To identify immediate needs and concerns, gather additional information, and tailor Psychological First Aid interventions.
You should be flexible in providing Psychological First Aid, and should adapt interventions for specific individuals, and their identified needs and concerns. Gather enough information so that you can tailor and prioritize your interventions to meet these needs. Gathering and clarifying information begins immediately after contact and continues throughout Psychological First Aid.
Remember that in most Psychological First Aid settings, your ability to gather information will be limited by time, survivors’ needs and priorities, and other factors. Although a formal assessment is not appropriate, you may ask about:
The form, Survivor Current Needs (Appendix D), may be helpful in documenting the basic information gathered from survivors. Likewise, the Psychological First Aid Provider Worksheet (Appendix D) may be useful in documenting services provided. These forms are designed for use within an incident command system for evaluation purposes, and where there are proper safeguards for confidentiality.
It may be especially useful for you to ask some questions to clarify the following:
Survivors who experienced direct life-threat to self or loved ones, injury to self, or those who witnessed injury or death are at increased risk for more severe and prolonged distress. Those who felt extremely terrified and helpless may also have more difficulty in recovering. For information about the survivor’s experiences, you may ask:
Provider Alert: In clarifying disaster-related traumatic experiences, avoid asking for in-depth descriptions that may provoke additional distress. Follow the survivor’s lead in discussing what happened. Don’t press survivors to disclose details of any trauma or loss. On the other hand, if they are anxious to talk about their experiences, politely and respectfully tell them that what would be most helpful now is to get some basic information so that you can help with their current needs, and plan for future care. Let them know that the opportunity to discuss their experiences in a proper setting can be arranged for the future.
The death of loved ones under traumatic circumstances is devastating, and over time can greatly complicate the grieving process. Ask about the death of loved ones with a question like:
For those who experienced the death of a loved one, provide emotional comfort, information about coping, social support, and acute grief, and offer a follow-up meeting.
Survivors may be highly concerned about immediate and ongoing danger. You may ask questions like:
For those with these concerns, help them obtain information about safety and protection.
Separation from loved ones and concern about their safety is an additional source of distress. If not addressed earlier, get information with questions like these:
For survivors with these concerns, provide practical assistance in connecting them with available information sources and registries that can help locate and reunite family members. See Safety and Comfort and Connection with Social Supports.
Pre-existing medical or mental heath conditions and need for medications are additional sources of post-disaster distress. Those with a history of psychological problems may experience a worsening of these problems, as well as more severe and prolonged postdisaster reactions. Give a high priority to immediate medical and mental health concerns. Ask questions like:
For those with medical or mental health conditions, provide practical assistance in obtaining medical or psychological care and medication.
If survivors have extensive material losses and post-disaster adversities, their recovery may be complicated with feelings of depression, demoralization, and hopelessness. For information about such loss, ask questions like:
For those with losses, provide emotional comfort, practical assistance to help link them with available resources, and information about coping and social support.
Extreme negative emotions can be very painful, difficult, and challenging, especially for children and adolescents. Children and adults may be ashamed to discuss these feelings. Listen carefully for signs of guilt or shame in their comments. To further clarify, you may say:
For those experiencing guilt or shame, provide emotional comfort and information about coping with these emotions. This can be found in the section, Information on Coping.
It is a priority to get a sense of whether an individual is having thoughts about causing harm to self or others. To explore these thoughts and feelings, ask questions like:
For those with these thoughts, get medical or mental health assistance immediately. If the survivor is at immediate risk of hurting themselves or others, stay with him/her until appropriate personnel arrive on the scene and assume management of the survivor.
Family, friends, and community support can greatly enhance the ability to cope with distress and post-disaster adversity. Ask about social support as follows:
For those lacking adequate social support, help them connect with available resources and services, provide information about coping and social support, and offer a follow-up meeting.
Provider Alert: In clarifying prior history of substance use, prior trauma and loss, and prior mental health problems, you should be sensitive to the immediate needs of the survivor, avoid asking for a history if not appropriate, and avoid asking for in-depth description. Give clear reasons for asking (for example, “Sometimes events like this can remind individuals of previous bad times . . .” “Sometimes individuals who use alcohol to cope with stress will notice an increase in drinking following an event such as this . . .”)
Exposure to trauma and post-disaster adversities can increase substance use, cause relapse of past substance abuse, or lead to new abuse. Get information about this by asking:
For those with potential substance use problems, provide information about coping and social support, link to appropriate services, and offer a follow-up meeting. For those with withdrawal symptoms, seek medical referral.
Those with a history of exposure to trauma or death of loved ones may experience more severe and prolonged post-disaster reactions and a renewal of prior trauma and grief reactions. For information about prior trauma, ask:
For those with prior exposure and/or loss, provide information about post-disaster and grief reactions, information about coping and social support, and offer a follow-up meeting.
Survivors can be very upset when the disaster or its aftermath interferes with upcoming special events, including important developmental activities (for example, birthdays, graduation, start of school or college, marriage, vacation). For information about this, ask:
For those with developmental concerns, provide information about coping and assist with strategies for practical help.
It is also useful to ask a general open-ended question to make sure that you have not missed any important information.
If the survivor identifies multiple concerns, summarize these and help to identify which issues are most pressing. Work with the survivor to prioritize the order in which concerns should be addressed.