A feasibility study of psychological first aid as a supportive intervention among police officers exposed to traumatic events

Universal mental health training for frontline professionals (UMHT)'s feasibility analysis

Background

Universal Mental Health Training for Frontline Professionals (UMHT) is an educational programme developed and piloted in Ukraine in 2021-2023. The UMHT trains frontline professionals (FLPs) to interact with, support, and refer individuals with mental health conditions for professional help.

Methods

To assess the UMHT feasibility in four focus areas (programme's demand, acceptability, adaptability, and extendability), we used statistics on the actual use of the programme, as well as data from satisfaction and usability surveying of 144 programme deliverers and 714 trained frontline professionals. A combination of Kruskal-Wallis and Post Hoc Dunn tests was used to identify statistically significant intergroup differences in the UMHT usability.

Results

Programme's demand increased through years of implementation (2021, 2022, 2023) in terms of the numbers of training events (27, 35, 90), trained frontline professionals (596, 779, 1548), involved donors and supporters (1, 4, 9) and implementers (2, 10, 18). The UMHT acceptability as satisfaction with the programme content and delivery, measured out of 5, is 4.81 (SD=0.291) for the UMHT trainers and 4.78(SD=0.434) for trained FLPs. The UMHT preparedness to use trained skills after participation in the training events, on the same scale, is 4.57 (SD=0.438) for the UMHT trainers and 4.46 (SD=0.650) for trained FLPs. The highest levels of usability of all UMHT skills on a scale from 0 to 1 were found for educators (0.68 [SD=0.118]), police officers (0.67 [SD=0.098]), and social workers (0.66 [SD=0.113]).

Conclusions

The UMHT offers a universal frame of interaction with people with mental health conditions for frontline professionals. Assessment of the UMHT feasibility shows the programme's potential for further development and implementation. Programme trainers as its deliverers and frontline professionals as its recipients report high satisfaction with training content and delivery as well as preparedness to apply gained knowledge and skills in practice.

The Effectiveness and Implementation of Psychological First Aid as a Therapeutic Intervention After Trauma: An Integrative Review

Psychological First Aid (PFA) is known to be an initial early intervention following traumatic exposure, yet little is known about its optimal implementation and effectiveness. This review aims to examine the evidence for the effectiveness of PFA interventions and how PFA interventions have been designed, implemented, and experienced. MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, PsychINFO, Embase, Web of Science, PILOTS, and China National Knowledge Infrastructure (in Chinese) databases were searched. Twenty studies from 4,735 records were included and quality rated, followed by an integrative synthesis of quantitative and qualitative evidence. PFA intervention following trauma exposure shows a positive effect for reducing anxiety and facilitating adaptive functioning in the immediate and intermediate term, yet the evidence for reducing Post-traumatic stress disorder/depressive symptoms is less compelling. Furthermore, commonalities in the components and techniques across different PFA approaches identified tend to align with four of Hobfoll's five essential elements: safety, calm, efficacy, and connectedness (as reflected among 7/11 PFA protocols), whereas the "hope" element was less developed. These commonalities include active listening, relaxation/stabilization, problem-solving/practical assistance, and social connection/referral. Intensive techniques such as cognitive reconstruction have also been incorporated, intensifying PFA delivery. The substantial variation observed in PFA format, timing, and duration, coupled with inadequate documentation of fidelity of implementation and adaptation, further constrains the ability to inform best practices for PFA. This is concerning for lay frontline providers, vital in early trauma response, who report implementation challenges despite valuing PFA as a time-sensitive, supportive, and practical approach.

Assessment of Knowledge and Practice Regarding Psychological First Aid Among Secondary School Students in Erbil City

BACKGROUND AND AIM

Secondary school students in Erbil City face various stressors and challenges that may impact their mental well-being. This study aimed to assess the knowledge and practical application of psychological first aid (PFA) among these students.

METHOD

This cross-sectional study was conducted from June 10th to June 25th, 2024, in six high schools in Erbil City, Iraq. Participants were selected using a purposive sampling method. Data were collected using two self-structured questionnaires, which included demographic information, a knowledge assessment, and a practical application assessment of PFA. Statistical analysis was performed using SPSS version 28 (IBM Corp., Armonk, NY). Frequency and percentage were used for categorical variables, and mean and standard deviation for quantitative variables. Ordinal regression analyses were conducted to assess the relationships between demographic variables and PFA knowledge and practice. Spearman correlation was used to determine the relationship between knowledge and practice. A p-value of less than 0.05 was considered statistically significant.

RESULTS

A total of 412 students were enrolled in the study. The mean scores for knowledge and practice indicated fair levels, with mean scores of 7.66 ± 1.34 for knowledge and 7.01 ± 1.38 for practice. The analysis showed that 11 students (2.7%) had poor knowledge, 161 students (39.1%) had fair knowledge, and 240 students (58.2%) had good knowledge of PFA. In terms of practice, 15 students (3.6%) exhibited poor practice, 237 students (57.6%) demonstrated fair practice, and 160 students (38.8%) showed good practice of PFA. Significant associations were found between several demographic variables and PFA knowledge and practice. Males had higher knowledge scores (estimate = 1.22, 95% CI: 0.20, 2.24, P = 0.02), as did students from families with insufficient monthly income (estimate = 0.91, 95% CI: 0.10, 1.72, P = 0.03) and those residing in urban areas (estimate = 0.83, 95% CI: 0.17, 1.50, P = 0.01). For practice, the occupation of the father was significant, with unemployed fathers associated with lower practice scores (estimate = -1.08, 95% CI: -2.06, -0.09, P = 0.03).

CONCLUSIONS

The study showed that students had fair knowledge and practice of PFA. To improve these scores, it is recommended that nurses and educators develop targeted interventions and training programs. These should focus on enhancing students' understanding and practical skills in PFA, ensuring they are better equipped to handle psychological distress among their peers.

Feasibility and acceptability of a culturally adapted psychological first aid training intervention (Preparing Me) to support the mental health and well-being of front-line healthcare workers in China: a feasibility randomized controlled trial

Background: Psychological first aid (PFA) training helps to prepare healthcare workers (HCWs) to manage trauma and stress during healthcare emergencies, yet evidence regarding its effectiveness and implementation is lacking.Method: A two-arm feasibility randomized controlled trial design was conducted in a Chinese tertiary hospital. Participants were randomly allocated to receive either a culturally adapted PFA training (the intervention arm) or psychoeducation (the control arm). Feasibility indicators and selected outcomes were collected.Results: In total, 215 workers who expressed an interest in participating in the trial were screened for eligibility, resulting in 96 eligible participants being randomly allocated to the intervention arm (n = 48) and control arm (n = 48). There was a higher retention rate for the face-to-face PFA training session than for the four online group PFA sessions. Participants rated the PFA training as very helpful (86%), with a satisfaction rate of 74.25%, and 47% reported being able to apply their PFA skills in responding to public health emergencies or providing front-line clinical care. Positive outcome changes were observed in PFA knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth. Their scores on depression, anxiety, stress, and burnout measures all declined. Most of these changes were sustained over 3 months (p < .05). Repeated measures analysis of variance found statistically significant interaction effects on depression (F2,232 = 2.874, p = .046, η p 2  = .031) and burnout (F2,211 = 3.729, p = .018, η p 2  = .037), indicating a greater reduction in symptoms of depression and burnout with PFA compared to psychoeducation training.Conclusion: This culturally adapted PFA training intervention was highly acceptable among Chinese HCWs and was feasible in a front-line care setting. Preliminary findings indicated positive changes for the PFA training intervention on knowledge, skills, attitudes, resilience, self-efficacy, compassion satisfaction, and post-traumatic growth, especially a reduction of depression and burnout. Further modifications are recommended and a fully powered evaluation of PFA training is warranted.

Exploring the needs of healthcare workers receiving psychological first aid during the COVID19 pandemic

BACKGROUND

Healthcare workers (HCW; e.g., nurses, social workers) work in stressful conditions, a situation that has been further exacerbated by the COVID-19 pandemic. A review of the supportive role of Psychological first aid (PFA) suggested that it can protect HCW from psychological distress. Despite the growing interest of PFA among public health organizations, there is a dearth of literature on its potential impact for the psychological well-being of HCW and its implementation within organizations.

OBJECTIVE

This study aimed to evaluate whether PFA met the psychological needs of HCW in Montreal, Quebec.

METHODS

A sample of 15 HCW who received PFA by a peer within their organization were recruited to participate in semi-structured interviews. Qualitative research using thematic analysis was conducted.

RESULTS

Five themes were identified: 1) PFA satisfied participants' psychosocial needs; 2) PFA provided by peers allowed participants to feel understood and supported; 3) High availability and multiple modalities facilitated PFA access; 4) Occupational and organizational cultures hindered PFA access; and 5) Recommendations to promote the use of the PFA service.

CONCLUSION

Results describe four psychosocial needs met by the PFA intervention: to have resources/strategies, to be validated, to obtain a better understanding of the psychological reactions they were experiencing, and to be guided and supported in their difficulties at work. Overall, these findings illustrate how PFA goes beyond the reduction of distress symptoms in the aftermath of a potentially traumatic event. The relevance to further the assessment of PFA's positive effects on psychological adaptation and/or recovery is also highlighted.