Matrix of Acute Crisis Interventions Models

Matrix of Acute Crisis Interventions Models

Model
Affiliation / Psychological First Aid (PFA)
National Child Traumatic Stress Network (NCTSN); NationalCenter for Posttraumatic Stress Disorder (NCPTSD); Funded by SAMHSA. / Psychological First Aid (PFA)
American Red Cross / Mental Health First AidUSA(MHFA)
National Council for Community Behavioral Healthcare, Maryland Department of Health and Mental Hygiene, Missouri Department of Mental Health
Background / References to PFA approaches extend over 50 years in disaster mental health and crisis response literature, with the first reference as early as the 1950s. On October 29–November 1, 2001 the U.S. Departments of Health and Human Services, Defense, Veterans Affairs, and Justice and the American Red Cross convened a meeting titled Evidenced-Based Early Psychological Intervention for Victims/Survivors of Mass Violence: A Workshop to Reach Consensus on Best Practices. PFA was identified as a key aspect of early psychological intervention.[1]
Subsequently, SAMHSA supported the development of PFA to replace interventions not supported by the literature, such as Critical Incident Stress Debriefing. To kick off this initiative, SAMHSA supported an expert review panel meeting held March 31–April 1, 2005. NCTSN and NCPTSD released the SAMHSA-funded Psychological First Aid Field Operations Guide, First Edition after Hurricane Katrina, and since then a SAMHSA-funded second edition has been released by NCTSN and NCPTSD.[2],[3] PFA has since been extensively used in response to large- and small-scale disasters, nationally and internationally. The model is also consistent with Federal Emergency Management Agency-funded and SAMHSA-administered Crisis Counseling Assistance and Training Program interventions. / The American Red Cross was one of the early collaborators on the PFA model. The organization developed its version for lay responders to support survivors and workers in all disaster relief settings. It is available to partner response organizations on a case-by-case basis at one of the 600 Red Cross chapters across the country. / Mental Health First Aid was developed in 2001 by Anthony Jorm, a mental health literacy professor, and Betty Kitchener, a nurse specializing in health education. The program is centered at the ORYGEN Research Centere at the University of Melbourne in, Australia. The National Council for Community Behavioral Healthcare, the Maryland State Department of Health and Mental Hygiene, and the Missouri Department of Mental Health worked with the program’s founders to bring MentalHealth First Aid to the U.S. Currently, Mental Health First Aid has been replicated in 14 countries, includingEngland, Scotland, Finland, Canada, Cambodia, Hong Kong, Ireland, Wales, and Singapore.[4]
Basic Features and Key Components / “PFA is an evidence-informed modular approach to assist children, adolescents, adults, and families in the immediate aftermath of disaster or terrorism.”[5] This model is consistent with the five essential elements of disaster behavioral health and trauma acute and mid-term intervention principles.[6] The model reduces initial distress and fosters short- and long-term adaptive functioning and coping. [7],[8]
PFA intervention strategies address eight core actions: [9]
●Contact and engagement
●Safety and comfort
●Stabilization
●Information gathering: current needs and concerns
●Practical assistance
●Connection with social supports
●Information on coping
●Linkage with collaborative services
The eight core actions above must meet the following standards: [10]
●Consistent with research evidence on risk and resilience following trauma
●Applicable and practical in field settings
●Appropriate for developmental levels across the lifespan
●Culturally informed and delivered in a flexible manner / The American Red Cross defines PFA as follows: “The practice of recognizing and responding to people who need help because they are feeling stress, resulting from the disaster situations within which they find themselves.” [11]
PFA intervention strategies address 12 actions:
●Making a connection
●Helping people be safe
●Being kind, calm, and compassionate
●Meeting people’s basic needs
●Listening
●Giving realistic assurance
●Encouraging good coping
●Helping people connect
●Giving accurate and timely information
●Making a referral to a disaster mentalhealth worker
●Ending the conversation
●Taking care of yourself
One key difference between the American Red Cross PFA model and other PFA models is the American Red Cross use of the proprietary Psychological Simple Triage andRapid Treatment(PsySTART)system. According to the American Red Cross, PsySTART is evidence-informed and facilitates behavioral health triage by all disaster behavioral health responders.[12],[13] / MHFA training helps a layperson assist someone experiencing a mental health crisis, such as contemplating suicide, with the goal to help support an individual until appropriate professionalhelp arrives. People who practice MHFA learn a five-step strategy that includes assessing risk, respectfully listening to and supporting the individual in crisis, and identifying appropriate professional help and other supports. Participants are also introduced to risk factors and warning signs for mental health or substance use problems, and they engage in experiential activities that build understanding of the impact of illness on individuals and families. They also learn about treatment and self-help strategies.[14]
The following are suggested as the MHFAaction plan: [15]
●Assess for risk, suicide, or harm
●Listen non-judgmentally
●Give reassurance and information
●Encourage appropriate professional help
●Encourage self-help and other support strategies
Evidence-Informed for Use With Survivors of Disaster or Terrorism? / The model is evidence-informed for survivors of disaster or terrorism. The model “is supported by mental health and other disaster response workers as the ‘acute intervention of choice’ when responding to the psychosocial needs of children, adults, and families affected by disaster or terrorism.”[16]
“Because many of the components have been guided by research, there is consensus among experts that these components provide effective ways to help survivors manage post-disaster distress and adversities, and to identify those who may require additional services.” [17]
One study examined the perceptions of providers who utilized PFA in response to a disaster. Study participants included 50 individuals who utilized PFA in their response to Hurricane Gustav or Ike. Findings indicated that participation in PFA training was perceived to increase confidence in working with adults and children. PFA was not seen as harmful to survivors and was perceived as an appropriate intervention for responding in the aftermath of hurricanes. [18] / According to the American Red Cross, American Red CrossPFA actions are evidence-informed for use with survivors of disaster or terrorism.[19] / The model is not evidence-informed specifically for use with survivors of disaster or terrorism.
Five published studies in Australia indicate the program saves lives, improves the mental health of the individual administering care and the one receiving it, expands knowledge of mental illnesses and treatments, increases the services provided, and reduces overall stigma by improving mental health literacy. The University of Maryland, through SAMHSA funding, will be assessing thefidelity of the U.S. implementation to the original model. [20]
National Registry of Evidenced-based Programs and Practices application is pending.
When Can This Be Used? / This model is designed to be used in the acute aftermath (e.g., the first few days or weeks) of a disaster or terrorism incident. The time of use will be longer for disasters with considerable community resource loss.[21] / Intended for use across all phases of disaster.[22],[23] / Designed to be used at any point a person needs to provide help to someone who may be in a mental health crisis. (This is not specific to disaster or terrorism events.) [24]This program is primarily a prevention and early-intervention program.
Target Audience forIntervention / Audiences include children, adolescents, parents/caregivers, families, and adults exposed to disaster, terrorism, or mass violence. PFA interventions can also be provided to special populations such as first responders and disaster relief workers. [25],[26]
Translations are available in Spanish, Simplified Chinese, Italian, Mandarin, and Japanese. Adaptations also exist for community religious professionals, the Medical Reserve Corps, school personnel, and staff at nursing homes and homeless shelters for youth and families.[27],[28] / Designed for disaster survivors receiving services by American Red Cross workers.[29] However, the disaster relief settings (e.g., shelters, outreach teams, etc.) are applicable across disaster response organizations, and the exercise scenarios can be adapted to non-Red Cross settings. / The core program is tailored for response to the general adult population experiencing a mental health crisis.
The program is designed to be used in responses provided and work performed by primary care professionals, employers and business leaders, faith communities, school personnel, and educators, State police and corrections officers, nursing home staff, mental health authorities, State policymakers, volunteers, young people, families, and the general public.[30]
Appropriate Locations for Use / PFA can be provided in diverse settings including “general population shelters, special needs shelters, field hospitals and medical triage areas, acute care facilities (e.g.,emergency departments), staging areas or respite centers for first responders or other relief workers, emergency operations centers, crisis hotlines or phone banks, feeding locations, disaster assistance service centers, family reception and assistance centers, homes, businesses, and other community settings (schools, homeless shelters).” [31] / Designed specifically for use by all American Red Cross personnel wherever they are responding.[32] / Designed for use in general community, family, and organizational settings.
Clinical vs. Nonclinical;
Professional vs. Paraprofessional / Nonclinical. This is a non-diagnostic, public health, outreach-oriented approach which does not presume the presence of mental illness.
For use by lay responders, paraprofessionals, and professionals. [33] / Nonclinical. This is a non-diagnostic, public health, outreach-oriented approach which does not presume the presence of mental illness.
For use by lay responders, paraprofessionals, and professionals.[34] / Clinical. Although this model is primarily for paraprofessionals, the focus is on education on the diagnostic signs of serious mental illness and intervention so that appropriate referrals can be made for clinical treatment or other supports. [35]
Primarily for use by paraprofessionals. It is designed for the general public. The model does not teach diagnosis or treatment strategies, but rather triage and peer assistance.
Who Administers This Intervention? / Disaster response workers who provide early assistance to disaster/trauma survivors can provide PFA. The model is appropriate for a “variety of response units including first responder teams, incident command systems, primary and emergency health care, school crisis response teams, faith-based organizations, Community Emergency Response Teams, Medical Reserve Corps, the Citizens Corps, and other disaster relief organizations.” [36] / American Red Cross lay providers, paraprofessionals, and licensed American Red Cross mental health professionals.[37] / MHFA has trained and certified instructors from community mental health and addictions treatment organizations, State departments of health, universities, hospitals, federally qualified health centers, faith-based organizations, police and criminal justice, developmental disability centers, mental health authorities, other mental health advocacy organizations including Mental Health America and National Alliance on Mental Illness affiliates, and independent trainers.These instructors, in turn, deliver the course to their colleagues, individuals affiliated with other community organizations, or the general public. [38]
Training (Including Cost, Audience, and Location) / The following PFA training and educational resources are available. All resources are free, can be provided for both paraprofessionals and professionals, and include both in-person and online training.
●Psychological First Aid Online This NCTSN 6-hour interactive course provides training on all PFA core actions as well as video demonstrations and tips from trauma experts and survivors. It is designed for novices and for those experienced in disaster response. In addition to SAMHSA, this course was also funded by NCPTSD and National Association of County and City Health Officials (NACCHO). The funding from NACCHO was provided through the Cooperative Agreement No. MRCSG061001 awarded by the HHS Office of the Surgeon General, Office of the Civilian Volunteer Medical Reserve Corps.
●Trainings offered through NCTSN.
●Psychological First Aid Field Operations Guide, Second Edition and
This comprehensive guide provides an overview of the use of PFA, as well as detailed information on the eight core actions; sample PFA responses with children, youths and adults; and handouts for PFA providers and disaster/terrorism survivors. This guide has been translated into Spanish, Italian, Mandarin, Simplified Chinese, and Japanese.
●Other resources

These resources include Psychological First Aid for Community Religious Professionals, which was developed NCTSN, NCPTSD, HealthCare Chaplaincy, and Fuller Theological Seminary; Psychological First Aid for Youth Experiencing Homelessness, which was developed by NCTSN and Hollywood Homeless Youth Partnership; Psychological First Aid for Families Experiencing Homelessness, which was developed by NCTSN and Ambit Network; PFA for Medical Reserve Corps; and PFA for Schools.
●PFA videos are available on YouTube.com based on training delivered by the Colorado Division of Behavioral Health.
●SAMHSA Chimera Cast video series Fundamentals of Disaster Planning and Response
●Responding to Crisis in the Aftermath of Disasters DVD series

This series, developed by NCTSN and NCPTSD, contains 16 educational vignettes to teach professionals and paraprofessionals intervention strategies with children and adults after a terrorist event or disaster. The topics include problem-solving, cognitive restructuring, psychoeducation, traumatic grief, traumatic reminders, classroom intervention, parenting, assessment, and anxiety management.
●NCTSN developed a PFA Learning Community to promote adoption by a variety of organizations and agencies that participate in disaster response and to increase sustainability of PFA practices within these organizations. For more information regarding PFA learning communities, contact the NCTSN. / Training is free and is offered by select American Red Cross chapters. The three American Red Cross PFA training courses include the following:[39]
●Psychological First Aid: Helping Others in Times of Stress
●Coping with Deployments: Psychological First Aid for Military Families
●Coping in Today's World: Psychological First Aid and Resilience for Families, Friends, and Neighbors (currently available only as a pilot in the Gulf region and in the San Diego, CA and San Bruno, CA communities) / The MHFAprogram runs 12 hours and is offered in a variety of formats. Most often, it isconducted as one 2-day seminar, two 1-day events spaced over a short period of time, or as four 3-hour sessions. MHFA courses are being scheduled across the country, and currently available courses can be found by visiting Training fees vary depending on location and number of meals provided (some courses are free; others charge up to $170).[40]

Created 1/14/2011 (Revised 2/11/2011)

[1] National Institute of Mental Health. (2002). Mental health and mass violence: Evidence-based early psychological intervention for victims/survivors of mass violence (NIMH Publication No. 02-5138). Rockville, MD: National Institute of Mental Health, National Institutes of Health.

[2] Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (National Child Traumatic Stress Network and NationalCenter for PTSD). (2006).Psychological first aid: field operations guide (2nd ed.). Available on and

[3] Retrieved from

[4]Retrieved from

[5] Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (National Child Traumatic Stress Network and NationalCenter for PTSD). (2006).Psychological first aid: field operations guide (2nd ed.). Available on and

[6] Hobfoll, S. E., Watson, P.J., Bell, C., Bryant, R. A., Brymer, M., Friedman, M. J., et al. (2007). Five essential elements ofimmediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry: Interpersonal and Biological Processes, 70(4), 283–315.

[7] Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (National Child Traumatic Stress Network and NationalCenter for PTSD). (2006).Psychological first aid: field operations guide (2nd ed.). Available on and

[8] Uhernik, J.A., & Husson, M.A. (2009). Psychological first aid: An evidence informed approach for acute disaster behavioral health response. In G.R. Walz, J.C. Bleuer, & R.K. Yep (Eds.),Compelling counseling interventions: VISTAS 2009 (pp. 271–280). Alexandria, VA: American Counseling Association.

[9] Allen, B., Brymer, M. J., Steinberg, A. M., Vernberg, E. M., Jacobs, A, Speier A, & Pynoos, R. S. (2010). Perceptions of use of psychological first aid among providers responding to Hurricanes Gustav and Ike. Journal of Traumatic Stress, 23, 509–513.

[10] Allen, B., Brymer, M. J., Steinberg, A. M., Vernberg, E. M., Jacobs, A, Speier A, & Pynoos, R. S. (2010). Perceptions of use of psychological first aid among providers responding to Hurricanes Gustav and Ike. Journal of Traumatic Stress, 23, 509–513.

[11] American Red Cross. (2006, July). Psychological first aid: Helping others in times of stress. PowerPoint presentation.

[12] American Red Cross. (2006, July). Psychological first aid: Helping others in times of stress. PowerPoint presentation.

[13]Hughes, L. (2009). Psychological first aid (PFA): Models, applications, and training. Presented at the SAMHSA All-Hazards Disaster Behavioral Health: Optimizing Psychological Resiliency in Difficult Economic Times conference,Bethesda, MD.

[14] Retrieved from

[15]Retrieved from

[16] Allen, B., Brymer, M. J., Steinberg, A. M., Vernberg, E. M., Jacobs, A, Speier A, & Pynoos, R. S. (2010). Perceptions of use of psychological first aid among providers responding to Hurricanes Gustav and Ike. Journal of Traumatic Stress, 23, 509–513.

[17] Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., Vernberg, E., & Watson, P. (National Child Traumatic Stress Network and NationalCenter for PTSD). (2006).Psychological first aid: field operations guide (2nd ed.). Available on and