Psychological First-Aid (PFA)
Well Staff WriterWhat is Psychological First Aid (PFA)?
Psychological First Aid (PFA) is a specifically targeted early intervention measure, akin to the emergency attention for the physically injured as they are triaged before entering longer-term medical care. PFA emerged in the mid-twentieth century and expanded post-9/11, as professionals realized that there was a gap in psychological intervention for survivors of disasters and large-scale “extreme events.”
PFA intervention is useful following a number of disaster types, from community unrest, natural disasters (fires, hurricanes, earthquakes), mass shootings/violence, and pandemics, including the coronavirus pandemic we are currently living through.
PFA aims to help stabilize survivors, not to begin therapy with them at the disaster site or directly following it. Instead, first responders and mental health professionals trained in PFA work to survivors find appropriate resources and long-term help.
In basic terms? PFA is provided as an important part of preliminary care for disaster survivors aiming to improve immediate stability and facilitate positive short- and long-term treatment outcomes.
What does PFA look like?
“Psychological First Aid” is an umbrella term which contains a variety of different models or frameworks. The term itself used for brevity, so that we can easily refer to a group of practices that aim to intervene in the immediate aftermath of an extreme event, a period ranging from a couple of hours to seven days after the disaster.
As overarching guidelines, researchers Hobfoll et al. (2007) defined five empirically-supported principles that guide the various PFA approaches. Trained practitioners should aim to “promote (1) a sense of safety, (2) calming, (3) a sense or self- and community efficacy, (4) connectedness, and (5) hope.”
What evidence is there for the effectiveness of PFA?
Unfortunately, there is not a lot of evidence for or against the effectiveness of PFA interventions, largely due to lack of evidence or issues in review methodologies. The scarcity of evidence is concerning, but we must consider the difficulty in performing rigorous study in the aftermath of a disaster: in practical terms, disasters are hard to predict in terms of timing and context, and there are many obvious ethical concerns about performing research in the midst of this “critical time of need.”
It is also difficult to evaluate such a broad category of intervention, since PFA frameworks exist globally, in different cultures and languages. Organizations like the World Health Organization (WHO), the War Trauma Foundation (WTF), and World Vision International (WVI), who came together to create the “Anthology of Resources” to be used internationally when constructing PFA approaches, and in 2013 the first “Curbside Manner” Stress First Aid (SFA) manual was released specifically for training first responders and firefighters. These codifications are helpful in creating common, international frameworks to streamline PFA approaches.
Despite this dearth of evidence, the importance of early intervention is understood to be paramount, and PFA training is important across disaster response fields to help survivors reduce immediate distress following extreme events, and to maximize survivor short- and long-term functioning in the wake of a disaster.
What’s next for PFA?
As approaches continue to be refined, the next step is continued research to help trained professionals provide the best possible early interventions for disaster survivors. While PFA has been accepted somewhat uncritically, a continued engagement with existing PFA frameworks will help professionals design evaluation protocols to improve and operationalize PFA practices. By refining these frameworks, professionals can work to demonstrate improved recovery trajectories for survivors.
How can you get trained in PFA?
Training in PFA can help with disaster preparedness, and is recommended for a number of fields. A full list of training options can be found here.
