Psychological First Aid:

The Johns Hopkins RAPID PFA

George S. Everly, Jr, PhD, ABPP

The Johns Hopkins Public Health Preparedness Programs

The Johns Hopkins Bloomberg School of Public Health

Psychological First Aid

This program is intended to introduce participants to the fundamentals of psychological
first aid
Psychological first aid (PFA) may be defined as a compassionate and supportive
presence designed to mitigate acute distress and assess the need for continued mental
health care (Everly and Flynn, 2005)
This program is designed specifically for:
Public health personnel
Public health educators
Emergency responders
Disaster workers with little or no formal mental health training

PFA Objectives
Participants will increase their abilities to:
Discuss key concepts related to PFA
Listen reflectively
Differentiate benign, non-incapacitating psychological/ behavioral crisis reactions from
more severe, potentially incapacitating, crisis reactions
Prioritize (triage) psychological/ behavioral crisis reactions
Mitigate acute distress and dysfunction, as appropriate
Recognize when to facilitate access to further mental health support
Practice self-care

Terms and Concepts

George S. Everly, Jr, PhD, ABPP

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The need

Disasters on the Rise

According to the United Nations International Strategy for Disaster Reduction, the
frequency of disasters caused by natural hazards has been increasing
Current global destabilization and armed conflicts will likely cause the number of
disasters to dramatically increase in the second decade of the millennium

Surge of Demand: Mental Health Services after Disasters

When considering the mental health aspects of public health emergencies and disasters,
we are most concerned with the phenomenon of surge
Experiences in the United States and other countries has shown repeatedly that following
disasters, particularly those occasioned by violence, there is a surge of demand for
health services, including mental health

Sources: Galea et al. (2005). The epidemiology of post-traumatic stress disorder after disasters. Epidemiol Rev, 27:7891; Hamblin, J. (2004). What are the traumatic stress effects of
terrorism? www.ncptsd.org/facts/disasters/fs_terrorism.html; Lating, J. (2005). Psychological contagion effect. In G. Everly, Jr & C. Parker, eds, Mental Health Aspects of Disasters, 5158.

More Specifically
In an analysis of over 160 empirical studies conducted by Norris and her colleagues
(2006), 41% of studies revealed evidence of severe to very severe impairment
(interference with functioning) among a significant number of disaster survivors

Surge of Demand: Mental Health Services after Disasters

Translating those statistics to actual demand, the increased demand for mental health
services may range from 1525% of the population directly affected

Raphael, 1986

in hours after a disaster, at least 25% of the population maybe stunned

and dazed, apathetic and wanderingsuffering from the disaster syndrome
especially if impact has been sudden and totally devastating At this point,
psychological first aid and triage are necessary.
Beverley Raphael (1986)
When Disaster Strikes

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The need to enhance surge capacity is self-evident;

the only question is: how?

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Recent Evidence Suggests:

1. Psychological crisis intervention can increase the perceptions of personal resilience and
preparedness, as well as enhance community resilience
OL McCabe; N Semon; JM Lating; GS Everly, Jr; et al. (In press). Developing an
academic-government-faith partnership to build disaster mental health preparedness
and community resilience: program description and lessons learned. Public Health
Reports.
GS Everly, Jr; OL McCabe, N Semon, CB Thompson, J Links. (2014). The
development of a model of psychological first aid (PFA) for non-mental health trained
public health personnel: the Johns Hopkins RAPID-PFA. Journal of Public Health
Management and Practice (online).

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Recent Evidence Suggests:

2. Psychological crisis intervention is superior to multisession psychotherapy post disaster,
for reducing acute distress
4. Psychotherapy post disaster may delay or complicate recovery
Boscarino, Adams, and Figley, 2011, J Nerv Ment Dis

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Data May Suggest

If correct, collectively these data suggest that traditional mental health interventions may
be problematic when applied in disaster settings
Furthermore, there may be value in implementing more crisis oriented interventions
But this is not a new idea

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