In this video I will introduce to you the preventive monitoring model as a psychosocial way of support after critical incidents. It's a way of trying to avoid posttraumatic stress from establishing in people affected by a crisis. This model is a therapeutic approach, an intervention and so it widely exceeds this psychological first aid course's objectives. But we thought it is important that as a psychological first aid provider you see the whole model we apply, and know what comes after psychological first aid, this way you will be able to better contextualize the importance of the task you will be doing during the first moments of answer to the incident. The model is valid both for daily critical incidents, which are the ones that affect only one family, and for massive critical incidents, but we must sincerely say that nowadays it's applied more to massive incidents. And we still have to establish the importance of this same kind of support in daily incident. Current preventive monitoring models assume, without exceptions, some premises to offer the most efficient help to the affected ones. In these premises we have, in first place, accepting and being convinced that all people, without exceptions, answer with acute stress in front of a critical incident, either massive or daily. But it also means assuming that not everybody will generate effects and that some will spontaneously recover. But the third premise establishes that in the way of managing the critical incident there is the key that allows us to increase the risk of the people with effects or diminish it. And so it establishes that the critical incident management itself has a very important and remarked role in the people's prognostic for their recovery. The fourth premise in this program is based on the studios that have proved that although it is obvious that there are some people that have a bigger natural resilience capacity, recuperation capacity, than others, this capacity can be stimulated in all cases and so it is a crucial task from preventive monitoring programs to stimulate and increase to the maximum this resilience capacity. Only this way we guarantee that people can recovery the best way they can. And after talking on these four premises we must have very clear that at the current moment, with what we already know about the answers people give to crisis, it has no sense waiting for two or three months after the critical incident without doing anything, waiting to evaluate which are the people that aren't properly recovering from the incident and giving them aid only then, when we have clear that they aren't recovering spontaneously. This way of acting maybe had some sense 10 years ago when we didn't have the current evidences. But now we know our capacity to stimulate and involve people in their healing process, it's absurd. And it's important that all emergency managers have the importance of participating clear from the first moment and during a certain time after the critical incident. The preventive monitoring model we propose is based in four actuation principles. The first one is about the importance of giving the affected ones autonomy and involving them in their own healing process. After a critical incident, affected people have just lost a part of their life's control, but not all of it, they haven't become useless, and so it is very, very important giving them this control back and counting with them, counting with their opinion and their capacity of answering to participate and even to design the monitoring programs. The second acting principle establishes that information and quality information on the critical incident, on what has happened and what will happen has a high contention power and even healing of the affected people and so it is unacceptable that this information is hidden from the affected people. The third principle has to do with power, with education's calming and normalizing capacity. If we are going to ask the affected to involve themselves because we know this is the best way to answering in front of a critical incident, it is important that we tell them once and again how can they do this. We must tell them which are the expected reactions, we must tell them what should they do to improve their answer and we must tell them what they shouldn't do because they can risk their recovery. And the fourth principle is that when people have passed or are passing through a critical incident, they are usually very weak and vulnerable and so the aid we are going to give them must be extraordinarily proactive, the help must get to them, the affected ones mustn't seek that help. And not only once, because there are some people that today won't need a thing but next week they might need something, and they shouldn't be the ones to look for it, the help must be present and offered to them once and again in a respectful and polite way. From these actuation principles and the premises it's based on, come the objects from our preventive monitoring model. We want to involve the affected ones in their own healing process, we want to treat affected people as what they are: people who are suffering normal and adaptive reactions in front of a totally abnormal situation for which they weren't prepared. We want to try to avoid any way of pathologies of what is happening to them both regarding the incident itself and their reaction and response to this incident. We want to offer people an effective and highly specialized help that will solve the real problems affected people have that turn around three axis: hyper-alert, reexperiencing and avoiding. And this aid must offer them concrete answers, useful in front of these symptoms, not global and general answers. And finally inside the preventive monitoring program we want to detect as soon as possible the people that have bigger chances of not recovering spontaneously, and we won't do this to offer a therapy from the beginning, but to offer them a bigger help, more psycho-educative guidelines and monitoring them closer, so that if they don't actually come over what is happening to them inside the recommended time lapse, they can have an effective help as soon as possible. Which elements does our preventive monitoring model have then? Well, I will briefly review the stages in the answer of a critical incident. We have a first moment, the impact moment which lasts from 24 to 72 hours and is characterized first by a shock and then by an adaptation to what's happening. That is, affected people must assimilate what happened. After this first stage comes the second one, the confrontation stage which usually takes from four to six weeks after the critical incident and is the moment in which the affected ones realize about the real importance of what happened. There begins the recovery stage, which lasts approximately until one year after the incident and the objective of which is reaching a similar functional and welfare level to the one they had before the critical incident. Finally there is a fourth stage to which not all affected people get, but which consists on finding a sense, a place in the own biography to what happened, a place which doesn't take everything, that is, someone that before a critical incident was a woman, mother, professional athlete, activist in a political party, after losing a son in a terrorist attack can perfectly decide how to find it sense, taking part on an activist group that tries to prevent these terrorist attacks from happening, but if she overcomes the critical incident she will become a woman, a mother, a professional athlete again, that is, this person's identity will have incorporated a new face which is the son's loss, and what she will do to try to avoid that other people pass through a similar incident, but she will have recovered her other identities as well. Well, which are the elements the preventive monitoring program must contain to go through these stages the affected by the critical incident pass through? In first place, there is what you are learning to do, psychological first aid which should, if possible, be offered during the first 24 or 72 hours after the critical incident, that is, the impact stage. While they are in shock and adapting to what happened. In some exceptional cases, psychological first aid can also be offered up to three and four weeks after the incident, because if we couldn't provide psychological first aid during the real impact moment in these first 72 hours, let's say, because the country is devastated, it's good that during the month after the impact we try to recovery this technique as a beginning of the steps that will come later. As a complement and also from the moment of the impact, some kind of technical specialized information should be available, as a phone support line or a free chat, in which affected people can solve their concrete doubts and problems. The affected ones are disconcerted, they are facing a new situation and they have questions: how do I explain my son we don't have a house? How do I tell grandpa he won't walk anymore? and then we have some concrete doubts. These doubts generate anxiety, an anxiety that is added to the acute stress the critical incident has already generated. Solving doubts immediately during 24 hours a day and every day, helps these people to confront better and distress and so it's extraordinarily useful. During the first month, during the confrontation stage it is very important that there is some psycho-education available for affected people, either as a written material or in community meetings, victim groups, in which people are informed about what they can do to recover properly. So we want to involve them in their own process. To do so, they must know what will happen to them, how can they take care of themselves and what should they try to do, or we won't be able to involve them. So anything that has to do with psycho-education in all its means is very important during this first month. Then, during the recovery stage, we must let people and families decide by themselves how much help and how often they need it if they do, but we can have clear that after the month, it is important that help can be focused on the family, because it's in the concrete families in which concrete difficulties appear. And so what was valid during the first month, which were general tips for all the affected ones, after that they should adopt a more concrete shape focused on the family. Around the end of the recovery process, that is, around a year after the critical incident it is important to make a screening, that is, checking whether the families and persons have recovered reasonably from the critical incident. They will probably still be affected, but what we will evaluate with this screening is whether we need to go to external therapeutic services or if the process is being made normally and the prognostic is that the family, the affected, will end up recovering by themselves, because they obtained it by themselves and with the help we have given them, the necessary resources for them. European experts have made some quality standards which try to define how the help given to affected by critical incidents should be. There are four standards established, the first one says that help should be available from the moment of the impact until at least nine months later, because people in their process of answering to a critical incident have different needs in the many stages through which they pass through and it is important that this help is available during all the time and is highly specialized, that is, which answer the victims' concrete needs. The second quality standard says that online and phone aid services are crucial, no matter their format, in which affected people can get an immediate answer during 24 hours a day to their concrete doubts and questions. Because waiting for this answer only increases the anxiety levels and, with this, the risk of getting effects. So we need some kind of mean which victims can contact every day of the year and all the hours of the day with one person who is a specialist in the theme who will answer properly. The third quality standard is about who should give this aid. It's totally recommended because of ethical reasons that professionals of the same company that has caused a damage solve this damage. You might be surprised because it's part of the Law that the authors of an accident must repair a damage done, and this is correct if the company pays the cost of the affected ones' psychological assistance. But it is highly damaging if the company that caused an accident establishes professionals that will help the affected ones, because although maybe it won't happen, some affected ones have doubts on who these professionals are actually helping, that is, they have doubts on these professionals' impartiality, and these doubts are highly damaging to the affected ones. And the fourth standard added not long ago is that psychosocial assistance activities to victims must always contain two kinds of activities, they must have two formats. One guided, grouped, well planned, but in which affected ones share a similar condition, in example all the parents that have lost a son, all people that have lost a brother, a friend in the accident, groups can exchange the experiences they had. They will do it anyway but if they are guided we can avoid shocks and on the other side we use the power of sharing and community to strengthen the affected ones' healing and recovery. But programs must also include activities focused in the family, because each family is different, they have different problems and needs, and so it must get a concrete orientation on its specific difficulties.
