‘Once you’ve been initiated into the Elderly, the world doesn’t want you back. […]. We – by whom I mean anyone over sixty – commit two offenses just by existing. One is Lack of Velocity. We drive too slowly, walk too slowly, talk too slowly. The world will do business with dictators, perverts, and drug barons of all stripes, but being slowed down it cannot abide. Our second offense is being Everyman’s memento mori. The world can only get comfy in shiny-eyed denial if we are out of sight. […]. Us elderly are the modern lepers. That’s the truth of it.’

It has been well-documented that young people with experience in the child welfare system (hereafter called young people in care) have far higher rates of mental health difficulties than the general population of youth. Many of these young people have experienced trauma and other major childhood adversities, including abuse, neglect, and exposure to domestic and/or community violence. Once in care, many young people find themselves separated from siblings and moving between different homes (and thus, caregivers). Such experiences can have profound and lifelong consequences for mental health and broader well-being. Research reviews estimate at least half of young people in the care system meet criteria for a mental health condition (Bronsard et al., 2016), with rates of many common mental health conditions far higher in these young people than in their peers. Chronic mental health difficulties are also the norm – we found that 70% of young people who are experiencing clinically-elevated mental health difficulties in their first year in care are still experiencing similar or worsened difficulties two years later (Hiller et al., 2023a). This shows that moving into care, which is an intervention in itself, is not always enough to expect improvements in mental health. With the right support, young people in care can thrive, but there remains an urgent need to understand how best to support social care and other systems to provide high quality support.

Psychological First Aid (PFA) is an early intervention widely recommended for recent trauma survivors (Vernberg et al., 2008). It emerged in the early 2000s as an alternative to debriefing, a popular technique which was found to increase the incidence of Posttraumatic Stress Disorder (PTSD) (Rose et al., 2002). Over a decade since the popularisation of PFA, its safety and efficacy have been questioned due to a lack of empirical evidence (Hermosilla et al., 2023; Shultz & Forbes, 2014). To address this knowledge gap, we conducted a study to assess the effectiveness of PFA in preventing early PTSD diagnosis, providing immediate emotional relief, and reducing PTSD and depression symptoms up to six months post-intervention (Figueroa et al., 2022).