Trauma and Abuse

Disaster Mental Health and Community-Based Psychological First Aid: Concepts and Education/Training

Gerard A. Jacobs, Brandon L. Gray, Sara E. Erickson, Elvira D. Gonzalez, and Randal P. Quevillon

University of South Dakota

Any community can experience a disaster, and many traumatic events occur without warning. Psychol- ogists can be an important resource assisting in psychological support for individuals and communities, in preparation for and in response to traumatic events. Disaster mental health and the community-based model of psychological first aid are described. The National Preparedness and Response Science Board has recommended that all mental health professionals be trained in disaster mental health, and that first responders, civic officials, emergency managers, and the general public be trained in community- based psychological first aid. Education and training resources in these two fields are described to assist psychologists and others in preparing themselves to assist their communities in difficult times and to help their communities learn to support one another. C© 2016 Wiley Periodicals, Inc. J. Clin. Psychol. 72:1307–1317, 2016.

Many communities have learned that disasters can strike without warning. Flight 232 crashed in Sioux City, at an airport that wasn’t even on their flight plan. Shanksville, Pennsylvania, doesn’t even have an airport, but on September 11, 2001, it was part of the largest terrorist attack against the United States to date, with one of the three aircraft involved crashing there. The 17 Canadian airports that hosted more than 200 flights diverted from the United States on September 11 certainly didn’t see that tremendous challenge coming.

Tornadoes often strike in the central region of the country known as tornado alley. Arguably, the most powerful tornado ever recorded struck the major urban area of Oklahoma City, as well as many outlying communities in 1999, and the 2011 Joplin, Missouri, tornado drew enormous national attention. However, Salt Lake City was struck by an unexpected tornado in 1999, and in 1997, a tornado literally descended from the clouds directly over Spencer, South Dakota, and erased the small town from the map. Disasters don’t always occur where they’re expected.

New Orleans, Houston, and Tampa expect to experience hurricanes. But one of the most devastating hurricanes in memory, Sandy, focused its devastation in New Jersey and New York. It left almost unimaginable destruction behind and affected millions of residents.

No matter where a provider may live, his or her home community may be struck by disaster at any time. It is important to understand how mental health professionals can prepare to assist individuals and communities who experience a traumatic (overwhelming) event and how to help their communities become more resilient.

Disaster Mental Health

Disaster mental health (DMH) refers to psychological support provided by mental health profes- sionals in preparation for, response to, and recovery from disasters. The term is most frequently used to refer to services provided in the emergency phase of a disaster response. It focuses on the mental health needs of those directly affected by disaster, and of those indirectly affected by disaster. Those indirectly affected include disaster relief personnel and family of those directly affected, as well as other secondary survivors (Jacobs, 1995). DMH generally includes crisis

Please address correspondence to: Gerard A. Jacobs, Ph.D., Disaster Mental Health Institute, University of South Dakota – SDU 101, 414 East Clark St., Vermillion SD 57069. E-mail: [email protected]

JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 72(12), 1307–1317 (2016) C© 2016 Wiley Periodicals, Inc. Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22316

1308 Journal of Clinical Psychology, December 2016

intervention, education, advocacy, problem solving, and, when an individual needs more tradi- tional mental health services, referral (Jacobs & Meyer, 2005). It is intended to primarily assist ordinary individuals who have experienced extraordinary events.

In 1992, the American Psychological Association (APA) announced the Disaster Response Network (DRN; soon to change its name to the Disaster Resources Network) as its gift to the nation on the occasion of APA’s 100th anniversary (Daw, 2001). State, provincial, and territorial psychological associations were encouraged to develop state DRNs to coordinate the efforts of psychologists who were interested in serving their communities in times of disaster. Some state DRNs have also included other mental health professions in keeping with the American Red Cross’s (Red Cross) policy of having various disciplines working collaboratively in providing services. APA encourages providers to be prepared to serve their communities in times of disaster, and its DRN works closely with the Red Cross to ensure that there are adequate numbers of providers available to serve both those who are directly affected by disasters and those who respond to them.

The Red Cross began providing DMH services as part of its disaster relief operations in November 1991, after signing a Statement of Understanding with APA in October 1991 (Jacobs, 1995). From the beginning of these services, the Red Cross has required providers to complete the Red Cross course Foundations of Disaster Mental Health (or its predecessors). That course has evolved over the intervening 24 years but focuses on teaching providers how to use their professional skills within the context of the Red Cross. Providers are asked to obtain external training in DMH, to understand the unique challenges of providing professional services in the broad range of environments in the aftermath of disaster.

The DMH model has been relatively effective since its initiation in late 1991 (van Ommeren, Saxena, & Saraceno, 2005). There have been challenges, however, in recruiting sufficient numbers of mental health professionals with adequate training in DMH, particularly in response to large events. In very large-scale disasters, such as the terrorist attacks of September 11, 2001, the logistics of physically moving qualified mental health professionals to all those in need also proved challenging. Even with the use of distance technology, matching providers with those in need of services can prove daunting. This is particularly true in natural disasters, which often affect the communications infrastructure.

In the aftermath of the September 11th responses, the Red Cross summoned its DMH technical experts together to discuss how DMH services might need to be changed in the future in light of lessons learned in the September 11th disaster relief operations. The group unanimously recommended that the community-based model of psychological first aid (CBPFA) be added as a strategy to supplement DMH in providing psychological support (G.A. Jacobs, personal communication, March 29, 2015). The International Federation of Red Cross and Red Crescent Societies (IFRC) in 2005 had selected CBPFA as the method of choice to assist developing countries in beginning psychological support programs (Jacobs & Meyer, 2005; Simonsen & Reyes, 2003).

CBPFA

CBPFA appears to have originated in Scandinavia, most likely in Denmark (Jacobs & Meyer, 2005; Knudsen, Hogsted, & Berliner, 2007), although the basic concept of psychological first aid in American medical literature dates to Blain, Hoch, and Ryan (1945). The general goal of CBPFA is to train members of the community (not mental health professionals) to provide basic psychological support to their families, friends, neighbors, and coworkers and manage their own stress (Jacobs & Meyer, 2005; Reyes, 2006; Simonsen & Reyes, 2003). While this is often discussed in the context of traumatic stress, it can also be useful in dealing with the stressors of everyday life. Additionally, CBPFA teaches people how to recognize when someone’s challenges require a referral to a mental health professional.

CBPFA is adapted for individual communities’ needs, but the consultation between trainers and community representatives usually begins with a general list of topics. One such list we use includes: How to be a Helper; Traumatic Stress; Active Listening; Problem Solving;

Training in CBPFA and DMH 1309

Instrumental (practical) Assistance; When and How to Make a Referral for Professional Assistance; Grief and Bereavement; Self-Care; and Ethics.

The CBPFA model builds on the strengths of the community it is intended to serve, incorpo- rating effective local traditions and values. Simonsen and Reyes (2003) considered this approach vital to the success of CBPFA. They defined a community as, “a group of people having a com- mon identity, relating to certain factors” (p. 58). When working with a community to begin a CBPFA program, it is typical to work with a committee representing the community and discuss how the training can best be adapted and implemented for that community (Jacobs, 2007).

In 2002, the Institute of Medicine (one of the National Academies of Science) empaneled a committee to study how best to prepare for the psychological consequences of terrorism (2003). The unanimous recommendation of the committee was that the nation needed to develop a program of CBPFA.

In 2008, President Bush ordered that a committee be formed to make recommendations for DMH response to terrorist attacks against the United States and public health emergencies such as pandemics. The committee was constituted as a subcommittee of the National Biodefense Science Board (now the National Preparedness and Response Science Board). The president gave the subcommittee 6 months to formulate their recommendations (NBSB, 2008).

One of the unanimous recommendations of the subcommittee was that the federal government “[p]romote the population’s psychological resilience” and, specifically, to “[p]romote psycholog- ical resilience of individuals, families, and communities through the development of a national strategy for the integration, dissemination, and ongoing evaluation of psychological first aid” (NBSB, 2008, p. 14). The NBSB Subcommittee also noted that, although there is extant research on the components of CBPFA training, there needed to be more research on the total package.

While the NBSB report did not specifically use the term CBPFA, its specific definition made their meaning clear:

“Psychological first aid,” as used in this context, refers to psychological support that is both used to improve one’s own resilience and is provided by non-mental health professionals to family, friends, neighbors, co-workers, and students. Psychological first aid focuses on education regarding traumatic stress and on active listening. The term also incorporates more sophisticated psychological support given by primary care providers to their patients. Properly executed, psychological first aid is adapted to the needs of each group or community (i.e., group of people with shared interests) implementing it, ensuring that the psychological first aid that is introduced in the community does not conflict with the world view of the group. It also emphasizes the inclusion of effective strategies for psychological support that may be specific to that group. This is done in concert with a representative community committee that helps to ensure responsiveness to the specific community. Psychological first aid includes understanding one’s role; the difference between anticipated stress reactions and traumatic stress; how to engage in active listening; when and where to refer individuals for additional assessment and intervention; and the importance of supervision, ethical behavior, and self-care. (NBSB, 2008, p. 12)

In keeping with the recommendation of the NBSB report, the U.S. Department of Health and Human Services (HHS) has recommended PFA training for all volunteer Medical Reserve Corps, Assistant Secretary for Preparedness and Response (ASPR), Office of Emergency Management, and National Disaster Medical System (NDMS) disaster responders (HHS, 2014).

Ehlers and Clark (2006) have maintained that understanding that traumatic stress can over- whelm anyone’s coping skills may be the best strategy for building resilience to traumatic stress. They reported that individuals who believed their traumatic stress symptoms were due to their own weakness, rather than an ordinary response to extraordinary events, were most likely to have long-term challenges with traumatic stress. Van Daele, Hermans, Van Audenhove, and Van den Bergh (2012) concurred with that perspective, concluding in a meta-analysis that psychoe- ducation is critical in preparing people of many ages and ethnic backgrounds for coping with

1310 Journal of Clinical Psychology, December 2016

traumatic events. Krupnick and Green (2008) and Wessely et al. (2008) were less convinced of the merits of psychoeducation, and called for more research on this strategy.

A variety of studies have reported that active listening and its components increase psycholog- ical support. Weger, Bell, and Robinson (2014) reported that the use of active listening increased the perception of being supported. In addition, Levitt (2001) reported that active listening used by beginning graduate students in counseling helped the listener to feel more self-efficacious. Maurer and Tindall (1983) reported that even focusing only on the use of the nonverbal active listening strategies increased a sense of empathy and helped build interpersonal relationship between the speaker and listener.

As mentioned above, another aspect of CBPFA is the provision of practical assistance in addition to the educating, listening, and problem solving. Litz, Gray, Bryant, and Adler (2002) reported that instrumental assistance was a vital tool in easing reactions to traumatic events.

Hobfoll et al. (2007) described five elements that need to be included in any program targeting traumatic stress: promoting a sense of safety, a sense of calm, a sense of self and collective efficacy, a sense of connectedness, and the instillation of hope. This article has been referred to as the gold standard for psychological support programs and many aspects of CBPFA promote these principles.

The more general term “psychological first aid” (PFA) is used to refer to many different strate- gies for basic psychological support. The National Child Traumatic Stress Network (NCTSN) and the National Center for Post-Traumatic Stress Disorder (NCPTSD) promote a model for psychological support that uses the term PFA to refer to the work done by both mental health professionals and trained members of the public (Brymer et al., 2006). This is probably the best known of the PFA models in the United States. The NCTSN and NCPTSD model incorporates many of the elements called for by Hobfoll et al. (2007). The NCTSN and NCPTSD model seems to be primarily a response-team model, in which individuals are trained to go to affected communities to serve those in need. This presents a significant logistic limitation in getting providers to those in need, particularly in large-scale events, a problem shared with the DMH model.

The NCTSN and NCPTSD model describes mental health professionals as doing “first aid.” The term PFA has also been used by some as synonymous with the first efforts of DMH pro- fessionals after a disaster (e.g., Young, 2006), or to blend the terms DMH and PFA (Pynoos & Nader, 1988). The varied use of the term PFA raises concerns, if only from the perspec- tive of precision in terminology. It seems to we authors, that the term PFA is more profitably reserved to describe the psychological support efforts of nonmental health professionals. Men- tal health professionals seem likely to have a far broader set of skills to bring to bear than nonmental health professionals, including better assessment of the immediate needs of an individual in crisis, a wider range of crisis intervention tools, and more incisive understand- ing of when an individual may benefit more from traditional mental health services. That broader set of skills seems more profitably addressed as “disaster mental health” or “disaster psychology.”

Disaster Mental Health Resources

Formal academic programs. Three formal academic programs focus on education in DMH. The first, the Disaster Mental Health Institute (DMHI) at the University of South Dakota (USD), began in 1997 and provides a doctoral specialization in clinical and disaster psychology and a graduate certificate in disaster mental health, which will be described in more detail later in this article. The Institute for Disaster Mental Health (IDMH) at the State University of New York New Paltz offers an “Advanced Certificate in Trauma and Disaster Mental Health,” which is a 15-credit program intended for professionals with counseling or social work degrees and students enrolled in master’s or doctoral programs. This program recently received approval from the New York Department of education (IDMH, 2015). Finally, the Denver University Graduate School of Professional Psychology offers a master’s degree in international disaster psychology. It is “intended to provide foundational skills in clinical psychology combined with the specific skills needed to work in the field of trauma and disaster globally” (2015).

Training in CBPFA and DMH 1311

Other DMH training resources. As noted earlier, the Red Cross requires mental health professionals to acquire training in DMH above and beyond its fundamentals of DMH course (Weaver, Dingman, Morgan, Hong, & North, 2000). Formal academic programs such as those discussed above may not be appropriate for all mental health professionals. Fortunately, there are also less-structured training opportunities available.

Various state psychological associations offer training through their DRNs. One of the better known DRN training programs is that offered by the North Carolina (NC) DRN (North Carolina Institute for Public Health, 2015).

The American Counseling Association (2015) also offers DMH training at its annual con- ference. This training includes the Red Cross required class, as well as additional training that targets competencies in five areas: team building; service delivery planning relationships complex problem solving; and technical and systems knowledge.

Individual universities also offer less formal training. For example, The University of Wash- ington’s Northwest Center for Public Health Practice offers an online 1-hour training to help participants understand some of the psychological challenges that occur as a result of disaster. Johns Hopkins University’s Center for Public Health Preparedness (2015) also offers brief online training regarding the importance of psychological support after disaster. Other universities may offer ad hoc training after local, regional, or national disasters as the University of Mississippi did after hurricane Katrina (Schulenberg et al., 2008), or are developing more complex DMH curricula (Schulenberg et al., in press).

Similarly, some nongovernmental organizations other than the Red Cross provide training for responders. One of the better-known programs is the National Organization for Victims Assistance (NOVA, 2015). They have three levels of training for individuals seeking to join a NOVA crisis response team: basic, advanced, and training of trainers. This training does not require participants to be mental health professionals.

A number of federal sources offer various types of training in DMH. The Substance Abuse and Mental Health Services Administration (SAMHSA) Crisis Counseling Assistance and Training Program is a federally funded grant program. Communities that receive a Presidential Disaster Declaration for Individual Assistance may apply for funding for an Immediate Services Program, which can provide funds for a 60-day program, and the Regular Services Program, which can fund a 9-month program. SAMHSA technical consultants will offer training and consultation under those programs.

SAMHSA (2011) also helps states, territories, local providers, and tribal groups strengthen their preparedness to deal with disaster through onsite and web-based consultation offered by its Disaster Technical Assistance Center (DTAC). The DTAC “provides disaster technical assistance, training, and consultation to help disaster behavioral health professionals plan for and respond effectively to mental health and substance abuse needs following a disaster” (p.1). Similarly, the Federal Emergency Management Agency (2015) provides training regarding ap- plying for and conducting these crisis intervention programs, targeting state government officials and mental health professionals. The International Association of Continuing Education and Training is the accreditor for the continuing education units.

The HHS Office of Minority Health offers an online “Cultural Competency Curriculum for Disaster Preparedness and Crisis Response” (2015). Each of the programs featured on Think Cultural Health are founded on the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (National CLAS Standards). These courses are targeted for a variety of disaster responders, including mental health professionals.

Research training in DMH. It is notable that there is also training that focuses on DMH research rather than direct services. Pfefferbaum et al. (2010) and Beaton, Johnson, Maida, Houston, and Pfefferbaum (2012) have described the development of disaster research training programs. These programs are intended to prepare professionals to effectively conduct research in DMH and to build the evidence base for effective interventions. The training includes clinical, research, applied clinical research, team building, and public health modules. There is also a version that focuses on research with children (Beaton et al., 2012). Similarly, Schulenberg et al. (In press), discussed the use of their research program to train graduate students in DMH.

1312 Journal of Clinical Psychology, December 2016

Psychological First Aid

The Red Cross adopted the recommendation made by its technical experts in DMH made after the September 11, 2001, terrorist attacks (mentioned above). It has introduced PFA training for families of deployed military personnel (American Red Cross, 2010), disaster responders (American Red Cross, 2012), and most recently the general public (American Red Cross, 2014). These courses are not truly community-based, because they are not adapted for individual com- munities, but they are based on a model of basic psychological support provided by nonmental health professionals.

Internationally, the IFRC’s Reference Centre for Psychosocial Support offers consultation and training to national Red Cross and Red Crescent societies, adapting the IFRC’s PFA model to each nation, fulfilling the community-based aspect of its model (IFRC, 2015).

Disaster Mental Health Institute Academic and Training Programs

On July 19, 1989, Flight 232 crashed in Sioux City, Iowa, about 40 miles from USD. USD’s doctoral clinical psychology training program (CTP) offered a psychological response team to the local chapter of the Red Cross. Following the disaster relief operation, Drs. Quevillon and Jacobs proposed to APA and to the Red Cross that the two organizations collaborate to develop a national plan for psychological support in the aftermath of disasters, with standardized policies, procedures, and training. APA and the Red Cross announced their Statement of Understanding in October 1991, and in November 1991, the Red Cross announced that Disaster Mental Health Services would join their roster of disaster response activities (Jacobs, 2007).

Faculty and students of the USD CTP responded to numerous disasters over the years and were closely involved with the development of DMH. In 1997, the South Dakota Board of Regents named the DMHI a Center of Excellence and authorized the DMHI to offer its graduate DMH programs.

Doctoral specialization in clinical and disaster psychology. There are two DMHI grad- uate curricula. The doctoral specialization in clinical and disaster psychology is only available to students enrolled in the USD CTP. Students must complete all the requirements of the CTP in addition to the Doctoral Specialization requirements. In developing the curriculum, the DMHI faculty had many discussions about what were the most critical components of disaster psychology.

As noted in the introduction, Fundamentals of Disaster Mental Health, which is the Red Cross course required to become a Red Cross DMH provider, does not teach mental health professionals about the field of DMH as much as it instructs the providers about how to use their professional knowledge within the context of the Red Cross. The Red Cross encourages mental health professionals to complete external training in DMH. Therefore, the central course in the doctoral curriculum is disaster mental health. This course incorporates the Red Cross’ fundamentals of disaster mental health course, which is currently 4 hours in length. However, that Red Cross course is embedded within 41 other hours of instruction in theory, research, and practice in disaster mental health.

Crisis intervention is another core skill within disaster psychology. It is also important for DMH providers to understand what are ordinary human reactions to traumatic stress and what responses might indicate the need for professional intervention. Surprisingly, many mental health professionals are not trained in these skills during their graduate studies. Courses in both of these topics are required in the doctoral specialization.

Some of the early disaster responses that formally included Red Cross Disaster Mental Health Services revealed that a number of mental health professionals could benefit from additional skills in dealing with diverse survivors and responders. The USD CTP emphasizes the importance of cultural responsiveness for clinicians. In keeping with that emphasis, a third required course in the doctoral specialization is serving the diverse community in disaster.

The doctoral specialty track also requires students to complete Introduction to behavior therapy and rural community mental health. Both of these courses were judged to provide

Training in CBPFA and DMH 1313

valuable theory and tools for working in both preparedness for and response to disasters. Behavior therapy is geared toward both behavioral and cognitive-behavioral strategies and provides background primarily for work with individuals and groups. Rural community mental health provides a theoretical foundation for understanding rural communities and the individuals living there, as well as working with those communities in preparing disaster response plans. These are particularly important skills in South Dakota and other primarily rural and frontier states. The skills also are useful, however, in urban and suburban communities.

In addition to these required courses, students need to complete one of five electives. Virtually all students have chosen management in disaster mental health as their elective. In addition to the coursework, students are required to complete either their thesis or dissertation (or both) on a topic in the area of traumatic stress or DMH. They must also have a DMHI faculty member on their committee, but any of the CTP faculty can serve as a student’s committee chair and major advisor.

After students have completed all coursework, they are required to complete a capstone exercise consisting of a tabletop disaster exercise, generally as a member of a group. A disaster scenario is presented to the group of students, who are then required to serve as the DMH management team for the virtual disaster response and design the DMH response to the scenario. Periodic situation reports (sitreps) are provided to the students by the faculty to update the scenario. Some of the sitreps present complications to the students’ emerging plan and require the participants to rethink their strategies. They are expected to develop a service delivery plan, including staffing requests (both immediate local resources to be recruited and requests for national resources) that may be needed to effectively respond. This scenario is conducted in “near real time,” although the sitreps often move the situation forward in time. The capstone exercise is judged by all DMHI faculty, as well as an experienced DMH responder from outside the program.

Graduate certificate in disaster mental health. The graduate certificate was developed to provide DMH training for existing mental health professionals and graduate students in mental health from programs other than the USD CTP. It requires three of the same courses as the specialization in clinical and disaster psychology: disaster mental health, crisis intervention, and serving the diverse community in disaster. An elective course is also required; students can choose between traumatic stress and management in disaster mental health. A number of students choose to complete both electives. The certificate also requires the participants to complete the same capstone exercise as for the doctoral specialization.

The NBSB’s recommendations included widespread training in DMH for a variety of pro- fessions in order for those in various roles and professions to understand DMH issues in the aftermath of disaster. Therefore, the graduate certificate was opened to any student who had completed a bachelor’s degree with a minimum GPA of 2.7 on a 4-point scale. In addition, all of the graduate certificate courses are offered in an online format, enabling students around the world to participate.

Specialized CBPFA Training

The DMHI also provides CBPFA training tailored to the needs of individual groups. Training has been conducted for emergency medical technicians (EMTs), paramedics, firefighters, law enforcement, and medical professionals. Trainings of trainers are also conducted. In addition to the NBSB’s recommendations about providing PFA training to various groups, the subcom- mittee’s recommendations on research included encouragement to conduct further research on PFA. Therefore, in addition to offering the customized training, the effectiveness of the training is routinely assessed.

Members of the USD rural research team have been engaged in research aimed at evaluation of the applicability of CBPFA with Native Americans in the region. Initially, consultation with elders from the local community and via talking circles comprised of Native youth from the region were used to adapt CBPFA to fit developmentally and culturally. This training was evaluated in a group of mostly Native college-bound students who were attending summer

1314 Journal of Clinical Psychology, December 2016

programs at USD. Posttest and follow-up results indicated that the program was well received and perceived as culturally appropriate, applicable, and potentially useful (Tait, 2011).

This project led to an ongoing series of projects in partnership with the tribal community on a nearby reservation in keeping with a tribal participatory research (TPR) model (Fisher & Ball, 2003). TPR, by necessity, involves an equal-plane partnership with the community as well as tribal oversight of all project elements. It also must employ tribal members as consultants and bridges between community needs and values and the research goals and employ community members as project staff. Finally, it is imperative to use culturally specific interventions and assessments in the research (Fisher & Ball, 2003).

CBPFA is considered ideal because community adaptation is built into the model (Jacobs & Myer, 2005). To date, the CBPFA training has been presented to direct care staff serving youth and families working within the Rosebud Sioux tribal program setting (Tait, 2015), and the results of the evaluation and a subsequent follow-up plus a series of qualitative interviews were presented to the Tribal Council and at a community meeting (Bordeaux-Rank, 2014). The community requested a broader application of CBPFA and, in ongoing consultation with the community, a training of trainers was conducted to extend the impact of the CBPFA training. Staff from a number of human service agencies on the reservation sent representatives to the week-long training, which aimed to provide participants with sufficient depth of content to allow them to conduct CBPFA trainings at their home agencies (Bordeaux-Rank, 2015).

Subsequently, the role of the rural research team will be as consultants and enablers to facilitate those trainings. The number and extent of those future trainings and future roles for the rural research team will be guided by the needs and wishes of the community.

A second USD research team, the disaster mental health research team, has also been study- ing CBPFA and collaborating with the rural research team in its work. This research team uses a community-participatory research model, which is similar to the TPR model described above. Several populations have been provided with training adapted in consultation with those com- munities. Reed (2013) reported that emergency medical technicians (EMTs) and paramedics felt that CBPFA was useful both for helping others and for managing their own stress. Similarly, community advisors (trained peer leaders who supervise, advocate for, and provide support to individuals living in the residence halls) increased their knowledge of CBPFA and reported that it was a useful technique both for supporting the students in their residence halls and in manag- ing their own stress (Moffitt, 2014). Larson-Stoa (2014) examined CBPFA in oncology medical staff and reported that it was useful in supporting patients and colleagues, and for managing personal stress. Further research continues on CBPFA with EMTs and paramedics, and with medical staff. The Red Cross’s course coping in today’s world is also being investigated for its effectiveness.

The DMHI has also provided trainings of trainers in psychological support and CBPFA in many countries, usually working through the Red Cross, IFRC, APA, International Union of Psychological Science, or the Asian Disaster Preparedness Center. The most recent of these was conducted in Nepal in the aftermath of the April 2015 earthquake.

Summary

The unpredictable nature of disasters and the devastation they incur emphasizes the impor- tance of preparedness. DMH training for mental health professionals is an important aspect of preparedness for providing psychological support in the aftermath of a disaster and serving the psychologist’s community after a traumatic event. However, recent large-scale disasters have demonstrated the need for alternative approaches to psychological support that do not rely solely on mental health professionals. CBPFA is an important program that teaches community mem- bers how to support friends, families, neighbors, colleagues, and themselves. Resources listed herein provide access to training and education in both CBPFA and DMH as well as literature discussing each concept. Readers are encouraged to seek out DMH education opportunities and promote the implementation of CBPFA in an effort to increase preparedness.

Training in CBPFA and DMH 1315

References

American Red Cross. (2010). Coping with deployments: psychological first aid for military families. Washin- gton DC: American Red Cross. Retrieved from https://intranet.redcross.org/content/redcross/ categories/our_services/service_to_the_armedforces/coping_with_deployments.html (NOT AVAIL- ABLE TO THE PUBLIC)

American Red Cross. (2012). Psychological first aid: Helping others in times of stress. Washington DC: American Red Cross. Retrieved from https://intranet.redcross.org/content/redcross/categories/our_ services/disaster-cycle-services/dcs-capabilities/individual_clientservices/disaster-mental-health- toolkit/psychological-first-aid-faq.html (NOT AVAILABLE TO THE PUBLIC)

American Red Cross. (2014). Coping in today’s world. Washington DC: American Red Cross. Retrieved from https://intranet.redcross.org/content/redcross/categories/our_services/disaster-cycle-services/dcs- capabilities/individual_clientservices/disaster-mental-health-toolkit/coping-in-today-s-world.html (NOT AVAILABLE TO THE PUBLIC)

Beaton, R. D., Johnson, L. C., Maida, C. A., Houston, J. B., & Pfefferbaum, B. (2012). Disaster research team building: A case study of a web-based disaster research training program. Traumatology, 18(4), 86–91. doi:10.1177/1534765612444881

Blain, D., Hoch, P., & Ryan, V. G. (1945). A course in psychological first aid and prevention. American Journal of Psychiatry, 101, 629–634.

Bordeaux-Rank, J. A. (2014). Tribal participatory research with community-based psychological first aid training for Native direct care staff: A continuation study (Unpublished master’s thesis). The University of South Dakota, Vermillion, SD.

Bordeaux-Rank, J. A. (2015). Tribal participatory research with community-based psychological first aid training of trainers on the Rosebud: A follow-up study (Doctoral dissertation in progress). The University of South Dakota, Vermillion, SD.

Brymer, M., Jacobs, A., Layne, C., Pynoos, R., Ruzek, J., Steinberg, A., . . . Watson, P., (2006). Psycho- logical first aid: Field operations guide (2nd ed.) Los Angeles: National Child Traumatic Stress Network and National Center for Post-Traumatic Stress Disorder. Retrieved from http://www. nctsnet.org/nctsn_assets/pdfs/pfa/2/PsyFirstAid.pdf

Daw, J. (2001). APA’s disaster response network: Help on the scene. Monitor, 32(10). Retrieved from http://www.apa.org/monitor/nov01/disaster.aspx

Department of Health and Human Services. (2014). Disaster behavioral health concept of operations. Washington, DC: U.S. Government Printing Office.

Disaster Mental Health Subcommittee. (2008). Disaster mental health recommendations: Report of the disaster mental health subcommittee of the National Biodefense Science Board. Retrieved from http://www.phe.gov/Preparedness/legal/boards/nprsb/Documents/nsbs-dmhreport-final.pdf

Ehlers, A., & Clark, D. M. (2006). Predictors of chronic posttraumatic stress disorder: Trauma memories and appraisals. In B. O. Rothbaum (Ed.), Pathological anxiety: Emotional processing in etiology and treatment (pp. 39–55). New York: Guilford Press.

Fisher, P. A. & Ball, T. J. (2003). Tribal participatory research: Mechanisms of a collaborative model. Amer- ican Journal of Community Psychology, 32(3.4), 207–216. doi:10.1023/B:AJCP.0000004742.39858.c5

Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., & Ursano, R. J. (2007). Five essential elements of immediate and mid-term mass trauma intervention: Empirical evidence. Psychiatry: Interpersonal & Biological Processes, 70(4), 283–315. doi:10.1521/psyc.2007.70.4.283

Institute of Medicine. (2003). Preparing for the psychological consequences of terrorism: A public health strategy. Washington, DC: National Academies Press.

International Federation of Red Cross and Red Crescent Societies. (2015). Reference centre for psychosocial support. Retrieved from http://www.ifrc.org/en/what-we-do/health/psychosocial-support/reference- centre-for-psychosocial-support/

Jacobs, G. A. (1995). The development of a national plan for disaster mental health. Professional Psychology: Research and Practice, 26, 543–549. doi:10.1037/0735-7028.26.6.543

Jacobs, G. (2007). The development and maturation of humanitarian psychology. American Psychologist, 62, 929–941. doi:10.1037/0003-066X.62.8.932

Jacobs, G. A., & Meyer, D. (2005). Psychological first aid: Clarifying the concept. In L. Barbanel & R. J. Sternberg (Eds.), Psychological interventions in times of crisis (pp. 57–71). New York: Springer Publishing.

1316 Journal of Clinical Psychology, December 2016

Knudsen, L., Hogsted, R., & Berliner, P. (1997). Psychological first aid and human support. Copenhagen Denmark: Danish Red Cross.

Krupnick, J. L., & Green, B. L. (2008). Psychoeducation to prevent PTSD: A paucity of evidence. Psychiatry: Interpersonal And Biological Processes, 71(4), 329–331. doi:10.1521/psyc.2008.71.4.329

Larson-Stoa, D. A. (2014). Perceived usefulness of psychological first aid training for oncology medical staff (Unpublished doctoral dissertation). The University of South Dakota, Vermillion, SD.

Levitt, D. H. (2001). Active listening and counselor self-efficacy: Emphasis on one micro-skill in beginning counselor training. The Clinical Supervisor, 20, 101–115. doi:10.1300/J001v20n02_09

Litz, B. T., Gray, M. J., Bryant, R. A., & Adler, A. B. (2002). Early intervention for trauma: Current status and future directions. Clinical Psychology: Science and Practice, 9(2), 112–134. doi:10.1093/clipsy/9.2.112

Maurer, R. E., & Tindall, J. H. (1983). Effect of postural congruence on client’s perception of counselor empathy. Journal of Counseling Psychology, 30(2), 158. doi:10.1037/0022-0167.30.2.158

Moffitt, M. (2014). Psychological first aid for peer community advisors (Unpublished master’s thesis). The University of South Dakota, Vermillion, SD.

National Biodefense Science Board. (2008). Disaster mental health recommendations: Report of the Disaster Mental Health Subcommittee of the National Biodefense Science Board. Retrieved from http://www.phe.gov/Preparedness/legal/boards/nprsb/Documents/nsbs-dmhreport-final.pdf

Pfefferbaum, B., Flynn, B. W., Schonfeld, D., Brown, L. M., Jacobs, G. A., Dodgen, D., . . . Lindley, D. (2012). The integration of mental and behavioral health into disaster preparedness, response, and recovery. Disaster Medicine and Public Health Preparedness, 6(1), 60–66. doi:10.1001/dmp.2012.1

Pfefferbaum, B., Houston, J. B., Reyes, G., Steinberg, A. M., Pynoos, R. S., Fairbank, J. A., . . . Maida, C. A. (2010). Building national capacity for child and family disaster mental health research. Professional Psychology Research and Practice, 41(1), 26–33. doi:10.1037/a0017056

Pfefferbaum, B., Schonfeld, D., Flynn, B. W., Norwood, A. E., Dodgen, D., Kaul, R. E., . . . Ruzek, J. I. (2012). The H1N1 Crisis: A case study of the integration of mental and behavioral health in public health crises. Disaster Medicine and Public Health Preparedness. 6(1), 67–71. doi:10.1001/dmp.2012.2

Reed, A. (2013). Community-based psychological first aid for emergency medical service providers (Unpub- lished master’s thesis). The University of South Dakota, Vermillion, SD.

Reyes, G. (2006). Psychological first aid: Principles of community-based psychosocial support. In G. Reyes & G. A. Jacobs (Eds.), Handbook of international disaster psychology (Vol. 2; pp. 1–12). Westport, CT: Praeger.

Schulenberg, S. E., Dellinger, K. A., Koestler, A. J., Kinnell, A. M. K., Swanson, D. A., Van Boening, M. V., & Forgette, R. G. (2008). Psychologists and hurricane katrina: natural disaster response through training, public education, and research. Training and Education in Professional Psychology, 2(2), 83–88. doi:10.1037/1931-3918.2.2.83

Schulenberg, S. E., Johnson, L. F., Drescher, C. F., Herzog, J. D., Willoughby, S. G., & Allen, M. (in press). Enhancing graduate student training through collaborative research: Working and learning together in re- sponse to the Gulf Oil Spill. Training and Education in Professional Psychology. doi:10.1037/tep0000062

Tait, K. L. (2011). Program evaluation of a cross-culturally modified psychological first aid training program for American Indian youth (Unpublished master’s thesis). The University of South Dakota, Vermillion, SD.

Tait, K. L. (2015). A community-based program evaluation of a cross-culturally adapted psychological first aid training program for native frontline service providers. (In progress doctoral dissertation). The University of South Dakota, Vermillion, SD.

U.S. Department of Health and Human Services. (2014). HHS disaster behavioral health concept of opera- tions. Washington, DC: U.S. Government Printing Office.

U.S. Department of Health and Human Services Office of Minority Health. (2015). Cultural competency curriculum for disaster preparedness and crisis response. Retrieved from https://cccdpcr.think- culturalhealth.hhs.gov.

Van Daele, T., Hermans, D., Van Audenhove, C., & Van den Bergh, O. (2012). Stress reduction through psychoeducation: A meta-analytic review. Health Education & Behavior, 39(4), 474–485. doi:10.1177/1090198111419202

Van Ommeren, M., Saxena, S., & Saraceno, B. (2005). Mental and social health during and after acute emergencies: Emerging consensus? Bulletin of the World Health Organization, 83(1), 71–75. doi:10.1590/S0042-96862005000100017

Training in CBPFA and DMH 1317

Weger, H. J., Bell, G. C., & Robinson, M. C. (2014). The relative effectiveness of active listening in initial interactions. International Journal of Listening, 28(1), 13–31. doi:10.1080/10904018.2013.813234

Wessely, S., Bryant, R. A., Greenberg, N., Earnshaw, M., Sharpley, J., & Hughes, J. H. (2008). Does psy- choeducation help prevent posttraumatic psychological distress? Psychiatry: Interpersonal and Biological Processes, 71(4), 287–302. doi:10.1521/psyc.2008.71.4.287

Young, B. H. (2006) The immediate response to disaster: Guidelines for adult psychological first aid. In E. C. Ritchie, P. J. Watson, & M. J. Friedman (Eds.), Interventions following mass violence and disasters: strategies for mental health practice (pp. 134–154). New York: Guilford Press.

Copyright of Journal of Clinical Psychology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.