Psychological First Aid Sport for refugees

a group of partcipants pose at an olympic refuge foundation gathering

A new initiative by the Olympic Refuge Foundation has a new initiative aims to increase the mental health and psychosocial support capacity of people working with refugees through sport.

Background

Psychological First Aid (PFA) is a first-line response to support the mental health and psychosocial wellbeing of people affected by crises. PFA is a skill set that can be used by both lay people and specialised professionals who may respond to people in acute distress. PFA has been used by people of all ages, including adolescents and young people, to provide basic psychosocial support and refer people in need of additional care or specialized services. The PFA Guide for Field Workers was published by the World Health Organization (WHO) in 2011 informed by decades of disaster literature and expert consensus. A comprehensive 2016 report on PFA identified mainstreaming PFA across humanitarian sectors as a priority.

While sport can protect and promote mental health, there is evidence showing the potential negative mental health consequences of sports programmes in displacement contexts that fail to provide a psychologically safe environment. Instability in contexts affected by forced displacement means that those involved in sports-based programming in these settings are at high risk of exposure to small and large crisis events (e.g., accidents, disasters, violence or mass events).

People involved in sport and physical activity programs may include coaches and administrators who represent a target workforce for increasing mental health literacy and capability, in order to recognise, respond to and refer community members in need of mental health support. PFA training for people involved in delivering sport in contexts of displacement may help ensure ‘do no harm’ approaches, promote psychologically safer sporting environments for participants and families and provide appropriate immediate support and referral for participants in need of more specialized mental health and psychosocial support.

PFAsport is an initiative of the Olympic Refuge Foundation developed to increase mental health and psychosocial support (MHPSS) capacity of people involved in sport. PFAsport represents a key opportunity to i) increase mental health literacy and basic psychosocial skills among the sports sector, ii) ensure sports programs are psychologically safe, iii) develop and strengthen referral pathways for people to access mental health and psychosocial support and iv) increase participation in sport and physical activity among people experiencing poor mental health.

Methods

Sixteen coaches and volunteers from various organisations supporting refugees through sport attended a one-day pilot of PFAsport in October 2022, in Paris, France hosted by the Olympic Refuge Foundation. The training was facilitated by Dr Leslie Snider, an author of the WHO PFA manual. Content included applying the PFA principles of ‘look, listen and link’, role playing crises simulation and group discussions including how PFA can be applied within sporting environments. The training was conducted in English with simultaneous translation provided by professional translators.

We assessed appropriateness, acceptability and feasibility using the Acceptability of Intervention Measure (AIM), the Intervention Appropriateness Measure (IAM) and the Feasibility of Intervention Measure (FIM). Each measure uses a 5-point Likert scale ranging from Completely Disagree (1) to Completely Agree (5), with possible scores ranging from 5 (poor) to 20 (high). The scale has acceptable psychometric properties and has been previously validated [1]. Data were collected through the REDcap data capturing platform. Qualitative feedback was also obtained through open-ended questions and through focus group discussion immediately following the training.

Results

In total, n=16 participants (n=7, 44% female) mean age 29.5 (SD= 7.7) years attended the training. There was no significant difference in age between males and female attendees (p >0.05).

Acceptability

The mean acceptability score was 17.5/20 (SD=2.2) and the median was 18/20 (IQR=16.3 to 19). In total, 14/16 participants (88%) scored the acceptability 16 or higher out of 20.

Appropriateness

Mean appropriateness score was 16.1/20 (SD=2.1) and the median was 16/20 (IQR=15.3 to 17). In total, 12/16 participants (75%) scored appropriateness 16 or higher out of 20.

Feasibility

Mean feasibility score was 16.8/20 (SD=2.2) and the median was 16/20 (IQR=15 to 20). In total, 11/15 (73%) participants scored 16 or higher out of 20 (n=1 had missing data for this section). No participants disagreed or completely disagreed with any of the feasibility items.

Discussion

PFA training for sports coaches and volunteers is highly acceptable, appropriate and feasible. The practical skills of PFA including identifying someone in distress, responding supportively, and providing appropriate “linking” to social support, services or specialised care as needed, are likely to help the sport sector better respond to the needs displaced young people, and maximise the safety of sport for people experiencing distress.

While results of this pilot are promising, adaptation and tailoring of PFAsport to better address the needs of the sporting sector is warranted. This will occur through the following process. Firstly, a steering committee of participants from the pilot as well as young people with lived experience of forced displacement, recruited through the Olympic Refuge Foundation’s implementing partners, will be formed. The steering committee will be invited to participate in an experienced based co-design process, involving workshops to share tools, techniques, resources and challenges in co-creating a responsive and flexible approach to the situations that coaches may experience in their work with people exposed to serious stressors, such as displacement. This will allow iterative adaptions and piloting of PFAsport to occur simultaneously.

PFAsport is likely to have a range of benefits for the sporting sector and people affected by displacement such as making sporting environments psychologically safer, increasing capability of the sector to respond to people in distress safely and effectively, strengthen impacts for sport on health and wellbeing, and ultimately reducing drop-out in sport and physical activity programs.

Subsequent workforce development programs should also consider targeting the capacity of the MHPSS workforce to better engage with the sports and physical activity sector.