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Psychological First Aid


Psychological First Aid is an evidence-informed modular approach for assisting ... Principles and techniques of Psychological First Aid meet four basic standards. ... – PowerPoint PPT presentation

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Title: Psychological First Aid

Psychological First Aid
  • Connie L. Best, Ph. D. Professor, and Director of
    Adult Services National Crime Victims Research
    and Treatment Center Medical University of South

  • South Carolina Area Health Education Consortium
  • Funded by the Health Resources and Services
  • Grant number T01HP01418
  • Principal Investigator David Garr, MD, Director
  • Project Director Beth Kennedy, MS, Associate
    Program Director SC AHEC
  • Core Team
  • Co-director Ralph Shealy, MD
  • Project Manager Deborah Stier Carson, PharmD
  • CME Director William Simpson, MD
  • Database Manager Frances Wickham Lee, DBA
  • Public Relations Ragan DuBose, MA
  • Web Master Mary Mauldin, EdD
  • Mental Health Consultant Connie Best, PhD
  • Public Health Consultant Harold Gabel, MD, MPh
  • Infectious Disease Consultant Michael Schmidt,

Psychological First Aid Field Operations Guide
  • Terrorism and Disaster Branch National Child
    Traumatic Stress Network
  • National Center for PTSD

Funded by The Substance Abuse and Mental Health
Services Administration (SAMHSA)
What is Psychological First Aid?
  • Psychological First Aid is an evidence-informed
    modular approach for assisting children,
    adolescents, adults, and families in the
    immediate aftermath of disaster and terrorism.
    PFA is designed to reduce the initial distress
    caused by traumatic events, and to foster short-
    and long-term adaptive functioning.

What is Psychological First Aid?
  • Principles and techniques of Psychological First
    Aid meet four basic standards.
  • They are
  • consistent with research evidence on risk and
    resilience following trauma
  • applicable and practical in field settings
  • appropriate to developmental level across the
  • culturally informed and adaptable.

Who Delivers PFA?
  • It is designed for delivery by mental health
    specialists who provide acute assistance to those
    affected as part of an organized response effort.
  • These specialists may be imbedded in a variety of
    response groups (e.g., primary and emergency
    health care providers, response teams, community
    and school crisis response teams, disaster
    response team, first responder).
  • It may also be used by mental health providers in
    more traditional settings in the event of large
    scale disasters.

When Should PFA Be Used?
  • In the immediate wake of disasters.

Where Should PFA Be Used?
  • It is designed for delivery in diverse settings,
    including staging areas, hospitals, schools,
    assistance centers, shelters, and other community
  • Following weapons of mass destruction (WMD)
    events, PFA may be delivered at mass casualty
    collection points, hospitals, and in field
    decontamination locations.

Strengths of Psychological First Aid?
  • Includes basic information-gathering techniques
    to help mental health professionals make rapid
    assessments of immediate concerns and needs and
    to tailor interventions in a flexible manner
  • Relies on field-tested, evidence-informed
    strategies that can be used in a variety of
  • Emphasizes developmentally and culturally
    appropriate interventions
  • Includes handouts that provide important
    information for use over the course of recovery

Basic Objectives of Psychological First Aid
  • Establish a human connection in a non-intrusive,
    compassionate manner
  • Enhance immediate and on-going safety
  • Calm and orient distressed and overwhelmed
  • Offer practical assistance and information
  • Connect survivors to social support networks,
    including family members
  • Support positive coping and empower survivors
  • Provide information to help survivors cope
    effectively with the psychological impact
  • Facilitate continuity in response efforts and
    link survivors with indigenous recovery systems

Guidelines for Delivering Psychological First Aid
  • Politely observe first, dont intrude. Then ask
    simple respectful questions, so as to be able to
    discuss how you may be of help.
  • Initiate contact only after you have observed the
    situation and the person or family, and have
    determined that contact is not likely to be an
    intrusion or disruptive.

Guidelines Cont.
  • Be prepared to be either avoided or flooded with
    contact by affected persons, and make brief but
    respectful contact with each person who
    approaches you.
  • Adapt the information you provide to directly
    address the persons immediate goals and clarify
    answers repeatedly as needed.

Guidelines Cont.
  • Give information that is accurate and
    age-appropriate for your audience, and correct
    inaccurate beliefs. If you dont know, tell them
    this and offer to find out.
  • Remember that the goal of Psychological First Aid
    is to reduce distress, assist with current needs,
    and promote adaptive functioning, not to elicit
    details of traumatic experiences and losses.

Some Behaviors to Avoid
  • Do not make assumptions about what the person is
    experiencing or what they have been through.
  • Do not assume that everyone exposed to a disaster
    will be traumatized.
  • Do not pathologize.
  • Most acute reactions are understandable and
    expectable given what people exposed to the
    disaster have personally experienced.
  • Do not label reactions as symptoms, or speak in
    terms of diagnoses, conditions, pathologies, or

Behaviors to Avoid Cont.
  • Do not assume that all survivors want to talk or
    need to talk to you. Often, being physically
    present in a supportive and calm way helps
    affected people to feel safer and more able to
  • Do not debrief by asking for details of what
  • Do not suggest fad interventions or present
    uninformed opinion as fact.

Be Aware of At-Risk Populations
  • Individuals that are at special risk after a
    disaster include
  • Children (especially children whose parents have
    died or are missing)
  • Those who have had multiple relocations and
  • Medically frail adults
  • The elderly
  • Those with serious mental illness
  • Those with physical disabilities or illness
  • Those with current or prior history of substance

At-Risk Populations Cont.
  • Adolescents who may be risk-takers
  • Adolescents and adults with substance abuse
  • Pregnant women
  • Mothers with babies and small children
  • Professionals or volunteers who participated in
    disaster response and recovery efforts
  • Whose who have experienced significant loss
  • Those exposed first hand to grotesque scenes or
    extreme life threat

Psychological First Aid Core Actions
  • Contact and Engagement
  • Safety and Comfort
  • Stabilization
  • Information Gathering Current needs and Concerns
  • Practical Assistance
  • Connection with Social Supports
  • Information on Coping
  • Linkage with Collaborative Services

1 Contact and Engagement
  • Goal To respond to contact initiated by affected
    persons, or initiate contacts in a non-intrusive,
    compassionate, and helpful manner.

1 Contact and Engagement
  • Introduce yourself with name, title, role
  • Ask permission to talk to them
  • Explain your objective, to determine whether
    there is anything you can do to make things
  • Find out if there is anything that needs
    immediate attention

2 Safety and Comfort
  • Goal Enhance immediate and ongoing safety, and
    provide physical and emotional comfort.

2 Safety and Comfort
  • Make sure the survivors are physically safe, to
    the extent possible
  • Re-organize the immediate environment if
  • If there are medical concerns, contact
    appropriate medical support
  • Attend to physical comfort
  • Promote social engagement
  • Attend to children who are separated from their
    parents, and to those acutely bereaved

3 Stabilization (if needed)
  • Goal To calm and orient emotionally-overwhelmed/d
    istraught survivors.

3 Stabilization (if needed)
  • Stabilize emotionallyoverwhelmed survivors
  • Respect privacy and give them a few minutes
  • Remain present and offer a drink or chair
  • Help them focus on specific manageable thoughts
    or goals
  • If none of your efforts work, consider
    consultation and possible medication

4 Information Gathering Current needs and
  • Goal To identify immediate needs and concerns,
    gather additional information, and tailor
    Psychological First Aid interventions.

4 Information Gathering Current needs and
  • Although a formal assessment is not appropriate,
    the provider may ask pertinent questions to
    obtain and clarify a variety of issues that can
    inform decisions about
  • Need for immediate referral
  • Need for additional services
  • Offering a follow-up meeting
  • Using components of PFA that may be helpful

4 Information Gathering Current needs and
  • It may be useful for the provider to ask some
    questions to clarify the following (depending
    on the context, providers qualifications
    specific role)
  • Nature and severity of experiences during the
  • Death of family member or close friend
  • Concerns about immediate post-disaster
    circumstances / threat
  • Separation from / concerns about loved ones

4 Information Gathering Current needs and
  • Physical illness and need for medication
  • Losses incurred as a result of the disaster
  • Extreme feelings of guilt or shame
  • Thoughts about causing harm to self or others
  • Lack of adequate supportive social network
  • Prior alcohol or drug use
  • Prior exposure to trauma and loss
  • Prior psychological problems
  • Specific youth, adult and family concerns over
    developmental impact

5 Practical Assistance
  • Goal To offer practical help to the survivor in
    addressing immediate needs and concerns.

5 Practical Assistance
  • Identify the most immediate needs
  • Clarify the need
  • Discuss an action plan
  • Act to address the need

6 Connection with Social Supports
  • Goal To help establish brief or ongoing
    contacts with primary support persons or other
    sources of support, including family members,
    friends, and community helping resources.

6 Connection with Social Supports
  • Enhance access to primary support persons
  • Encourage use of immediate available support
  • Discuss support-seeking and giving
  • If appropriate, give handouts

7 Information on Coping
  • Goal To provide information (about stress
    reactions and coping) to reduce distress and
    promote adaptive functioning

7 Information on Coping
  • Provide basic information about stress reactions
  • Review common psychological reactions to
    traumatic experiences
  • (intrusive reactions, avoidance, physical
    arousal, grief, depression and others)
  • Provide basic information on ways of coping
  • Demonstrate basic relaxation techniques
  • Assist with anger management sleep problems and
    substance use

8 Linkage with Collaborative Services
  • Goal To link survivors with needed services, and
    inform them about available services that may be
    needed in the future.

8 Linkage with Collaborative Services
  • Provide direct links to additional services
  • Promote continuity in helping relationships

Questions and Answers?