Summary of John’s Hopkins RAPID model Psychological First Aid Course

Summary of John’s Hopkins RAPID model

Psychological First Aid

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By: Sama Al-Maqbali

This course intended to introduce us to the fundamental of something called “psychological first aid”. Psychological first aid, or PFA may be defined as a compassionate and supportive presence designed to mitigate acute distress, and assess the need for continued mental health care. This course was designed specially for public health personnel, educators, emergency responders, as well as people with little or no formal mental health training. Just keep in mind, it’s not therapy. It’s not diagnosis.

Recent evidence suggests that psychological crisis intervention, such as PFA, can increase the perception of personal resilience. Psychological crisis intervention has been shown to be superior to multisession psychotherapy post disaster, for reducing acute distress. So, this is not something that we simply do because we don’t have enough shrinks to go around.

Then the only question is, how do we do psychological first aid?

And, the John Hopkins RAPID, R-A-P-I-D, is one model of PFA. 1. Reflective Listening (RL): Listening is am active process, not a passive one. It begins with gaining rapport through listening.

The goals of RL are: - Making a contact - Providing an introduction: who are you?/what are you doing?

- Establish rapport: by using specific active RL techniques such as paraphrasing to establish some degree of empathy. (empathy not sympathy). So, try to give them a jump start they need. The great 20th century physician Henry Murray said “There is nothing powerful as a well phrased question”.

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Summary Paraphrasing: Rephrase what they said to a question. Make it like a conversation e.g.: It sound to me like/ Or in other words you are saying …..

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- Get insight to the persons need, it tells them you are interested , rather than telling them what to. It says you are valuable I am here to help. But I need your assistance to help you.

In order to that, I need to know about who you are, and what happened?

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NEVER FORGOT TO ASK HOW CAN I HELP YOU?

So as I mentioned you need to ask questions, to establish a rapport. But first you must know that we have 2 types of question: 1. Closed question: Where the answer will be yes or no(restrict response). This is efficient to establish facts e.g.: Are you injured? / Hurt? /Bleeding?

2. Open ended questions: Less efficient, more productive e.g.: How are u ? / What’s going on? This can fill in the details and give us further information.

Remember: When you will ask a person “Are you doing okay?” even if not they will mostly say yes. So, try to ask in a different way because they might be guilty having an assistance.

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Now lets describe a situation what someone may say to you, and let’s see if you can identify which response if more reflective:

- Situation: A person is in distress says “I’ve been told I cannot live in my house anymore after the flood. Something about mold. I just cannot understand. House is solid as rock?”

So, having heard that how would you formulate a RL response?

Let’s see more responses: 1. Let’s find someone to explain all this.

2.

Have you spoken with someone from the health Department?

3. Things really can be confusing. You sound pretty angry now.

4. What have you done so far to get an explanation?

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Now you may say that all four are applicable. But, that is not the question, Remember R in RAPID. So, which of theses is most effective lets go through each one.

1. Let’s find someone to explain all this. Solution is directive, it solves the Problem but ignores the obvious frustration and perhaps anger in the voice.

2.

Have you spoken with someone from the health Department? This is close ended question, and it attempts to solve the problem. It misses the emotional content.

3. Things really can be confusing. You sound pretty angry now. It captures both content and emotion. It is example of an attempt understand to develop empathy.

4. What have you done so far to get an explanation? Now this is an open question, good attempt to get further information, it misses emotion.

All of these can be seen as steps toward solving the problem. We reflect in our earlier comments that understanding empathy is the platform for assisting someone else in the healing process.

2. Assessment (A): It’s being cognizant that there are usually three groups of survivors. Those that are doing fine and don’t need us (Eustress). Those who look bad but probably will be resilient (Distress) who needs to be identified, assessed and monitor. And lastly, the dysfunction group who look bad and really are. They need help doing the things they need to do (Dysfunction) who needs to identified, assessed and taking action for them.

This will helpfully assist you in distinguishing distress from dysfunction. They have broken them into domains. !4

1. Cognitive Reactions Distress

Dysfunction

Temporary confusion

Incapacitating confusion, diminished cognitive capacity

Inability to concentrate

Hopelessness

Reduced problem-solving capacity

Suicidal thoughts

Overwhelmed

Homicidal thoughts

Reliving the event and nightmares

Hallucination

Obsession

Paranoid delusion

2. Emotional Reactions Distress

Dysfunction

Fear

Panic attacks: extreme anxiety attacks

Sadness

Immobilizing depression

Irritability

Affecting numbing

Anger

Post Traumatic stress disorder: Disorder is what we are concerned with. In which you might receive the event to the point that you find it hard to concentrate on anything else. Where you suffer from nightmares, cant get enough rest and sleep.

Frustration

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Anxiety

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Bereavement-loss

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3. Behavioral Reactions Distress

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Dysfunction

Temporary phobic avoidance

Persistent avoidance

Compulsions

Immobilizing compulsions

Hoarding

Aggression/ violence

Sleep disturbance

Self Medication

Easily Startled

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4. Spiritual Reactions Distress

Dysfunction

Questioning faith

Cessation of faith related practices

Questioning god action

Projecting Faith onto others

This list is not comprehensive, it is just to sensitize you to some of the things that they commonly see and should not be too concerned about versus the things that they see less commonly, and should be very concerned about.

The distinguished distressed from dysfunction, things that interfere with one’s ability to do things one needs to do. To help oneself or perhaps others.

Now you may say wow that’s overwhelming list. And I have already told you that’s not a comprehensive one.

So, couple of comments: - It’s perfectly acceptable to take lists such as these out into field, just keep them as pocket reminders.

- As you hear, as you see signs, it is absolutely critical that you are able to see them.

With time your reliance upon them will diminish.

After assessment, we must:

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3. Prioritize (P): Here we have evidence-based versus risk-based models. You don’t use one to the exclusion of the other. Evidence-based models say I will attend to those people who need the greatest attention first. Nd there is evidence of that. And the evidence is manifest by their inability to attend to the activities of daily living. The things they need to do to care for the people who need, need to be cared for. The risk-based triage approach says, I’m concerned not just about the moment, but perhaps down the road a little bit. And, looking at people who have seen death and destruction, who have been physically injured, who have been separated from home and loved ones. Those people we know are at higher risk, but that’s all it is, is risk.

In the final analysis, psychological triage the key resides in recognizing and prioritizing dysfunction inclinations and behaviors. So, we’ve got the r, the a and the p what’s I all about? How do we intervene?

4. Intervention (I): Intervention is stabilization and mitigation. Stabilize, how can I stop thing from getting worse? I can remove provocative queues. I can foster a task orientation. I could let people tell their story. I could delay impulsive actions. I can use distraction. How do I mitigate acute distress? Said another way, how do I make thing’s little better? I can educate. I can normalize.

I can offer reassurance. I can foster hope. I can delay impulsive action. I can correct misunderstandings. And, I can plant the seed of post-traumatic growth. I can reframe, if possible (Is the glass hale empty? Half full? Yes, it depend on how you see the things, / whether you want to lose the opportunity or not). So, my intervention consisted of stabilization and mitigation.

5. Disposition (D): But, there is a third prong to this approach, and it is disposition.

After your intervention if: - The person is more capable of taking care of him\her self and/or capable of discharging his or her responsibilities. Then your I has ended.

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- It is recommended that you follow up with the person at some point deemed most appropriate. (How are you? How the last several days been?). So, you go back to the start at that level again. But, you do not have to tell them to repeat the story.

- Sometime 2nd follow up maybe useful, - However, if the 3rd follow up seems indicated, it’s probably time to facilitate access to another level of care.

Facilitating access to the next level of care as indicated. Whether that’s medical, psychological, financial, spiritual, or logistical care. In which you need to see whether the person is able to function without further intervention or not?

And lastly, let’s not become the victim, first responders, and others in the helping profession, may also be vulnerable, and that means you. Psychological first aid ends by taking care of ourselves. So how are you feeling about psychological first aid? Well, the good news is this was a beginning. And I think it was a good beginning. And the better news is there are better opportunities out there. And a whole world is waiting for you to learn, to help others. So, start here and the sky is the limit.

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