I’ve been thinking about Fred Rogers lately, as have many people these days. See, when I was young, I was an avid watcher of Mister Rogers’ Neighborhood. We had always been instructed by this American icon to “look for the helpers”- the first responders, the emergency workers- all the people who rush to give relief and aid after disasters which seem to be hitting us with relentless speed these days. Mister Rogers taught us that we can find hope and support by learning about those who come to help in times of tragedy and trauma.
And as we approach the one-year anniversary of the worst anti-Semitic attack in U.S. history, right in Pittsburgh’s Squirrel Hill, Mister Rogers’ own neighborhood and mine as well, I’ve been thinking about all those helpers. I keep trying to look to them to see what they can teach us about how to deal with trauma when it impacts on us directly or indirectly.
Dr. Moshe Farchi, head of the Stress, Trauma and Resilience Program at Tel-Hai College, is a well-known helper here in Israel. His approach, known as the Six C’s model, has been adopted as the national model for psychological first aid by Israel’s Ministry of Health. And through his long-standing relationship with Natan, an all-volunteer, humanitarian aid organization, the impact of his approach has gone global. Grounded in neuroscience, Dr. Farchi’s strategy to help people reset their system after witnessing a trauma can cross cultures with relative ease.
For the past fifteen years, Natan’s volunteers – Jews, Christians and Muslims – with experience in fields such as primary life-saving care and psycho-social support, have been on call, ready to be deployed within days of a disaster. The multi-cultural and linguistic diversity of the volunteers has allowed them to be especially effective in refugee camps in places like Serbia and Greece, where they have been able to communicate in Arabic with those fleeing from various countries including Syria, Iraq or Afghanistan.
Having gone through training in the Six C’s approach, Natan’s volunteers are able to deploy emergency mental health intervention as needed. Together with Dr. Farchi, they have provided training for first responders on how to treat people who suffer psychological stress during a traumatic event in countries such as Mozambique, Haiti, and the Philippines. And the points on the map get back to Pittsburgh as well. The group of United Hatzalah volunteers from Israel who arrived last year in Pittsburgh immediately following the tragedy to help in the many efforts to provide psychological and emotional support were trained in the Six C’s model.
When I sat down with Dr. Farchi to learn more about this universal approach, I kept thinking of how we sometimes make lists to stave off chaos. To help a person in extreme distress in the moments following a traumatic event after the physical threat has passed, it can be useful to consider this idea of a ‘to do’ list. The goal is a ‘reset’- shifting a traumatized individual from a sense of helplessness to one of action. Rather than focusing on what may be a natural impulse of soothing, we should prioritize the ‘doing’, by activating the person both mentally and physically.
And recognizing that mental health professionals aren’t likely to be immediately available, Dr. Farchi has purposely developed a model that can easily be implemented by anyone on the scene. So since 2013, there has been training not only for soldiers, emergency responders, firefighters, and police officers, but also for thousands of high school students, social workers, and laypersons around the country.
In keeping with the theme of a ‘to do’ list, here are some items for providing psychological first aid:
- Give assurance that the individual is not alone (e.g., “We are here with you, we are not going anywhere until you are safe again”)
- Speak in a monotone, with a direct voice that is not emotionally laden.
- Ask questions regarding the event, either about time (e.g., “How long have you been here?) or quantity (e.g., “How many people are injured?”), and give them simple options (e.g., “Do you want to talk first to your parents or your teacher?”)
- Come up with concrete tasks to ‘snap’ them out of passivity and provide simple options to choose: (e.g., “I need your help: Do you want to help with the registration of everybody or do you want to collect your things into make sure that nothing is missing?”).
And the ‘not to do’ list includes the following, many of which may be surprising:
- Do not hold the person or try to calm with your touch.
- Do not soothe with a singsong voice.
- Do not sit the individual down in a resting position.
- Do not remove them entirely from the situation, or attempt to distract them from the event.
With all this in mind, you can begin to guess the Six C’s. It starts with verbal commitment to traumatized individuals to assure them of their safety. Then by speaking using cognitive verbal communication, and challenging them to act, it can help increase their sense of control and thereby reduce a feeling of helplessness. Amidst confusion and panic, these actions can help the person get a handle on what has happened and understand that the immediate threat is over. It can create a sense of continuity, which helps to minimize confusion and the possibility of flashbacks later. Often it will be important to follow up with emotional support, but only after the individual returns to a degree of functionality.
This all may seem like a bit to take in… as these operating instructions might not come naturally for most of us. And we all hope that we will never need to use them. Yet this response could be one of our best tools for helping people overcome what has happened and be resilient even in the face of tragedy.
And so, as we mourn those lost in the Pittsburgh massacre, and too many other lost lives, we can consider how we choose to respond to the challenges that we face. There are helpers out there, many helpers, as was so famously demonstrated in Pittsburgh and elsewhere. We should not be paralyzed by a sense of helplessness. We can continually look to our helpers near and far, learning from their wisdom. And you know what? Mister Rogers would definitely approve.