Psychological first aid (PFA) is an evidenced-informed approach aimed at helping individuals affected in the immediate aftermath of a disaster or traumatic incident. It was first utilized by the military during World War II and has since been adapted and implemented in the United States in public health settings and by workplaces and organizations such as the National Center for PTSD, Red Cross and the American Psychological Association (Fox et al., 2012). Although there are various adaptations of PFA, they all incorporate the following elements: safety, calming, connectedness, self-efficacy and hope (Hobfoll et al., 2007). PFA’s main objectives indicate that it is not meant to be a therapeutic intervention in the typical sense, but rather an acute approach for the establishment of safety and support, the reduction of post-trauma distress and the furtherance of adaptive coping and functioning (Ruzek et al., 2007). PFA consists of eight core actions including contact and engagement, safety and comfort, stabilization, information gathering, practical assistance, connection with social supports, information on coping, and linkage with collaborative services. PFA providers may use this comprehensive set of strategies to guide their responses following a crisis situation. Despite the overwhelming support for implementing PFA-based programming in the immediate aftermath of a traumatic event, research investigating the effectiveness of PFA is limited. However, a study conducted by Fox et al. (2012) revealed that while scientific evidence of PFA is lacking, adequate support may be found by expert opinion, objective observation and rational conclusions.
The COVID-19 pandemic, a progression from the novel coronavirus that first emerged in December 2019, has severely impacted health care workers’ mental health. Recent research on COVID-19-related stress indicates that various factors are associated with impacting mental health concerns (Spoorthy et al., 2020) including lack of social and workplace support, training and communication; working in high-risk areas (e.g., emergency room); poor self-efficacy; and maladaptive coping skills (Naushad et al., 2019). Sociodemographic features (e.g., age, gender, ethnicity, etc.) may also have a differential effect on the mental health of health care workers. For example, Cai et al. (2020) suggested that women may experience higher rates of depression, anxiety and distress. Conversely, several factors may be protective against COVID-19-related stress for health care workers. These include elements such as the safety of family members, effective safeguards to prevent the spread of the disease in the workplace, access to psychological materials and resources, supportive social networks, validation and adaptive coping skills (Cai et al., 2020; Mohindra et al., 2020).
As hospitals and medical organizations anticipate a surge of mental health concerns in health care workers who are impacted by COVID-19, PFA’s set of pragmatic interventions focused on alleviating acute distress can be adapted to deliver a continuum of staff support (Ng, 2020; Wu, Connors, & Everly, 2020). When implementing care, special considerations should be given to health care workers with PFA catered to target a broad variety of mental health needs from staff across all disciplines (Horesh & Brown, 2020). For example, health care professionals working on the front lines may experience elevated symptoms of anxiety, frustration and helplessness, while those working in other roles may feel isolated, disempowered or guilty that they should be doing more (Wu et al., 2020). Given these common themes, PFA can provide a safe context for staff to receive support for their psychological needs. Additionally, PFA’s main tenets of establishing contact through a compassionate presence, protecting people from further harm, helping individuals feel heard and connecting them to additional resources can be utilized to address these various issues (Ng, 2020). The basic principles of PFA can also be used to reduce burnout, provide coping skills and support psychological and behavioral functioning by focusing on concerns unique to pandemic-related stressors (Ng, 2020; Ornell, Schuch, Sordi, & Kessler, 2020).
While PFA can be administered individually, adapting a group format for health care workers experiencing stressors related to COVID-19 may be highly beneficial. PFA peer support groups facilitated by mental health professionals can help individuals develop mental health literacy and gain coping skills through listening and supporting each other (Ng, 2020; Wu et al., 2020). Through peer support, PFA groups can help health care staff feel less isolated and alone with their experiences. Group facilitators should also normalize commonly experienced feelings related to anxiety and encourage their expression (Wu et al., 2020). Allowing staff to feel supported and heard with their psychological needs can help reduce the amount of stress related to COVID-19 and increase resilience among staff members. PFA groups should deliver supportive care that is less stigmatizing and more focused on crisis intervention rather than counseling or psychiatric care (Gold, 2020). Additionally, PFA groups can serve to screen, triage and refer health care workers to services at the appropriate level and prevent mental health issues from escalating. As such, PFA groups should be crisis-based, culturally sensitive and not compulsory, with attention given to each health care worker’s level of safety, comfort and connection with social supports and resources (Gold, 2020).
In the face of an unprecedented public health crisis, it is essential to consider how the mental health needs of health care workers can be addressed, since no best practice guidelines for psychosocial care during COVID-19 have been established (Ornell et al., 2020). The adaptation of the PFA model for use among health care staff offers a non-intimidating and effective way for individuals to receive support for their psychological needs. Hence, PFA’s crisis-based interventions tailored to reduce acute distress associated with traumatic events can serve as an appropriate modality for medical organizations seeking to provide psychological care for health care personnel affected by COVID-19.
About the Authors
Maggie Wang, MA, MT-BC, is currently pursuing her doctorate in clinical psychology at the PGSP-Stanford Psy.D. Consortium. She received her master’s degree in music therapy from New York University. Her clinical and research interests predominantly include mood and anxiety disorders, trauma and health psychology.
Alexis Moore, MS, is a doctoral candidate in clinical psychology at the PGSP-Stanford Psy.D. Consortium. Her primary clinical and research interests are in the areas of trauma, OCD and psychosis. She has varied clinical experience including training at the VA Palo Alto Health Care System and Stanford’s Department of Psychiatry and Behavioral Sciences.
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