ICISF SAFER-R Model Addresses Immediate Biopsychosocial Model Needs
By: Timothy Neal, MS, AT, ATC, CCISM
As an ICISF approved instructor of critical incident stress management and a member of the peer-to-peer support for athletic trainers following a critical incident, the National Athletic Trainers’ Association ATs Care program, I know first-hand the value of the ICISF SAFER-R Model of Individual Crisis Intervention developed by Dr. George Everly (Everly, 1996). While I have taught this model and applied the SAFER-R concepts during interventions, it wasn’t until I started my coursework in a Master of Social Work (MSW) degree at Ohio University that I appreciated the foresight of the SAFER-R contents as it addresses the immediate biopsychosocial needs of the person receiving interventions. The biopsychosocial model originated in the late 1970s by Dr. Engel (Engel, 1980). Other professionals in psychology have since picked up this concept and have done further research into its efficacy (Ashford et al, 2018). The biopsychosocial model has three elements: biophysical, psychological, and social. The biopsychosocial model is the cornerstone of social work with clients.
Approaching a client from a biopsychological perspective assists the client in meeting their needs. As an advanced student in social work, I am an intern at a local social services agency where I provide psychotherapy to clients under the supervision of my field instructor. Utilizing motivational interviewing skills of open-ended questions, affirmations of progress or encouragement, reflections, and summarizing the discussion and goals to be developed (OARS), I recognize similarities with the biopsychosocial model and the SAFER-R model designed to assist a person immediately after a critical incident.
Briefly, here are the similarities between the biopsychosocial model developed by Dr. Engel and the SAFER-R model created by Dr. Everly:
SAFER-R Model:
Stabilize: meeting basic needs. This first step meets the biophysical needs for addressing the immediate health status of the individual in crisis. Are they safe? Are they injured? Do they need food or drink to help the individual reach a place where they can communicate with the person providing assistance? In the biopsychosocial model, attending to the individual’s biophysical health and wellness is the first step in addressing the physical element.
Acknowledge the crisis: reviewing the event and reaction. Here the immediate psychological component of the biopsychosocial model is introduced. It is at this point that the psychological first-aid of the psychological component is implemented by reviewing the emotional impact the critical incident has on the individual.
Facilitate understanding: trying to normalize the situation for the individual. In this phase of the SAFER-R model, the psychological component of the biopsychosocial model is advanced into the cognitive domain necessary to assist the individual into normalization and starting to reassure the person as they progress to the next step of the SAFER-R model, encouragement.
Encourage effective coping: what are the mechanisms of action to cope with the critical incident? Here again, the psychological component of the biopsychosocial model is utilized as coping styles are a key element to one’s psychological make-up and personality traits. The individual is asked how they normally cope with stress. Also, it is during this phase that a return to the biophysical component is used when encouraging and gently educating the individual affected on how to take care of themselves physically via diet, hydration, and sleep. Additionally, the last component of the biopsychosocial model, social support, is introduced. It is during this phase of the SAFER-R model that a person providing the intervention starts asking about the social support available to the individual in order to reduce stress and return to normalcy following a critical incident.
Recovery or Referral: access to continued care following the critical incident. It is here where the person providing the intervention acts upon their best judgment and follow-up with the individual involved to ensure that the person involved in the critical incident is recovering effectively or may need additional evaluation or care from a mental health care professional such as a social worker trained in providing psychotherapy. It is at this phase of the SAFER-R model that all of the biopsychosocial components are once again reviewed and applied prior to the end of the intervention to determine if the biophysical, psychological, and social support parameters are being considered before ending the intervention. If those parameters are not satisfactory, a referral to a mental health care professional is suggested.
The SAFER-R model created by Dr. George Everly is a very effective intervention in addressing the biopsychosocial needs of an individual in the immediacy of a critical incident. While the biopsychosocial model developed by Dr. Engel is for a lifetime of needs, a critical incident may threaten one or all three of the biopsychosocial elements of an individual in the short term. As a member of ATs Care, I know first-hand the value of the SAFER-R model providing psychological interventions to athletic trainers following a critical incident. As one who will be adding an additional credential with my MSW degree and providing psychotherapy to athletes and college students in addition to my instruction as a professor, I will be employing the use of the SAFER-R model when providing immediate interventions, and believe that social workers could gain another valuable tool in working with clients under extremely stressful incidents by being trained in critical incident stress management through an approved course offered by the International Critical Incident Stress Foundation.
References
Ashford, J. B., LeCroy, C. W., & Williams, L. R. (2018). Human behavior in the social environment (6th ed.). Centage.
Engel, G.L. (1980). The clinical application of the biopsychosocial model. American Journal of Psychiatry, 137(5), 535-544.
Everly, G. S., Jr. (1996). A rapid crisis intervention technique for law enforcement. In Reese, J. T. & Soloman, R. (eds.), Organizational issues in law enforcement. Federal Bureau of Investigation, Washington, DC.