Implementation of Psychological First Aid
Kimberly Burkhart, PhD
Psychological First Aid (PFA; created by the National Child Traumatic Stress Network in partnership with the National Center for PTSD) is intended for use with children, adolescents, caregivers, families, and adults and can be implemented in a variety of settings including field hospitals, shelters, EDs, family assistance centers, and even schools. PFA is based on the assumption that most people will not develop posttraumatic stress symptoms in response to a traumatic event and that by meeting people’s immediate needs through human connection, we provide a buffer against ongoing distress. This is a supportive intervention that can be delivered by mental health professionals, first responders, and other disaster response workers in the immediate aftermath of a disaster, which is defined as up to 4 weeks post-exposure.
Several guidelines have been identified for delivering PFA. The provider should observe the situation before approaching the individual. Respectful questions should be asked to determine what the individual/family needs to determine the approach taken. Be calm, patient, responsive, and speak in a developmentally and culturally appropriate way. When working with children, it is particularly important to help children verbalize their emotions, listen carefully to the child and conduct frequent check-ins to make sure that the child knows that they are heard, identify the child’s strengths, be aware that the child may show developmental regression, and parenting guidance might be needed.
Survivors may present as disoriented, panicky, withdrawn, irritable/angry, and/or extremely worried. Focus should be placed on problem solving and offering coping strategies in response to the immediate situation.
There are eight core actions of PFA: Contact and Engagement, Safety and Comfort, Stabilization, Information Gathering, Practical Assistance, Connection with Social Supports, Information on Coping, and Linkage with Collaborative Services. It is likely that not all actions will need to be taken. The provider engages in active listening to determine which core action(s) is needed. Each core action is defined below.
- Contact and Engagement: Respond to and initiate contact with survivors
- Safety and Comfort: Enhance safety by providing physical and emotional comfort
- Stabilization: Calm and orient survivors (if needed)
- Information Gathering: Identify immediate needs/concerns
- Practical Assistance: Offer practical help in response to immediate needs/concerns
- Connection with Social Supports: Facilitate contact with established supports
- Information on Coping: Provide information on stress reactions and basic coping skills that can be used to decrease distress
- Linkage with Collaborative Services: Link survivors with community-based services
PFA in Practice!
6-year-old boy (“Mikey”) presents to the ED due to a wildfire. Mom and Mikey were separated at the hospital. Mom is receiving medical treatment related to burns. Mikey has some minor cuts on his arms. Mikey is crying and continues to ask about his mom. You’ve been asked to respond to Mikey.
What Should You Do?
Consult your PFA Field Operations Guide (accessed through the National Child Traumatic Stress Network). Assess for Mikey’s current needs in the following areas: Behavioral, Emotional, Physical, and Cognitive.
Mikey has received medical treatment for his cuts. He is experiencing anxiety related to being separated from his mother and due to being in a new medical setting. He is tearful and having difficulty remembering and describing what happened.
Contact and Engagement: Ask about immediate needs. What can you do to make Mikey more comfortable? You find out the location of Mikey’s mom and assure him that she is being taken good care of at the hospital. You get Mikey a cup of water.
Information Gathering: Find out what Mikey knows about the wildfire. Mikey doesn’t know his phone number or address. He is not a patient that is within your hospital system. Once calm, Mikey remembers that he has contact information on the tongue of his shoe. Mikey reports that his dad wasn’t home and that he’s been away from the house for a while.
Connection with Social Supports: You call the two phone numbers listed in Mikey’s shoe. Dad answers the phone. He is away on a business trip. He provides all contact information and will arrange for grandma to come to the hospital. You call grandma and develop a plan for grandma to connect with Mikey.
Information on Coping: Explain the action plan to Mikey. Use developmentally-appropriate language and check-in to make sure that he understands that his mother is being taken care of by doctors, his dad is on his way home, and grandma is coming to pick him up. Explain that you will continue to check in on him until his grandma comes. You see that he has a superhero t-shirt on. You initiate conversation about the superhero and tell Mikey that he has been very brave. You coach him on how to take deep breaths. You practice with him breathing in through your nose like you are smelling a flower and out through your mouth like you are blowing out a birthday candle.
Mikey is now calm and you are able to attend to other patients presenting to the ED.