ‘C’to
always be kind and helpful and respectful towards others. At times, ‘C’even feels
pressurized to be nice and helpful towards others.
Situation 4: ‘D’ has been experiencing the same dream from last one week. ‘D’ shared it with the
school counsellor but has no idea why it is so.
Facilitator Guide B.4 – Section 3
The Johari Window is a simple and useful tool for understanding and training on self-awareness,
and personal development. It is a model of self-awareness and is used to represent information
including feelings, experiences, views, attitudes, skills, intentions, and motivation. The analogue
of the Window represents the different aspects of oneself.
The analogy used by Joseph Luft and Harry Ingham to describe Johari’s Window is as follows -
Think about your home. Think about all the rooms and spaces in your home. Think about your
windows. How many windows does your house have? Do they all give you the same view? Imag-
ine if you looked out of the only one of them. What would happen? What would you see?
If we always looked out of only one window of our house, then our perspective of the world
would be limited to the view out of that window. If we looked out to the sea, the world would
look like all water. If it looked out to the mountains, the world would look like all mountains.
We have similar windows in our mind, and we tend to look out only through our own particular
windows. This affects our perspective about ourselves and the world. The Johari Window has
given four quadrants of the self. These are as follows:
• Arena or the Open Self – what is known by the person about himself/herself and is also
known by others.
• Blind Spots or the Blind self – what is unknown by the person about himself/herself, but
which others know.
• Façade or the Hidden Self – what the person knows about himself/herself that other do not
know.
• Dark Self or the Unknown Self – what is unknown by the person about himself/herself and is
also unknown by others.
Having an understanding of the self or being self-aware is important. Because when we have a
better understanding of ourselves, we are able to experience ourselves as unique and separate
individuals. We feel empowered to make changes and to build on areas of strengths as well as
identify areas of improvements.
Self-awareness also help us check our negative perception about self, what we think and how we
feel and perceive ourselves. A negative sense of self will lead to unpleasant affect or emotions
and feeling and in turn affects our overall psychological wellbeing.

32
 Facilitator Guide B.4 – Section 4
Self-awareness Worksheet
Arena

Write things about

yourself that everyone
knows

Façade

Write things about

yourself that nobody
knows

Blind Spot

Ask a friend to tell you

things about you that
they think you do not
know

33
 B.5. Understanding Social Well-being
Mandatory Online In-person

Social well-being is the third component of mental health. Do either of these activities below
to introduce the concept.

B.5.1. Activity: Relationship Scale

Optional Online In-person

An important component of social well-being is healthy inter-personal relationships.

Step 1: Ask participants to think about all the relationship in their lives and place them on
an importance scale in the worksheet provided in Facilitator Guide B.5 – Section 2.
Give 5 mins. For this task.

Step 2: Ask the following questions and discuss:

 Why are all these relationships important?
 How would you feel if a very important relationship was no longer part of your
life?
 How would you feel if a less important relationship was no longer part of your
life?
 How would you feel if there is no relationship in your life?

Step 3: Introduce and explain the concept of social well-being. Use Facilitator Guide B.5 –
Section 1.

B.5.2. Activity: My Magic Wall of Relationships

Optional Online In-person

Step 1: Ask participants to think about all the relationship in their lives and fill them in the
worksheet provided in Facilitator Guide B.5 – Section 3. Give 5 mins. For this task.

Step 2: Ask the following questions and discuss:

 Why all these relationships are important?
 Describe in what ways the people you have marked as close (personal) are
important to you?
 Describe in what ways the people you have marked as Social are important to
you?
 Describe in what ways the people you have marked as Family are important to
you?

Step 3: Introduce and explain the concept of social well-being. Use Facilitator Guide B.5 –
Section 1.

34
 Facilitator Guide B.5 – Section 1
Social well-being is the third component of mental health. It is one’s ability to make and maintain
meaningful positive relationships with family, friends, neighbours, and co-workers. Good social
well-being includes not only having relationships but also the ability to behave in a fair and just
manner in the relationships and maintaining acceptable social standards.

We build our social wellbeing by interacting with people around us. These interactions involve
using good communication skills, creating, and maintaining meaningful relationships, respecting
ourselves and others, and creating support systems (with family and friends).

Social wellbeing is strongly linked to social inclusion and a sense of belonging. On the other
hand, lack of or no relationship or unhealthy relationship can affect our overall mental well-being.
Facilitator Guide B.5 – Section 2
My Relationship Scale
Less important Important Very Important

Facilitator Guide B.5 – Section 3

My Magic Wall of Relationships
Relationship Type Person Ways he/she is important
to me
Close (Personal)

Social

Family

35
36
Part C. COVID-19
and Children’s
Mental Health

37
 Objectives Expected Outputs
„ To explore the factors affecting mental „ Participants will learn about various fac-
health of children due to the pandemic tors which may impact the mental health
of children
„ To learn about the impact of the pandemic
on children’s mental health „ Participants will learn about the impact
of the pandemic on children
„ To identify/recognize the signs and symp-
toms of mental illness in children „ Participants will learn to recognize the
signs and symptoms of mental illness
and mental health issues in children
Methodology Material Required
„ Presentation In-person (F): A4 size sheets, pens/pencils,
flip chart, markers, a small bowl or box, pro-
„ Discussion jector and screen or LCD screen, laptop or
desktop, audio speakers, thumb pins, stapler
„ Activity
and pins, double-sided tape, cello tape
„ Brainstorming In-person (P): Notebook and pen
Prerequisites Online (F): Laptop or desktop, online plat-
In-person (F): The training room must be able form such as Zoom (or similar) with a profes-
to accommodate 20-25 participants in a circular sional subscription (including polls, breakout
seating setup. rooms, recording, etc.).
Online (P): Participants must be comfortable Online (P): Good internet connection and a
with Zoom (or similar) and be seated in a private smartphone with a large screen or a laptop/
space without external noise and distractions. desktop with Zoom (or similar) app installed.

The recent pandemic and subsequent lockdown have had a profound impact not only on the
physical health of the children, but also on their mental health and well-being. In a study, it
was found that the onset of COVID-19 outbreak has lowered children’s emotional well-being
by 74%.

There are multiple factors directly or indirectly associated with the pandemic, that may
affect the mental health and well-being of children. In this section, an attempt will be made
to explore the factors which may affect children’s mental health and its impact.

38
C.1. Exploring Factors Affecting Mental Health of Children
Mandatory Online In-person

C.1.1. Activity: Factors Affecting Mental Health

Online

Mandatory In-person

Step 1: Divide the participants into four equal groups.

Step 2: Ask group members to sit together.

Step 3: Give each group a chart paper with one of the following topics on it.

 Chart 1: Individual/personal factors

 Chart 2: Factors within the family
 Chart 3: Social factors
 Chart 4: Economic factors

Step 4: Ask the participants to brainstorm and list down all the factors which may affect the
mental health of children on the given topic.

Step 5: Once the groups have finished listing the factors, ask each group to present their list
one-by-one.

Step 6: Discuss on the factors on the basis of the lists given in Facilitators Guide C.1.

If this activity is to be done online, use breakout groups.

39
 Facilitator
Guide C.1

l factor s
dual/per sona
Chart 1: Indivi
th
„ Poor heal
ss
psychiatric illne
„ Ongoing
staying alone
„ Living or
„ Disability traits – extrov
ert
n w ith ce rt ai n personality
„ Childre
n of pandemic
„ Perceptio

Char t 2: Factors withi

n the family
„ Witnessing violence at
home
„ Experiencing abuse an
d violence at home
„ Poor relationships with
parents and other fam
„ ily members
Ill health of any paren
t or family members
„ Poor relationships at
home amongst the fam
„ ily members
Witnessing death at ho
me
„ Socio-economic cond
ition of the family
„ Increase in home chore
s especially for girl ch
ild

40
 ental factors
h ar t 3: So ci al/ Environm
C
of schools
„ Closure
udies
n of regular st
„ Disruptio
isolation
stancing and
„ Social di
ation
ation of educ
„ Digitaliz tion
– due to migra
M ov in g to new place
„ out pan-
w s/ to o muc h of news ab
„ Fake ne
demic

Char t 4: Economic factors

„ Access to food and shelter
„ Loss of parent’s job
„ Non-availability of the resources to
continue education such as android
phone, internet connection etc.
„ Reverse migration – leaving of school/
education

41
 Additional points to be discussed
„ High stress in family due to social isolation, economic hardship and loss of livelihood in-
creases risks of domestic violence and child abuse, including spanking or beating, or using
harsh language.
„ School closures and movement restrictions means children are forced to spend much more
time at home with adults and caregivers who are already stressed and worried.
„ Sexual abuse can happen to a child or an adolescent at any time or place.
„ Spending more time online also increases the risk of exposure to online sexual abuse and
grooming for sexual exploitation, cyber-bullying, and other online threats for children.
„ Children in quarantine or isolation may be away from adult supervision, which may also
increase protection risks.

C.2. Understanding the Pandemic Impact on Child Mental

Health

Mandatory Online In-person

C.2.1. Activity: Open Discussion and Brainstorming

Mandatory In-person

Step 1: Ask each participant to tell one major change that he/she has observed in children
during the pandemic.

Step 2: Write down all the answers given by participants on a flip chart.

Step 3: Discuss the information given in Facilitator Guide C.2.

Online

If this activity is to be done online, ask participants to type their answers in the chat window.
Or send a link to a form where participants can record their answer.

Facilitator Guide C.2

The impact of COVID-19 and subsequent lockdown has been felt differently amongst different
populations. The impact on mental health will always be more on one group i.e., children. Children
may face additional challenges to understand, absorb and deal with the changes that COVID-19 is
bringing into their lives. Due to closing of the schools, children’s interaction and communication
with their playmates and school mates, their play time, social bonding with their peers, regular
routines have been hindered, which are vital for their growth, development, and learning.

The children who are at most significant risk are the youngest ones as their brains are still devel-
oping and are being exposed to high levels of stress and isolation, which can lead to permanent
abnormal development.

Children exposed to stressors such as separation through isolation from their families and friends,
seeing or being aware of critically ill members affected with corona virus, or the death of loved
ones or even thinking of their own death from the virus can cause them to develop anxiety, panic
attacks, depression, and other mental illnesses.

42
The impact of pandemic on the mental health of children is manifold and has affected various
aspects of their lives.

„ Development of psychiatric illness/disorders like depression, anxiety, PTSD, etc.

Constant fear of contracting the virus, restricted social interaction and isolation makes chil-
dren more anxious, worried, and sad. If it continues for a longer period and with no support
and intervention, children can develop psychiatric illnesses like depression, anxiety, panic
attacks, etc. They may experience:
• Difficulties in sleeping and eating
• Nightmares
• Being withdrawn or aggressive
• Complain of pain in stomach or headache without any physical reason
• Fears or afraid to be left alone
• Clinging, depending behaviours
• New fears manifest (for instance of the dark)
• Decreased interest in playing and engaging in playful activities
• Being sad, crying more than usual or for no apparent reason

„ Relapse of psychiatric illness

Children who have been or had been suffering from psychiatric illness prior to the COVID-19
may witness a relapse of the illness.
„ Loss of interpersonal relationship
The migration and isolation due to pandemic has also resulted in the loss of relationships for
the children. Children who, with their family, moved back to their native villages, lost contact
with their peers, friends, school, and teachers. This change and loss associated with the pan-
demic may lead children to experience grief, sadness and at time this may manifests in anger
and violence or loss of interest in academics.
„ Loss of loved ones due to pandemic and experience of grief
Loss touches all our lives, yet we frequently fail to recognize its existence except in extreme
cases such as death, war, or natural disasters. Loss of friendships, loss of school or education,
loss of loved ones due to death, loss of a parent’s job are all such conditions that can have
an impact on the mental health of children. All such losses whether tangible or intangible,
involves a grieving process and if it is not recognized and acknowledged and unless support
is received, any such significant change will become and probably remain a source of stress.
If the children continue to experience loss for a longer duration without any support or
intervention then very likely children may develop mental health issues ranging from loss of
interest, depression to developing psychiatric illness.
„ Low self-esteem and self-concept
Children who witness abuse and violence often blame themselves for the abuse. They feel
unwanted and think poorly of themselves. Children who may have witnessed or faced abuse
at home may develop feeling of poor sense of worth or low self-esteem.
„ Impact of digitalization of education
This is key as it can spawn a lot of other issues under the guise of education.
• Health issues (eye strain, myopia, poor posture, headaches, dry eyes, carpal tunnel syn-
drome, etc.)
• Safety and Security issues (exposure to pornographic material, underage social media
interactions, cyber-bullying, grooming, etc.)
• Academic issues (mindless copy/paste, loss of writing skills, loss of spelling skills, plagia-
rism, adoption of unfair means during exams, etc.).

43
 „ Impact due to loss of education
Due to the pandemic and migration, a lot of children were forced to leave their school and
go back to their native villages. This has resulted in the loss of school and education. The
pandemic has seen an increase in the dropout rate of children, especially girl children.
„ Increased vulnerability
The pandemic has also raised the protection concerns of the children. A sharp increase was
reported in the cases of abuse and violation of child rights during the lockdown such as
increase in the cases of child marriages and trafficking of children for the purpose of sexual
exploitation, marriage, etc.
„ Impact of closure of schools and disruption in regular studies
Closure of schools and disruption of regular studies have increased the anxieties and wor-
ries of children. The impact of closure of schools and disruption in regular studies can be
variable for different grades. The impact is very different for primary as that is a high devel-
opmental stage where socialization deficits can be debilitating in the long run. In secondary,
it’s more a matter of loss of academic curriculum and potential impact on future options for
livelihood. In middle school, it’s about losing out on the fundamentals that provide a base for
secondary.

C.3. Recognizing Signs and Symptoms of Mental Health Issues

Mandatory Online In-person Facilitators

Young children in difficulty may have underlying mental health issues. The manifestation of
the mental health issues by children can be variable. In the same situation, some children
may become silent or withdrawn, whereas others may express anger and hyperactivity.
Teachers/schools need to look beyond the behaviour of the children to understand what
might be going on with a child.

C.3.1 Activity: Presentation

Mandatory Online In-person Facilitators

Prerequisite: Create a presentation with the material given in Facilitator Guide C.3.

Step 1: Present the warning signs and symptoms of mental health issues in children with
the help of the presentation.

Step 2: Share the specific warning signs and symptoms of various mental illnesses and
other mental health issues faced by children as given in Annexure II.

Step 3: Share that some of these may require immediate support or intervention from the
adults in the child’s life or may require the support of a professional counsellor or
mental health expert.

44
 Facilitator
Warning Signs and Symptoms for Guide C.3
Mental Health Issues

Feelings
„ Persistent sadness
„ Hopelessness
„ Anxiousness
„ Being afraid
„ Guilt and shame
„ Being irritable and angry most of the time for no apparent reason
„ Significant changes in mood unrelated to events
„ Feeling bad about oneself or one’s appearance
„ Lacking energy to do things
„ Feeling tired most of the time

45
 Thoughts
„ Preoccupation with death and dying
„ Thoughts about suicide or hurting oneself
„ Overly rapid thoughts and ideas
„ Thinking of oneself as bad or evil
„ Finding it difficult to make decisions
„ Limited understanding and difficulty with conceptual thinking
„ Suspicious and inability to trust anyone

46
Behaviour
„ Being overly isolated or withdrawn
„ Avoiding social situations
„ Crying a lot for no apparent reason
„ Having irrational fears that affect to function normally
„ Showing loss of interest in leisure activities
„ Inability to enjoy themselves
„ Disturbed sleep pattern – either sleeping too much or too less
„ Nightmares
„ Beginning to act in a sexually proactive manner
„ Drug or alcohol use
„ Increase risk taking behaviour
„ Disturbed eating pattern – eating too much or starving self
„ Undergoing significant weight loss or gain
„ Lacking in energy or bored
„ Often complaints of headaches, stomach aches or general illness
„ Restless, fidgety or being hyperactive
„ Self-harm
„ Talking about suicide
„ Behaving in age-inappropriate manner – regressive behaviour
„ Often starting fights with other pupils
„ Regularly breaking the rules with little regards for the feelings of others
„ Adopting ritualistic, repetitive, or routine behaviour that appears to be irrational
„ Aggression towards adults and other pupils

47
 Some common stress reactions to any disaster may include:
„ Confusion
„ Fear
„ Feelings of hopelessness and helplessness
„ Sleep problems
„ Physical pain
„ Anxiety
„ Anger
„ Grief
„ Shock
„ Aggressiveness
„ Withdrawal
„ Guilt
„ Shaken religious faith
„ Loss of confidence in self or others.
„ Keep a check on the following also:
„ Status messages of children
„ Level of WhatsApp (or similar) group participation
„ Attendance and participation in online classes
„ Quality of work submitted and responses in class
„ Sentiments expressed in reflective writing (essays, dear diary, etc.)
„ Sentiments expressed through art
„ Social media presence and activity
„ Learning circles of 5-8 children
These can give important insights into the mental health of children. A number of these checks
must be carried out proactively, rather than passively. The community worker must make an
effort to track these mechanisms to remain on top of things. For example, if phone numbers
are not stored in the phone and kept up to date, one cannot track status messages. Or, if art and
reflective writing are not solicited, there will be no way of knowing.
Note: In difficult circumstances, emotional reactions are common and normal phenomena. But if
you are concerned that a child may be struggling with a mental health problem then observe and
consider the following:
„ Frequency: how often does the child exhibit the behaviours of concern?
„ Duration: how long do they last?
„ Intensity: to what extent do the behaviours interfere with the child’s activities?
The age specific reactions to trauma are given in Annexure III.

48
Part D. Psychological
First Aid (PFA)

49
 Objectives Expected Outputs
„ To understand the concept of Psychologi- „ Participants will learn about the concept
cal First Aid (PFA) of PFA
„ To learn how to provide PFA to children in „ Participants will learn how to support and
times of crisis provide PFA to children in times of crisis
„ To learn basic skills required to deliver PFA „ Participants will learn about the basic skills
„ To explore and understand what consti- required to deliver PFA
tutes a ‘Safe and Caring Environment’ „ Participants will learn how to create a safe
and caring environment for children in
school
Methodology Material Required
„ Presentation In-person (F): A4 sheets, pens/pencils, flip
„ Discussion chart, markers, a small bowl or box, projector
and screen or LCD screen, laptop or desktop,
„ Activity
audio speakers, thumb pins, stapler and pins,
„ Scenarios double-sided tape, cello tape
„ Brainstorming In-person (P): Notebook and pen
Prerequisites Online (F): Laptop or desktop, online platform
„ In-person (F): The training room must be such as Zoom (or similar) with a professional
able to accommodate 20-25 participants in subscription (including polls, breakout rooms,
a circular seating setup. recording, etc.).
„ Online (P): Participants must be comfort- Online (P): Good internet connection and a
able with Zoom (or similar) and be seated smartphone with a large screen or a laptop/
in a private space without external noise desktop with Zoom (or similar) app installed.
and distractions.

Note: This section is for teachers and caregivers only.

Facilitators

Teachers are in an excellent position to help their students after any disaster, crisis, or emergency.
Just as teachers help children to connect with appropriate academic and counselling services under
normal circumstances, teachers can also help children return to school, stay in school, continue to
learn, and return to their usual activities after any emergency/pandemic like situation or a personal
tragedy. Teachers can help their students if they:
� Take a proactive approach and look for signs of distress in children
� Identify children who need support to deal with a crisis
� Observe or listen to them for risk factors or for any adverse reactions
� Provide them immediate support
� Connect them to appropriate services that might help children deal with a crisis.

This is called providing Psychological First Aid (PFA) - just as in time of accident or medical emergen-
cy people are given medical first aid and linked to necessary medical aid, PFA is provided in times of
mental crises.

In the earlier section, we attempted to understand the concept of Mental well-being and its compo-
nents. In this section, we will learn how a teacher can deliver PFA to a student and what skills are
needed for the same.

50
D.1. Understanding PFA
Mandatory Online In-person Facilitators

D.1.1. Activity: Understanding PFA

Prerequisite: Create a presentation with the material in Facilitator Guide D.1.

Step 1: Present different aspects of PFA with the help of a presentation.

Step 2: Share the additional material on age-specific reactions to trauma as given in Annex-
ure III and the detailed material on PFA as given in Annexure IV.

Step 3: Share that PFA may require immediate support or intervention from a professional
counsellor or mental health expert.

Facilitator Guide D.1

What is PFA?
PFA is a humane supportive response to a fellow human being who is suffering and who may
need support.

What does PFA involve?

It involves:
„ Providing practical care and support, which does not intrude
„ Assessing needs and concerns
„ Helping people to address basic needs (for example, food and water, information)
„ Listening to people, but not pressuring them to talk
„ Comforting people and helping them to feel calm
„ Helping people connect to information, services, and social supports
„ Protecting people from further harm

What does not constitute PFA?

It is important to understand what PFA is not. It is not:
„ Something only professionals can give
„ Professional counselling
„ Clinical or psychiatric intervention (although it can be part of good clinical care)
„ Psychological debriefing
„ Asking someone to analyse what happened to them
„ Asking someone to put time and events in order
„ Pressing people to tell you their story
„ Asking people details about how they feel or what happened or their reactions to an event

Why is PFA needed for children?

PFA is needed because in crisis events, children:
„ React and think differently than adults
„ Have specific needs according to their ages
„ Are vulnerable to adverse effects due to their physical size and social and emotional attach-
ments to caregivers

51
 What is the goal of PFA?
The goal of PFA is to create and sustain an environment of:
„ Safety
„ Calm and Comfort
„ Connectedness
„ Self-Empowerment
„ Hope
PFA addresses basic needs, reduces psychological distress by providing a caring and comforting
presence, and provides education on common stress reactions. It empowers the individual by
supporting strengths and encouraging existing coping skills. It also provides connections to natu-
ral support networks, and referrals to professional services as and when needed.

Where and when should PFA be used?

PFA can be used in any setting where children are found in trauma - in shelters, schools, hospi-
tals, private homes, at workplace, and in community settings.

PFA is aimed at helping people who have been very recently affected by a crisis event. This is
usually done during or immediately after an event. However, it may be given sometimes days or
weeks after the event, depending on how long the event lasted and how severe it was. One can
provide PFA at the first contact with any distressed child.

What are the basic objectives of PFA?

„ Establish a human connection in a non-intrusive, compassionate manner
„ Enhance immediate and ongoing safety and provide physical and emotional comfort
„ Calm and orient emotionally overwhelmed or distraught survivors
„ Help survivors to tell specifically what their immediate needs and concerns are and gather
additional information as appropriate
„ Offer practical assistance and information to help survivors address their immediate needs
and concerns
„ Connect survivors as soon as possible to social support networks, including family members,
friends, neighbours, and community resources
„ Share and support adaptive coping mechanisms, acknowledge coping efforts and strengths,
and empower survivors
„ Encourage adults, children, and families to take an active role in a survivor’s recovery
„ Provide information that may help survivors cope effectively with the psychological impact
of disasters
„ Be clear about your availability, and (when appropriate) link the survivor to another member
of a disaster response team or to local recovery systems, mental health services, public-sec-
tor services, and organizations

52
D.2. Delivering PFA

Mandatory Online In-person Facilitators

D.2.1. Activity: Delivering PFA

Step 1: Do a role play along with your co-facilitator of how PFA can be provided to a dis-
tressed child.

Step 2: Discuss about delivering PFA. Use the content given in Facilitator Guide D.2.

Note: If the training is done online, play a simulation video for delivery of PFA. The links for the
videos are given in Facilitator Guide D.2.

Additional material has been provided in Annexure IV.

Facilitator Guide D.2

Links for Simulation videos
https://www.youtube.com/watch?v=kly45u9ml_A
https://www.youtube.com/watch?v=_h0L6u68tbI
https://www.youtube.com/watch?v=nCtKGrJQ7sw
https://www.youtube.com/watch?v=8i8CMPhsxT0
Delivering PFA: Action Principles for PFA for Children

• Learn about the crisis event/situation

Prepare • Learn about the available services and support
• Learn about the safety and security concerns

• Check for the safety of the child

Look • Look for children with obvious urgent basic need
• Look for children, parents, care-givers with serious distress
reactions

• Apporach children and parents who may need support

Listen
• Ask about their needs (of children, parents and care-givers)
and concerns
• Listen to them and help them to feel calm

• Help children address basic needs and access to services

Link • Help children cope with problems
• Give correct and age-appropriate information
• Connect children with loved ones and social support

53
 Prepare
Crisis situations can be chaotic and often need urgent action. However, wherever possible before
entering a crisis site, try to get accurate information about the situation. Consider the following
questions before entering a crisis site:
The crisis „ What happened?
event „ When and where did it take place?
„ How many people are likely to be affected and who are they?
Available „ Who is providing for basic needs like emergency medical care, food, or coun-
services and selling for children?
supports „ Where and how can people access those services?
„ Who else is helping? Are community members involved in responding?
Safety and „ Is the crisis event over or continuing, such as an aftershock from an abuse or
security conflict?
concerns „ What dangers may be present in the environment?
„ Are there areas/site to avoid entering because they are not secure or safe
(for example, obvious physical dangers) or because you are not allowed to be
there?
Look
In crisis and disaster scenarios, in this stage the PFA user needs to determine which individuals
are most in need of immediate care and assist them first. It could be possible that some children
may be more impacted by the pandemic and require immediate assistance. For instance, a
toddler might be showing more signs of stress than a third-grader, or vice versa. Look and
prioritize the needs of such children. Ask the questions and deliver the important message.

Safety „ What dangers can you see in the house „ If you are not certain about
or in the community of the child, such the safety of the crisis site,
as active conflict, abuse, or violence at then do not go. Try to get
home? help for people in need. If
„ Can you be there without likely harm to possible, communicate with
yourself or others? people in distress from a safe
distance like on phone, if
possible.
People with „ Does anyone appear to be critically „ Know your role and try to
obvious urgent injured and in need of emergency get help for people who need
basic needs medical help? (In case of abuse or special assistance or who
violence at home – domestic violence) have obvious urgent basic
„ Does anyone seem to need rescuing, needs.
such as children who might imply sexual „ Take the help of child
abuse at home? protection agencies such as
„ Does anyone have obvious urgent basic CHILDLINE -1098, CWCs,
needs, such as food, protection? SJPU, DCPU and CWPOs.
„ Which people may need help in
terms of accessing basic services and
special attention to be protected from
discrimination and violence?
„ Who else is available around you to help?

54
People with „ Are there people who appear extremely „ Consider who may benefit
serious dis- upset, not able to move on their own, not from PFA and how you can
tress reactions responding to others, or in shock? help best.
„ Where and who are the most distressed „ In case the distress is
people? severe, it is best to refer to
a professional counsellor or
therapist or psychiatrist, if
needed.
Listen
Listening actively to people/children you are helping is essential to understand their situation
and needs, to help them to feel calm, and to be able to offer appropriate help. Learn to listen with
your:
„ Eyes: giving the child your undivided attention
„ Ears: truly hearing their concerns
„ Heart: with care and showing respect

Ask children, parents and

Approach children and par- Listen to them and help
care-givers about their
ents who may need support them to feel calm
needs and concerns

• Approach people re- • Although some needs • Stay connected to the

spectfully and according may be obvious, such person
to their culture. as food, but always ask • Do not pressure the
• Introduce yourself by what people need and person to talk.
name and organization what their concerns are. • Listen in case if the they
• Ask if you can provide • Find out what is most want to talk about what
help. important to them at this happened to them.
• If possible, find a safe moment, and help them • If they are very dis-
and quiet place to talk. work out what their tressed, help them to
• Help the person feel priorities are. make feel calm and try
comfortable; for exam- • since the module focus to make sure they are
ple, offer water if you on the education of the not alone.
can. children, PFA uses will
• Try to keep the person also make an assess-
safe. ment of the reason for
• Remove the person from dropout or if there are
immediate danger, if it is chances of dropout from
safe to do so. school and make a note
• Try to protect the per- of it.
son from exposure to the
media for their privacy
and dignity.
• If the person is very dis-
tressed, try to make sure
that they are not alone.

55
 Link
The next step in the process is to link children with resources.

Help children address Connect children

Help children cope
basic needs and Give information with loved ones and
with problems
access to services social support

• Immediately after • Help children • Children affect- • Help keep

a crisis event, identify supports ed by a crisis families together,
try to help the for themselves, event will want and keep children
children in dis- such as friends or accurate infor- with their parents
tress to meet the family, who can mation about: - and loved ones.
basic needs they help them in the − the event; • Help children to
request, such as current situation. − loved ones contact friends
food, water, med- • Give practical or other and relatives so
ical support. suggestions for who are they can get sup-
• Learn what children to meet impacted; port, for instance,
specific needs their own needs − their safety; provide a way for
children have - (for instance, − their rights; them to call their
such as health explain how they − how to friends, teachers
care, clothing or can register for access the etc. for support.
material for read- online classes or services • Help bring
ing or education- course during the and things parents and child
al link or source pandemic). they need. together to help
for entertainment • Ask the child to each other.
etc. and try to consider how
link them to the they coped with
available help. difficult situations
• Make sure in the past , and
vulnerable or affirm their ability
marginalized to cope with the
people are not current situa-
overlooked. tions.
• Follow up with • Ask the child
people, if you what helps them
promise to do so. to feel better.
Encourage them
to use positive
coping strate-
gies and avoid
negative coping
strategies.

56
D.3 Building Skills to Provide PFA
Mandatory Online In-person Facilitators

In this section, we would be learning about the skills required to effectively provide PFA to
children. The following core skills are necessary to support children in times of crisis:

� Rapport Building
� Active Listening
� Reflection and Paraphrasing
� Communication

Carry out the activities given below and use Facilitator Guide D.3 to explain all the skills one
by one.

D.3.1. Activity: Building and Maintaining Rapport with Children

Mandatory Online In-person Facilitators

The purpose of this activity is to identify and explore the skills and strategies use to build and
maintain rapport and a trusting relationship.

Step 1: Divide participants into three groups.

Step 2: Give each group one topic to brainstorm for 10 mins. Each topic is considered an
important aspect of rapport building:
1. How to Look
2. How to Sound
3. How to Begin

They should brainstorm Ḥabout specific ways to build rapport under each topic.
Encourage specific responses. For example, if someone says, “look welcoming,” ask,
“Exactly, what does that look like?”

Step 3: Ask each group to present their topic one-by-one.

Step 4: Share the details of each topic. Use information provided in Facilitator Guide D.3 –
Section 1.

57
 Facilitator Guide D.3 – Section 1
How do you look? (in-person and online – audio and/or video)
„ Is your body relaxed?
„ Do you smile easily?
„ What mannerisms are you aware of that might distract? For example, hair twisting, leg
bouncing, pen playing, etc.
„ What does your face look like when you are concentrating?
„ How would you describe your ‘professional’ appearance?
„ How do you show that you are listening? For example, nodding, appropriate eye contact, etc.
How is your voice and voice tone? (in-person and online – audio and/or video)
„ Are you speaking clearly? Slowly, so others can understand you.
„ Are you speaking gently and softly (confidentially)?
„ Do you avoid using slang? For example, “whatever…”.
„ Do you explain any abbreviations you use?
„ How do you show that you are listening? For example, restating what you heard from the
client.
How do you begin your interaction? (in-person and online – audio and/or video)
„ How do you introduce yourself ?
„ What words of welcome do you use? For example, “How can I help you today?”
„ What questions do you ask?
„ How do you ask these questions?
„ How do you show respect?
„ How do you build trust?
Rapport is the ability to relate to others in a way that creates a level of trust and understanding.
It is important to build rapport with them at the time of any crisis to make them feel comfortable
and relaxed. Building and maintaining good rapport with children will also help them to open-up
about their experience of the crisis and be more willing to accept help.

D.3.2. Activity: Developing the Skill of Active Listening

Mandatory Online In-person Facilitators

Prerequisite: Select a picture which participants can draw easily within 1-2 min.

Step 1: Share the picture on the screen and ask participants to draw it as perfectly as possi-
ble. Give 2 mins. for this.

Step 2: In the background, play a song and instruct the participants to listen to the song
and to try remember the lyrics of the song.

Step 3: Ask the participants if they can remember the lyrics of the song and ask them to
sing the whole song.

Step 4: Ask the participants what they feel about the activity? Did they find it difficult to do
two things at the same time?
Step 5: Share the concept of active listening. Use Facilitator Guide D.3 – Section 2 for refer-
ence.

58
 Facilitator Guide D.3 – Section 2
Active Listening is the key component of providing PFA. It is one of the most important things
that one can do, which we often take for granted – to listen actively and carefully. Many times,
people will tell what they need, they can even direct how to help them, but the key is, one is
really willing to actively listen to them and respond accordingly.
Active listening requires that we must be present at that moment, not just physically but men-
tally also. We must be compassionate and patient enough to listen to the stories and experi-
ences that someone is willing to share. In the absence of it, one might try to force the help that
others may not even require. It becomes one size fits all. Therefore, it is important to develop
the skill of active listening so that individual needs of the children can be identified, and effec-
tive support can be provided.

D.3.3. Activity: Mirroring Emotions

Mandatory Online In-person Facilitators

The objective of the activity is to experience empathy and understand reflection and para-
phrasing.

Step 1: Ask participants to find a partner and form a circle of pairs.

Step 2: Ask the pairs to face each other and designate each other as A and B.

Step 3: In Round 1 ask A to play the ‘person’ and B to play the ‘mirror’.

Step 4: Ask A to make a movement or express an emotion and ask B to mirror or copy it as
accurately as possible. Ask all pairs to do this for 2-3 mins.

Note: Encourage the participants to make as many movements as possible

for their mirror images to follow, beginning with facial expressions, then body
movements.

Step 5: In Round 2 ask them to switch; ask B to play the ‘person’ and A to play the ‘mirror’.

Step 6: Ask B to make a movement or express an emotion and ask A to mirror or copy it as
accurately as possible. Ask all pairs to do this for 2-3 mins.
Step 7: Discuss how they felt about it. Use the following questions during the discussion:
� What did you feel about the activity?
� When you were the mirror, how were you able to keep up with the movements
of the person you were reflecting?
� How did you feel when you saw your own expressions and movement being
mirrored?
� When, in our life, do we feel the need to reflect each other’s emotions and why?

Step 8: Explain the concept of reflection and paraphrasing. Use Facilitator Guide D.3 – Sec-
tion 3 for reference.

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 Facilitator Guide D.3 – Section 3
Reflection and paraphrasing
Accurate acknowledgement of a child’s feelings is necessary and critical to support the child.
Noting key feelings and helping the child understand, accept, or clarify the feelings is one of
the important skills in providing support to the child. Reflection is like holding a mirror for the
child to help him see the emotions that the child may be experiencing. When we use the skill
of reflection, we are looking to match the tone, the feeling of the words, and the child’s facial
expression or body language as they spoke.
Paraphrasing is repeating back the understanding of the feelings and thoughts shared by the
child using their own words. A paraphrase reflects the essence of what has been shared by the
child. The skill of paraphrasing is important as it helps the child to feel both heard and under-
stood.
If the skill of paraphrasing is done accurately and currently, it helps to communicate empathy
to the child and help in building a better and stronger relationship.
Empathy is the ability to put oneself in someone else’s shoes - to understand the other person’s
situation, perceptions, and feelings from their point of view - and to be able to communicate
that understanding back to the person.

D.3.3. Activity: Role Play on Communication

Mandatory Online In-person Facilitators

Step 1: Ask for 10 volunteers. Ask them to form 5 pairs.

Step 2: Explain that one person in each pair will play the role of someone who has just wit-
nessed a car accident. The other person in each pair will play the role of the helper.

Step 3: Share (on five pieces of paper) the five different instructions given in Facilitator
Guide D.3 – Section 4 - one to each helper – and ask them to not share with anyone
including their partner.

Step 4: Give 3 minutes to each pair for their role play. Ask remaining participants to note
down their observations.

Step 5: Hold a discussion by asking the distressed people in the role play what happened
and how they felt during the conversation. Ask the helpers what they were trying to
do. Then ask the participants to share their observations.

Note: The purpose of this exercise is to show the importance of both verbal and
non-verbal communication. A list of Do’s and Don’ts of Effective Communication
with Children while providing PFA is provided in Annexure IV.

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 Facilitator Guide D.3 – Section 4
Situations for Role Play
On a slip of paper give any of the below mentioned instruction/situation to the participant
playing the role of the helper. As the distressed person talks to the helper and tells their story,
the helper act as instructed in the slip. The following instructions/ situation can be given:
Pair 1: Look around the room and appear distracted.
Pair 2: Interrupt and prevent the distressed person from telling their story.
Pair 3: Change the subject frequently.
Pair 4: Talk to or text someone else when the distressed person is talking.
Pair 5: Pressure the distressed person to tell his/her story in a particular sequence or in a
manner which more comfortable with the helper.
Stay in your role throughout the interaction, even though it may not be how you would nor-
mally act!

Communication Skills (verbal and non-verbal)

Communication is a vital key to build a trusting and helping relationship. Especially, at the time
of crisis or distress, a reassuring word, communicating empathy through words or gestures
is essential. Communication helps to explore, express, and clarify the thoughts, feelings, and
attitudes of an individual, which become the basis for a supportive, helping, and long-term
healthy relationship.

D.3.4. Activity: Paper Cut

Mandatory Online In-person Facilitators

The activity highlights the importance of perception and asking questions in the communi-
cation process. It illustrates the importance of clarification in communication and helps us
check our own perception of a situation and how it can differ from others.

Step 1: Distribute one sheet of A4 size paper to each participant.

Step 2: Explain that they will be given a set of instructions and they must follow the instruc-
tions precisely and quietly, without asking any questions from the facilitator or
even from each other. They must not look at someone else’s work either.

Note: For better results, you can ask participants to close their eyes just before
starting the instructions.

Step 3: Call out the following instructions to the participants slowly, one by one:
1. Hold up the papers please.
2. Fold the paper in half.
3. Cut (or neatly tear) off the top right corner of the folded paper.
4. Fold in half again.
5. Cut off the top left corner of the paper.
6. Fold in half again.
7. Cut off the bottom right corner of the paper.

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 8. Fold in half again.
9. Cut off the bottom left corner of the paper.
10. Unfold the paper.

Step 4: Ask participants to open their eyes and show their papers to each other and exam-
ine similarities or differences.

Step 5: Discuss about the activity with the following questions:

� Did you all end up with similar patterns or there were different patterns? Why is
that?
� Were the instructions clear enough?
� What was missing from the instructions?
� Why is clarification critical in communication?
� What happens if we do not clarify the instruction or doubts in the conversation?

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Part E. Building a Safe
and Caring
Environment

63
 E.1. Building a Safe and Caring Environment
E.1.1. Activity: What Does a Safe Environment Look Like?

Step 1: Share a few scenarios one by one with the participants as given in Facilitator Guide
E.1. Give 5 minutes to the participants to ponder on them.

Step 2: Discuss whether the scenarios given are examples of a safe and caring environment
or not. If yes, then how. If no, then why not.

Step 3: After the discussion, share your thoughts on what constitutes a safe and caring
environment using the material in Facilitator Guide E.1.

Facilitator Guide E.1

Scenario 1: Meera’s teacher observed that Meera is distracted in the classroom. After the
class is over, the teacher asks Meera to come and meet her in the staff room to
talk about the things that may be bothering her. When Meera reaches the staff
room, she finds that all the teachers are sitting and having lunch. Meera’s teacher
approached her and started asking her why she was distracted in class.

Scenario 2: Sanjay’s mother informed his teacher that Sanjay is having trouble sleeping and
he worries a lot. Sanjay’s mother also informed his teacher that last night Sanjay
had a bad dream and he also wet the bed. Sanjay’s mother was concerned for him
and told his teacher to pay a little more attention to him. When Sanjay reached
school, three of his teachers approached him and asked him about his situation
and advised him to stay strong and not to worry.

Scenario 3: Kritika’s classmate informed her teacher that Kritika was crying yesterday after
the class. She informed Kritika’s teacher that she has not been able to concentrate
in her studies and she has been beaten up by her parents also for the same. Kriti-
ka’s teacher called her and asked her to stay back after class. When everyone had
left, Kritika’s teacher spoke to her at length about her situation and asked if she
would like to get any help or would like to visit the school counsellor.

Scenario 4: Prem’s school counsellor approached his school principal and shared with her
that Prem had come to her and complained about his math teacher. He shared
that the math teacher is rude in the class and verbally abuses him sometimes. The
principal told the counsellor that she will look into the issue.

Note: Much of the focus of the school authorities is on ensuring the physical health and safety
of the children. But very little efforts are taken to promote the mental health of children.

64
 What a Safe and Caring Environment Looks Like
Physical Space
„ A clean and properly ventilated space
„ Minimum distractions
„ Expressive art material
„ Proper sitting arrangement
„ No threat of physical abuse
„ Mutual respect is promoted
Behaviour of the Teachers and Other Adults
„ Sensitive to the needs of each individual child
„ Able to communicate in an open and honest manner
„ Able to show and express empathy
„ Has required skills to support a child in distress
„ Uses comfortable/positive gestures
„ Expresses interest in the child’s situation through verbal and non-verbal communication
„ Non-abusive towards children – physically or emotionally or verbally
„ Maintains confidentiality
„ Maintains the respect and dignity of the child
„ Does not rush to give advice without any consideration for individual differences
Attitudes of the Teachers and Other Adults
„ Non-judgmental towards the child’s behaviour
„ Understands and appreciates the phase of child development and challenges associated with
it
„ Willingness to help the child in distress

65
66
67
68
Annexure

69
 Annexure I: Ice-Breaking Activities

Two Truths and a Lie

Suitable for: small group

Task: Give each participant three post-it notes. In two post-it notes ask them to write something true
about themselves and in one post-it note ask them to write something false about them or a lie about
them. Once everyone finish writing then ask each participant to share what they have written on the
post-it note, and others will guess, out of the three statements which statement is false about the
person.

Get to Know You

Suitable for: Small familiar group

Task: Have each participant write five facts about themselves on a post-it note and then put the notes
on a board. The facilitator writes one too. Once everyone is done writing, the facilitator will read each
post-it note one-by-one and participants will try to guess who wrote it. Continue until all the notes
are done.

Birthday Line
Suitable for: Larger unfamiliar group

Task: The facilitator can ask participants to either line up in alphabetic order or according to the date
or month of their birthday.

Lost in Space
Suitable for: Large unfamiliar group

Task: Ask participants to imagine that they are living in a space station. Suddenly, the space station
malfunctions, and they must evacuate. They are only allowed to take five items with them. Which
items would they choose? Ask participants to share their answers in the chat box, explaining why
they chose those five items.

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Annexure II: Warning Signs and Symptoms of Mental
Illness and Mental Health Issues

Facilitators

1) Depression
• Persistent sad mood
• Decrease/slow physical activity
• Problems in studies
• Disturbed sleep - either sleeping too much or unable to sleep
• Change in eating pattern - either eating too much or too less
• Gain or lost significant weight
• Withdrawn or prefer to live alone
• Losing interest in leisure activities - like play
• Decrease participation in social activities
• Complaint of body pain - stomach pain, headaches
• Crying easily
• Thinks about death and dying - talks about life being worthless
• At times appears to be lost or confused

2) Anxiety
• Excessive worrying about everyday things
• Irritable and angry mood
• Persistent fear of unknown
• Problems in concentrating on the task at hand
• Inattentiveness
• Avoid going to social events
• Awkward behaviour at social gatherings
• Difficulty in initiating or maintaining communication
• Being tongue tied or difficult to find the words to say
• Require constant reassurance
• Frequently take bathroom breaks
• Increase in heartbeat, sweating or shortness of breath when asked to perform a new task
or go to a new place
• Difficulty in sleeping
• Procrastinating behaviour
• Mood swings
• Refuse to go to school or other anxiety provoking places.
• Fear of certain places or going out
• Difficulty in performing in school - in academics or in extracurricular activities

3) Post-Traumatic Stress Disorder (PTSD)

• Flashbacks
• Nightmares
• Have problems in sleeping
• Feel sad
• Feel nervous, alert, and watchful

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 • Lose interest in things
• Constantly remember traumatic event
• Trouble feeling affectionate
• Be more aggressive than before, even violent
• Stay away from certain places or situations that bring back memories
• Have problems in school or in studies
• Decrease academic performance
• Trouble focusing and concentrating
• Have physical symptoms such as headaches or stomach aches
• Emotional numbness

4) Panic Attacks
• Dizziness
• Fainting or being unconscious
• Nausea
• Racing or pounding of heart
• Shortness of breath
• Fear of dying
• Fear of losing control
• Trembling or shaking
• Complaint of chest pain
• Hyperventilating

5) Learning Difficulties and Disorders

It has also been observed that when a child is having any learning difficulties or disability
then too, they display emotional or psychological difficulties. Learning difficulties or dis-
ability or any other school or academic related issues too can have an impact on the mental
health of the children. Hence, it is important to identify if the child is experiencing mental
health issues due to learning difficulties or disorders. The causes of learning disorders can be
broadly categorized as follows:

Learning
disorders

Recent onset
Always Problems at

School Change
of school/
Specific delay medium
Neighbourhood
Intellectual dis- in development Home Family punitive
Change
ability (Global (Language Absence teachers
Company status
Developmental Arithmstis, of parents bullying poor
difference Anti-
delay) Visual Spatial, Separation infrastructure
social peers
Visual-motor) excessive
Academic
pressure

72
 Consistent poor academic performance either as a whole or in a particular subject

• Difficulty in reading, writing, spelling, or arithmetic individually or together

• Memory problems - difficulty in remembering
• Difficulty in comprehensions
• Lack of fine motor skills which may lead to poor and slow handwriting
• Inattentiveness
• Difficulty in concentration
• Trouble following directions and instructions
• Poor organization skills
• Mirror image of certain alphabets
• Difficulty in differentiating between similar looking or sounding letters and words

6) Inattention and Hyperactivity Disorder

• Easily distracted
• Forgetful in daily activities
• Lacks organization skills
• Fidgets with hands or feet or squirms in seat
• Talks too much
• Difficulty in waiting for chance
• Deliberately annoys people
• Gets angry easily
• Trouble keeping track of the tasks and activities
• Trouble following instructions
• Avoids tasks which require mental efforts
• Often leaves work unfinished
• Shows interest in multiple things but rarely finishes any task
• Inappropriate anger outburst
• Interrupting others

7) Low Self-esteem and Self-confidence

• Make negative statements about self and others
• Seems discourage
• Avoid school and social gatherings
• Not interested in making friends
• Is either very helpful or not helping others at all
• Withdrawn from social activities and friends
• Bully others
• Does not accept feedback from others
• Difficulty in accepting compliments too
• Self-doubts
• Avoid tasks without even trying - show fear of failure
• Makes self-critical statements life – “nobody likes me, I never do anything right and so on”
• Quit soon after taking a task or playing a game
• Make excuses or try to put blame on others

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 8) Grief
• Not able to talk or hear about the deceased
• Anger accompanied by destruction
• Persisting anxieties/phobic behaviours
• Develop accident proneness
• Exaggerated attachment to surviving parent
• Stealing or illegal behaviour
• Use of alcohol or drug or smoke
• Blame self for the loss
• Preoccupation with death - talk about joining the deceased
• Disturb eating and sleeping pattern
• Drastic decline in academic performance
• Shows serious social withdrawal (When used to be social)

9) Child Abuse
Abused children experience significant psychological and emotional distress as they are
traumatized during the most critical period of their lives - when assumptions about self,
others and the world are being formed, when their relations to their own internal states are
being established. And, when coping and relationship skills are first acquired. Given below
are some of the signs and symptoms or indicators which children may manifest, if they have
faced abuse or have been facing abuse -
• Withdrawal from friends or usual activities
• Changes in behaviour — such as aggression, anger, hostility, or hyperactivity — or chang-
es in school performance
• Depression, anxiety or unusual fears, or a sudden loss of self-confidence
• An apparent lack of supervision
• Frequent absences from school
• Reluctance to leave school activities, as if he or she doesn’t want to go home
• Attempts at running away
• Rebellious or defiant behaviour
• Self-harm or attempts at suicide

Physical abuse - signs and symptoms

• Unexplained injuries, such as bruises, fractures or burns

• Injuries that don’t match the given explanation

Sexual abuse - signs and symptoms

• Sexual behaviour or knowledge that’s inappropriate for the child’s age

• Pregnancy or a sexually transmitted infection
• Blood in the child’s underwear
• Statements that he or she was sexually abused
• Inappropriate sexual contact with other children

Emotional abuse - signs and symptoms

• Delayed or inappropriate emotional development

• Loss of self-confidence or self-esteem
• Social withdrawal or a loss of interest or enthusiasm

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 • Depression
• Avoidance of certain situations, such as refusing to go to school or ride the bus
• Desperately seeks affection
• A decrease in school performance or loss of interest in school
• Loss of previously acquired developmental skills

Neglect - signs and symptoms

• Poor growth or weight gain or being overweight

• Poor hygiene
• Lack of clothing or supplies to meet physical needs
• Taking food or money without permission
• Hiding food for later
• Poor record of school attendance
• Lack of appropriate attention for medical, dental, or psychological problems or lack of
necessary follow-up care

10) Parental Behaviour

Sometimes a parent’s demeanour or behaviour sends red flags about child abuse. Warning
signs include a parent who:
• Shows little concern for the child
• Appears unable to recognize physical or emotional distress in the child
• Blames the child for the problems
• Consistently belittles or berates the child, and describes the child with negative terms,
such as “worthless” or “evil”
• Expects the child to provide him or her with attention and care and seems jealous of
other family members getting attention from the child
• Uses harsh physical discipline
• Demands an inappropriate level of physical or academic performance
• Severely limits the child’s contact with others
• Offers conflicting or unconvincing explanations for a child’s injuries or no explanation at
all.

As far as possible avoid any clinical diagnosis. Most acute reactions are understandable and expect-
able given what people exposed to the crisis situation. Do not label reactions as “symptoms,” or
speak in terms of “diagnoses,” “conditions,” “pathologies,” or “disorders” or make any diagnosis if
the child/student show one or two symptoms mentioned above on a certain occasion or in a particu-
lar situation.

Note: In difficult circumstances, the emotional reactions are common and normal phenomena, but
if you are concerned that one of your students may be struggling with a mental health problem or if
you have observed above mentioned signs and symptoms in your student, then before reaching to
any conclusion, consider the following also -

• Frequency: How often does the student exhibit the behaviours of concern? Whether the
behaviour is observed once only or it has become a regular thing?
• Duration: How long do they last?
• Intensity: To what extent do the behaviours interfere with the child’s activities?

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 Annexure III: Age-specific Reactions to Trauma
Facilitators

Age Common reaction to any difficult situation

0-3 years Cling more to parents
Regression to younger behaviour
Changes in sleep and eating patterns
Crying and irritability
Afraid of things that did not frighten them before
Hyperactivity and poor concentration
Changes in play activity: Less or no interest in playing or only for short periods,
repetitive play. Plays aggressively and in a violent way
More opposing and demanding than before
Very sensitive to how others react
4-6 years Clinging to parents or other adults
Regress to younger behaviour, for example, thumb-sucking
Stop talking
Inactive or hyperactive
Do not play or play repetitive games
Anxious and worry that bad things are going to happen
Sleep disturbances, including nightmares
Changes in eating patterns
Become easily confused
Are unable to concentrate well
Take on adult roles
Irritability
7-12 years Level of physical activity changes
Feel and behave confused
Withdraw from social contact
Talk about the event in a repetitive manner
Are reluctant to go to school
Feel and express fear
Negative impact on memory, concentration, and attention
Sleep and appetite disturbances
Aggression, irritability, restlessness
Somatic complaints (physical symptoms related to emotional stress)
Concerned about other affected people
Self-blame and guilt feelings

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Age Common reaction to any difficult situation
13+ Feel intense grief
Feel self-conscious or guilt and shame that they were unable to help those who
were hurt
Show excessive concern about other affected persons
May become self-absorbed and feel self-pity
Changes in interpersonal relationships
Increase in risk-taking behaviour, self-destructive behaviour, avoidant behaviour,
aggression
Experience major shifts in their view of the world
A sense of hopelessness about the present and the future
Become defiant of authorities and parents
Start to rely more on peers for socializing

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 Annexure IV: Delivery of Psychological First Aid
Facilitators

Tips for better Delivering Psychological First Aid (PFA)

• Professional Behaviour
• Operate only within the framework of an authorized disaster response system.
• Model healthy responses. Be calm, courteous, organized, and helpful.
• Be visible and available.
• Maintain confidentiality as appropriate.
• Remain within the scope of your expertise and your designated role.
• Make appropriate referrals when additional expertise is needed or requested by the survivor.
• Be knowledgeable and sensitive to issues of culture and diversity.
• Pay attention to your own emotional and physical reactions, and practice self-care.

Guidelines for Delivering Psychological First Aid (PFA)

• Politely observe first. Don’t intrude. Then ask simple respectful questions to determine how
you may help.
• Often, the best way to make contact is to provide practical assistance (food, water, blankets).
• Initiate contact only after you have observed the situation and the person or family and have
determined that contact is not likely to be intrusive or disruptive.
• Be prepared that survivors will either avoid you or flood you with contact.
• Speak calmly. Be patient, responsive, and sensitive.
• Speak slowly, in simple concrete terms. don’t use acronyms or jargon.
• If survivors want to talk, be prepared to listen. When you listen, focus on hearing what they
want to tell you, and how you can be of help.
• Acknowledge the positive features of what the survivor has done to keep themselves safe.
• Give information that directly addresses the survivor’s immediate goals and clarify answers
repeatedly as needed.
• Give information that is accurate and age-appropriate for your audience.
• When communicating through a translator or interpreter, look at and talk to the person you
are addressing, not at the translator or interpreter.
• Remember that the goal of Psychological First Aid is to reduce distress, assist with current
needs, and promote adaptive functioning, not to elicit details of traumatic experiences and
losses.

Some Behaviours to Avoid

• Do not make assumptions about what survivors are experiencing or what they have been
through.
• Do not assume that everyone exposed to a disaster will be traumatized.
• Do not pathologies. Most acute reactions are understandable and expectable given what
people exposed to the disaster have experienced. Do not label reactions as “symptoms,” or
speak in terms of “diagnoses,” “conditions,” “pathologies,” or “disorders.”
• Do not talk down to or patronize the survivor, or focus on his/her helplessness, weaknesses,
mistakes, or disability. Focus instead on what the person has done that is effective or may

78
 have contributed to helping others in need, both during the disaster and in the present set-
ting.
• Do not assume that all survivors want to talk or need to talk to you. Often, being physically
present in a supportive and calm way helps affected people feel safer and able to cope.
• Do not “debrief” by asking for details of what happened.
• Do not speculate or offer possibly inaccurate information. If you cannot answer a survivor’s
question, do your best to learn the facts.

Working with Children and Adolescents

• For young children, sit or crouch at the child’s eye level.
• Help school-age children verbalize their feelings, concerns, and questions. Provide simple
labels for common emotional reactions (for example, mad, sad, scared, worried). Do not use
extreme words like “terrified” or “horrified” because this may increase their distress.
• Listen carefully and check in with the child to make sure you understand him/her.
• Be aware that children may show developmental regression in their behaviour and use of
language.
• Match your language to the child’s developmental level. Younger children typically have less
understanding of abstract concepts like “death.” Use direct and simple language as much as
possible.
• Talk to adolescents “adult-to-adult,” so you give the message that you respect their feelings,
concerns, and questions.
• Reinforce these techniques with the child’s parents/caregivers to help them provide appro-
priate emotional support to their child.

Working with Older Adults

• Older adults have strengths as well as vulnerabilities. Many older adults have acquired effec-
tive coping skills over a lifetime of dealing with adversities.
• For those who may have a hearing difficulty, speak clearly and in a low pitch.
• Don’t make assumptions based only on physical appearance or age, for example, that a
confused elder has irreversible problems with memory, reasoning, or judgment. Reasons
for apparent confusion may include disaster-related disorientation, change in surroundings,
poor vision or hearing, poor nutrition or dehydration, sleep deprivation, a medical condition
or problems with medications, social isolation, and/or feeling helpless or vulnerable.
• An older adult with a mental health disability may be more upset or confused in unfamiliar
surroundings. If you identify such an individual, help to make arrangements for a mental
health consultation or referral.

Working with Survivors with Disabilities

• When needed, try to provide assistance in an area with little noise or other stimulation.
• Address the person directly, rather than the caretaker, unless direct communication is diffi-
cult.
• If communication (hearing, memory, speech) seems impaired, speak simply and slowly.
• Take the word of a person who claims to have a disability–even if the disability is not obvious
or familiar to you.
• When you are unsure of how to help, ask, “What can I do to help?” and trust what the person
tells you.

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 • When possible, enable the person to be self-sufficient.
• Offer a blind or visually impaired person your arm to help him/her move about in unfamiliar
surroundings.
• If needed, offer to write down information and make arrangements for the person to receive
written announcements.
• Keep essential aids (such as medications, oxygen tank, respiratory equipment, and wheel-
chair) with the person.

Helping People Feel Calm

Some children who experience a crisis may be very anxious or upset. They may feel confused or over-
whelmed and may have some physical reactions such as shaking or trembling, difficulty breathing or
feeling their heart pounding.
The following are some techniques to help very distressed children to feel calm in their mind and
body:

• Keep your tone of voice calm and soft.

• If culturally appropriate, try to maintain some eye contact with the person as you talk with
them.
• Remind the person that you are there to help them. Remind them that they are safe, if it is
true.
• If someone feels unreal or disconnected from their surroundings, it may help them to make
contact with their current environment and themselves. You can do this by asking them to:
o Place and feel their feet on the floor.
o Tap their fingers or hands on their lap.
o Notice some non-distressing things in their environment, such as things they can
see, hear, or feel. Have them tell you what they see and hear?
o Encourage the person to focus on their breathing, and to breathe slowly.
o Encourage them to try the 5-4-3-2-1 method - Working backward from 5, use your
senses to list things you notice around you. For example, you might start by listing
five things you hear, then four things you see, then three things you can touch from
where you’re sitting, two things you can smell, and one thing you can taste. For in-
stance - Try to notice the little things you might not always pay attention to, such as
the colour of the flecks in the carpet or the hum of your computer.
o Imagine leaving the painful feelings behind - Picture yourself:
 gathering the emotions
 balling them up, and
 putting them into a box walking, swimming, biking, or jogging away from
painful feelings
 imagining your thoughts as a song or TV show you dislike, changing the
channel or turning down the volume — they’re still there, but you don’t have
to listen to them.

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Coping
Everyone has natural ways of coping. Encourage children to use their own positive coping strategies,
while avoiding negative strategies. This will help them feel stronger and regain a sense of control. You
will need to adapt the following suggestions to take account of the child’s culture and what is possi-
ble in the crisis.

• Encourage positive coping strategies

o Get enough rest.
o Eat as regularly as possible and drink water.
o Follow the COVID-19 protocols
o Talk and spend time with family and friends.
o Discuss problems with someone you trust.
o Do activities that help you relax (walk, sing, pray, play with friends online or with
siblings).
o Do physical exercise.
o Find safe ways to help others in the crisis and get involved in community activities.
• Discourage negative coping strategies
o Don’t take drugs, smoke, or drink alcohol.
o Don’t sleep all day.
o Don’t work all the time without any rest or relaxation.
o Don’t isolate yourself from friends and loved ones.
o Don’t neglect basic personal hygiene.
o Don’t be violent.

Activities to keep Children Engaged

Keeping children engaged in different activities will help them to divert their attention from the pan-
demic and calm them down. In the below link various activities have been complied to keep children
engaged. The teacher or parent can supervise the activities. If doing reading, try and read the book
along with children.

• haqcrc.org/blog/young-busy-bees/
• https://interagencystandingcommittee.org/system/files/2020-04/My%20Hero%20is%20
You%2C%20Storybook%20for%20Children%20on%20COVID-19.pdf - “MY HERO IS YOU”
(English)
• https://interagencystandingcommittee.org/system/files/2020-07/My%20Hero%20is%20
You%2C%20Storybook%20for%20Children%20on%20COVID-19%20%28Assamese%29.pdf -
“MY HERO IS YOU” (Assamese)
• https://interagencystandingcommittee.org/system/files/2020-05/My%20Hero%20is%20
You%2C%20Storybook%20for%20Children%20on%20COVID-19%20%28Hindi%29.pdf - “MY
HERO IS YOU” (Hindi)

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 Do’s and Don’ts when Offering PFA

Do’s Don’ts
Listen more than you speak to identify Pressure others to speak if they do not want to
concerns speak
Ask probing questions gently Ask why this or that
Use open-ended questions: when, where, what, Be judgmental
who
Acknowledge feelings and understanding of Use technical terminology
events
Normalize emotions and reactions Talk about yourself or personal issues or
troubles
Recognize internal resources and capacity to Give false promises or false assurances
cope
Provide correct and age appropriate Share someone else’s story or experiences.
information about COVID 19.
Be honest of what you don’t know. This is a Exploit the trust and confidentiality shared
new virus that we are all learning about.
Be patient and calm
Allow processing and ventilation of emotions
Listen to individual’s options and help them
make the choices
Ensure confidentiality unless issues mentioned
affect the safety of the individual or others
Ensure the – “do no harm principle” is upheld

Do’s and Don’ts of PFA Communication

List of Do’s and Don’ts for effective communication with children while providing Psychological First
Aid

Do’s Don’ts
Be honest and trustworthy Don’t exploit your relationship as a helper
Be aware of and set aside your own biases and Don’t ask the person for any money or favour
prejudices for helping them
Make it clear to people that even if they refuse Don’t make false promises or give false
help now, they can still access help in the information. Don’t exaggerate your skills
future.

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Do’s Don’ts
Behave appropriately by considering the Don’t force help on people, and don’t be
person’s culture, age, and gender. intrusive or pushy.
Find a quiet place to talk, and minimize outside Don’t pressure someone to tell their story
distraction
Respect people’s right to make their own Don’t interrupt or rush someone’s story (for
decisions. example, don’t look at your watch or speak too
rapidly)
Respect privacy and keep the person’s story Don’t touch the person if you’re not sure it is
confidential, if this is appropriate appropriate to do so.
Stay near the person but keep an appropriate Don’t judge what they have or haven’t done, or
distance depending on their age, gender & how they are feeling. Don’t say: “You shouldn’t
culture feel that way” or “You should feel lucky you
survived”.
Let them know you are listening for example, Don’t make up things you don’t know
nod your head or say ‘hmm...’
Be patient and calm Don’t use terms that are too technical
Provide factual information, if you have it. Be Don’t tell them someone else’s story
honest about what you know and don’t know. “I
don’t know, but I will try to find out about that
for you”.
Give information in a way the person can Don’t talk about your own troubles
understand – keep it simple.
Acknowledge how they are feeling and any Don’t think and act as if you must solve all the
losses or important events they tell you about, person’s problems for them.
such as loss of their home or death of a loved
one. “I’m so sorry. I can imagine this is very
sad for you”
Acknowledge the person’s strengths and how Don’t take away the person’s strength and
they have helped themselves. sense of being able to care for themselves
Allow for silence Don’t talk about people in negative terms (for
example, don’t call them ‘crazy’ or ‘mad’)

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 Annexure V: Useful Reading Material
1) Psychosocial Support for Children during COVID-19: A Manual for Parents and Care-givers –
By UNICEF and Childline
2) Self-Esteem – Key to your child’s Future – By Tony Humphreys
3) Adolescents Mental Health Promotion – A series of Trainer’s Module – By WHO
a. Trainers’ Guide on Strengthening Interpersonal Relationships.
b. Trainers’ Guide on conflict Resolution - https://apps.who.int/iris/bitstream/han-
dle/10665/204755/B4897.pdf?sequence=1&isAllowed=y
c. Trainers’ Guide on coping with stress.
d. Trainers’ Guide on dealing with Emotions.
e. Trainers’ Guide on Enhancement of Self-Confidence.
f. Trainers’ Guide on Alcohol use and abuse - https://apps.who.int/iris/bitstream/han-
dle/10665/204754/B4896.pdf?sequence=1&isAllowed=y
g. Trainers’ Guide on Handling peer pressure.
h. Trainers’ Guide on Promotion of Mental Health of Adolescents - https://apps.who.int/
iris/bitstream/handle/10665/206026/B0752.pdf?sequence=1&isAllowed=y
4) An E-book for young children on COVID-19 – By Public Health Foundation of India - https://
phfi.org/wp-content/uploads/2020/04/E-book-for-young-children-on-COVID-19.pdf
5) Doing What Matters in times of Stress - An Illustrated Guide – By WHO - https://apps.who.int/
iris/bitstream/handle/10665/331901/9789240003910-eng.pdf
6) Psychological First Aid (Hindi) – By WHO

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References
• National Child Traumatic Stress Network and National Centre for PTSD, Psychological First Aid:
Field Operations Guide, 2nd Edition. July 2006. Available on: www.nctsn.org and www.ncptsd.
va.gov.
• Psychosocial Support for Children during COVID-19: A Manual for Parents and Care-givers – By
UNICE and Childline
• https://www.ready.gov/sites/default/files/documents/files/PFA_SchoolCrisis.pdf
• https://www.who.int/mental_health/world-mental-health-day/ppt.pdf
• https://relief.unboundmedicine.com/relief/view/PTSD-National-Center-for-PTSD/1230010/all/
Introduction_and_Overview
• file:///D:/MY%20DATA/Downloads/9789241548618_eng%20(1).pdf
• Teacher’s Manual on Life Skills: Classes IX-X by CBSE
• Kapur, M (2011). Counselling Children with Psychological Problems. Pearson: Delhi.

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