A Rapid Realist Review of Group Psychological First Aid for Humanitarian Workers and Volunteers

Abstract

Humanitarian workers are at an elevated risk of occupational trauma exposure and its associated psychological consequences, and experience increased levels of anxiety, depression, and post-traumatic stress disorder (PTSD) compared to the general population. Psychological first aid (PFA) aims to prevent acute distress reactions from developing into long-term distress by instilling feelings of safety, calmness, self- and community efficacy, connectedness and hope. Group PFA (GPFA) delivers PFA in a group or team setting. This research sought to understand ‘What works, for whom, in what context, and why for group psychological first aid for humanitarian workers, including volunteers?’ A rapid realist review (RRR) was conducted. Initial theories were generated to answer the question and were subsequently refined based on 15 documents identified through a systematic search of databases and grey literature, in addition to the inputs from a core reference panel and two external experts in GPFA. The findings generated seven programme theories that addressed the research question and offered consideration for the implementation of GPFA for the humanitarian workforce across contexts and age groups. GPFA enables individuals to understand their natural reactions, develop adaptive coping strategies, and build social connections that promote a sense of belonging and security. The integrated design of GPFA ensures that individuals are linked to additional supports and have their basic needs addressed. While the evidence is sparce on GPFA, its ability to provide support to humanitarian workers is promising.

Building a critical incident peer response team: A full theatre team welfare intervention

“…We believe a peer-led team approach has merit, and is supported by the literature on PFA for groups. 10,16,17…”

“…11,17 It is the team that provides the support to each other through validation of shared reactions, social connection, and through role modelling to guide constructive self-help behaviours, including seeking help. 16,17 It is not the facilitator who directly delivers this support. This avoids any suggestion of a victim versus hero dynamic, and is empowering for the team.…”

“…We have developed a critical incident peer response (CIPR) team at Waikato Hospital to provide peer-led PFA 10,16,17 to the full theatre team as a group. In light of the conflicting evidence about CISM debriefing, and in recognition of organisational demands favouring a shorter and earlier intervention, we have adapted our approach to focus on the ‘defuse’ component of CISM, ensuring all key safety factors are achieved.…”

“…The structure of our intervention closely mirrors published structures for early PFA as detailed in Table 2. 10,11,15 –17,31…”

Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model

“…Therefore, although the HCWs who elected to participate in our symptom monitoring service (and consented for their data to be used in research) reported relatively low levels of distress, for which the cause is difficult to determine, this result does not negate the critical importance of implementing psychological support programs for HCWs. Additionally, while our goal regarding the assessment of mental health symptoms in the current study was to describe our sample and document their mental health functioning, it should be noted that there remains a need for research that rigorously evaluates the effectiveness of PFA using similar measures (Corey et al, 2021;Yue et al, 2020).…”