Psychological First Aid:Adaptation, training & outcomes

IASC RG Meeting

Paris, November 2011• Megan McGrath, WVI

• Leslie Snider, WTF

• Mark van Ommeren, WHO

PFA Guide for Field Workers

• WHO publication www.who.int

• Collaborative effort:– World Health Organization – War Trauma Foundation– World Vision International

• Endorsed by 24 UN/NGO international agencies

• In process of translation and adaptation to varied contexts

QuickTime™ and a decompressor

are needed to see this picture.

QuickTime™ and a decompressor

are needed to see this picture.

Process of Developing Guide“a journey of a thousand miles begins with a single step”

• 2008 scan for existing resources & needs• 2009 WHO commissioned PFA systematic review• 2009 Anthology of resources• 2009-10 First draft designed• 2010 Haiti pilot (WVI - Alison Schafer)• 2010 Extensive international peer review (60+)• 2011 Second select peer review from LMC colleagues,

child protection, IASC Ref Group and plain English• 2011 August release on World Humanitarian Day

The PFA Field Guide - Endorsements

Psychological First Aid (PFA) is:

A description of a humane, supportive response to a fellow human being who is suffering and who may need support. PFA involves the following themes:

– Providing practical care and support that does not intrude

– Assessing needs and concerns– Helping people to access basic needs (e.g. food and

water, information)– Comforting people and helping them to feel calm– Helping people connect to information, services and

social supports– Protecting people from further harm

Based on Sphere (2011) & IASC MHPSS Guidelines (2007)

PFA is not....• It is NOT something only professionals can do• It is NOT professional counseling• It is NOT a clinical or psychiatric intervention (although it

can be part of good clinical care)• It is NOT psychological debriefing• It is NOT asking someone to analyze what happened to

them or to put time and events in order• It is NOT pressing people to tell you their story• It is NOT asking people details about how they

feel or what happened

Why PFA?

• People do better over the long-term if they…– Feel safe, connected to

others, calm and hopeful

– Have access to social, physical and emotional support

– Feel able to help themselves, as individuals and communities

How do we know?• “Evidence informed” - factors associated with

PTSD (ES>0.2): – Adults: peri-traumatic dissociation, lack of social

support post-trauma, trauma severity, life stress post-trauma, perceived life threat, peri-traumatic emotional response

– Children: pre-trauma psychopathology, threat to life and pre-trauma parental distress

• Supported by Hobfoll principles & evidence that lack of social support is associated with a poorer outcome

• Consistent with recent guidelines (NATO/ TENTS, etc.)

Recommendations (Bisson & Lewis, 2009)

• Caution against step-by-step manualised intervention

• Doesn’t require advance knowledge

• Can be easily taught to workers without mental health training

PFA Action Principles

Prepare-------------------

Look Listen Link

PFA TrainingWHO/WTF/WVI have conducted training in Suriname, Somaliland, Iraq, West Bank/ Gaza, Sri Lanka and Europe (IOM, Dutch security network)

WVA/WTF/GPG Sri Lanka project 2011-13WVI rolling out training within organizationPlanned for Sudan, aid workers in DarfurMany other groups planning or doing training (TPO Nepal, Belize, IOM, IMC…)

PFA Adaptation & Training Group established on MHPSS network

Translations of the Guide

• WHO MH Dept coordinating all official UN translations (Chinese, Spanish, Russian, Arabic, French)

• For non-official languages, send requests to WangJ@who.int

• Current translations requested:Urdu, Tamil, Sinhala, French, Spanish, Arabic, Japanese, Chinese, Romanian, Hebrew, Korean…Confirmed: French, Urdu, Japanese, Chinese

Ordering Books (WHO Bookstore)

• WHO MH Dept is sending all endorsing agencies 50 copies of the guide (they are in the mail)

• WHO MH Dept will send 1-2 copies upon request, but not handling large requests

• Standard cost $12/book, but it is possible to negotiate reduced rates (possibly about $6/book)

• Possible for any agency/group of agencies to access designer files for a special print run

Intriguing QuestionsDo we have a shared understanding of what PFA is - and is not? (beware CISD trap!)How to adapt the guidance for different…?

Socio-economic contextsCrisis eventsCultures, customs and languages

How best to capture global lessons in adapting & applying PFA? How to measure process & outcomes (!!) of PFA training and application in the field?

Pre-post training knowledge, skills, practice?Personal effects of training on trainer well-being?Beneficiaries?…the Hobfoll principles?

References

1. Bisson, J.K. & Lewis, C. (2009) Systematic Review of Psychological First Aid, Commissioned by World Health Organization.

2. PFA Anthology: www.wartrauma.nl and www.psychosocialnetwork.net

3. Schafer, Snider and van Ommeren. Psychological first aid pilot: Haiti emergency response. Intervention Journal, Vol. 8(3): 245-254, Nov 2010.

http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf

Acknowledgements• Writing & Editorial Team:

– L. Snider (WTF), A. Schafer (WVI), M. van Ommeren (WHO)

• Steering Committee: – Stefan Germann (WVI), Erin Jones (WVI), Relinde Reiffers

(WTF), Shekhar Saxena (WHO), Marieke Schouten (WTF), Leslie Snider (WTF), Mark van Ommeren (WHO)

• Illustrations: Julie Smith (PD Consulting)• Photos: Red Cross/Red Crescent photos courtesy of Melissa

Ekin Kizildemir & Suat Ozcagdas• Funding: World Vision International• Reviewers:

– We thank the many reviewers and endorsing agencies