The adaptation of psychological first aid for children released from war captivity (PFA-CC): A qualitative evaluation

The abduction of children during armed conflict is a pervasive problem on a global scale. However, interventions aimed at alleviating acute distress in children released from war captivity remain rare.

We conducted a qualitative evaluation of PFA-CC-a Psychological First Aid Intervention (PFA) tailored to children and adolescents (aged 2.5-18 years) in Israel, administered immediately following their release from war captivity. The goal was to assess its feasibility, fidelity, and practitioner experiences.

We employed an ethnographic approach to evaluation. Data collection methods included 250 h of participant observation and in-depth interviews with a subset of practitioners (n = 37)-social workers, psychologists, psychiatrists, nurses, and pediatricians-who delivered the intervention.

Practitioners described techniques they employed for establishing safety, promoting calmness and fostering self-efficacy in the post-captivity context. Particular emphasis was placed on assisting families in delivering difficult news, respecting children's autonomy and free choice, following children's pace in processing trauma, re-establishing daily routines, and preparing for reintegration. Two important adaptations to the classical PFA model-the use of a transitional hospital setting and the adoption of a family-centred approach-were consistently identified as intervention strengths.

Our study suggests that PFA-CC is a feasible and appropriate early intervention for children released from war captivity. Key implications for early intervention include: (1) adoption of a dialectical approach that balances children's autonomy with boundaries; (2) creation of a dedicated, enclosed, and 'sterile' space to foster safety; (3) implementation of a family-centered approach amid acute family disruption and displacement.