Psychological First Aid generally provided by trained, licensed human services professionals. In this book, most of what would be seen as psychological first aid and initial crisis therapy is what we define as crisis intervention. To attend to the mental health needs of survivors of large-scale disasters, public health personnel are now being taught to use empirically grounded, best practice techniques called psychological first aid that are designed to provide immediate, palliative mental health assistance to survivors (Parker, Barnett, Everly, & Links, 2006). The National Institute of Mental Health (2002) defines psychological first aid as establishing the safety of the client, reducing stress-related symptoms, providing rest and physical recuperation, and linking clients to critical resources and social support systems. Raphael (1977) first coined the term psychological first aid in her discussion of crisis work with an Australian railway disaster. She described a variety of activities that provided caring support, empathic responding, concrete information and assistance, and reuniting of survivors with social support systems. Paramount in psychological first aid is attending to Maslow's needs hierarchy and taking care of survival needs first. Many counselors, social workers, and psychologists helped meet basic support needs of food, shelter, clothing, and other survival needs during the aftermath of Hurricane Katrina before they ever did any \"counseling.\" Controversy has arisen over who should get care, what kind of care should be provided, how it should be delivered, by whom, and under what circumstances immediately after a traumatic eventespecially after a mass disaster. Much of this controversy has arisen in regard to critical incident stress debriefing (Mitchell & Everly, 1995) and the notion that everybody exposed to a traumatic event needs to talk about it as quickly after the event as possible to stave off PTSD. A huge controversy has erupted over this treatment approach (to be discussed in Chapter 17), to the point that the prevailing approach for immediate disaster intervention is now psychological first aid that is nonintrusive and does not promote discussion of the traumatic event (Young, 2006). The notion is that not all people will need psychological help and the initial paratraumatic symptoms that most people manifest will self-eradicate in a short period of time (National Institute of Mental Health, 2002). The National Center for PTSD (U.S. Department of Veterans Affairs, 2011) has published a field manual, Psychological First Aid: Field Operations Guide, that offers an evidence-informed modular approach for assisting people in the immediate aftermath of disaster and terrorism, to reduce initial distress and to foster short- and long-term adaptive functioning. The manual states that it is for use by first responders, incident command systems, primary and emergency health care providers, school crisis response teams, faith-based organizations, disaster relief organizations, Community Emergency Response Teams, Medical Reserve Corps, and the Citizens Corps in diverse settings. This approach to psychological first aid includes eight core actions (U.S. Department of Veterans Affairs, 2011, p. 18): 1. Contact and Engagement Goal: To respond to contacts initiated by survivors, or to initiate contacts in a nonintrusive, compassionate, and helpful manner. 2. Safety and Comfort Goal: To enhance immediate and ongoing safety, and provide physical and emotional comfort. 3. Stabilization (if needed) Goal: To calm and orient emotionally overwhelmed or disoriented survivors. 4. Information Gathering: Current Needs and Concerns Goal: To identify immediate needs and concerns, gather additional information, and tailor psychological first aid interventions. 5. Practical Assistance Goal: To offer practical help to survivors in addressing immediate needs and concerns. 6. Connection with Social Supports Goal: To help establish brief or ongoing contacts with primary support persons and other sources of support, including family members, friends, and community helping resources. 7. Information on Coping Goal: To provide information about stress reactions and coping to reduce distress and promote adaptive functioning. 8. Linkage with Collaborative Services Goal: To link survivors with available services needed at the time or in the future. Psychological first aid provides the bare-bones basics of crisis intervention. It is designed to be palliative. It is not designed to cure or fix anything, but rather to provide nonintrusive physical and psychological support. Social workers would be very comfortable with this model because a great deal of it resembles social work services. If we consider the first four tasks (Predispositioning, Problem Definition, Providing Support, Safety) of the model of crisis intervention you will meet in Chapter 3 as being close to what is meant by psychological first aid, then psychological first aid is clearly necessary. Whether it is also sufficient in providing immediate crisis intervention services is another matter. Certainly not all people need immediate psychological assistance, nor should they have it forced on them, but the high adrenal moments of a lot of crisis intervention make us believe that something more than psychological first aid is needed to defuse emotional volatility, de-escalate life-threatening behavior, and reframe and cool the insane, irrational, hot cognitions that typify many crisis situations. The ACT Model The ACT model proposed by Roberts (2005) is an acronym: Assessment of the presenting problem, including emergency psychiatric and other medical needs and trauma assessment Connecting clients to support systems Traumatic reactions and posttraumatic stress disorders The model has seven generally linear stages: crisis assessment, establishing rapport, identifying major problems, dealing with feelings, generating and exploring alternatives, developing plans, and providing follow-up (pp. 104-106). This model has been designed to deal with the onset of a traumatic event and, probably even more appropriately, with what Kleespies (2009) calls behavioral emergencies. Playbook/Game Plan Model As you will see in detail in this book, specially trained police officers called Crisis Intervention Team (CIT) officers are playing a larger and larger role as first line responders to the mentally ill and other emotional distraught individuals who come to the attention of law enforcement. Major Sam Cochran (retired former coordinator of the Memphis Police Department CIT) has developed a crisis intervention model based on coaching, which has a great deal of face validity given that most police officers have engaged in some kind of team sport so a playbook/game plan makes perfect sense and there is ready acceptance in trying to learn it. It is specifically tailored to diffuse and de-escalate angry, distraught, out-of-control potentially lethal individuals that are in the middle of a crisis and who come to police attention through 911 \"mental illness\" calls (Kirchberg, James, Cochran, & Dupont, 2013). It trains first line responders through a game plan strategy that teaches them how to assess individuals' verbal and nonverbal behavior and develop a game plan that uses a combination of verbal de-escalation techniques (plays) to defuse individuals who may be manifesting lethal behavior toward themselves or others. We will visit some of these \"plays\" in Chapter 4, The Tools of the Trade. Eclectic/Integrated Crisis Intervention Theory In current psychotherapeutic theory the term \"eclectic\" has taken on a somewhat negative connotation as a sort of \"anything goes, try and see if it works\" approach and has generally been replaced with the term \"integrated\Characteristics of Effective Crisis Workers LO? Almost everyone can be taught the techniques in this book and with practice can employ them with some degree of skill. However, the crisis worker who can take intervention to the performing art level is more than the sum of techniques read about and skills mastered. A master of this art is going to have not only technical skill and theoretical knowledge but also a good deal of the following characteristics