2-Who , When and Where

Psychological First-aid Beginning:

PFA is not a new intervention. Rather, it is better conceptualized as documenting and operationalizing good common sense – those activities that sensible, caring human beings would do for each other anyway.

The term Psychological First Aid was first coined by Drayer, Cameron, Woodward, and Glass (1954) in a manuscript they wrote for the American Psychiatric Association on request of the U.S. Federal Civil Defense Administration. The purpose of the manuscript was to provide guidance for managing in the aftermath of community disasters. By the 1970s the principles and foundations of crisis (psychological) intervention were being utilized in disaster work with adults. By 1990 emergency organizations such as the Danish Red Cross were applying the principles as a preferred model for early intervention following exposure to a traumatic event. The principles have continued to gain widespread international acceptance, culminating in their inclusion in international guidelines.

WHO

PFA is for distressed people who have been recently exposed to a serious crisis event. You can provide help to both children and adults. In Egypt one of the places that give PFA is "Red Crescent". However, not everyone who experiences a crisis event will need or want PFA. Don't force help on people who do not want it, but make yourself easily available to those who may want support.

There may be situations when someone needs much more advanced support than PFA alone. Know your limits and get help from others, such as medical personnel (if available), your colleagues or other people in the area, local authorities, or community and religious leaders. In the following box we have listed people who need more immediate advanced support. People in these situations need medical or other help as a priority to save life.

People who need moreimmediate advanced Support:

• People with serious, life-threatening injuries who need emergency medical care. • People who are so upset that they cannot care for themselves or their children. • People who may hurt themselves. • People who may hurt others.

WHEN

Although people may need access to help and support for a long time after an event, PFA is aimed at helping people who have been very recently affected by a crisis event. You can provide PFA when you first have contact with very distressed people. This is usually during or immediately after an event. However, it may sometimes be days or weeks after, depending on how long the event lasted and how severe it was.

WHERE

You can offer PFA wherever it is safe enough for you to do so. This is often in community settings, such as at the scene of an accident, or places where distressed people are served, such as health centers, shelters or camps, schools and distribution sites for food or other types of help. Ideally, try to provide PFA where you can have some privacy to talk with the person when appropriate. For people who have been exposed to certain types of crisis events, such as sexual violence, privacy is essential for confidentiality and to respect the person’s dignity.

HOW

Action principles of PFA:

Principle Actions

LOOK

• Check for safety • Check for people with obvious urgent basic needs • Check for people with Serious distress reactions

LISTEN

• Approach people who may need support • Ask about people's needs and concerns • Listen to people and help them to feel come

LINK

• Help people address basic needs and access services • Help people cope with problems • Give information • Connect people with loved ones and social support

RAPID Model

1. Reflective listening: refers to the ability to utilize active listening techniques, establish empathy, and determine important aspects of the survivor’s experience. 2. Assessment: entails, first, screening to answer the binary (yes-no) query of whether there are indicators to warrant exploration into a person’s capacity for adaptive mental and behavioral functioning and, second (if necessary), a brief assessment of dimensional factors that are likely to facilitate or impede rapid recovery of adaptive functioning, for example, the ability to understand and follow directions, the ability to express emotions in a healthful and constructive manner, social adaptability, and the ability to access interpersonal resources; 3. Prioritization (of assessed functional needs): is essentially a triage task intended to guide an acute intervention plan for more severe physical, psychological, and behavioral reactions. Beyond physical and medical priorities, the focus is on the ability of the survivor to perform basic activities of daily living; 4. Intervention (once physical and medical needs are addressed): is applied, as needed, using stress management and/or cognitive/behavioral techniques to reduce acute distress; 5. Disposition: involving the determination if survivors have regained the functional capacity to engage in the basic activities of daily living, or need referral and transitioning to other clinical or social supports (possibly with continuing advocacy and liaison needs).

Although not part of the RAPID acronym, but “Self Care” is very important. Remember that Primary civilian victims experience adverse reactions to disaster, but first responders and others in the helping professions may also be vulnerable to similar adverse reactions!