Psychological First Aid
Reducing initial distress
caused by traumatic events
Kelly Morris, MAPC LAC
Native Arizonan
Married (to a firefighter/paramedic) since
Mother of two sons
Master of Arts in
Professional Counseling
Licensed Associate Counselor,
State of AZ
Resilient Relationships, LLC
Therapist, Deer Valley
Information obtained from…
► National
Center for PTSD
► National Child Traumatic Stress Network
► Psychological First Aid: Field Operations
Guide, 2nd Edition
► International Critical Incident Stress
PFA Online Course
PFA vs. Mental Health Triage
Mental Health Triage is designed to assess
whether a person is likely to have a preexisting mental illness or disorder within
the context of an environmental
emergency, disaster, etc., and assessing
appropriate care.
What is PFA?
► Psychological
First Aid is an evidenceformed modular approach to help in the
immediate aftermath of disaster or terrorism
► Designed to reduce initial distress
► Foster short- and long-term adaptive
functioning and coping
The Need for PFA
► Over
80% of Americans will be exposed to a
traumatic event (Breslau).
► Approximately 9% of those exposed
develop PTSD.
► Disasters may create significant impairment
in 40-50% of those exposed (Norris, 2001,
Who can deliver PFA?
Designed for delivery by mental health and
other disaster response workers within a
wide variety of response units:
First responder teams
Health care providers
School crisis response teams
Faith-based organizations
Et. Al.
Where should PFA be used?
Designed for diverse setting:
► General population shelters
► Special needs facilities (day programs;
group homes, etc.)
► Medical triage areas
► Staging areas
► Respite centers for First Responders/Relief
Basic Objectives of PFA
► Establish
a human connection in a nonintrusive, compassionate manner.
► Enhance immediate & ongoing safety and
provide physical & emotional comfort.
► Calm & orient emotionally overwhelmed or
distraught survivors.
► Offer practical assistance & information to
address immediate needs/concerns.
Overview of Core Actions
Basic objectives of providing early
assistance within days or weeks following
an event.
Providers should be flexible, and base the
amount of time spent on each core action
on the survivors’ specific needs and
PFA Core Actions
Contact and Engagement – GOAL:
To respond to contact initiated by
survivors, or initiate contacts in a nonintrusive, compassionate manner.
2. Safety and Comfort
Goal: To enhance immediate and ongoing
safety, and provide physical and
emotional comfort.
3. Stabilization (if needed)
Goal: To calm and
orient emotionally
overwhelmed or
(Possibly need
Mental health
4. Information Gathering
Current Needs and Concerns
Goal: Identify immediate needs/concerns,
gather additional information; tailor
PFA interventions.
5. Practical Assistance
Goal: To offer practical help to survivors in
addressing immediate needs and concerns.
6. Connection with Social Supports
Goal: To help establish brief and/or
ongoing contacts with primary support
persons and other sources of support,
including family members, friends, and
community helping resources.
7. Information on Coping
Goal: To provide
information about
stress reactions and
coping to reduce
distress and promote
adaptive functioning.
8. Linkage with Collaborative
Goal: Link survivors with available services
needed at the time or in the future.
Responders are human, too!
► Approximately
50% of disaster workers are
likely to develop significant distress (Meyers
& Wee, 2005).
► Terrorism likely to affect majority of
population (IOM, 2003); Ranges from 4090%.
► As many as 45% of those directly exposed
to mass disasters may develop PTSD or
Depression (North, et al., JAMA)
Before YOU Begin…
Providing care & support in the immediate
aftermath of disaster can be an enriching
profession and personal experience through
helping others.
It can also be physically and emotionally
Consider your current health, family, work
Personal Considerations
Assess your comfort level with the various
situations you may experiencing while
providing PFA.
Working with:
► Individuals who are experiencing intense
distress and extreme reactions.
► Individuals in non-traditional settings.
► In a chaotic, unpredictable environment.
Personal Considerations, cont.
► Working
in an environment with minimal or
no supervision…or, conversely,
► Working with and providing support to
individuals from diverse cultures, ethnic
groups, developmental levels, and faith
► Environments where risk of harm or
exposure is not fully known.
Personal Health Considerations
► Recent
surgeries or medical treatments
► Recent emotional or psychological
challenges or problems
► Any significant life changes or losses within
the past 6-12 months
► Earlier losses or other negative life events
(triggered emotions)
Health Considerations, cont.
► Dietary
restrictions that may impede work
► Ability to remain active for long periods of
► Ability to endure physically exhausting
► If needed, enough medication available
Family Considerations
► Is
your family prepared for your absence?
► Prepared for you to work in environments
where risk of harm is unknown?
► Will your support system (family/friends)
assume some of your family responsibilities
while you are away?
Family Considerations, cont.
► Do
you have any unresolved
family/relationship issues that will make it
challenging for you to focus on disasterrelated responsibilities?
► Do you have a strong, supportive
environment to return to after your disaster
Personal/Family/Work/Life Plan
Take time to prepare for:
► Family & other household responsibilities
► Pet care
► Work responsibilities
► Community activities/responsibilities
► Other responsibilities & concerns
During Relief Work
In providing PFA, it is important to
recognize common and extreme stress
reactions, how organizations can reduce the
risk of extreme stress to providers, and how
best to take care of yourself during your
Common STRESS Reactions
There are a number of common responses
when working with survivors:
► Increase/decrease in activity level
► Sleeping difficulties
► Substance use
► Numbing
► Irritability, anger, and frustration
Common Stress Reactions, cont.
► Vicarious
traumatization in the form of
shock, fearfulness, horror, helplessness
► Confusion, lack of attention, difficulty
making decisions
► Physical reactions (headaches,
stomachaches, being easily startled)
► Depressive or anxiety symptoms
EXTREME Stress Reactions
► Compassion
stress: helplessness, confusion,
► Compassion fatigue: demoralization,
alienation, resignation.
► Preoccupation or compulsive reexperiencing of trauma experienced either
directly or indirectly.
Extreme Stress Reactions, cont.
► Attempts
to over-control in professional or
personal situations
► Withdrawal and isolation
► Preventing feelings by relying on
substances, over-preoccupation with work,
drastic changes in sleep
Extreme Reactions (Wait! There’s More!)
► Serious
difficulties in interpersonal
relationships, including domestic violence
► Unnecessary risk-taking
► Depression accompanied by hopelessness
(which has the potential to place individuals
at higher risk for suicide)
Provider Self-Care (Proactivity)
► Manage personal resources
► Plan for family/home safety (child care; pet
care, etc.)
► Get adequate exercise, nutrition, relaxation
Provider Self-Care, cont.
Use stress management tools regularly, such as:
► Accessing
supervision routinely to share concerns,
difficult experiences, and strategizing
► Practice brief relaxation techniques
► Use the buddy system to share upsetting
emotional responses
► Stay aware of limitations and needs
Self Care, cont.
► Recognize
when your are Hungry, Angry,
Lonely or Tired (HALT), and take
appropriate self-care measures
► Increase activities that are positive
► Practice your faith/philosophy/spirituality
Self Care, cont.
► Spend
time with family/friends
► Learn how to “put stress away”
► Write/draw/paint
► Limit caffeine, tobacco, and substance use
Make every effort to…
► Pace
yourself; self-monitor
► Maintain boundaries: delegate, say “no”,
avoid working with too many survivors in a
given ‘shift’.
► Check in regularly with colleagues,
► Work with partners
Make every effort to…
► Take
relaxation/stress management/bodily
care/refreshment breaks
► Try to be flexible, patient, and tolerant
► Accept things you cannot change.
WIN-WIN Opportunity!
Identify, utilize, and maintain self-care now:
► Physical Health
► Mental – Emotional Health
► Relationships (Marriage / family / work)
► Personal Interests (Hobbies, activities, etc.)
Your well-being will be enhanced…
Favorable Outcome…
You will have increased the probability of a
favorable outcome of a disaster because you
have increased:
► Optimism
► Confidence
► Resources
► Resilience
Not only for survivors, but for yourself!

Psychological First Aid