So welcome back. As I mentioned earlier we are going to look a little closer at the historical platforms for what we do today. The first use of the term psychological first aid, as far as we can tell, was, that in a monograph published by the American Psychiatric Association, who's actually published in 1954, and I'm quoting now. It says in all disasters, whether they result from forces of nature or from enemy attack. The people involved are subjected to stresses of a severity in quality not generally encountered. It's vital for all disaster workers, notice all disaster workers to have some familiarity with common patterns of reaction to unusual emotional stress, must also know the fundamental principles of coping most effectively with disturbed people. So this set the precedent. However, there was a latency. Why was there a latency? Not totally sure however the 1950s and the 1960s could be considered the golden age of psychotherapeutic practice I guess the golden age of psychotherapy. There was little interest in responding to acute psychological distress so almost forty years later A disaster mental health initiative was fielded by the American Red Cross. It consisted of a corps of licensed mental health clinicians who were provided a brief refresher in psychological crisis intervention and also informed on how to work within the American Red Cross disaster response system. The first national deployment was August, 1992 in response to Hurricane Andrew. Which devastated South Florida. This deployment system worked well in most disasters. However, the year 2005 was a game changer. In 2005, Hurricane Katrina devastated the Gulf Coast of the United States, and this devastation demonstrated the importance of having mental health resources that extend beyond the importation of external mental health clinicians. And this is the posture that we assumed here at John Hopkins. Was that building community surge capacity needed to happen more internally than from external importation sources. The importance of building indigenous surveillance and acute intervention resources became obvious in the wake of Hurricane Katrina. In 2003, the Institute of Medicine had actually written, a broad spectrum of professional responders is necessary to meet disaster-related psychological needs effectively. Those outside the mental health professions, who regularly interface with the public, can contribute substantially to community healing. However, these professionals will require knowledge and training in order to provide effective support. Now while this Institute of Medicine report was specifically in response to the threat of terrorism. We think it's applicable here. Now, what it does is take us away from the notion of importing mental health professionals as our primary source of building community surge capacity. We here at Hopkins embrace that notion. And developed our Psychological First Aid program in response to those suggestions. The IOM went on to say, in the past the decade, there's been a growing movement in the world to develop a concept similar to physical first aid for coping with stressful and traumatic events in life. If the strategy's been known by a number of names but is most commonly referred to as Psychological first aid. So again let me remind you of our core definition our core term. As we define psychological first aid here. Psychological first aid may be defined as a compassionate and supportive presence designed to mitigate acute distress And assess the need for continued mental health care. It is not treatment for post traumatic stress disorder. It is not a treatment for post traumatic depression. As I said in my opening the opening remarks. The processes of diagnoses and treatment are reserved for another point on the continuum of care. If we conceive of mental health intervention on a continuum we will see that psychological first aid is the tip of the spear. It is the first point on that continuum. It does not compete with counseling and psychotherapy. It does not compete with diagnosis. It is simply the earliest point on the continuum. Of what should be a comprehensive spectrum of care. So what have we learned from history? More importantly, how have we applied what we've learned from history? This program introduces you to the RAPID PFA model that we've developed here at Johns Hopkins. The rapid PFA model represents a simple structure that can be applied within minutes to enhance the compassionate presence, and reduce acute distress. Let me walk you through the acronym itself, for this will give you some sense of where we're headed. R. The R stands for building rapport and using reflective listening. People often ask me how do you know what you're going to do in a crisis intervention session, or an intervention. And the answer is, you listen. I've actually been doing this work for 40 years, and I don't know that I've ever done two interventions exactly the same way. Why is that? because no two people are the same and no two adverse situations are ever the same. I must listen. It's one of the most important things that you can do, which parenthetically I will say we often take for granted, one of the most important things you can do is listen. Listen carefully. In many instances people will tell you what they need. They will direct you to how to best help them. But you must be willing to listen. The biggest mistake I see in the field is that people interface with people in acute distress. And they come with a preconceived notion of what they're going to do. Almost a one size fits all. We must be present, we must be compassionate. We must be compassionate enough and patient enough to listen to the story that someone will tell us. But it all begins with rapport. So we'll talk a little bit about how one builds a relationship and how to build one quickly. The A in rapid, stands for assessment. This is simply the ability to tell, almost in a surveillance kind of way, who might be e, experiencing acute distress, in that moment and who might not. This is not about diagnosis, and I know I sound like a broken record at times on this but it's not about formulating a diagnosis it is looking at who is in acute distress and apparently needs assistance versus those who don't. The P is actually dovetailing with the A. It comes right on the end, asks the question of the people that need help, to whom should I respond first? This concept of triage, and remember the root of the term triage is its French derivation, and means to pick or to select or to create a hierarchy. It is well known in physical medicine to show up at a disaster scene we have a rather formalized system for assigning people to levels of care. The urgency of care. It was not until 1999 that people really started to look at psychological triage in the wake of disasters. So this is a skill set that, especially if you've gone to school, even in mental health school, psychiatry, psychology, social work, counseling If you went to school before the late 90s, this was a topic that was probably not introduced. So, we build rapport. We listen to people. We assess their current needs. We ask ourselves, of those who need our assistance who should be at the front of the line? The next point is, what do we do? Intervention, the I, really asks the question, what can I do now to offer some sense of stabilization, some sense of mitigation of acute distress. What can I do to help? So we will review certain intervention strategies, not therapy, but certain things that can shall we say, take the sting out of acute adversity. Certain things perhaps that pave the way for the healing process. Lastly, disposition and follow up. What does that mean? Well, let's go back and recap again. We've established rapport, we've established an acute relationship, we're listening to people. We're assessing the need for intervention. We are prioritizing those who we think do need acute care. We are doing something to stabilize those in most need of care, to mitigate their acute distress. And after we have applied these interventions. The next question is, how effective? What do I do now? I've done an intervention. What do I do now? Well, the question, what do I do now? Is answered by observing the person you've just done the intervention with. How are they doing? Are they able to return to some level of productive functioning? If not, what do they need? Last but not least, psychological first aid should never be a one-off intervention. It should never be a one time good luck in life pat on the back intervention. We always try to follow up. Now realistically, this is not always possible. But if we can't follow up perhaps we can provide a system or mechanism by which follow up can be applied. So I want to make this point very clear. Psychological first aid is not designed to be a once only intervention. And again, keep in mind the continuum of care. Psychological first aid is simply the earliest point on that continuum. And hopefully evolves into a process that meets all of the needs of those who survive adversity. When we come back we're actually going to stroll through the R A P I D. We'll analyze each, it's strengths, it's weaknesses, it's components and it's context
