Question 1

When does your next course starts or how can I register?

George Everly · Accepted Answer

If you are referencing the Johns Hopkins Cousera PFA class, it is asynchronous so you can take it anytime anywhere. I also teach PFA related classes for the International Critical Incident Stress Foundation. They have online classes as well but most of their classes are in person and offered over one or two days throughout the country

Question 2

I volunteer in a community for mental health disorders, now with confinement, these people are not supported, they are at home, many of them are living alone. I have been thinking to make an on-line group to check on them through zoom. Any suggestions will be helpful.

George Everly · Accepted Answer

Staying connected is imperative. I highly recommend virtual suport groups. I also recommend establishing a vitual "buddy system"

Question 3

Most of the disaster response or PFA assume that the disaster is a contained event. With Covid-19 it looks like we are in for a marathon a stressor that could carry on for 6-12 months, how do we adapt these methods to respond to the long term nature of what we are facing.

George Everly · Accepted Answer

Focus on the response, not the incident. Believe it or not, the duration of the event is almost irrelevant except for personal planning during an ongoing event

Question 4

I work as a therapist in a military boarding school for children aged 11- 18 years. I have been asked to provide weekly tips and suggestions for young people and staff at home to help them cope with the current crisis. I have started doing this but any other suggestions? Thank you.

George Everly · Accepted Answer

I recommend providing tips on wellness practices: mindfulness, exercise, staying connected albeit remotely, writing a COVID journal, taking the opportunity to do things we lacked time for previously.

Question 5

How does offering psych first aid differ following a prolonged event compared to an acute / relatively quick ending event?

George Everly · Accepted Answer

It really does not. In that PFA focuses upon the response to an incident it can be provided at any point in the trajectory of an incident for as long as there are adverse reactions manifest even including anniversary reactions.

Question 6

Hello, Dr. Everly. What is the best way for a clinical mental health counselor to get training to acquire competence in disaster mental health? And after that competence is acquired, what are some ways to volunteer mental health services? Thank you!

George Everly · Accepted Answer

Get formal training from an organization that specializes in such training: Green Cross and International Critical incident Stress Foundation offer such training throughout the world. Also check with you local university. I teach classes in disaster mental health, human resilience, and PFA at Johns Hopkins. There is an examination-based  certification in critical incident stress management offered by the University of Maryland, Baltimore County Dept of Emergency Health Services

Question 7

Do you have suggestions or tips for how a Psychologist or other professionally trained mental health clinician can ensure they limit care to psychological first aid without bleeding into formal intervention in a way that is both responsibly caring but also ethically practicing?

George Everly · Accepted Answer

Great question, though beyond the scope of this forum. That said I suggest getting formal training so as to understand the difference between PFA and therapy. One technique that seems helpful is to imagine that you only have 15 minutes with each person you will contact. And that you can only see that person 2-3 times. Now ask yourself what would I do differently, if anything?

Question 8

Working on an inpatient psychiatric ward in a Brooklyn psychiatric hospital that is being significantly impacted by covid19. Ward and daily routines have been upended as well as staffing. Do you have advice for what we must address, first and foremost, to assist our patients and attending staff.

George Everly · Accepted Answer

At Johns Hopkins we employ a contiuum of care ranging from peers support, EAP, chaplaincy, and wellness to psychiatric interventions. We have just finished a series of videos for frontline leaders on building resilience-focused leadership as well.. We just published a paper in Annals of Internal Medicine describing our initial approach (Wu, Connors, Everly)

Question 9

As a therapist, what are the things I need to focus on for volunteer work requested by the state?  Thank you.

George Everly · Accepted Answer

Learning how very different PFA is from therapy. Research has shown multi-session therapy in the acute phase of a disaster may actually be harmful.

Question 10

Can someone offer PFA if they are also experiencing the same incident? For example, we are all dealing with the pandemic, but can I still be able to offer help to someone in distress? And is empathy more profound in such instances. 'I know what you're going through' might be true in this case?

George Everly · Accepted Answer

Yes, as long as you can maintain an objective distance. I do not recommend empathic approaches, rather perspective-taking seems as effective if not more so.

Question 11

Do you envision that psychological first aid will ever be as accepted and widespread in our community as physical first aid?

George Everly · Accepted Answer

Not until the importance of mental health is as appreciated. That said, it is gaining in recognition and popularity especially in the context of COVID-19

Question 12

Hi George, is psychological first aid an evidence-based intervention? And has it been shown to be more effective for certain populations and/or crises?

George Everly · Accepted Answer

HI. The model with which I'm most familiar is the Johns Hopkins RAPID model of PFA. There are three content validation studies, two randomized controlled outcome trails, and one mixed methods study supporting its efficacy. I cannot speak to other models of PFA.

Question 13

What is the difference between psychological first aid and mental health first aid?

George Everly · Accepted Answer

MHFA is a form of PFA. The Johns Hopkins RAPID model is also a form of PFA

Question 14

Can PFA courses be tailored to specific groups or industries? For example, I work in a school setting and am interested in training for all school staff to help build resilience within the community.

George Everly · Accepted Answer

This is in my opinion an excellent idea. Please see the journal Crisis Stress and Human Resilience Vol. 1, #4 (open access online) wherein I discuss PFA as a means to achieve universal mental healthcare.

Question 15

What are the signs to look for that people are not recovering well on their own and with the support of PFA and require further mental health support?

George Everly · Accepted Answer

I shall avoid the discussion of clinical indicia and rather focus on the simple yet helpful notion of functionality. Simply said, if in the wake of loss or other adversity and although given some form of psychologcal support the person is incapable of doing the things they need to do or are in any way a potential threat to their own health or the health of others, it would seem referral/faciitation of access to higher level care would be indicated. Similary, if dispite intervention the person shows no sign of improvement referral would seem indicated.

Question 16

What is your opinion on critical-incident stress debriefing? Is there ever a situation in which the evidence supports this being used?

George Everly · Accepted Answer

Thanks for your question. There are only 4 randomized controlled trials on CISD that adhered to the prescribed intervention guidelines. Three were conducted in the military, one was with emergency services personnel. The findings across all settings were consistent. All studies showed some evidence of positive outcome. No study showed any evidence of harm. Thus, it would seem reasonable to say the CISD intervention shows promise with homogenous (with regard to trauma exposure) groups of emeregncy service and military personnel. A similar conclusion was reached in a SAMHSA review. I know of no evidence that CISD should be applied to hetergeneous groups of civilians. I see no evidence that CISD is a "treatment" for trauma, nor should it be a subsitute for treatment.

Question 17

What factors or modifications need to be considered in using psychological first aid with children?

George Everly · Accepted Answer

Great question, Sadly I will pass on that as I'm not a child psychologist nor do i work with children. So sorry.

Question 18

With the COVID19 situation, do you have any tips for psychologists who are used to providing level 3 interventions to their clients, who now need to switch to level 1 and 2 interventions e.g., psychological first aid?

George Everly · Accepted Answer

Yes, get formal training!
Realign expectations as to what is a successful outcome.
We have found that a significant impact can be made in a 15 minute contact but it requires rethinking the intervention process.
Watch the countertransference.

Question 19

As a member of a sizeable company, I would like to recommend our HR team be trained in psychological first aid. Could you list the benefits for a corporation to have trained PFA officers?

George Everly · Accepted Answer

Hello. There are many benefits in my opinion, but several come to mind:
1) Research suggests it saves the organization money through retention and perhaps lowered healthcare costs when applied as part of a continuum of care.
2) It demonstrates the organization values the human resource.
3) It fosters personal resiliency (and organizational rsilience), which is imperative in times of crisis.
4) We believe it fosters organizational cohesion.

Question 20

I work with the volunteer rural fire service who assisted with Australia's bushfire crisis. Could you explain how the RAPID model can be used in this type of organization?

George Everly · Accepted Answer

Hello. I would recommend implementing two procudures: 1) training all supervisors in PFA and 2) establishing a peer support team all members of which would be training in PFA.

Question 21

How can I support my remote team's mental health using psychological first aid?

George Everly · Accepted Answer

PFA can be done remotely. Remember that crisis telephone hotlines date back to the early 1900s. Now with video conferencing capabilities PFA can be done very effectively in my experience. But formal training is of course required in my opnion.

Question 22

Is there a safe and helpful way to approach an angry grief-stricken parent?

George Everly · Accepted Answer

Many consider dealing with grief a specialty within mental health as it presents unique challenges. From a PFA point of view I would simply begin with a supportive and compassionate presence, resisting the temptation to quickly make it all better. Suggesting grief counseling might be appropriate.

Question 23

Do you feel that psychological first aid should be mandatory on all mine sites?

George Everly · Accepted Answer

I think PFA training should be taught to all frontline supervisors in vitually all organizations, but especially high risk professions. I also think that occupations that are high risk for psychological injury should have "peer support" teams trained in PFA. I would consider mining a high risk occupation

Question 24

How does psychological first aid affect changes in mood and anxiety?

George Everly · Accepted Answer

The question you are asking I believe has to do with mechanisms of action. As drugs have mechanisms of action, so do psychological interventions. Depending upon the type of PFA model you employ, the mechanisms of therapeutic outcome could be: cathartic ventilation, reassurance, explanatory guidance, anticipatory guidance, prescriptive guidance, cognitive reframing, or simple education.

Question 25

Hello Dr Everly, in your opinion, is PFA only suitable as an early intervention?

George Everly · Accepted Answer

Hi. Great question which no one has ever asked me. No. Depending upon the model that is used I believe it could be used at any point in the trajectorey of a problem or symptom presentation. The brief "listen and refer" model will have less utility than the "listen, mitigate, and refer" models.

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