Caring for Those Who Work
with the Dead:
Adapting a Psychological First AidIntervention to Your Setting

Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University

Caring for Those Who Work
with the Dead:
Adapting a Psychological First Aid Intervention
to Your Setting
Center for the Study of Traumatic Stress
Department of Psychiatry
Uniformed Services University of the Health Sciences
4301 Jones Bridge Road
Bethesda, MD 20814-4799
www.CSTSonline.org

Caring for Those Who Work with the Dead:
Adapting a Psychological First Aid Intervention to Your Setting
Working with the dead, especially following mass-casualty events is one of the most stressful aspects ofdisaster work. In order to deal with this stress, an innovative early intervention was developed that uses
the principles of Psychological First Aid (PFA; Hobfoll et al., 2007; NCTSN, 2006). The intervention isdesigned to improve stress management and coping skills, and build resilience in personnel who workwith human remains. The intervention can be adapted for civilian and military (e.g., TEAM, Troop
Education for Army Morale, see Biggs et al., 2016) populations, including medical personnel, police,
firefighters, disaster workers, and mortuary personnel. The intervention can include parallel workshops
for spouses.
The intervention is based on the five evidence-informed principles of PFA:
1. physical and psychological safety
2. calming
3. connecting
4. self-efficacy
5. hope/optimism
Goals include:• recognize stress in oneself and others• increase adaptive coping• identify when one is in need of care
• promote health care-seeking• overcome obstacles to obtaining health care
• improve communication skills• build supportive relationships• address health risk behaviors (e.g., increased alcohol/tobacco use)
The intervention has traditionally been conducted in person in an interactive group environment,
however, it can be adapted to an online format using remote video conferencing and sharing materials
electronically when individuals are not able to meet in person. The intervention is delivered throughsessions provided at specified intervals (e.g., once a week) and informational handouts. Optionally, theintervention content can be posted on a dedicated website for 24/7 access. Workshops begin with
rapport building followed by active group-based discussions and exercises. Groups can include male andfemale participants and ensure continuity with cultural issues. Workshops include role-play, practice
exercises, and relaxation exercises used to model and reinforce PFA concepts. Facilitators may selectillustrative video clips to augment the materials. Remote delivery follows the same PFA concepts withactivities adapted to an online format.
Suggested session structure:• Orientation: Welcome and introduction to the study• Workshop 1: PFA introduction, physical and psychological safetyo Understanding stressful events and the stress response, triggers, and reminders
o Interaction between thoughts, feelings, and behaviors• Workshop 2: PFA calming and connectingo Teach calming exercises••o Guidance on giving and receiving support (role-play)
Workshop 3: PFA self- and collective-efficacy, hope/optimismo Learning to set realistic personal goalso Problem solving technique exercises
Workshop 4: Review of all PFA principles

Enclosed materials:• READ ME FIRST - Adapting a Psychological First Aid Intervention to Your Setting [this document]• Intervention materials [folder]o Intervention Handbook
o Orientation [folder]▪ OR - Handout - Five Principles of Psychological First Aid▪ OR - Handout - Resources List
▪ OR - Roadmap for Facilitators▪ OR-WS4 - Supporting Material - Five Principles of PFA Postero Workshop 1 [folder]▪ WS1 - Exercise - Thoughts, Feelings, Actions▪ WS1 - Handout - Alcohol, Medication and Drug Use After Difficult Events▪ WS1 - Handout - Common Reactions When Dealing with Difficult Events▪ WS1 - Roadmap for Facilitators▪ WS1 - Supporting Material - Potential Concerns to Address in Workshop 1▪ WS1, WS3, WS4 - Supporting Material - Thoughts, Feelings, Actions Postero Workshop 2 [folder]▪ WS2 - Exercise - Types of Support▪ WS2 - Handout - Calming Techniques▪ WS2 - Handout - Connecting with Others-Giving Social Support▪ WS2 - Roadmap for Facilitators▪ WS2 - Supporting Material - Calming Info from PFA Field Op Guide▪ WS2 - Supporting Material - Calming Info from SPR Field Op Guideo Workshop 3 [folder]▪ WS3 - Handout - Helping Your Buddy Solve Problems▪ WS3 - Handout - Problem Solving▪ WS3 - Roadmap for Facilitators▪ WS3 - Supporting Material - Promoting Self-Efficacy & Hope-Optimism
o Workshop 4 [folder]▪ WS4 - Exercise - Role-Play Scenario▪ WS4 - Handout - Following Medical Recommendations for Health▪ WS4 - Handout - Helpful Coping Strategies▪ WS4 - Handout - Take Home Points▪ WS4 - Handout - The Bottom Line
▪ WS4 - Roadmap for Facilitators
Suggested approach to reviewing the intervention materials:• Step 1: Read the Intervention Handbook. This is the overall guide for conducting theintervention. Consider how the intervention can be adapted to your specific setting and inperson vs. online.

•••Step 2: Read the handouts, exercises, and supporting materials. These documents address
specific activities and content in the intervention sessions.
Step 3: Review the Roadmaps for Facilitators. These are the quick reference documents to keep
facilitators on track to maintain the structure and timing of the intervention sessions.
Step 4: Adapt the materials to your setting (e.g., your population and in person vs. online). You
are welcome to adapt and use any of the documents in the Intervention Materials folder.

Key Supporting Literature• Benedek, D. M., & Fullerton, C. S. (2007). Translating five essential elements into programs andpractice. Psychiatry, 70, 345-349.
• Biggs, Q. M., Fullerton, C. S., McCarroll, J. E., Liu, X., Wang, L., Dacuyan, N. M., … Ursano, R. J.
(2016). Early intervention for post-traumatic stress disorder, depression, and quality of life inmortuary affairs soldiers post-deployment. Military Medicine, 181(11/12), e1553-1560.
• Hobfoll, S. E., et al. (2007). Five essential elements of immediate and mid-term mass trauma
intervention: Empirical evidence. Psychiatry, 70, 283-315.
• National Center for PTSD and National Child Traumatic Stress Network, Skills for Psychological
Recovery: Field Operations Guide, 2nd Edition. August, 2007. Available at: www.nctsn.org.
• National Child Traumatic Stress Network, Psychological First Aid: Field Operations Guide, 2ndEdition. July, 2006. Available at: www.nctsn.org.
• Ursano, R. J., McCarroll, J. E., & Fullerton, C. S. (2003). Traumatic death in terrorism anddisasters: the effects on posttraumatic stress and behavior. In R. J. Ursano, C. S. Fullerton, & A.
E. Norwood (Eds.), Terrorism and disaster: individual and community mental health interventions(pp. 308-332). Cambridge, UK: Cambridge University Press.
If you have any questions about the intervention or enclosed materials, please contact the Center for
the Study of Traumatic Stress at email: cstsinfo@usuhs.edu