This work was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA),

US Department of Health and Human Services (HHS).

National Child Traumatic Stress Network

National Center for PTSD

®

Psychological First Aid for Schools

Field Operations Guide

Psychological First Aid 

for Schools 

Field Operations Guide

2nd Edition

National Child Traumatic Stress Network

National Center for PTSD

This work was funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), US 

Department of Health and Human Services (HHS). The views, opinions, and content are those of the authors and 

do not necessarily reflect those of SAMHSA or HHS.

®
National Child Traumatic Stress Network 

Established by Congress in 2000, the National Child Traumatic Stress Network (NCTSN) brings a singular and 

comprehensive focus to childhood trauma. NCTSN’s collaboration of frontline providers, researchers, and families 

is committed to raising the standard of care while increasing access to services. Combining knowledge of child 

development, expertise in the full range of child traumatic experiences, and dedication to evidence-based practices, 

the NCTSN changes the course of children’s lives by changing the course of their care.

National Center for PTSD 

The VA’s National Center for PTSD is a world leader in research and education programs focusing on PTSD and 

other psychological and medical consequences of traumatic stress. Mandated by Congress in 1989, the Center is a 

consortium of seven academic centers of excellence providing research, education, and consultation in the field of 

traumatic stress. 

The views, opinions, and content are those of the authors and do not necessarily reflect those of SAMHSA or HHS. 

Copyright © 2009 Brymer, Escudero, Jacobs, Kronenberg, Macy, Mock, Payne, Pynoos, Taylor, and Vogel. All rights 

reserved. You are welcome to copy or redistribute this material, in print form or electronically, provided that the text 

is not modified, the authors are cited in any use, and no fee is charged for copies of this publication. Unauthorized 

commercial publication or exploitation of this material is strictly prohibited. This guide was adapted, with permission, 

by the authors (Melissa Brymer, Anne Jacobs, Christopher Layne, Robert Pynoos, Josef Ruzek, Alan Steinberg, 

Eric Vernberg, and Patricia Watson), from the National Child Traumatic Stress Network and the National Center 

for PTSD Psychological First Aid Field Operations Guide (© 2006). Anyone seeking to adapt the NCTSN/NCPTSD 

Psychological First Aid guides or related materials, should first contact Melissa Brymer, Ph.D., Psy.D., at mbrymer@

mednet.ucla.edu
Acknowledgments

The Psychological First Aid Field Operations Guide was originally developed and revised by the National 

Child Traumatic Stress Network and the National Center for PTSD. The principal authors of these editions (in 

alphabetical order) include Melissa Brymer, Anne Jacobs, Christopher Layne, Robert Pynoos, Josef Ruzek, 

Alan Steinberg, Eric Vernberg, and Patricia Watson. 

The Psychological First Aid for Schools Field Operations Guide was adapted by a working group of the 

National Child Traumatic Stress Network, chaired by Melissa Brymer, PhD., Psy.D. The primary contributors 

to this adaptation (in alphabetical order) included: Melissa Brymer, Pia Escudero, Anne Jacobs, Mindy 

Kronenberg, Robert Macy, Lou Ann Mock, Linda Payne, Robert Pynoos, Matt Taylor, and Juliet Vogel.

Other contributors include Robert Abramovitz, Brian Allen, DeAnna Griffin, Malcolm Gordon, Robin Gurwitch, 

Joshua Kaufman, Joy Osofsky, Gilbert Reyes, Caryll Sprague, Rick van den Pol, Patricia Watson, Cynthia 

Whitham, and Marleen Wong.

Carolyn Wendt and Margaret Bonanno provided editorial and graphic support throughout the development of 

Psychological First Aid for Schools. 

Special acknowledgment is given to Dr. Bob Seaver for the illustrations provided throughout this publication.

For citation: Brymer M., Taylor M., Escudero P., Jacobs A., Kronenberg M., Macy R., Mock L., Payne L., 

Pynoos R., & Vogel J. Psychological first aid for schools: Field operations guide, 2nd Edition. (2012). Los 

Angeles: National Child Traumatic Stress Network. 

Psychological First Aid for Schools Field Operations Guide 1

Table of Contents

Introduction and Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 

Preparing to Deliver Psychological First Aid for Schools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Psychological First Aid Core Actions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

1. Contact and Engagement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 

2. Safety and Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

3. Stabilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

4. Information Gathering: Current Needs and Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

5. Practical Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

6. Connection with Social Supports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 

7. Information on Coping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57

8. Linkage with Collaborative Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Appendices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 

Psychological First Aid for Schools Field Operations Guide 3

Introduction 

and Overview

The field of school safety and emergency management has evolved significantly over the past decade. Tragically, 

acts of violence, natural disasters, and terrorist attacks have taught us many lessons. We also know that other 

types of emergencies can impact schools, including medical emergencies, transportation accidents, sports injuries, 

peer victimization, public health emergencies, and the sudden death of a member of the school community. We 

now recognize the need for school emergency management plans that are up-to-date and take an “all-hazards” 

approach with clear communication channels and procedures that effectively reunite parents and caregivers with 

students. We have also learned that preparing school administrators, teachers, and school partnering agencies 

before a critical event is crucial for effective response, the value of ongoing training and emergency exercises, and 

that having intervention models that address the public health, mental health, and psychosocial needs of students 

and staff is essential to a safe school environment and the resumption of learning.

What Is Psychological First Aid for Schools?

Psychological First Aid for Schools (PFA-S) is an evidence-informed intervention model to assist students, 

families, school personnel, and school partners in the immediate aftermath of an emergency. PFA-S is 

designed to reduce the initial distress caused by emergencies, and to foster short- and long-term adaptive 

functioning and coping. The principles and techniques of PFA-S meet five basic standards. They are:

1. Consistent with research evidence on risk and resilience following trauma 

2. Respectful of and consistent with the school administration of the academic setting, school culture, and 

the behavior (code of conduct) of students

3. Applicable and practical in field settings 

4. Appropriate for developmental levels across the lifespan 

5. Delivered in a culturally-informed and flexible manner 

PFA-S assumes that students and staff members may experience a broad range of early reactions (e.g., 

physical, cognitive, psychological, behavioral, spiritual) following an emergency. Some of these reactions can 

cause distress that interferes with adaptive coping, but support from informed, compassionate, and caring 

professionals can help students and staff members recover from these reactions. PFA-S has the potential to 

mitigate the development of severe mental health problems or long-term difficulties in recovery by identifying 

individuals who may need additional services and linking them to such services as needed.
National Child Traumatic Stress Network National Center for PTSD 4

Introduction and Overview

Why Provide Psychological First Aid in Schools?

1. Schools are typically the first service agencies to resume operations after a disaster/emergency 

and can become a primary source of community support during and after the incident. Schools are 

where children spend a majority of their day and where they receive substantial support from teachers 

and other staff members, and some schools are the primary setting for psychosocial support and child 

mental health services. In many ways, teachers and staff are the “first and last responders” for children in 

an emergency. Students look to their teachers and to school administrators for leadership and guidance, 

while parents expect and demand that school personnel respond competently and appropriately in such 

situations. In a school-wide emergency, children’s “everyday” school personnel can provide much of the 

intervention needed to stabilize the situation. 

2. Preparing for emergencies is critical for all school staff. While school personnel should be prepared 

to respond to high impact/low frequency events such as school shootings, large-scale natural disasters, 

and public health emergencies, they must also be prepared to address smaller scale events that schools 

face each day. Emergency events that do not typically garner national headlines, but do disrupt the 

learning environment, include suicides, transportation accidents, peer victimization, community violence, 

staff or student deaths, injuries on the playground, and infectious diseases. Preparedness involves (1) 

having a comprehensive response and recovery plan, (2) training staff to address the immediate, midterm, and long-term needs of students and staff members, (3) frequent practicing of the comprehensive 

response and recovery plan, and (4) evaluation and redesign of plan components that no longer meet 

operational standards for the school. When people are trained in emergency protocols (including 

students, when appropriate) and have knowledge of techniques to reduce anxiety and establish calm, 

they are better able to handle the emergency and be of help to the people affected. 

3. Emergencies affect students’ academic and social achievement. Having an effective school 

psychosocial and mental health recovery plan in place, which includes interventions such as PFA-S, 

is critical when emergencies threaten to significantly disrupt the learning environment. Such events 

frequently adversely affected students’ academic and social performance. Counseling services and 

programs addressing students’ developmental needs have traditionally been viewed as supplementary 

services, “add-ons” to the academic mission of the school. However, when students’ psychosocial 

and mental health needs are addressed in a developmental, systematic, and comprehensive manner, 

students achieve at a higher level.

4. Trauma-related distress can have a long-term impact if left untreated. Unaddressed mental health 

needs, including those from exposure to violence and other potentially traumatic events, increase dropout 

rates, lower academic achievement, disrupt peer relationships, and impact overall well-being. Thus, 

school mental health initiatives such as PFA-S are not only important for the well-being of children and 

school personnel, but are also critical for the central educational mission of schools.

5. Brief interventions can produce positive results that last. A growing body of research shows that 

there are brief, effective interventions that have a long-lasting positive influence on students’ and staff 

members’ trauma-related distress. PFA-S draws from the best available evidence identifying factors that 

promote improved student and staff functioning after disasters and other emergencies. 
Psychological First Aid for Schools Field Operations Guide 5

Introduction and Overview

When Should PFA-S Be Used?

PFA-S is most effective immediately following the incident (e.g., from one hour to a couple of weeks after 

an event). In some circumstances, assuming the safety of students and staff has been ensured, PFA-S can 

be initiated while an incident is still occurring, such as in sheltered-in-place or lockdown situations.

Who Is PFA-S for?

PFA-S is intended for students, school personnel, and their families who have been exposed to a disaster 

or other emergency. Whether an emergency occurs on school grounds or in the community at large, 

schools serve as a central location for professionals to assist children, families, school personnel, and 

school partners. 

Who Delivers PFA-S?

Because it is not psychotherapy, an extended “treatment,” or a stand-alone mental health intervention, 

any staff member, regardless of whether he/she has had mental health training, can deliver aspects of 

PFA-S and can contribute to the school recovery by functioning within the PFA framework. Similarly, 

trained members of community emergency response agencies and mental health professionals may 

provide PFA-S. During and after an emergency, teachers and other staff are a critical link in promoting 

resilience, in recognizing the signs of traumatic stress, and in helping students and their families regain a 

sense of normalcy. For more guidance on how to deliver PFA-S based on your role in the school (principal/

administrator, teacher, health-related professional, support staff), see Appendix A.

What Are the Basic Objectives of the PFA-S Provider?

✔	 To establish a positive connection with students and staff members in a non-intrusive, compassionate 

manner

✔	 To enhance immediate and ongoing safety and provide physical and emotional comfort

✔	 To calm and orient emotionally overwhelmed or distraught students and staff

✔	 To help students and staff members identify their immediate needs and concerns

✔	 To offer practical assistance and information to help students and staff members address their 

immediate needs and concerns

✔	 To connect students and staff members as soon as possible to social support networks, including 

family members, friends, coaches, and other school or community groups

✔	 To empower students, staff, and families to take an active role in their recovery, by acknowledging their 

coping efforts and strengths, and supporting adaptive coping

✔	 To make clear your availability and (when appropriate) link the student and staff to other relevant 

school or community resources such as school counseling services, peer support programs, 

afterschool activities, tutoring, primary care physicians, local recovery systems, mental health services, 

employee assistance programs, public-sector services, and other relief organizations
National Child Traumatic Stress Network National Center for PTSD 6

Introduction and Overview

How Does PFA-S Fit into Existing School Emergency Plans?

The Emergency Management Cycle in Schools and PFA-S

Whether conducting school vulnerability assessments or adopting an intervention such as PFA-S, schools 

organize safety initiatives based on the four-part emergency management cycle. The four-part emergency 

management cycle includes:

Prevention/mitigation 

phase

Schools both assess and address building security, the safety and integrity of 

facilities, the culture/climate of schools, and the need for secondary prevention 

mental health programs.

Preparedness phase Schools facilitate a rapid, coordinated, and effective response in the event of an 

actual emergency by taking the following steps:

• Refining emergency management plans and emergency procedures in 

collaboration with key members of the emergency response community (fire 

and police departments, disaster services, and public health)

• Periodically reviewing and reinforcing emergency plans and procedures with 

staff

• Defining building-level and district-level Incident Command System (ICS) 

structures

• Implementing staff trainings on various topics, including parent-student 

reunification and PFA-S

• Conducting emergency simulations in collaboration with outside agencies

• Developing and regularly updating a list of providers trained in PFA-S

Response phase Action is taken to effectively contain and resolve an emergency and to decrease 

the potential for such an emergency to escalate. During this phase, the school 

executes the emergency management plan and emergency procedures and 

initiates preliminary activation of the PFA-S teams. Although the response phase 

may have a clear ending point for emergency response agencies, the transition 

into the fourth phase, recovery, may be less distinct.

Recovery phase Steps are taken to assist students, staff, and their families in the recovery 

process and to restore educational operations in schools. This phase involves 

conducting damage assessments and making repairs, implementing business 

continuity plans, and addressing grief and stress reactions. The very early 

stages of the recovery phase (hours or days after an emergency) are the most 

appropriate time to deliver PFA-S. Depending on the nature of the incident, 

recovery may be a long-term process. PFA-S is an acute intervention; for 

information about longer-term interventions appropriate for students and families 

who have lingering or severe symptoms, go to www.NCTSN.org for a review of 

evidence-based interventions and treatments.

This approach grew from the collaborative efforts of various federal agencies, including the Federal Emergency Management Agency, the 

U.S. Department of Homeland Security, and the U.S. Department of Education’s Office of Safe and Drug Free Schools and its Readiness 

and Emergency Management in Schools program.
Psychological First Aid for Schools Field Operations Guide 7

Introduction and Overview

The Incident Command System and PFA-S

As suggested above, ICS is a central protocol adopted by schools across the nation. In fact, ICS is mandated 

through the National Incident Management System (NIMS) for any agencies receiving federal funding. It helps 

schools enhance emergency communications and allows them to work with multiple agencies during difficult 

and dangerous circumstances. The ICS is an emergency management structure that: 

1. Creates a manageable span of control, ensuring that no one individual oversees too many activities

2. Establishes predetermined incident command locations and facilities

3. Implements the management of resources

4. Ensures integrated communication across multiple organizations

Within the context of an ICS, emergency mental health recovery services occur in a section of the ICS structure known 

as Operations (see figure for a sample of ICS structure). Thus, coordination of PFA-S activities during an emergency 

situation would fall under the direction of the Operations Section Chief who, in turn, reports to the person in charge of 

all emergency response activities, the Incident Commander. Such coordination is critical, given the speed at which 

decisions must be made, information must be shared, and resources must be allocated during an emergency.

Moreover, the Incident Command System is scalable, meaning that it expands and contracts (sections are “activated”) 

only as the situation requires. In a small-scale emergency, only a small portion of the ICS may be engaged. Similarly, 

the individuals serving in certain roles within the ICS may change depending on how the emergency situation unfolds. 

To enter a school site successfully as a PFA-S provider, you will need to work within the framework of the 

school’s ICS, where the roles and decision-making processes have been clearly defined. You will need to 

communicate and coordinate all activities with the authorized personnel or organizations that are managing the 

setting. If you are the team leader, ideally you should be an employee who is regularly onsite, who is a good 

organizer, who is able to delegate, and understands both the referral process and the ICS. 

Public Information Officer

Operations Planning

Incident Commander

Operations Planning Logistics Finance & Administration

Student Supervision

Transportation Facility & Materials Food Services Personnel

Documentation/Recorder Staffing Insurance Claims

Health Services/First Aid

Site/facility Security Communications

Psychological First Aid

(PFA-S) Team Leader

Public Information Officer Liaison Officer

Safety Officer
Introduction and Overview
Psychological First Aid for Schools Field Operations Guide 9

Preparing to Deliver 

Psychological First Aid for Schools

The PFA-S Provider

As a PFA-S provider, you should be aware of the nature of the event, understand the current circumstances, 

and be informed about the type and availability of relief and support services and the school’s ICS. If you are 

providing PFA services on behalf of an outside responding agency, it is critical that you first coordinate with 

the appropriate school officials before you begin delivering services.

Personal and Professional Requirements

Interventions in emergency situations are goal-directed, time-limited, and strength-based. In order to achieve 

a positive outcome, you may encourage survivors to express their concerns and feelings, while at the same 

time containing such emotions within an atmosphere of safety and calm. You may also help survivors to 

identify positive coping strategies.

You should have these professional skills:

 Knowledge of and training in the techniques of PFA-S

 Ability to assess the ongoing needs of students, staff, and others impacted by the event

 Ability to offer age-appropriate and culturally-appropriate intervention strategies 

 Knowledge of available resources to which you can refer survivors

 Basic understanding of how PFA-S fits within the Incident Command System

 Ability to remain within the scope of your expertise and designated role

 Ability to pay attention to your own emotional and physical reactions, and practice self-care

Students take their cues from how others are reacting. By demonstrating calm and clear thinking, you can 

help those impacted by the event to know that they can rely on you. Others may follow your lead and remain 

focused, even if they do not feel calm, safe, effective, or hopeful. PFA-S providers often model a sense 

of hope that students and staff cannot yet feel, as they are still attempting to deal with the event and the 

concerns surrounding it.
National Child Traumatic Stress Network National Center for PTSD 10

Preparing to Deliver Psychological First Aid for Schools

Preparing to Deliver PFA-S

Learn about the School

When responding to a school incident, take into account the history of the school and its surrounding 

community. Here are some questions for you to consider:

• Have there been any previous adverse events at the school (e.g., threats, violence on campus, staff/

student deaths, racism or conflicts with certain ethnic groups)?

• Have these adverse events occurred recently and/or frequently? 

• Has the school had prior experience with any post-event interventions? If yes, did the administration/staff 

find previous interventions helpful or disruptive?

• Have there been any recent events at the school and/or are there any groups functioning within the 

school community that explicitly promote the strength of the school or that serve as a protective factor for 

individuals?

• What is the current morale of the school staff and students, and the current “climate” of the school 

community as a whole?

• Are there any upcoming events at the school (e.g., dances, standardized testing, graduation, 

accreditation review, sporting events, anniversaries of past events) that might positively or negatively 

affect the recovery of the school community?

• Are there any recent changes to school staff (e.g., a new principal, reduction in nursing staff time) that 

may affect response/recovery efforts?

• What is the present relationship of the school to the community? What collaborative relationships, 

coalitions, and/or stakeholders exist that support the school?

• Are there any members of the school staff who have personal trauma histories that should be taken into 

consideration by those making decisions related to emergency response or recovery procedures?

Identify the Distinguishing Features of the Event

Since every emergency is different, take the nature of the event into account. Before providing services, you 

should know the following:

 Location/s of the event/s

 Time/s and duration of the event/s 

 Magnitude of the event:

– Number of persons injured or dead

– Was it a confined or open area?

– Was it an isolated or crowded area?

– What were the disturbing features of the event (e.g., sexual abuse, mutilation, torture, chemical 

exposure)?
Psychological First Aid for Schools Field Operations Guide 11

Preparing to Deliver Psychological First Aid for Schools

 Impact of the event relative to the size of the community

 Cause of the event: 

– Accident/man-made 

– Natural disaster 

– Intentional (e.g., act of terrorism, shooting, suicide)

 Levels of exposure to the event, including:

– Secondary exposures (e.g., administering first aid to the injured, rescue efforts, additional threats)

– Significance of losses (e.g., students or staff who were particularly prominent in the school)

 Unique features of the event (e.g., disasters with no warnings, prior knowledge of the violent event, recent 

previous suicide attempts, prior cluster suicides, similarities to prior adverse events)

 Rumors circulating about the event

Be Aware of At-Risk Populations

Students and staff members who are at special risk include those who:

• Had direct exposure (e.g., exposed firsthand or experienced extreme life threat)

• Have been injured

• Have experienced the death or serious injury of a loved one

• Had a close personal relationship with any victim(s)

• Have a history of depression or suicidal thoughts or attempts

• Have a history of anxiety, shyness, or low self-confidence 

• Have a history of risk-taking behavior

• Have experienced prior traumatic events and are at current risk, including:

– Those exposed to community violence or domestic violence

– Those with a history of abuse and/or neglect

– War or other refugees or political asylees

– Members of economically disadvantaged groups

– Medically vulnerable individuals

– Those from disaster-prone regions

Certain groups of individuals in the school community may mistrust others, feel stigmatized, or fear 

repercussions (e.g., deportation, punishment), in addition to lacking knowledge about recovery services. 

Children of rescuers and first responders may also be at special risk in situations where their parents are in 

danger. Finally, students with an individualized educational plan (IEP) or those who meet the requirements of 

a disability as delineated by the Individuals with Disabilities Education Act (IDEA) may need accommodations 

or additional assistance.
National Child Traumatic Stress Network National Center for PTSD 12

Preparing to Deliver Psychological First Aid for Schools

Be Sensitive to Racial and Cultural Diversity

Remember to respect cultural, ethnic, religious, racial, and language differences. Whether providing outreach or 

services, be aware of your personal values and prejudices and how these may agree or conflict with those of the 

school community you are serving. Training in cultural competence can facilitate this awareness. Students and 

staff members are better able to cope when they maintain their traditions, rituals, gender roles, and social bonds.

Guidelines for Delivering PFA-S

✔	 Operate only within the framework of an authorized school emergency response system.

✔	 Before you approach an individual or a group, first observe politely. 

✔	 Initiate contact only after you have determined that you are not intruding or interrupting. 

✔	 Offer practical assistance (food, water). This is often the best way to make contact. 

✔	 Ask simple, respectful questions to determine how you may help.

✔	 Remain flexible and adjust to people and their situations as needed. Do not enter the site with any 

agenda other than providing PFA-S.

✔	 Be prepared for those impacted by the event to either avoid you or flood you with contact.

✔	 Speak calmly. Be patient, responsive, and sensitive. 

✔	 Speak slowly, in simple concrete terms; do not use acronyms or jargon.

✔	 Listen carefully when students or staff members want to talk. Focus on understanding (“getting”) what they 

want to tell you, and hearing how you can be of help. Children who are too young to speak, or who may not 

speak clearly, often express their feelings and show what they want through their behaviors, such as play.

✔	 Support and reinforce the person’s individual strengths and coping strategies, including the positive 

things he/she has done to stay safe.

✔	 Give information that directly addresses the person’s immediate goals, and clarify answers repeatedly as 

needed.

✔	 Give information that is accurate and age-appropriate. Remember that even very young children need to 

know what has happened. Tell children the truth, but keep it brief and speak to their developmental level 

(e.g., avoid discussing the details of a death).

✔	 Reassure young children that the adults are there to protect them and keep them safe. Even when adults do 

not feel safe, young children need to be assured that everything possible is being done to keep them safe. 

✔	 When communicating through an interpreter, look at the person with whom you are talking, not at the 

translator or interpreter. 

✔	 PFA-S leaders should reach out to those in positions of authority (e.g., administrators, school resource 

officers) who have been equally exposed but who, due to their position, need to project a sense of calm 

and control to those under their care.
Psychological First Aid for Schools Field Operations Guide 13

Preparing to Deliver Psychological First Aid for Schools

✔	 Assist support staff (e.g., custodians, bus drivers, food workers, librarians, secretaries, coaches, 

instructional aides) whose emotional needs may be overlooked in emergencies. These staff members, 

who are often involved in directing, calming, and reassuring students and parents, are among the 

important stabilizing factors in students’ lives. 

✔	 Remember that the goal of PFA-S is to reduce distress, assist with current needs, and promote adaptive 

functioning, not to elicit details of traumatic experiences and losses.

✔	 Keep in mind that the goal of schools is to support academic achievement. Ask students what they need 

to be able to attend school every day, to complete their work and succeed in school, and to stay safe in 

their lives outside of school. 

Behaviors to Avoid

✘	 Do not make assumptions about what students and staff have experienced during the incident or are 

experiencing currently.

✘	 Do not assume that everyone who has been through the emergency will be traumatized.

✘	 Do not pathologize. Most acute reactions are understandable and expectable, given what students 

and staff have experienced. Do not label reactions as “symptoms” or speak in terms of “diagnoses,” 

“conditions,” “pathologies,” or “disorders.”

✘	 Do not talk down to or patronize students or staff. Do not focus on the individual’s helplessness, 

weaknesses, mistakes, or disability. Focus instead on what he/she has done that is effective or has 

contributed to helping themselves or others, both during the emergency and in the present setting. Let 

the student know that continuing to attend school and performing academically shows his/her strength 

and resilience. Highlight to staff that coming to work every day or taking on additional duties shows 

their strength.

✘	 Do not assume that all students and staff members want or need to talk to you. Being physically 

present in a supportive and calm way in itself often helps affected people feel safer and more able 

to cope.

✘	 Do not “debrief” by asking for details of what happened.

✘	 Do not speculate or give information that might be inaccurate. If you cannot answer a question, say so, 

and do your best to learn the facts.

Adapt PFA-S for Students with Disabilities or Other Impairments

Children with special needs, specifically those with a disability who receive accommodation services, may 

not be as responsive to PFA-S techniques and adjustments may be needed. Design and adapt interventions 

to their particular abilities and enlist their teachers and teaching assistants for help. In this way, you will 

contribute to a successful resolution of the situation. Some considerations for different disabilities follow: 

Autism

Children with an autism spectrum disorder (ASD), such as Asperger’s Disorder, may be mainstreamed in 

general education classes or in self-contained classrooms depending on their disability and accompanying 

behavioral issues.
National Child Traumatic Stress Network National Center for PTSD 14

Preparing to Deliver Psychological First Aid for Schools

HOW 

TO 

HELP

These students may be particularly sensitive to new people and to changes in their 

routine or surroundings. If possible, announce changes before they occur. These 

students may have heightened sensitivity to sounds, bright lights, new tastes, smells, 

or cold temperature that may disrupt their emotional equilibrium in response, for 

example, to sirens or alarm bells. Students with ASD may be obsessive or hyperfocused on some element of the crisis, and they may upset others when they 

perseverate on the details of an event or exhibit self-soothing behaviors such as 

rocking.

Many of these students have behavior plans that include their going to a 

predetermined “safe place” when they are distressed. When possible to do so, allow 

them to follow their behavior plans. They will respond best to a familiar teacher or 

other person in authority who can calmly reassure them of their safety and set firm 

limits on their behaviors.

For students in a self-contained classroom, the most helpful intervention will be a 

return to their normal daily routine. They may not be responsive to new people. For 

many of these students, attempts to teach them exercises meant to help them cope 

may, in fact, increase their distress. 

Learning Disabilities

Children with one or more learning disabilities (such as dyslexia, visual/spatial problems, expressive or 

receptive language disorders, memory deficits) tend to be in general education classes. 

HOW 

TO 

HELP

These children should be responsive to most PFA-S strategies. The nature of the 

learning disability may affect a child’s ability to benefit from a specific exercise. For 

example, a student with a language disability may have difficulty expressing his/

her feelings in writing, or he/she may have difficulty accurately recalling contact 

information such as a phone number and street address. Adapt specific exercises to 

the student’s strengths.

Speech Impairment 

Children with speech and language deficits, including students with language processing issues, tend to be in 

general education classes.

HOW 

TO 

HELP

Students with language deficits may have difficulties with comprehension or with 

verbal expression. These students may respond best to exercises that include 

activities and visual cues, such as artwork, or relaxation strategies that can be 

modeled rather than just described.
Psychological First Aid for Schools Field Operations Guide 15

Preparing to Deliver Psychological First Aid for Schools

Cognitive Impairment 

Students with mental retardation/cognitive delays may be mainstreamed in general education classes or in 

self-contained classrooms, depending on the severity of their disability and accompanying behavioral issues. 

HOW 

TO 

HELP

Similar to students with autism, students with cognitive delays will do best after 

they return to their normal routine. Higher functioning students in general education 

classes may require simpler, more concrete directions, but they should respond to 

most PFA-S strategies.

Emotional Disturbance

Children identified as having an emotional impairment may have a variety of mood (depression, anxiety, anger, 

fear, apathy) and/or behavioral (aggression, withdrawal, hyperactivity, temper tantrums) issues, with the most 

serious disturbances including distorted thinking, excessive anxiety, bizarre motor acts, abnormal mood swings, 

or psychosis. Some of these students will have a trauma history, and the current event may bring up reminders of 

past events that will be unsettling and disruptive. These students, whether mainstreamed in the general population 

or in self-contained classrooms, may act unpredictably and need their teachers and support staff to intervene. 

HOW 

TO 

HELP

While most children with an emotional disturbance status may be responsive to 

the PFA-S techniques you are using, ask their teachers to identify which students 

may be resistant or become distressed. Most of these children will have behavioral 

intervention plans that include options for them to follow in certain circumstances; for 

example, a child who may become out of control is allowed to visit a particular adult 

or engage in a particular activity in order to self-soothe. When possible, try to follow 

the familiar and established routine. If this is not feasible, the child’s teacher, aide, or 

another familiar member of the child’s team should be the one to explain the new plan 

to him/her.

Orthopedic, Hearing, or Visual Impairment

Children with orthopedic, hearing, or visual impairments will often experience an increased sense of 

vulnerability and distress when the unexpected happens. 

HOW 

TO 

HELP

Reassure these children that they are safe, and work with their teachers or aides 

to design or adapt interventions for their needs. Again, their teachers and teaching 

assistants will be best able to help restore calm.
National Child Traumatic Stress Network National Center for PTSD 16

Preparing to Deliver Psychological First Aid for Schools

Other Health Impairment

Children will other health impairments (e.g., asthma, epilepsy, diabetes) may have limited strength, vitality, or 

alertness due to chronic or acute health problems. 

HOW 

TO 

HELP

Watch carefully for signs that students are having physical distress. Ask them if they 

are physically okay and if they need any help. Seek appropriate medical attention as 

needed.

Attention-Deficit/Hyperactivity Disorder (ADHD)

In a crisis, you may see students with ADHD increase their symptoms of hyperactivity and impulsivity, 

resulting in out of control behavior. 

HOW 

TO 

HELP

Students with ADHD will benefit from activities that allow for physical movement. 

When giving directions, calmly tell students exactly what you expect, avoid directions 

with more than one or two steps, and give warnings about specific consequences for 

inappropriate behavior.

Implement PFA-S in Groups

PFA-S can be delivered in various group settings, such as in classrooms, with a small group of students, or 

with school staff. It is best to run groups with another provider. 

When meeting with groups, keep the following in mind:

• Tailor the discussion to the shared needs and concerns of the group.

• Focus the discussion on problem solving and applying coping strategies to immediate issues.

• Allow only one person at a time to speak.

• Answer questions honestly, but limit the information to what the students and staff can handle and tolerate.

• Do not let discussions about concerns lapse into complaints.

• Redirect the discussion if it turns to descriptions of gruesome or disturbing details of the emergency. If 

an answer might be upsetting, tell the individual that at this time the information would not be helpful to 

everyone, but that you can discuss it privately later.

• If you sense that individuals are becoming anxious or distressed, interrupt and lead the group in a 

relaxation exercise (e.g., ask everyone to be silent and to take a few slow breaths; then refocus the 

conversation). 

• If an individual needs further support, offer to meet with him/her after the group discussion.

• Keep the focus on creating a supportive environment for each other, with the overall goal of having the 

school return to a healthy learning environment.

For more guidelines on conducting PFA-S in groups (assemblies, classroom, and small groups), see Appendix B.
Psychological First Aid for Schools Field Operations Guide 17

Psychological First Aid Core Actions

1. Contact and Engagement 

Goal: To initiate contacts or to respond to contacts by students and staff in 

a non-intrusive, 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 students and staff

4. Information Gathering: 

Current Needs and Concerns 

Goal: To identify immediate needs and concerns, gather 

additional information, and tailor Psychological First Aid for 

Schools interventions to meet these needs

5. Practical Assistance 

Goal: To offer practical help to students and staff in addressing immediate 

needs and concerns

6. Connection with Social Supports 

Goal: To help establish brief or ongoing contacts with primary 

support persons or other sources of support, including family, 

friends, teachers, and other school and/or community 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 students and staff with available services 

needed at the time or in the future

These core actions of Psychological First Aid for Schools constitute the basic objectives of providing early 

assistance within hours, days, or weeks following an event. Be flexible and base the amount of time you 

spend on each core action on the person’s specific needs and concerns.

Psychological First Aid for Schools Field Operations Guide 19

Core Action 1: 

Contact and Engagement 

Illustration by Dr. Bob Seaver

Goal To initiate contacts or to respond to contacts by students and staff in a non-intrusive, 

compassionate, and helpful manner

Your first contact with a student or staff member is an important opportunity to promote a sense of calm, 

hope, and support to those impacted by the event. You may be delivering services in a large setting, such 

as a school gymnasium, classroom, or offsite evacuation field. Make sure the setting has been explicitly 

designated as safe and secure by an emergency response agency and/or as communicated through the 

Incident Command System (ICS).
National Child Traumatic Stress Network National Center for PTSD 20

Core Action 1: Contact and Engagement

Making Initial Contact

Keep the following in mind when making initial contact:

 Remember that some students, staff, or family members may not seek your help, but may still benefit 

from assistance. Actively engage individuals by walking around the setting and introducing yourself. Try to 

be mindful not to interrupt conversations.

 While an entire school or class may have witnessed or been affected by an event, no two individuals are 

likely to be impacted the same way.

 Not all individuals will be traumatized or be in need of PFA-S. Expect resilience, but be on the lookout 

for those who appear to be struggling or who are likely to be “at-risk” due to other factors mentioned 

previously. One way is by observing their behavior first, either alone or with their peers.

 Reach as many individuals as possible for initial contact, but do not assume that they will all need further 

assistance.

 Do not assume that people will respond to you immediately or positively. It may take time for some 

students or bereaved persons to feel a degree of safety, confidence, and trust. 

 If an individual declines your offer of help, respect his/her decision and indicate when and where he/she 

can locate a PFA-S provider later on.

 One way to engage students and staff is by attending to their basic needs (e.g., passing out water, food). 

 Ensure that students and others are able to hear, read, and understand information, regardless of their 

language fluency or their auditory, speech, or cognitive abilities. If working in self-contained classrooms or 

with students with an IEP, have a teacher or aide who regularly works with the student present, if feasible. 

 Hysteria spreads like wildfire. If possible, isolate an agitated person from others, but make sure everyone 

who wants assistance receives it.

Provider Alert

• Respond first to those who seek you out.

• If a number of people approach you simultaneously, make contact with as many as you can.

• Giving a brief look of interest and calm concern can be grounding and helpful to people who are 

feeling overwhelmed or confused.

Introduce Yourself/Ask about Immediate Needs 

 Introduce yourself, if you have not been introduced by a teacher or other staff member, by giving your 

name and title, and describing your role. 

 Ask for permission to explain how you might be of help. 
Psychological First Aid for Schools Field Operations Guide 21

Core Action 1: Contact and Engagement

 Speak calmly and slowly. 

 Refrain from looking around or being distracted. 

 Ask about any pressing problem that needs immediate attention. 

 Give priority to urgent medical concerns and immediately relay them to the PFA-S Team Leader via phone 

or radio. The Team Leader, in turn, should seek resources from the Operations Section Chief. If phone or 

radio are not available, then relay the information via a staff member or a designated student “runner.” 

 If you speak with a child in significant distress, contact a teacher, school counselor, parent, or caregiver 

as soon as possible to let him/her know about your conversation so he/she can provide additional support 

to the child.

To make initial contact, you might say:

Staff/Family Members Hello. My name is ___________. I work with __________ and I am part of the 

school-based mental health recovery team. 

I’m checking in with staff/family members to see how they are doing, and to see 

if I can help in any way. Is it okay if I talk to you for a few minutes? May I ask your 

name? Mrs. Williams, before we talk, is there something that you need right now?

Adolescent My name is ___________. I work with __________ and I am part of the 

school-based mental health recovery team. I am touching base with students 

to see how they are doing and find out what they need. Is it okay if I talk to 

you for a few minutes?

Child (Get on child’s eye level, smile and greet the child, using her/his name and 

speaking calmly.)

Hi, Lisa. My name is ___________. I am working with Mr./Ms./Teacher 

__________ to help you and your family/classmates. Is there anything you 

need right now? Are you warm enough? Do you want a drink or some food?

Culture Alert

The type of physical or personal contact considered appropriate may vary from person to person and across 

cultures and social groups, for example, how close to stand next to someone, how much eye contact to 

make, or whether or not to touch someone, especially of the opposite sex.

Do: 

✔	 Look for clues that indicate an individual’s need for “personal space.”

✔	 Seek guidance about the most common and important cultural norms from school or community 

cultural leaders who best understand local customs. Also ask about cultural variations, both between 

distinctive groups and within groups, to avoid stereotypes.

✔	 Ask the person what cultural traditions or rituals are important to him/her. 

(continued on next page)
National Child Traumatic Stress Network National Center for PTSD 22

Core Action 1: Contact and Engagement

Culture Alert (continued)

Don’t:

✘	 Use sustained eye contact or stand too close to an individual unless he/she initiates such contact.

✘	 Touch the individual unless you have asked permission. Only touch in a way that cannot be 

misinterpreted by others.

✘	 Make assumptions about the individual’s culture, race, nationality, or belief system.

✘	 Expect all members of a group to be too similar in their beliefs and behaviors.

Initiating Contact and Engagement by Setting

PFA-S needs to be adapted depending on the setting where you deliver the services. For specific guidelines 

for assemblies, classrooms, and small groups, see Appendix B. 

Provider Alert

We distinguish between delivering PFA-S to small groups in large, open settings (groups organized in an 

evacuation field or multiple groups in a gymnasium) and attempting to deliver PFA-S to large groups of 

students all at once. We strongly discourage delivering PFA-S or any other intervention to large groups of 

individuals, as it may be particularly harmful, given how quickly intense emotions may spread.

If possible avoid large group settings—such as an auditorium—when you need to deliver emotionally sensitive 

information, even if it is just limited to updates on the emergency. Many administrators may choose to hold 

a large, all-school gathering immediately after an emergency because of its convenience and the perception 

that information can be delivered accurately to large groups. The reality is that, in an emotionally charged 

environment, one message will be heard many different ways and may easily become distorted. Similarly, 

strong emotions expressed in a large group setting may cause unnecessary distress. 

For parent-student reunification sites and student assembly areas, ensure that private rooms or discrete 

locations are available to deliver PFA-S to particularly vulnerable individuals. When entering these areas, first 

observe how individuals or groups are functioning to determine the level of need. Typically, giving regular and 

accurate updates helps to reduce anxiety. However, if the situation is still unfolding, updated information may 

not be available yet. In these situations, help students and families cope with their anxieties and fears, and 

clarify any misinformation. Staying calm is critical. Identify students with special needs and determine whether 

a familiar adult or staff member is available to provide additional support.

In situations in which small groups of students and staff gather informally or in classroom settings, the 

purpose of these meetings is not to discuss the details of the event. In most situations, these individuals will 

have had varying experiences. Exposure to individuals sharing explicit details of the event by those who 

have had limited experience of the event may cause unnecessary distress. PFA-S providers can organize 

small groups of individuals with similar experiences, such as all students who were injured, or friends of the 

deceased, to create a place for more detailed discussions to occur. 
Psychological First Aid for Schools Field Operations Guide 23

Core Action 1: Contact and Engagement

Putting PFA into Practice 

An elementary school principal requested help after one of his students was hit and killed by a car over 

the weekend. A safe room was established where students could go if they were feeling overwhelmed or 

needed to be with friends. One student was observed sitting in a corner, apart from the others, extremely 

upset. A teacher quietly walked over and sat with her. When the student appeared calmer, the teacher 

asked if she could talk with her. The student initially refused, so the teacher asked if she could continue 

to sit next to her. After a few minutes, the student began discussing how the loss of her friend was so 

overwhelming to her.

The teacher said little, but was able to comfort the student through observation, body language, 

and quiet support.

Protect Confidentiality

Given the lack of privacy in some school settings, you may find it challenging to try to protect the 

confidentiality of students, staff, and families after an emergency. However, it is important that you maintain 

the highest level of confidentiality possible. As a provider of PFA services in a school setting, you likely belong 

to a category of mandated reporters and must abide by state abuse and neglect reporting laws. You should 

be aware of the Health Insurance Portability and Accountability Act (HIPAA) and the provisions related to 

disaster and terrorism. Similarly, you should be aware of privacy and information-sharing concerns associated 

with the Federal Educational Records Protection Act (FERPA), particularly as these relate to the sharing of 

information about students who are deemed a potential harm to themselves or others.

If you have questions about releasing information, your PFA-S team leader should discuss this with school 

administration and determine if this needs to be further reviewed by the school’s legal counsel. Talking to 

co-workers about the challenges of working in the post-emergency environment can be helpful, but any 

discussions need to preserve confidentiality.

Psychological First Aid for Schools Field Operations Guide 25

Core Action 2: 

Safety and Comfort 

Illustration by Dr. Bob Seaver

Goal To enhance immediate and ongoing safety, and provide physical and emotional 

comfort

Restoring a sense of safety and giving physical and emotional comfort in the immediate aftermath of an 

emergency can begin to reduce distress and worry for students and staff members. When you can give 

individuals some sense of predictability, they regain a feeling of security and control.

Keep in mind that the primary responsibility for maintaining the safety of the school community rests with the 

school administration and staff. In other words, if you are working on behalf of an outside responding agency, you 

must first coordinate with the appropriate school officials before providing any information to students or staff.
National Child Traumatic Stress Network National Center for PTSD 26

You can provide comfort and increase sense of safety in a number of ways, including helping students, staff, 

and their families to: 

 Do things that are:

– Active (rather than passive waiting)

– Practical (using available resources)

– Familiar (drawing on past experience)

– Soothing (calming and relaxing, easy on the nerves)

 Get current, accurate, and up-to-date information, while avoiding exposure to information that is 

inaccurate or excessively upsetting

 Get information about how responders are making the situation safer

Ensure Immediate Physical Safety

If you are providing PFA in a school setting where there may still be either a real or perceived threat to safety, 

make sure that everyone is physically safe to the extent possible. If necessary, reorganize the immediate 

environment to increase both physical and emotional sense of safety. Immediately report any safety concerns. 

For example:

 Find the appropriate officials who can resolve safety concerns beyond your control, such as threats or weapons.

 If clearly safe to do so, remove clutter or damaged equipment from the area where you are working. Let 

the PFA-S Team Leader or the Operations Section Chief coordinating response efforts know if there are 

sharp objects, spilled liquids, broken glass, or other dangerous items that need removal. 

 Ask students, staff members, or caregivers if there are special medical concerns, medical devices, or 

medications that individuals may need. If yes, contact a school nurse, medical team leader, or relative. 

Other safety concerns involve:

 Threat of harm to self or others – Look for signs that students or family members may hurt themselves 

or others (e.g., students expressing intense anger or agitation). If you need additional support or are not 

trained to assess at-risk individuals, get help by contacting medical or mental health personnel, an EMT, 

or security to handle the situation.

 Shock – Seek immediate medical support if an individual is showing signs of shock or has these symptoms: 

pale, clammy skin; weakness or rapid pulse; dizziness or irregular breathing; dull or glassy eyes; is 

unresponsive to communication; lacks bladder or bowel control; or shows restlessness, agitation, or confusion. 

Provide Information about Response Activities and Services

Students and staff need to understand the broader context of response activities occurring at the school 

and in the community. When even the most minimal of predictable schedules or activities is reestablished, 

individuals begin to feel more stable. 

Core Action 2: Safety and Comfort
Psychological First Aid for Schools Field Operations Guide 27

Provide information about:

 What to do next

 The status, if known and if safe, of their classmates, teachers, other school staff, and relatives who may 

also be in the school

 What is being done to assist them

 What is currently known about the unfolding event

 The support services available to them and their families

 When and where school services will be resumed

 The best way to get updated information about the situation in the hours or days ahead

In providing information:

 Make sure school authorities have granted permission to share event-specific information, such as the 

circumstances of the current situation, the names of those directly affected by event, and when school 

services will resume.

 Use your judgment as to whether and when to present specific information. 

 Use clear and concise language while avoiding technical jargon.

 Position yourself, when feasible, at eye level with the individual.

 Use a calm, reassuring tone of voice and give the person time and space to talk.

 Provide accurate information, in easy to understand terms, to young students, about who will be supervising 

them and what to expect next. Consider using visual cues and materials to illustrate your information. 

 Consider when talking to students:

– Is it appropriate to share this information given his/her age?

– Does he/she appear able to comprehend what you are saying?

– Is he/she ready to hear the content of what you are saying?

Remember:

 Address immediate needs and concerns to reduce fears, answer pressing questions, and support 

adaptive coping.

 Students, staff, and family members may be getting information from many sources of technology (texting, 

Twitter, Facebook, TV, radio, phone, Internet). Ask about what they have heard or read and address any 

misinformation or distressing information.

 Do not guess or invent information if you do not know it in order to provide reassurance. Instead, develop 

a plan, with those you are helping, to get them the information. 

Core Action 2: Safety and Comfort
National Child Traumatic Stress Network National Center for PTSD 28

Core Action 2: Safety and Comfort

 Do not reassure people of the availability of goods or services (e.g., shelter, medicines, donations) unless 

you know that such goods and services will be available.

 When working with families, be sure to include children in discussions and in sharing information if it is 

appropriate. Do not just speak to the parent or caregiver. When children are left out of discussions, they 

may feel more insecure.

Examples of what you might say include: 

Parent/Caregiver A parent-student reunification area has been set up on the football field. At 

this location, you can get updated information about the situation. There is 

also food and water. When the students are released, they will go to this 

location. Do you need directions? Do you have any other questions?

Group of Students Here’s what’s going to happen next. When your class is released, we will 

walk over to the football field, where your parents and the buses will be 

waiting. The principal informed me that we’re currently safe. Do you have any 

questions right now?

Individual Student We’re working hard to make you and the rest of the school safe. I was 

informed by the principal that we have to stay here to keep us safe. Your 

parents have been notified and are waiting on the football field. When I am 

told it is okay, we will walk over together. Do you have any other questions?

Attend to Physical Comfort

 Look for simple ways to make the physical environment more comfortable. 

 Make sure that the area in which you will work with the students or staff is accessible for individuals with 

disabilities, has minimal distractions, is warm, has good lighting, and has areas where you can speak 

privately.

 Help students and staff to soothe and comfort themselves and others around them.

 Keep young children with staff members who are familiar to them. When available, give them toys that 

they can hold and take care of to help them soothe themselves. 

 Encourage students and staff to participate in getting things they need for comfort (offer to walk over to 

the food area with the person rather than retrieve food for him/her). Taking action helps reduce feelings of 

helplessness and dependency.

Address Media and Social Networking Safety Concerns

In addition to securing their physical safety, protect individuals from unnecessary exposure to additional 

potentially traumatic events and reminders, including sights, sounds, or smells that may be frightening. This 

includes media and social networking information.
Psychological First Aid for Schools Field Operations Guide 29

Core Action 2: Safety and Comfort

 Point out that excessive viewing of media coverage may not only upset them, but may also subtly retraumatize them. 

 Discourage teachers and other staff from ongoing media viewing in and outside the classroom.

 Remind them that some reports may not be accurate and identify where they can get reliable and up-todate information.

 Many individuals may use the Internet, texting, and/or social networking (e.g., Twitter, Facebook) to 

share information. Be aware that the amount of emergency information being shared through these 

technologies will be out of your control, but it is important to monitor what is being communicated. For 

example, students often develop a “memorial page” on Facebook when a member of the community is 

injured or died. Regularly monitor this page to see if disturbing details or misinformation are being posted. 

Notify the administrator about this site so that he/she can delete any inappropriate posts.

 Be proactive by encouraging school officials to post accurate information and psychoeducational material 

(including recommendations for where to seek assistance) on these forums, on other social media sites, 

and on official websites as soon as possible. 

 Encourage students to ask questions or share information they have learned from these forums with 

trusted adults. Ask students what they heard or what they know about the situation to help you start the 

discussion.

 Shield students from reporters, onlookers, and attorneys, in order to help protect their privacy. Many 

schools have a clear policy not to allow their students to be interviewed by the media during an 

emergency. If the policy does allow for interviews, remind students that they may decline a media 

interview or have an adult they trust with them, if they choose to participate.

Provider Alert

It is very natural for students to seek out information through the media. At times, however, they may 

become fixated on it. While such behavior may be a protective factor—in that children are seeking to 

understand the event, learn more, put it into context, and avoid further danger—such behavior can also 

evoke fear and distress. You should tell teachers, parents, and other caregivers that: 

• They should monitor and limit children’s exposure to the media, and discuss any concerns the 

children have. Encourage them to regularly check in to keep communication open. 

• They can let children know that they are keeping track of information and that they should come to 

them for updates.

• Young children are often confused by repeated media coverage and assume that the events that they 

see in the media are happening over and over again.

• They should be careful about adults watching media reports if children are in the same or an adjacent 

room, as children can overhear and become confused and frightened by what they learn. 

• For parents, suggest that they may consider watching or listening to limited, carefully selected news 

with their children and then discussing the information together afterwards. This will help children 

process the event and allow them to see their family members as protective and supportive.
National Child Traumatic Stress Network National Center for PTSD 30

Core Action 2: Safety and Comfort

Examples of what you might say include:

Teacher/Other Staff It’s a good idea to shield yourself and your students from further frightening or 

disturbing sights and sounds as much as possible. Even televised scenes or 

pictures can be very disturbing to children. It doesn’t hurt for adults to take a 

break from all the media coverage, too.

Adolescent/Child You’ve been through a lot already. Kids often want to watch TV a lot or go 

online after something like this, but that can be more upsetting and not very 

helpful. It’s best to stay away from media reports that show this stuff. If you 

happen to see something that bothers you, be sure to tell your parents, your 

teacher, or another trusted adult.

Attend Funerals and School Memorials to Monitor Those at Risk

In conjunction with school officials, consider how funerals and school memorials may serve as trauma reminders 

for students and staff. Although there are many concerns associated with holding school-wide functions to 

memorialize a violent event or accident, some schools still choose to hold them. A PFA-S provider should always 

be present at such events. The potential for memorial events to re-traumatize is real, particularly for elementary 

students. Take care during the event to monitor those in attendance, engage them in a sensitive way, and 

provide psychoeducational materials. While it is helpful to provide psychoeducational materials to attendees of 

memorials and to high-risk students on anniversary events, it is never appropriate to do so at funerals.

During funerals and school memorials, some individuals who were not close to the event but who have experienced 

similar loss in their lives or have other risk factors may become extremely upset. Those at risk may include those 

having pervasive fantasies about reuniting with the individual who has died or those who have a history of:

 Attempted suicide

 Substance abuse 

 Severe depression or other mental illness

 Violent behavior, particularly when combined with access to weapons

After providing immediate assistance when these individuals become upset, collaborate with other providers 

to monitor them in the days and weeks following the event. Reactions may linger and it is important for these 

individuals to know that there are supports and resources available to them.

Provider Alert

Permanent memorials should be avoided. A school community is a dynamic process, and often 

the emotional significance of a memorial is lost over time. Unless the event was of major historical 

significance to the community, future generations of students and staff should not be constricted, 

however slightly, by tragedies of the past. Similarly, schools should avoid living memorials, such as trees 

or flower gardens, as their ongoing maintenance or health may become an issue.
Psychological First Aid for Schools Field Operations Guide 31

Core Action 2: Safety and Comfort

Address Personal Belongings, “Empty Chairs,” and Temporary Memorials

Although it is important to protect students and staff from being constantly reminded of an event or becoming too 

emotional, do allow individuals to grieve at their own pace. Many well-intentioned adults quickly remove all traces of 

a teacher or student who has died; however, many students/staff members want to honor the life of the deceased.

 Do not immediately remove pictures of the deceased that are displayed in the classroom or school.

 Do not immediately place another student in the desk/seat of the person who has died.

 Do allow students to talk about their memories of the person who has died. If a student’s focus on the 

deceased persists and later interferes with functioning, he/she may be encouraged to speak to a family 

member or professional outside of the classroom.

 Prior to any emergencies, schools should work with their school board and the community to establish 

procedures for accepting donations, as well as for removing temporary memorials. For example, schools may 

have a pre-designated, temporary, in-school memorial site where flowers, poems, cards, and photographs can 

be collected and displayed. However, schools should clearly communicate from the start that such memorials 

are temporary and will be in place for a limited time, and that after that time the items will be collected and 

given to the deceased individual’s family. Consider having a well-respected representative of the student body 

assist in this process, to provide a sense of closure and respect for the student body as a whole. The school 

should work with the family if online memorials are created in order to monitor these sites for at-risk individuals.

Help Students/Staff with Grief

Culture Alert 

Beliefs and attitudes about death, funerals, and expressions of grief are strongly influenced by family, culture, 

religious beliefs, and rituals related to mourning. Learn about the cultural norms of the student and staff 

through the assistance of community cultural and school leaders who best understand local customs. Even 

within cultural and religious groups, beliefs and practices can vary widely. Do not assume that all individuals in 

a given group will believe or behave the same way. You should allow individuals to engage in their traditions, 

practices, and rituals in order to provide mutual support for each other, to seek meaning, to manage the range 

of emotional responses and death-related adversities they may experience, and to honor the death appropriately.

Acute Grief Reactions are likely to be intense and prevalent among those who have suffered the death 

of a loved one or close friend. They may feel shock, disbelief, sadness, and anger; feel responsible for not 

preventing the death; regret not providing comfort or having a proper leave-taking; or miss the deceased 

and wish for reunion (including having dreams of seeing the person again). Although painful to experience, 

grief reactions are healthy responses that reflect the significance of the death. Over time, grief reactions tend 

to include more pleasant thoughts and experiences, such as telling positive stories about a loved one and 

remembering him/her in comforting ways. 
National Child Traumatic Stress Network National Center for PTSD 32

Core Action 2: Safety and Comfort

Provider Alert

Children’s and adolescents’ understanding of death varies depending on age and prior experience with 

death, and is strongly influenced by family, religious, and cultural values. 

Preschool children may not understand that death is permanent and may believe that if they wish it, the 

person will come back. They need help to confirm the physical reality of a person’s death—that he/she is 

no longer breathing, moving, or having thoughts, and feels no discomfort or pain. They may worry about 

something bad happening to another family member. It may be helpful to explain death to young children 

through the use of storybooks (see www.NCTSN.org for a list of commonly used books). 

School-age children understand the physical reality of death, but may picture death as a monster or a 

skeleton. In longing for the loved one’s return, they may feel an upsetting “ghostlike” presence of the lost 

person, but not tell anyone. 

Adolescents generally understand that death is irreversible. Losing a family member or friend can trigger 

rage and impulsive decisions, such as quitting school, running away, or abusing substances. These 

issues need prompt attention by the family and/or school.

When speaking to adults about how to help children, you can say:

Adult It can be helpful to think about times when children will miss their friend, for 

instance, at recess or in class. Say something like, “It is hard not to have Suzie 

here and I know a lot of us are missing her right now,” to ease their discomfort, 

make them feel less alone, and help them to handle these difficult times better.

When you see a sudden change in the children—looking lost, sad, or even 

angry—and you suspect that they are missing their friend, let them know 

that you, too, have times when you feel that way. Say something like, “I’m 

wondering if you’re thinking about Suzie. Many of us are thinking about her, 

too. There are many feelings that may come up. What are you feeling? I am 

happy to talk with you or we can connect you to the school counselor, too.”

When working with acutely bereaved individuals, remember that:

 The person should be treated with dignity, respect, and compassion. 

 Grief reactions will vary from person to person.

 What they are experiencing is understandable and expectable, given the loss.

 There is no “correct” course of grieving; how a person grieves is dependent not only on his/her cultural 

and religious beliefs, but also on his/her developmental level.

 You can explain that they will most likely continue to experience periods of sadness, loneliness, or anger. 

 Grief puts older children and adults at risk for abuse of over-the-counter medications, smoking, alcohol, 

drug usage, and depression and suicidal thoughts. 

 Students and staff should be made aware of the above risks, the importance of self-care, and the 

availability of professional help.
Psychological First Aid for Schools Field Operations Guide 33

Core Action 2: Safety and Comfort

Watch for individuals who may present with irrational blame, fear, or other strong emotions and who may 

require longer-term attention and more intensive services. Work closely with school administrators to provide 

outreach actively throughout the school, particularly in large-scale emergencies and/or during memorials or 

anniversaries, to find those students and staff who may need assistance but may not seek help. Some may 

feel guilty because they survived while others did not. They may believe that they caused the death in some 

way. Try to help dispel students’ sense of responsibility and assure them that, in events like this, they are not 

to blame for what happened. If an individual continues to feel this way, work on getting him/her additional 

assistance.

To emphasize the importance of understanding and respecting each other’s course of grief, you may say:

Adult/Student Each person will express his or her grief differently. Some may not cry, 

while others cry a lot. Some may want to talk, while others don’t. No one 

should feel bad about this or think there is something wrong with someone 

who expresses grief in an unfamiliar way. What is most important is to 

respect the different ways each person feels and help each other in the 

days and weeks ahead.

Some individuals will not have words to describe their feelings of grief, and may resist talking with others 

about how they feel. Sometimes distracting activities, such as drawing, listening to music, or reading, will be 

more calming than conversation. For those who wish to be alone, provide them with some privacy if it is safe 

to do so. When a student or adult does want to talk with you about the loved one, listen quietly and do not feel 

you need to say much. Do not probe. 

Do Not Say:

✘	 I know how you feel.

✘	 It was probably for the best.

✘	 He is better off now. 

✘	 It was her time to go.

✘	 At least he went quickly.

✘	 Let’s talk about something else.

✘	 You are strong enough to deal with this.

✘	 Be glad he passed quickly.

✘	 It’s good that you are alive.

✘	 You’ll feel better soon.

✘	 You did everything you could.

✘	 You need to grieve.

✘	 You need to relax.

✘	 That which doesn’t kill us makes us stronger.

✘	 It’s good that no one else died.

✘	 It could be worse; you still have a brother/sister/

mother/father.

✘	 Everything happens for the best according to a 

higher plan.

✘	 Someday you will have an answer.

✘	 (To a child) You are the man/woman of the house 

now.

✘	 You should work towards getting over this.

If the grieving person says any of the above things, you can respectfully acknowledge the feeling or thought, 

but do not initiate such statements.
National Child Traumatic Stress Network National Center for PTSD 34

Core Action 2: Safety and Comfort

Provide Additional Support to Staff

Teachers and other staff may have additional adversities that affect them. Teachers feel protective of the 

students in their classes. Secretaries and receptionists frequently field phone calls from worried parents, 

the media, and others. Custodians feel responsible for the physical building, and often have the burden of 

cleaning up the physical evidence of the event. Security guards must direct frightened, concerned people 

while remaining calm themselves. 

In the event of an emergency, school staff instinctively put the students first. More frequently than not, staff 

go on “autopilot,” reacting with swiftness to ensure the students’ safety, whether this means moving them 

to another location, securing the doors of a classroom to prevent further violence, aiding in escape, and/or 

protecting students from disturbing visual images. Do not assume that a staff member who appears focused 

and active is not worried about his/her personal safety and emotional reactivity. The majority of staff will 

contain their reactions for the sake of their students’ well-being.

Take time to meet with staff, either in groups or individually, in a private space that is apart from the students. 

Be certain that there is a box of tissues in the room and, if possible, food and beverages. Update staff about 

the situation, plans, and safety of the school community. As you work with staff:

 Promote a sense of safety and provide psychoeducation about emotional reactions.

 Acknowledge fears and worries about personal safety or health issues.

 Find out what staff may specifically need and try to provide it.

 Secure the use of a landline telephone, cell phone, or email, as much is possible, so that they can contact 

and reassure family members that they are safe.

 Demonstrate calming techniques, such as slow breathing, thought stopping, or grounding. 

 Compliment their professionalism, protective instincts, and fast thinking.

 Recommend limiting “second guessing” or reevaluating their actions “in hindsight.” 

Putting PFA into Practice 

After the suicide of a student, an event that many individuals in the school community witnessed, teachers 

immediately focused on the safety of their students—quickly moving them to an adjoining building, 

comforting them, and attending to their needs. The adults were also shaken, confused, and upset, but did 

not show these reactions in front of the students. Once the students were released from school, a private 

room was designated and the adults were organized into small groups, where providers could determine 

their physical or emotional concerns, answer their questions, reassure them, and attend to their needs. 

School staff began to feel calmer and safer as the providers exhibited sensitivity to their needs 

and attended to their well-being.
Psychological First Aid for Schools Field Operations Guide 35

Core Action 3: 

Stabilization 

Illustration by Dr. Bob Seaver

Goal To calm and orient emotionally overwhelmed or disoriented students and school 

staff

Students and adults whose reactions are so intense and persistent that they significantly interfere with the 

ability to function are of the most concern and may require stabilization. Stabilization is used immediately after 

an event to help calm an individual who appears disoriented or extremely agitated. 

In many instances, students and staff may be numb rather than overly agitated, and they may appear at first 

to be reacting normally to the event. Watch carefully to see whether these individuals also demonstrate signs 

of being connected to (aware of or interactive with) their surroundings or people in the vicinity. If they do not, 

attempt to stabilize them immediately and seek out a health or mental health professional for help. 
National Child Traumatic Stress Network National Center for PTSD 36

Core Action 3: Stabilization

REMEMBER

– Most individuals affected by school emergencies will not require stabilization. 

– Strong emotions, numbing, and anxiety are expected short-term responses to traumatic stress; they 

do not necessarily signal the need for additional intervention beyond standard support. 

– If medical or mental health professionals are available, seek them out for help.

Adults, adolescents, or school-aged children who need stabilization may be: 

• Disoriented: engaging in aimless disorganized behavior 

• Disconnected: numb; startlingly unaffected by the event

• Confused: not able to understand what is happening around them; not making sense 

• Panicked: extremely anxious; unable to settle; their eyes wide and darting 

• Hysterical: sobbing uncontrollably; hyperventilating; rocking 

• Excessively preoccupied: unable to think about anything else

• In denial: refusing to accept that the event took place

• In physical shock: not being able to move; frozen

• Glassy-eyed and staring vacantly; unable to find direction

• Unresponsive to verbal questions or commands

• Exhibiting frantic searching behavior

• Feeling incapacitated by worry

• Engaging in risky activities

Young children who need stabilization may be: 

• Staring blankly

• Unresponsive

• Displaying behaviors they had outgrown (e.g., urinating in inappropriate places, sucking a thumb)

• Screaming

• Crying or sobbing uncontrollably

• Hyperventilating

• Moving in an agitated way (thrashing, pushing away)

• Hiding (in a corner or under a table)

• Clinging excessively

Approach Distressed Individuals 

If the person is too upset, agitated, withdrawn, or disoriented to talk, or if he/she shows extreme anxiety, fear, 

or panic, consider the following:
Psychological First Aid for Schools Field Operations Guide 37

Core Action 3: Stabilization

Q: If a student, is there a 

caregiver available?

Yes – Make sure this adult appears stable. Focus on empowering 

the caregiver in his/her role of calming the child. Reassure the 

caregiver that you are available to assist.

No – A familiar staff person may serve to help a child regain control.

Q: Is there a staff member who 

knows the student or adult 

well enough to provide 

emotional support?

Yes – Have that person take the student or adult to a quiet place. 

Let the staff member know you are available to help.

No – You should help the person. Do not forget to remain calm 

yourself. Follow the steps below.

Caution: Do not simply try to convince the person to “calm down” 

or to “feel safe.” Neither tends to be effective.

Support Distressed Individuals 

For adults, adolescents, and school-aged children

 Respect the person’s privacy and give him/her a few minutes before you intervene. Say you will be 

available if he/she needs you, or that you will check back in a few minutes to see how he/she is doing and 

whether there is anything you can do to help at that time.

 Remain calm, quiet, and present, rather than trying to talk to him/her directly, as your questioning may 

contribute to cognitive and/or emotional overload. 

 Remain available, while giving him/her a few minutes to calm down.

 Stand nearby as you talk to other individuals, do some paperwork, or do other tasks, watching to see if 

the person needs or wishes help.

 Offer support and help him/her focus on specific manageable feelings, thoughts, and goals.

 Give information that orients him/her to the surroundings, such as how the setting is organized, what will 

be happening, and what steps he/she may consider.

 Clarify any misinformation or misunderstanding about what is taking place, while helping to curtail rumors.

 Attempt to determine what the student or adult is experiencing, so that you can address the individual’s 

immediate concern or difficulty.

For young children

 Remain calm, quiet, and reassuring. Sit with the child at eye level as you speak in a low tone and in a 

reassuring manner. 

 Reassure and calm through physical contact, such as a protective arm across the shoulder, if it appears 

welcome. Some children may dislike or have a negative association with being touched. If you are 

unsure, ask them if you may touch them. 
National Child Traumatic Stress Network National Center for PTSD 38

Core Action 3: Stabilization

 Distract the child from the situation by asking questions about his/her favorite story, hobby, sport, or song. 

Keep the circumstances in mind so that you do not inadvertently trigger greater anxiety by asking about 

a topic that may be related to existing fears (such as asking, “What is your favorite bedtime story?” when 

the child is fearful for his/her caregiver’s safety).

 Give age-appropriate information about what to expect, and always answer questions in an honest, 

developmentally appropriate way. 

 Do not overwhelm children with too much information. Under stress, a child can only process so much 

information, and will likely change the subject or move to a different activity when feeling overwhelmed. 

Watch for and be respectful of the cues the child gives.

 Reconnect children with their caregivers or staff who know them as soon as possible.

Putting PFA into Practice 

Upon arriving late at school, a high school student learned that his best friend had died the night before. 

The principal had been informed by the family early that morning, and news of the death had spread 

through the school. Staff were very concerned about the friend’s reactions once he learned of the death. 

One teacher, who felt he had established a positive relationship with the teen, offered to be with the 

principal when he broke the news. The teen immediately became extremely agitated, pacing the office, 

holding and shaking his head, shouting “No, no, no!” Sensing that the boy was near panic, the principal 

and the teacher spoke calmly and gently, guiding the boy to sit and take slow breaths. The teacher then 

stayed in the office with the teen, offering emotional support by his mere physical presence until the teen 

was ready to ask questions and speak about his friend.

Observation, physical presence, a soothing voice, and anxiety-reducing techniques (e.g., slow breathing) 

helped to stabilize the teen.

Use these talking points to help individuals understand their reactions: 

For adults, adolescents, and school-aged children

 You may feel intense emotions coming and going like waves. (You may also feel emotionally knocked 

down or dragged under, just when you thought you were standing on firm ground.)

 You may find that shocking experiences trigger strong—and often upsetting—self-protective “alarm” 

reactions in the body, such as an adrenaline surge, startling easily, or being on-guard.

 Sometimes you may feel so anxious, upset, and out of control, you wonder if you’re going crazy. Remember 

that these are expectable and understandable reactions to a very upsetting and frightening event. 

 Sometimes the best way to recover is to take a few moments to do activities that calm you (take a walk, 

breathe slowly, listen to music).

 Calm yourself by keeping in mind the family members and friends who love you and support you.

 Staying busy or helping others can distract you from your thoughts and feelings.

 There are people here to help you learn more ways to calm yourself.
Psychological First Aid for Schools Field Operations Guide 39

Core Action 3: Stabilization

REMEMBER

Adolescents and young adults may have impulses to do something risky, just to feel better temporarily. 

They may not see the need to be cautious. Ask them to try talking to an adult they trust before acting 

impulsively. For example, you might say, “When something bad like this happens, it is really important 

to talk to adults that you trust. Is there anyone who helps you feel better? Maybe I can help you reach 

him or her.”

For young children 

 After bad things happen, your body may have strong feelings that come and go like waves in the ocean. 

First you’re feeling sort of okay, but then you feel bad all over again. When you feel really bad, that’s a 

good time to talk to your mom and/or dad to help you calm down. Here at school, there are teachers or 

other adults you can talk to.

 Did you know that lots of people need help at times like this? See all the people here with the vests on 

and all those guys out front with the yellow jackets? All these people—and many more—are working 

together to help keep you and the other children safe, and to help people feel better.

 One trick to help you start to feel a little better is to do something. Just sitting here might be boring or 

make you feel even worse. Would you like to play with the other kids or would you like to draw? Do you 

know Mrs. Smith? She’s teaching some kids a breathing game to help them calm their bodies. Calming 

your body can help calm your mind, and that can help you start to feel better.

Assist Individuals with Extreme Agitation and Disorientation

If the person appears extremely agitated, has accelerated speech, seems out of touch with the surroundings, 

or is crying intensely, it may be helpful to:

 Position yourself at eye level, so he/she becomes aware of you.

 Ask the individual to listen to you and look at you.

 Find out if he/she knows who he/she is, where he/she is, and what is happening.

 Ask him/her to describe the surroundings and say where both of you are.

If these actions do not help, introduce a technique called “grounding,” by saying:

Child/Student After a frightening experience, you can be very upset or angry or unable to 

stop thinking about what happened. I can help you feel less overwhelmed by 

teaching you about something called “grounding.” Grounding works by having 

you focus on the things you see and hear around you, instead of all the 

thoughts you’re having. Would you like to try it?
National Child Traumatic Stress Network National Center for PTSD 40

Core Action 3: Stabilization

If the person agrees, speak in a calm, quiet voice and lead him/her through the steps:

 Sit in a comfortable position with your legs and arms uncrossed.

 Breathe in and out slowly three times.

 Look around you and name five non-distressing, simple objects that you can see. For example, you might 

say, “I see the floor, I see a shoe, I see a table, I see a chair, I see my friend.”

 Breathe in and out slowly three times.

 Next, name five non-distressing sounds you can hear. For example, you might say, “I hear a teacher 

talking, I hear myself breathing, I hear a door close, I hear kids playing, I hear a cell phone ringing.”

 Breathe in and out slowly three times.

 Next, name five non-distressing things you can feel. For example, you might say, “I can feel the pen in my 

hand, I can feel my toes inside my shoes, I can feel my back pressing against my chair, I can feel my feet 

on the floor, I can feel my lips pressed together.”

 Breathe in and out slowly three times.

If the person selects distressing objects or sounds to name, interrupt him/her and suggest he/she pick items 

that are not upsetting.

You might have a younger student name the colors of objects that he/she sees around them. For example, 

you could say, “Next, name five colors that you can see from where you are sitting. Tell me something you see 

that is blue, now something that’s yellow, now something green.”

Stabilize Students in Group Settings

While working with a group of students, monitor how the students are responding to the discussion. If you 

see that students are getting distressed, stabilize the situation by conducting a neutral group activity. These 

activities can be drawing/coloring, a writing exercise, a breathing exercise, making a collage, or working 

together on a mural. If a student is still having problems calming down, you or another PFA-S provider should 

work with him/her in private. 

Putting PFA into Practice 

After the sudden, violent death of a favorite teacher, the fourth grade class came together to talk about 

him and the upsetting news. As the level of anxiety increased among the students, the adult stopped the 

discussion and guided the students in slow breathing, stretching out their arms, and then shaking the 

tension out of their hands. Once relaxed, the group resumed their discussion.

Taking a break in the discussion and doing a calming activity can quickly stabilize a situation.
Psychological First Aid for Schools Field Operations Guide 41

Core Action 4: 

Information Gathering: 

Needs and Current Concerns

Illustration by Dr. Bob Seaver

Goal To identify immediate needs and concerns, gather additional information, and tailor 

Psychological First Aid for Schools interventions to meet these needs

In most emergencies, you will have limited time to gather information, and you will have to adjust to 

individuals’ needs and priorities. Therefore, you will need to be flexible in adapting PFA-S interventions. 

Although a formal assessment is not appropriate, gather enough information so that you can tailor 

interventions quickly to these needs and concerns. 
National Child Traumatic Stress Network National Center for PTSD 42

Core Action 4: Information Gathering: Needs and Current Concerns

Gather Information Directly with These Questions:

1. How are you doing now? What are your immediate needs and concerns?

Students and staff will experience the emergency differently. By asking these questions, you will find 

out what concerns are most pressing. Also, ask if they have any immediate safety issues, medical or 

psychiatric concerns, or problems attending to basic needs. Highlight that you are willing to discuss 

whatever they wish—a big problem or even something they think is trivial. Some students and staff may 

not talk because they feel others are in greater need of your services. Assure them that you and your 

team have time for everyone. 

2. What happened to you during the event? How were you affected?

You will want to find out how the person was impacted by the event. You might ask:

 Where were you during the emergency?

 Did you feel threatened? Did you get hurt/injured?

 Do you still feel threatened?

 What problems do you have now? Do you have any continuing or ongoing problems?

 Did a loved one die or suffer severe injury?

 Have you lost contact with, or are you separated from, a loved one?

 Did you (or your family) lose any personal property?

 Did your pet die or get hurt?

Provider Alert

In clarifying emergency-related experiences, avoid asking for in-depth descriptions, as this may provoke 

additional distress. Follow the individual’s lead in discussing what happened. Do not press him/her to 

disclose the details of a trauma or loss. If a person is anxious to talk about an experience, respectfully say 

that you can best help now by getting some basic information so that you can help with his/her current 

needs, and that you will give him/her referrals to talk with a school counselor or professional about his/her 

experiences. Remind the person that immediately after an emergency it is difficult to fully protect his/her 

privacy, and that the situation may not permit you to give him/her enough time to fully assist with his/her 

experiences.
Psychological First Aid for Schools Field Operations Guide 43

Core Action 4: Information Gathering: Needs and Current Concerns

3. How has the event impacted you, your family, and your friends?

When asking this question, use the names of the individuals that the person has already mentioned. 

When working with middle or high school students, ask how their classmates and friends are doing. Note 

whether students are limiting their interactions with others, delaying important developmental activities 

(birthday, prom, getting a driver’s license), or increasing at-risk behaviors (drinking, using drugs, reckless 

driving, self-injurious behaviors). Also, explore students’ ability to do schoolwork, their sleep habits, and 

recent moods.

4. When you look ahead, do you have any concerns? Is there anything 

bothering you about your future?

These questions allow you to identify any academic concerns, worries about relationships, changes in 

parental behavior, and developmental issues.

5. Is there anything else you would like to share?

You can use the form Student/Staff Current Needs (Appendix C) to document the information you have 

gathered. Additionally, use the Psychological First Aid Provider Worksheet (Appendix C) to document the 

services you have provided. 

Gather Information Indirectly

Use other ways to gather information in addition to direct interviewing. For example, encourage the use of 

the referral procedures in place for teachers and staff so that if they see changes in a student’s behavior 

they can contact you or another PFA-S provider to follow up. As noted previously, you can work with school 

administration to find out what happened during the event. The more you know about what occurred, the 

better you will be able to identify individuals who need to be checked on. 

The PFA-Team Leader can also monitor daily attendance, and disciplinary and nursing logs to identify 

students at risk. Remember: some students and staff will ask for help, but most will not. Some may complain 

of physical symptoms (e.g., headaches, stomachaches, rapid heart beat) and frequently visit the nurse. Be 

watchful, so you can identify and help those individuals affected by the emergency. 

Gather Information to Guide Your Intervention Choices

As PFA-S is a modular and flexible approach, the information you obtain will guide the intervention strategies 

you choose to use. The table Areas of Concern and PFA Intervention on the following pages indicates the 

strategies to use based on different pressing needs or concerns reported. Much of the information that will be 

gathered is from conversation and what the individual reports as current concerns. Do not use the table as a 

checklist and ask each of these questions. Also keep in mind your role. If an individual brings up concerns you 

are not trained to assist in, get help from the PFA-S Team Leader or a mental health professional.
National Child Traumatic Stress Network National Center for PTSD 44

Core Action 4: Information Gathering: Needs and Current Concerns

Areas of Concern and PFA Interventions

Areas of Concern Questions to Ask PFA Intervention Strategies

Nature and Severity of 

Experiences

• “Where were you during the 

crisis?”

• “Did you get hurt?”

• “Did you see anyone get hurt?”

• “How afraid were you?”

• Provide information about postcrisis reactions and coping

• Arrange medical care for those 

injured

• Provide a sense of safety and 

calm

• Offer a follow-up meeting

Death of a Loved One • “Did someone close to you get 

hurt or die as a result of the 

event? Who got hurt or died?”

• Provide emotional comfort, 

acute grief assistance, and 

practical assistance

• Connect with social supports

• For younger children, ensure 

that a familiar adult is attending 

to him/her

• Offer a follow-up meeting

Immediate Safety Concerns 

and Ongoing Threat

• “Tell me what you understand.”

• “Do you have concerns about 

your safety or the safety of your 

family or friends?”

• “Do you have concerns about 

the safety of the school?”

• Help obtain information about 

safety and protection

• Provide information obtained 

from officials about the incident 

as well as available services

• Report safety concerns to the 

appropriate authority

Separations from, or Concern 

for, the Safety of Loved Ones

• “Are you worried about anyone 

close to you right now? Do you 

know where they are?”

• “Is there anyone you care 

about, like a family member or 

friend, who is missing?”

• Provide practical assistance to 

connect people to information 

resources and registries to help 

locate and reunite loved ones

Physical Illness, Mental Health 

Conditions, and Need for 

Medications

• “Do you have any medical or 

mental health condition that 

needs attention?”

• “Do you need any medications 

that you don’t have?”

• “Can you get in touch with your 

doctor or parents?”

• Provide practical assistance 

to obtain medical and/

or psychological care and 

medication

Losses (Home, School, 

Neighborhood, Property, Pets, 

etc.)

• “Was your school / home badly 

damaged or destroyed?”

• “What did you lose that is 

important to you?”

• “Did a pet die or get lost?”

• “Was your business or 

neighborhood badly damaged 

or destroyed?”

• Provide emotional comfort

• Provide practical assistance 

to help link the person with 

available resources

• Provide information about 

positive coping and social 

support
Psychological First Aid for Schools Field Operations Guide 45

Core Action 4: Information Gathering: Needs and Current Concerns

Areas of Concern Questions to Ask PFA Intervention Strategies

Extreme Feelings of Guilt and/

or Shame

• “Do you feel that some part of 

the incident was your fault?”

• “Do you feel you could have 

done something differently that 

would have changed the course 

of what happened?”

• Provide emotional comfort

• Provide information about 

coping with these distressing 

emotions

Thoughts about Causing Harm 

to Self or Others

• “Sometimes situations like these 

can be overwhelming. Have you 

had any thoughts about harming 

yourself?”

• “Have you had any thoughts 

about harming someone else?”

• Get immediate medical or 

mental health assistance

• Stay with the individual until 

appropriate personnel arrive 

and assume management of 

his/her care

Availability of Social Support • “Do you know of family 

members, friends, or community 

agencies that can help with 

the problems you’re currently 

facing?”

• “Do you feel comfortable 

speaking to your family or 

friends when you need help or 

want to talk? Who can you go to 

for help?”

• Help the person connect 

with available resources and 

services

• Provide information about 

coping and social support

• Offer a follow-up meeting

Prior Alcohol or Drug Use • “Have you been using 

alcohol, drugs, or prescription 

medications to stop thinking 

about the event?”

• “Have you had any problems 

in the past with alcohol or drug 

use?”

• Provide information about 

coping and social support

• Link to appropriate services

• Offer a follow-up meeting

• For those undergoing 

withdrawal, seek a medical 

referral

Prior Exposure to Trauma and 

Death of Loved Ones

• “Sometimes events like this 

can remind people of previous 

trauma and loss. Have you 

ever been in a similar situation 

before?” 

• “Has some other bad thing 

happened to you in the past?”

• “Have you ever had someone 

close to you die?”

• Provide information about 

post-crisis and grief reactions, 

coping, and social support

• Offer a follow-up meeting

• Take note of those students who 

report prior trauma/loss, as they 

may have future academic or 

behavioral problems

Specific Youth, Adult, and 

Family Concerns about 

Developmental Impact

• “Were there any special events 

coming up that were disrupted 

by this event?”

• Provide information on coping

• Assist with strategies for 

practical help

Psychological First Aid for Schools Field Operations Guide 47

Core Action 5: 

Practical Assistance 

Illustration by Dr. Bob Seaver

Goal To offer practical help to students and staff to address their immediate needs and 

concerns
National Child Traumatic Stress Network National Center for PTSD 48

Core Action 5: Practical Assistance

Individuals likely to have more favorable outcomes after emergencies are those who have one or more of the 

following characteristics:

 Optimism (a belief that things will turn out as well as can be expected) 

 Confidence that life is predictable 

 Belief that they can achieve the goals they set (self-efficacy)

 Belief that outside sources will act benevolently on one’s behalf (e.g., that the community is willing to 

help)

 Positive self-talk or beliefs (e.g., “I have gotten through some tough situations in the past and I can get 

through this too”)

 Knowledge that they will have the resources they need (such as support from others, money for essential 

expenses, the opportunity to receive tutoring services)

Providing students, staff, and their families with needed resources can empower them, help them have hope, 

and restore their dignity. Therefore, assisting individuals with current or anticipated problems is a central 

component of PFA-S. 

Offer Practical Assistance to School Personnel

After emergencies, staff members are often asked by students and their families about resources available at 

the school and in the community to address post-event adversities. Keep staff informed about the resources or 

services that are currently available and where they can connect families to organizations or individuals who are 

coordinating such activities. This information should include ways to help address students’ academic needs 

and connect them with resources to facilitate their learning (identify whether transfer students have an IEP in 

place, availability of tutoring services, and/or where they can obtain school supply donations). Work with teachers 

around what homework strategies will help students with attention and concentration problems. Some events may 

cause students additional stress. For example, athletes who have to relocate to a new school may be concerned 

about being able join the team at the new school, or that a temporary decline in grades may impact their potential 

for acceptance at colleges. Work with the appropriate school staff member to address these types of concerns. 

To facilitate the school’s recovery, school staff can encourage students to organize or participate in various 

recovery activities, including donation drives, clean-up days, or events that promote wellness or civic 

responsibility. Teachers can establish class goals and can display the class’s progress as they move forward. 

Staff can help students’ problem-solve how they can share with others in the school community or how they 

can lend a helping hand.

Staff may have their own needs, and they may welcome your assistance. For example, they may have lost 

their own homes in a disaster and struggle with the rebuilding process themselves. Helping staff problemsolve together on how to support their school community and each other can improve their recovery process.

Throughout any contact, do all you can to help students and staff members identify immediate needs, 

set priorities, and choose initial steps to address the problems they face. Even under conditions of stress 
Psychological First Aid for Schools Field Operations Guide 49

Core Action 5: Practical Assistance

and adversity, helping individuals set achievable goals may reverse their immediate feelings of failure and 

inability to cope, give them repeated successes, and help them reestablish the sense of control necessary for 

recovery.

Offer Practical Assistance to Students and Staff

Students, staff, and family members benefit from clarifying their needs and concerns, developing a plan 

to address them, and acting on the plan. Their ability to clarify what they want, think through alternatives, 

select the best option, and follow through develops gradually. For example, many school-age students can 

participate in problem solving, but they will require the assistance of adults to follow through with their plans. 

When appropriate, share the plans you have developed with parents/caregivers or involve parents/caregivers 

in making the plans, so that they can help the child or adolescent complete them. 

Follow these four steps when offering practical assistance:

Step 1: Identify the Most Immediate Needs

If the student, staff member, or family member has identified several needs or current concerns, focus on them one 

at a time. For some needs, there will be immediate solutions (e.g., getting school books, phoning a family member 

to reassure him/her that the student or staff member is okay). Others (locating a lost loved one, obtaining services 

due to a newly acquired disability/injury, securing insurance for lost property, acquiring childcare for after-school 

hours) will not be solved quickly, and may be impossible to solve within the school setting. Collaborate with the 

individual to help him/her select the issues that require immediate help. For example, you might say: 

Adult I understand from what you’re telling me, Mrs. Williams, that your main goal 

right now is to rebuild your house so that your kids can stay in the same 

school. Let’s make a plan for what you have to do next.

Adolescent/ Child It sounds as if you are really worried about four different things: (1) what happened 

to your house, (2) when your dad is coming for you, (3) whether you will be able to 

return to your classroom, and (4) what will happen next. All of these are important, 

but let’s decide which is most important right now, and then make a plan.

Step 2: Clarify the Need

Talk with the individual to specify the primary problem. Once you have helped him/her clarify the problem, you 

will be able to identify the next practical step to address it. You might say:

Teacher/ School 

Personnel

I understand that your first concern is about several students whose parents 

can’t be contacted. Let’s work on a plan to address that problem.

Adolescent/ Child It sounds as if you are worried about several things. Right now let’s focus on 

finding out where your sister is.
National Child Traumatic Stress Network National Center for PTSD 50

Core Action 5: Practical Assistance

Teacher/ School 

Personnel

I understand that your biggest worry right now is what to tell your students 

about the situation. Let’s talk about what you might say.

Adolescent/ Child You seem to be very worried about what is going to happen next. Let’s talk 

about what you can expect for the rest of the day.

Step 3: Discuss an Action Plan

Discuss what can be done to address the individual’s needs or concerns. He/she may have ideas, or 

you can offer a suggestion. If you know ahead of time what services are available, you can help obtain 

food, clothing, shelter, tutoring, mental health, or childcare services, financial assistance, help to locate 

missing family members or friends, and volunteer opportunities for those who want to help in the relief 

efforts. Give school personnel realistic expectations about resources and support, qualification criteria, and 

application procedures. The more you understand the community’s and school system’s plan for dealing with 

emergencies, the more you will be a reliable resource for what can be expected.

Step 4: Act to Address the Need

Help the individual to take action. For example, help him/her set an appointment for a needed service, or 

assist him/her in completing paperwork. Within the school setting, you may be able to address the need 

yourself, but you may also help staff to decide on the actions to address that need. For example, encourage 

community agencies to present and have available the paperwork at a parent’s meeting, so that parents have 

a better understanding of available services and they can sign up for more than one program or service at a 

time.

Putting PFA into Practice 

Over the weekend, a family who had two students enrolled in the school lost everything in a residential 

fire. The vice principal contacted the mother, who was worried about how she could acquire clothing and 

school supplies so that her children could return to the school. The vice principal told her that the PTA 

and the school community wanted to help. The mother gave permission, a fund was set up in the family’s 

name, and the students organized a bake sale to raise money.

Assisting others after an emergency can be rewarding for the entire school community.
Psychological First Aid for Schools Field Operations Guide 51

Core Action 6: 

Connection with Social Supports

Illustration by Dr. Bob Seaver

Goal To help establish brief or ongoing contacts with primary support persons or other 

sources of support, including family, friends, teachers, and school and/or community 

resources 

Social support is an important component of emotional well-being and recovery following emergencies. 

Students and staff members who are well connected with others are more likely to engage in supportive 

activities (both receiving and giving support) that assist with recovery. 
National Child Traumatic Stress Network National Center for PTSD 52

Core Action 6: Connection with Social Supports

Provide Basic Information about Social Supports 

Social support can come in many forms:

• Emotional support: a listening ear, understanding, love, acceptance

• Social connection: feeling as if you fit in and have things in common with other people; having people 

with whom you can talk and do activities 

• Feeling needed: feeling that you are important to others, that you are valued, useful, and productive, 

and that people appreciate you

• Reassurance of self-worth: people who help you feel confident in yourself and your abilities, who 

believe that you can handle the challenges you face, and who help you remember the effective things 

you have done in past difficult situations

• Reliable support: having people reassure you that they will be there for you if you need them and that 

you can rely on them for help

• Advice and information: having people show you how to do something, give you information that 

you need, or offer good advice, and help you understand that your reactions to the event are common; 

having people who are good role models, from whom you can learn how to cope with what is happening 

in positive ways

• Physical assistance: having people to help you do things, such as cleaning up the classroom, helping 

you with paperwork, or gathering class assignments for you

• Material assistance: having people who can get you access to food, clothing, shelter, medicine, 

textbooks, school supplies, or money

Assist students and their families, as well as staff members, to develop and maintain their social connections 

as soon as possible. Critical to recovery, social connectedness has these benefits:

 Opportunities for sharing knowledge

 Opportunities for a range of social support activities, including:

– Practical problem-solving

– Emotional understanding and acceptance 

– Sharing of experiences and concerns

– Normalization of reactions

– Teaching each other about coping

Enhance Access to Primary Support Persons 

(Family and Significant Others)

Most individuals will immediately want to contact those with whom they have a primary relationship (parents, 

other family members, close friends, teachers, spouses or intimate partners, neighbors, and clergy). Take 

practical steps to assist students and school staff to reach these individuals (in person, by phone, by e-mail, 

through Internet databases/social media sites). 
Psychological First Aid for Schools Field Operations Guide 53

Core Action 6: Connection with Social Supports

They may want to contact other sources of social support, such as coaches, peers, co-workers, or club 

members (after-school clubs or sports teams). For most students and staff, the school itself functions as a 

setting of primary support. Reinforcing the connectedness to the school “family” will be helpful. Some students 

and staff may also be worried about family members in neighboring schools. Provide information about what 

is known about the nearby schools and clarify any misinformation about the safety of others. 

Enhance the School Community

One of the objectives of PFA-S is to stabilize the school community and to foster an environment for learning. 

To accomplish this goal:

 Promote a sense of tolerance by helping students and staff members understand that everyone is on their 

own recovery path. Some will need longer, while others may not have been affected. Acceptance of this 

difference and giving each other support can foster a healthy recovery environment. 

 Highlight the importance of mutual aid among the students and staff. Brainstorm ways that groups can 

work together to address mutual problems.

 Encourage students to watch out for each other. If they see a change in a peer’s behavior or mood, they 

should notify a parent, school counselor, or other trusted adult. 

 Create a plan for integrating new students who may have temporarily or permanently transferred to the 

school. Attempt to integrate these students into the school culture, and orient them to the school rules/

procedures as quickly as possible. Avoid singling these students out in a way that alienates them from 

the rest of the student body. For example, transfer students who have been given increased personal 

attention and received new backpacks or supplies from staff might be resented by other members of the 

student body, making it more difficult for new students to find friends or feel included. 

 If a school structure has been destroyed and students have been assigned to new locations, strategize 

ways to reconnect old classmates if possible. Work with the school administration or community agencies 

to create events that will bring together students from the same community (e.g., charity runs, food 

drives). A website can also be set up so that students can communicate with each other. If siblings are 

separated, encourage “bring your sibling to school day,” so that they can see the classrooms and the new 

building. 

 Facilitate social support activities by encouraging staff and teachers to increase the number of group 

activities and collaborative assignments. 

 Alert students and staff to upcoming community events and school-sponsored meetings. Give details 

about events, and add precautions if you are concerned that some students may not be ready for some 

events (e.g., memorials).

 Consider what developmental milestones may have interrupted for students and staff (e.g., graduation, 

retirement, first dance) and help them find ways to address this disruption. For example, they may have to 

postpone or relocate the celebration or they may have to adjust their expectations.
National Child Traumatic Stress Network National Center for PTSD 54

Core Action 6: Connection with Social Supports

Some individuals may need assistance in adjusting to changes in their relationships. For example, parents may 

monitor their children more after an emergency, which may be especially difficult for adolescents to handle. 

You may have to help students understand that their parents were also affected by the situation and that these 

changes are typically temporary. Other changes may be due to some individuals’ being more directly impacted 

by the event, how they are coping (seeking help vs. avoidance), and their involvement in the situation. Individuals 

who have visible injuries may have difficulty relating to their peers; they may become a reminder to others of what 

happened and lose important connections. Those who were considered “heroes” may gain immediate attention 

from the school community, and then struggle when those connections fade. If they were friends with an individual 

who is being blamed for the incident, they may be faced with alienation or bullying. As these changes occur, 

you may have to help facilitate communication between peer groups, or help individuals with seeking or giving 

support. Peer-to-peer programs can also help facilitate a sense of belonging among students. 

Discuss Support-Seeking and Giving

If students or staff members are reluctant to seek support, there may be many reasons, including:

 Not knowing what they need (and perhaps feeling that they should know)

 Feeling embarrassed or weak because they need help

 Feeling guilty about receiving help when others are in greater need

 Not knowing where to turn for help

 Not knowing how to ask for help

 Worrying that they will be a burden or depress others

 Thinking that since they’ve been helped in the past, they shouldn’t ask again

 Fearing that they will get so upset that they will lose control

 Doubting that support will be available or helpful

 Thinking, “No one can understand what I’m going through”

 Having tried to get help in the past and finding that help was not there (feeling let down or betrayed)

 Fearing that the people they ask will be angry or make them feel guilty for needing help

In helping students and staff to appreciate the value of social support and engaging with others, you can also 

help them to:

 Think about the type of support that would be most helpful

 Think about whom they might approach for that type of support

 Choose the right time and place to approach the person

 Talk to the support person and explain how he/she can be of help

 Thank the support person afterwards for his/her time and help
Psychological First Aid for Schools Field Operations Guide 55

Core Action 6: Connection with Social Supports

Let people know that, following a stressful, frightening event, some people choose not to talk about their 

experiences, and that spending time (sitting, walking, hanging out, playing a game) with people can allow one 

to feel close without talking. For example, your message might be: 

Adult/Caregiver When you’re able to leave school, you may not want to talk, but just be with 

the people you feel close to. At some point, you may find it helpful to talk 

about what you have been through. You can decide what to talk about and 

when. You don’t have to talk about everything that occurred, just what you 

choose to share with the other person.

Adolescent/Child When something really upsetting like this happens, it’s okay not to talk if you 

don’t want to. Hanging out with people you are close to without saying a word 

can be a good thing to do. But if you want or need something, be sure to 

reach out to someone you trust.

For those who would like to provide support to others, you can help them to: 

 Discover ways that they can help others (tutor students who missed school, organize fundraisers, 

disseminate donations, ask a friend if he/she wants to talk)

 Identify a person or persons to help

 Find an uninterrupted time and place to talk or to help

 Show interest, attention, and care

 Offer to talk or spend time together as often as needed

Let them know that, instead of discussing the event, it is better to provide practical assistance and help to 

problem-solve current needs and concerns.

Model Support

As a provider, you can model positive supportive responses, such as:

Reflective comments: “From what you’re saying, I can see how you would be . . .” 

“It sounds as if you’re saying . . .” 

“It seems that you are . . .” 

Clarifying comments: “Tell me if I’m wrong, but it sounds as if you . . .” 

“Am I right when I say that you . . .” 
National Child Traumatic Stress Network National Center for PTSD 56

Core Action 6: Connection with Social Supports

Supportive 

comments:

“No wonder you feel . . .” 

“It sounds really hard . . .” 

“It sounds as if you’re being hard on yourself.”

“It is such a tough thing to go through something like this.”

“I’m really sorry this is such a tough time for you.”

“We can talk more tomorrow if you’d like.”

Empowering 

comments and 

questions:

“What have you done in the past to help yourself feel better when things got 

difficult?”

“What do you think would help you to feel better?”

“I have an information sheet with some ideas about how to deal with difficult 

situations. Maybe there’s an idea or two here that might be helpful for you.”

“People can be very different in what helps them to feel better. When things 

get difficult for me, it has helped me to . . . Do you think something like that 

would work for you?”

If appropriate, distribute the handouts Connecting with Others: Seeking Social Support and Connecting 

with Others: Giving Social Support provided in Appendix C.

Putting PFA into Practice 

Following a school shooting, the track team struggled with how to support one another.

The team had always been close. Two of its members had been shot and could no longer compete with 

the team. A PFA provider, along with the coach, met with the entire team to discuss ways they could 

support each other during this difficult time. The injured students discussed how they wanted to remain 

part of the team, so the group problem-solved that the students would become managers of the team 

and have specific roles in the meets. The group agreed to check in again after the first meet to see how 

everyone was doing.

Creating open communication and an understanding of each other’s recovery can create problemsolving strategies that can foster a group’s recovery.
Psychological First Aid for Schools Field Operations Guide 57

Core Action 7: 

Information on Coping

Illustration by Dr. Bob Seaver

Goal To provide information about stress reactions and coping to reduce distress and 

promote adaptive functioning

Emergencies can be disorienting, confusing, and overwhelming, putting students and staff members at risk 

for feeling incompetent to handle problems that they face. Feeling confident that one can cope with traumarelated stress and adversity is beneficial to recovery.
National Child Traumatic Stress Network National Center for PTSD 58

Core Action 7: Information on Coping

Giving students, staff, and their families certain information can help them manage their stress reactions and 

deal more effectively with problems. Such information includes:

 What is currently known about the unfolding event

 What is being done to assist them

 What, where, and when services are available

 What post-disaster reactions to expect and how to manage them

 What they can do to assist with self-care, family care, and adaptive coping

Provide Basic Information about Stress Reactions

Briefly discuss the stress reactions that people commonly experience after a crisis. You may: 

 Highlight that they may be frightened or alarmed by their own response, and may view their reactions in 

negative ways (e.g., thinking, “There’s something wrong with me” or “I’m weak”). You can reduce their 

worry about their own responses by explaining that their reactions are understandable and expectable.

 Avoid pathologizing stress reactions; do not use terms like “symptoms” or “disorder.” 

 Make sure you note that there is a range of possible reactions from negative to positive, including 

a greater appreciation of life, family, and friends, or a strengthening of spiritual beliefs and social 

connections, so as not to give people the suggestion that they will only be negatively affected by events.

 Indicate that if their stress reactions continue to interfere with their ability to function adequately for more 

than a month, they should seek psychological services or student support staff to help restore their preevent level of functioning. (Remember that you may have to refer earlier if the individual is having major 

difficulty with sleep, unable to care for oneself, or shows signs of safety concerns.)

Provider Alert

While it may be helpful to describe stress reactions and to note that intense reactions are common but 

often diminish over time, avoid providing “blanket” reassurance that stress reactions will disappear. This 

may set up unrealistic expectations about the time it takes to recover.

Putting PFA into Practice 

PFA providers were called to a school after the death of a preschool student. Parents were concerned about how 

to explain death to children who had not previously experienced a death. Providers gave parents and teachers 

information about young children’s limited understanding of death and the need to explain death in sensitive, but 

concrete, terms. Providers also gave information about common grief reactions and the need to actively listen to 

young children’s feelings. Some of the parents were reluctant to talk to their child about death, stating that their 

child did not need to know and would not understand. However, when several parents utilized the information 

they were provided and talked with their children, they were surprised and relieved to find their children able to 

talk about the death, to express sadness for the loss, and to share positive memories of their friend. 

Providing psychoeducation to parents can help them be more responsive to their children.
Psychological First Aid for Schools Field Operations Guide 59

Core Action 7: Information on Coping

Common Psychological Reactions to Traumatic 

Experiences and Losses

Below is basic information about posttraumatic stress and other reactions that you can discuss with students 

and staff as issues arise.

Posttraumatic stress reactions:

Intrusive Reactions are ways in which the traumatic experience comes back to mind. These reactions 

include distressing thoughts or mental images of the event (e.g., visualizing what one saw) or dreams about 

what happened. In children, bad dreams may not be specifically about the trauma. Intrusive reactions also 

include upsetting emotional or physical reactions to reminders of the experience. Some people may feel 

and act as if one of their worst experiences is happening all over again. These reactions can interfere with 

individuals’ attention, concentration, and overall functioning at school.

Avoidance and Withdrawal Reactions are ways people use to keep away from, or protect against, intrusive 

reactions. They may try to avoid talking, thinking, and having feelings about the emergency, and avoid 

reminders of the event, including places and people. They may restrict or numb their emotions to protect 

themselves against distress. Their feelings of detachment and estrangement from others may lead to social 

withdrawal. They may lose interest in formerly pleasurable activities. Those experiencing these reactions may 

miss school more frequently, limit their participation in school activities, or change their peer group.

Physical Arousal Reactions are bodily responses to danger that occur when the danger is no longer 

present. People may react by constantly being “on the lookout” for danger, by startling easily or being jumpy, 

by being irritable or having outbursts of anger, having difficulty falling or staying asleep, and having problems 

concentrating or paying attention. Those struggling with these reactions can result in problems with school or 

work functioning, completing chores or homework, peers relationships, and overall health.

Other kinds of reactions: 

Grief Reactions will be prevalent among those who survived the event but have suffered losses, such as the 

death of loved ones, or loss of their home, possessions, pets, school, or community. Loss may lead to feelings 

of sadness and anger, guilt or regret over the death, missing or longing for the deceased, and dreams of seeing 

the person again. More information on grief reactions can be found in the section on Safety and Comfort. 

Traumatic Grief Reactions occur when children and adults have suffered the traumatic death of a loved one. 

Some survivors may stay focused on the circumstances of the death, including being preoccupied with how the 

death could have been prevented, what the loved one’s last moments were like, and who was at fault. These 

reactions may interfere with grieving, making it more difficult for survivors to adjust to the death over time. More 

information on traumatic grief reactions and how to respond can be found in the section on Safety and Comfort.

Depression is associated with prolonged grief reactions, and is strongly related to the accumulation of postevent adversities. Reactions include persistent depressed or irritable mood, loss of appetite, sleep disturbance, 

greatly diminished interest or pleasure in life activities, fatigue or loss of energy, feelings of worthlessness or 

guilt, feelings of hopelessness, and sometimes thoughts about suicide. 
National Child Traumatic Stress Network National Center for PTSD 60

Core Action 7: Information on Coping

Physical Reactions are commonly experienced, even in the absence of any underlying physical injury or 

illness. These reactions include headaches, dizziness, stomachaches, muscle aches, rapid heart beating, 

tightness in the chest, hyperventilation, loss of appetite, and bowel problems. 

Reminders and hardships:

Trauma Reminders can be sights, sounds, places, smells, specific people, time of day, situations, or even 

feelings such as being afraid or anxious. Trauma reminders are related to the specific type of event—such as 

a hurricane, shooting, flood, tornado, or fire—and specific circumcumstances can evoke upsetting thoughts 

and feelings about what happened. Examples include hearing the sound of wind, rain, helicopters, screaming 

or shouting, and seeing individuals who were present at the event. Students reacting to such reminders can 

cause them to be distracted, miss teacher instruction, engage in risky behaviors, and may result in a decline 

in academic performance.

Loss Reminders can also be sights, sounds, places, smells, specific people, time of day, situations, or 

feelings. Examples include seeing a picture of a lost loved one or seeing their belongings, such as their 

locker or desk. Loss reminders bring to mind the absence of the loved one. Missing the deceased can evoke 

strong feelings of sadness, anxiety, uncertainty about life without him/her, anger, loneliness, abandonment, or 

hopelessness. Loss reminders can lead students to miss school or other activities to avoid experiencing these 

reminders.

Change Reminders can be people, places, things, activities, or hardships that remind people of how their 

lives have changed as the result of an emergency. Change reminders can be something as simple as waking 

up in a different bed in the morning, going to a different school, or being in a refurbished place. Even nice 

things can remind people of how life has changed and make them miss what they had before.

Hardships often follow in the wake of disaster and can make it more difficult to recover. Hardships place 

additional strains on survivors and can contribute to feelings of anxiety, depression, irritability, uncertainty, and 

mental and physical exhaustion. Hardships can be loss of home or possessions, lack of money, shortages 

of food or water, separations from friends and family, school closures, medical or physical health problems, 

the process of obtaining compensation for losses, moving to a new area, and lack of fun activities. For these 

types of emergencies, the response phase may be longer and trauma/grief specific services will be needed to 

facilitate the school recovery.
Psychological First Aid for Schools Field Operations Guide 61

Core Action 7: Information on Coping

Talking with Students about Physical and 

Emotional Reactions 

Students may show a wide range of responses in the aftermath of an emergency. Some students will seem to 

bounce back fairly quickly, while others will take more time to recover. Keep in mind that children of the same 

age, exposed to the same event, may show very different reactions. Children also vary in their capacity to see 

connections between events and emotions. Many will benefit from a basic explanation of how trauma-related 

experiences produce upsetting emotions and physical sensations. Below are suggestions for working with 

students individually or within groups: 

Suggestions Examples

Ask students to tell you about their physical 

sensations, instead of directly asking them to 

describe their emotions.

“How do you feel inside?”

“Do you feel something like butterflies in your 

stomach or tight all over?”

Students have a wide range of reactions after crises. If 

they have problems identifying their reactions, suggest 

one or two and then let them come up with other ways. 

pick one, rather than asking open-ended questions.

“Each one of you may have differently reactions 

to what happened. There is no right or wrong way. 

Some students may feel sad, others may feel knots 

in your stomach. What are other reactions?”

Draw (or ask the student to draw) an outline of a 

person, and use this to help the student talk about 

his/her physical sensations.

[Point to stomach] “How does it feel here?”

The following script provides a basic explanation that helps children to talk about their reactions: 

Sample Script:

Helping 

Students Talk 

about Emotions

When something really bad happens, kids may feel funny, strange, or 

uncomfortable. Maybe your heart is beating really fast, or your hands feel sweaty, 

or your stomach hurts, or your legs or arms feel weak or shaky. Other times kids 

just feel funny inside their heads, almost as if they cannot press stop on the DVR 

and they keep watching the bad thing happen over and over again in their mind. 

Sometimes your body keeps having these feelings for a while even after the bad 

thing is over and you are safe. These feelings are your body’s way of telling you 

again how bad the event was. 

There is a wide range of reactions that you may be feeling. Do you have any of 

these feelings now, or other ones that I didn’t talk about? Can you tell me where 

you feel them, and what they feel like? 

Sometimes these strange or uncomfortable feelings come up when kids see, hear, 

or smell things that remind them of the bad thing that happened, like strong winds, 

glass breaking, or the smell of smoke. It can be very scary for kids to have these 

feelings in their bodies, especially if they don’t know why they are happening or 

what to do about them. If you like, I can tell you some ways to help you cope better. 

Would you like that? 
National Child Traumatic Stress Network National Center for PTSD 62

Core Action 7: Information on Copingx

Providing Basic Information on Coping 

Discuss a variety of ways to cope effectively with post-event reactions and adversity. Adaptive coping 

actions help to reduce anxiety, lessen other distressing reactions, improve the situation, or help people get 

through bad times. Maladaptive coping actions tend to be ineffective in addressing problems.

Adaptive Coping Actions Maladaptive Coping Actions

✔	Talking to someone (friend, teacher, support 

group, counselor)

✘	 Watching too much TV or playing computer 

games too long

✔	Getting needed information ✘	 Withdrawing from activities

✔	Getting adequate rest, nutrition, exercise ✘	 Withdrawing from family or friends

✔	Engaging in positive, distracting activities (sports, 

hobbies, reading)

✘	 Working too many hours or overly participating in 

activities to avoid reminders or feelings

✔	Trying your best to maintain a normal schedule ✘	 Getting violently angry

✔	Telling yourself that it is natural to be upset for 

some period of time; using calming self-talk

✘	 Blaming yourself or others excessively

✔	Taking breaks; using relaxation methods ✘	 Overeating or not eating enough

✔	Keeping a journal ✘	 Using alcohol or drugs to cope

✔	Focusing on something practical that you can do 

right now to manage the situation better

✘	 Doing risky or dangerous things

✔	Using coping methods that have been successful 

in the past

✘	 Not taking care of yourself (too little sleep, poor 

diet, no exercise)

The aim of discussing positive and negative forms of coping is to:

 Help students and staff consider different coping options 

 Identify and acknowledge their personal coping strengths

 Guide students and staff to examine the negative consequences of maladaptive coping actions

 Encourage students to make conscious, goal-oriented choices 

 Enhance a sense of personal control over their coping choices

Activity for Students

To help students identify positive and negative forms of coping, write down on slips of paper methods 

that students are currently using to cope. Then talk with them about adaptive and maladaptive coping 

strategies. Have the students sort the pieces of paper into two piles, one for each category, and then 

discuss ways they can increase their adaptive coping strategies. For younger children, play a memory 

game in which each coping strategy is written on two pieces of paper. Place the blank side of each paper 

face up, and have the children find matching pairs. Once a child finds a pair, discuss whether this is a 

good or bad strategy to help him/her feel better.
Psychological First Aid for Schools Field Operations Guide 63

Core Action 7: Information on Coping

Relaxation Exercises 

Breathing exercises help reduce feelings of arousal and physical tension and, if practiced regularly, can 

improve sleep, eating, and functioning. You can teach simple breathing exercises quickly, particularly when 

people are calm and can pay attention. Give out the handout Tips for Relaxation (Appendix C) to reinforce 

the use and practice of these techniques. To teach a breathing exercise, you might say:

School Staff/ 

Adolescents

1. Sit in a comfortable position with your arms and legs uncrossed.

2. Inhale slowly through your nose or mouth (one-thousand one, onethousand two, one-thousand three), and fill your lungs. 

3. Silently and gently say to yourself, “I’m filling my body with calm.” 

4. Exhale slowly through your mouth (one-thousand one, one-thousand two, 

one-thousand three), and comfortably empty your lungs.

5. Silently and gently say to yourself, “I’m letting the tension drain away.” 

6. Repeat five times slowly.

Children Let’s practice a different way of breathing that can help calm our bodies. 

1. I want each of you to think about your favorite color. Okay, we are going 

to breathe in through our noses or mouths. When we breathe in, we are 

going to think about our favorite color and the beautiful things that you 

connect with that color.

2. Next, we will breathe out slowly through our mouths. When we breathe 

out, we are going to breathe out the gray and the uncomfortable feelings 

that have been building up. Let out the air, slowly and quietly.

3. Let’s try it together. Breathe in really slowly and inhale thinking about your 

favorite color and the beautiful things connected to this color while I count 

to three. One...two...three. Good job. Now, while I count again, slowly 

let the air out while thinking about the color gray and all the unpleasant 

feelings. One...two...three. Great job. Let’s try it again together. 

[Remember to praise children for their efforts.]

If you find that a person has previously learned a relaxation technique, support him/her in doing what he/she 

has already learned rather than teaching new skills.

Relaxation Exercises in Groups

When teaching these skills in a group setting, have students seat themselves throughout the room in 

order to have more personal space. Some students may feel more comfortable closing their eyes, while 

others will not. Position yourself in the room in such a way that you can supervise the students during the 

exercise without having to walk too close to them. Students may find it disconcerting to have someone 

pass close by during relaxation. 
National Child Traumatic Stress Network National Center for PTSD 64

Core Action 7: Information on Coping

Helping with Difficulties 

Concentrating and Learning

In the aftermath of emergencies, students and staff members may have difficulties concentrating on school 

tasks, focusing on work, and learning. They may have trouble thinking about anything other than what 

happened, how life is different, and what may be ahead. This may make it difficult for them to focus on what 

is required in school, and add to their distress. Find out if this is happening, and help students and staff 

members to find ways to focus and get back on track with schoolwork/teaching and other necessary tasks.

Things to Ask:

 What are you worried about? How much are you thinking about it? For example, have you had trouble 

sleeping? Are you thinking a lot about what happened?

 What would be a different way to give yourself time to think about what happened and what it means to 

you, so that it would be less likely to interfere with what you have to do right now?

 What are some ways that you can stay focused and achieve what you need to do now?

Other Things to Consider:

 Help the person focus on needed activities by encouraging him/her to set aside times for talking with 

others or for thinking about his/her concerns. Make sure the person doesn’t plan to think about his/her 

concerns at bedtime. 

 Encourage the person to allow more time to complete school-related tasks, including taking more breaks 

and asking for help from others.

 Work with teachers and parents to modify classroom and homework structures for students with particular 

difficulty concentrating, by reducing distractions, breaking schoolwork into more achievable chunks, and 

giving more frequent assistance and feedback on the student’s performance. 

 Remind the person that he/she will feel better in the long run by staying on track with what is in front of 

him/her now.

 Provide referral for additional services for individuals who have continued sleep difficulties, are overly 

preoccupied with thinking about what happened, and worried about the future.
Psychological First Aid for Schools Field Operations Guide 65

Core Action 7: Information on Coping

Helping with Feelings of Anger and Frustration

Discussion Points about Anger

 Many students and staff members will struggle with feelings of anger after crises. They may see the event 

as unfair to themselves, their families, and the community.

 Having an anger problem before the event can make it more challenging to deal with anger afterwards.

 It is common to feel angry, but angry actions or unsafe behaviors can cause problems with family or friends.

 Holding on to the anger can hurt survivors or leave them feeling “stuck” in that bad moment. Coping with 

and letting go of anger, or directing energy toward positive activities, can help them move forward.

 Controlling anger is a great way to stay in charge. The calmer 

you are, the more you have the upper hand. If a student and/

or staff member cannot control his/her anger, then others will 

have to step in to control them. Teens, in particular, seldom 

like the feeling of someone else taking control.

Ways to Help Individuals Cope with Anger

1. Establish a connection. Take time to get to know the person 

and to gain some trust. Those who act out in angry ways may 

actually feel quite scared and vulnerable. 

2. Discuss the warning signs of anger. Suggest that they can become more aware of early warning signs 

of anger by watching for clenched fists, biting one’s lip, yelling, and/or throwing objects. 

3. Develop a plan. Brainstorm several ways to cope with anger. Help 

students and staff plan responses to fit different challenging situations. 

4. Model and role-play. Demonstrate using the plan in a challenging 

situation. First, you should play (model) the role of the angry individual 

applying his/her plan. Then, have the person practice the anger coping 

plan. Do this a couple of times, until he/she feels comfortable with 

the plan. If you are working in a group, pick a member who appears 

comfortable speaking in front of others to try it.

5. Reinforce. Praise the individual’s efforts when you see them using 

their anger coping plan. Sometimes students find it helpful to share 

their plan with others (parents, for example) who can support the 

student’s coping. 

6. Monitor and evaluate. If possible, try out the plan an agreed-upon 

number of times; later, review how well it worked or did not work. 

Change the plan as needed. 

Ways to Cope

• Take a “time out”

• Talk to a friend

• Exercise

• Write about it

• Draw a picture

• Read a book

• Listen to music

• Pray/meditate

• Look at it from 

another’s viewpoint

• Problem-solve

Provider Alert

Working with angry individuals can 

make professionals feel uncomfortable. 

Remain calm yourself. Keep safety in 

mind, but remind yourself that anger 

in these situations is common. If an 

individual appears out of control or 

becomes violent, contact security.
National Child Traumatic Stress Network National Center for PTSD 66

Core Action 7: Information on Coping

Helping with Guilt, Shame, and 

Other Difficult Emotions 

Students and staff may think about what caused the event, how they reacted, and what the future holds. They 

may blame themselves or others, adding to their distress. Listen for such negative beliefs, and help them to 

look at the situation in ways that are less upsetting. 

Things to Ask:

 What would be a different way to look at the situation that would be less upsetting and more helpful? 

What’s another way of thinking about this?

 What are some other ways people might look at the situation. Would this be more or less upsetting to 

you? What would you say to a good friend who was talking like this? Can you say the same things to 

yourself?

Developmental Alert

When working with younger children, use an activity. They often find it easier to focus on play objects 

such as dolls or puppets or to draw pictures related to their feelings. 

Remember that the purpose of the activity is to help children find a different way to view their situation, 

not merely to act out their feelings without resolution. Actively participate by labeling feelings, clarifying 

the thoughts of the characters, or joining in the play to model a different way of thinking about or 

responding to the situation. 

Other Things to Consider:

 Explain that even if he/she feels at fault, that does not make it true. If he/she is receptive, offer some 

alternative ways of looking at the situation. 

 Help to clarify misunderstandings, rumors, and distortions that exacerbate distress, unwarranted guilt, or 

shame. 

 For children and adolescents who have difficulty labeling these thoughts, you can write out their negative 

thoughts on a piece of paper (“I did something wrong,” “I caused it to happen,” “I was misbehaving”). 

For a child still struggling with this, you may suggest some negative thoughts that other children have 

had and invite him/her to identify the ones that fit best. You can then discuss each one, clarify any 

misunderstandings, discuss helpful counter-thoughts, and write those down as well. 

 Remind the person that he/she is not at fault, even if he/she has not expressed this concern directly.

 In the event that the person is in some way responsible and is dealing with the resulting guilt, he/

she should be referred for ongoing counseling. These situations fall outside the scope of short-term 

interventions such as PFA-S.
Psychological First Aid for Schools Field Operations Guide 67

Core Action 7: Information on Coping

Risk-Taking Behaviors

Following Traumatic Events 

Things to Keep in Mind: 

 Some students and young adults increase their risk-taking behaviors 

and may have more accidents.

 Their actions may be more unpredictable or impulsive.

 Trauma increases adults’ and students’ risk for substance abuse, and 

substance abuse increases the risk of trauma.

 They may react to traumatic reminders (sounds, sights, smells 

associated with the emergency) with risky behaviors.

 Students and young adults exposed to traumatic events may adopt a 

“live for today” attitude and be less focused on the future.

How to Help:

 Be alert for possible dangerous behaviors among students.

 Follow up with younger students who show an increase in visits to the nurse due to accidents and injuries.

 Discuss the potential for an increase in risky behavior with students and staff, how it relates to the emergency 

and reminders, and the temporary need to be more careful for a few months after a crisis or disaster.

 Discuss these risks with parents. Encourage them to temporarily increase supervision and set clear, firm 

limits on risky behaviors. 

 Involve students in meaningful activities that have a tangible outcome, such as a project to help others in 

their community.

 Encourage students and staff who have previously received treatment for substance abuse to seek 

additional support in the weeks and months following an emergency.

Risky Behaviors

• Reckless driving

• Cutting

• Unsafe sexual 

behaviors

• Drug and alcohol use

• Delinquent behavior

• Running away

• Dangerous behaviors 

on the playground
National Child Traumatic Stress Network National Center for PTSD 68

Core Action 7: Information on Coping

Monitoring Warning Signs

Students may show a variety of behaviors that indicate that they are having difficulty coping with the emergency. 

Be on the lookout for students exhibiting the following behaviors, as they may benefit from extra support:

 Increased worries or fears about self and others 

 Unusually whiny, irritable, moody

 Behavior changes (activity level, anger, withdrawal)

 Somatic complaints (stomachaches, headaches)

 Recreating the event (acting it out in play)

 Overreacting to sudden sounds or movements

 Dwelling about death or dying

 Difficulty following directions or accepting authority

 Nightmares or disturbing memories during the day

 Chronic decrease in school performance and completing assignments

 Increased problems with peers or interacting with others

 Hyperarousal (problems sleeping, easily startled)

 Avoidance behaviors (resists experiencing things that remind him/her of the event)

 Appearing numb emotionally

Preschool Elementary School

• New fears (the dark, monsters, going to the 

bathroom alone)

• Separation anxiety/clinginess

• Regression in development (loss of toilet training 

skills, baby talk)

• Aggression (biting, hitting)

• Excessive clinginess to adults

• More whining 

• More babyish behaviors

• Signs of risky behavior, such as increased 

accidents on the playground

Middle School High School

• Difficulties with authority (challenging or defying)

• Troubled thoughts, such as recurring revenge 

fantasies

• Increase in impulsive, risky behaviors 

• Drug or alcohol use/abuse

• Repetitive thoughts or comments about death 

(writing, art, or Internet searches about morbid 

topics)
Psychological First Aid for Schools Field Operations Guide 69

Core Action 7: Information on Coping

Helping with Sleep Problems 

Sleep difficulties are common following an emergency. People tend to stay on alert, which makes it hard to 

fall asleep and causes frequent awakenings during the night. Worrying about adversities and life changes 

can also make it hard to fall asleep. Disturbances in sleep can have a major effect on mood, concentration, 

decision-making, and risk for injury. Ask students and staff members about any trouble sleeping, sleep 

routines, and sleep-related habits. 

Problem-Solve Ways to Improve Sleep:

 Go to sleep at the same time and get up at the same time each day.

 Reduce alcohol consumption, as alcohol disrupts sleep.

 Eliminate consumption of caffeinated beverages in the afternoon or evening.

 Increase regular exercise, but not too close to bedtime.

 Relax before bedtime by doing something calming, such as listening to 

soothing music, meditating or praying, or reading.

 Limit daytime naps to 15 minutes and do not nap after 4 PM.

Other Things to Consider:

 Encourage them to talk about and get support from others as worrying and reacting to reminders can 

disrupt sleep.

 Enourage the individual to use calming strategies, such as breathing exercises, meditation, stretching, 

yoga, prayer, or listening to quiet music.

 Talk to the student’s parents about how they can provide their child with additional support at night. For 

example, they could soothe their child, give more time to the nighttime routine, or practice the relaxation 

exercises at bedtime.

Caution: Teens and 

Adults

Avoid driving, 

physical labor, or 

activity—such as 

home repairs or 

cleaning up a park—

if you are sleeping 

poorly. Be extra 

careful when you are 

feeling tired.

Psychological First Aid for Schools Field Operations Guide 71

Core Action 8: 

Linkage with 

Collaborative Services

Illustration by Dr. Bob Seaver

Goal To link students and staff with available services they need now or will need in the 

future
National Child Traumatic Stress Network National Center for PTSD 72

Core Action 8: Linkage with Collaborative Services

Provide Direct Link to Additional Needed Services

Identify which of the student’s, staff member’s, or family members’ needs and current concerns require 

additional information or services, and discuss with that person how to connect with these additional 

resources. Be aware of school policy about making referrals to outside resources and of existing links 

the school may have with outside agencies. Make sure you adhere to confidentiality laws and parental 

notification policies. Do what is necessary to ensure effective linkage with those services (walk the family 

over to a service agency representative, set up a meeting with a community representative who may provide 

appropriate referrals, or talk with the school representative who typically makes referrals for students). 

Examples of situations requiring a referral include:

• An acute medical problem that needs immediate attention

• An acute mental health problem that needs immediate attention

• Worsening of a preexisting medical, emotional, or behavioral problem

• Threat of harm to self or others

• Concerns related to alcohol or drug use

• Cases involving domestic, child, or elder abuse (be aware of reporting laws)

• When pastoral counseling is desired

• Ongoing difficulties with coping (four weeks or more after the event)

• Significant developmental concerns about children or adolescents

• When they ask for a referral

In addition, encourage families and staff to reconnect to agencies that provided services and support to them 

before the event, including: 

 Mental health services

 Medical services

 Social support services

 Child welfare services

 Drug and alcohol support groups

 Churches, synagogues, temples, mosques or other spiritual groups

When making a referral:

 Give the person a brief summary of your understanding of his/her needs and concerns.

 Check for the accuracy of your summary.

 Describe the option of referral, including how this may help and what will take place if the individual goes 

for further help.

 Ask about the person’s reaction to the suggested referral, and ask for permission to share information 

with the new provider.

 Give written referral information or, if possible, make an appointment then and there.
Psychological First Aid for Schools Field Operations Guide 73

Core Action 8: Linkage with Collaborative Services

 Ask for permission and/or a written release from the parent to share information with the professional 

receiving the referral.

 Make sure that both a parent and the school are aware of your concern that a referral for continuing care 

may be warranted.

 Recommend that any follow-up services for the family include (at least) a brief evaluation of child and 

adolescent adjustment.

Promote Continuity in Helping Relationships

As the recovery process continues, follow up with teachers and other staff members to monitor any significant 

emotional or behavioral reactions students may be displaying. Ensure that all staff members know the procedures 

for how and when to make a referral. Make sure a member of the counseling staff or a nurse is monitoring 

students’ attendance, nursing visits, academic performance, and disciplinary records to identify students who may 

be at-risk. It is always good practice to inform the individual who made the referral that you followed up with the 

referral. Finally, a member of the team should contact agencies with whom your school has preexisting mutual 

aid agreements and identify others to contact for additional services your school community requires for recovery. 

Meet with these agencies regularly to ensure that they are able to support the school community’s needs.

A secondary—but important—concern for many students and staff members is keeping in contact with responders 

who have been helpful. If you are an outside responder, you will not be able to have continuing contact with 

students and staff, as you will leave once the crisis is resolved. Fortunately, school personnel provide continuity 

and help protect against feelings of abandonment or rejection. You can create a sense of continuing care if you:

 Emphasize the role of school personnel in providing immediate and ongoing support for students, and 

personally “hand off” students with whom you have worked to school personnel who will remain onsite.

 Provide names and contact information for the local public health and public mental health service providers 

in the community. There may also be other local providers or agencies that have volunteered to provide 

post-disaster follow-up services for the community. (Be wary of referring to unknown volunteer providers.) 

Minimize the need for a student or staff member to retell his/her story, by sharing information with those who 

will have ongoing contact. Orient the new provider to what he/she needs to know about the person and, if 

possible, provide an introduction.

Putting PFA into Practice 

A student was badly injured in a bus accident and missed several days of school. When he returned, 

he had difficulty concentrating and completing his school work. His counselor recommended that he 

see a mental health professional, but he refused. The counselor addressed the student’s concerns 

and he agreed that it would make him feel better if the counselor talked to the psychologist first. The 

student’s parents agreed with this. When the counselor made contact, the parents agreed to have the first 

appointment at the school, with the counselor present, to help with the transition.

Spend extra time understanding an individual’s concerns about a referral, and problem-solve 

ways to ease the transition.
Core Action 8: Linkage with Collaborative Services
Psychological First Aid for Schools Field Operations Guide 75

PSYCHOLOGICAL FIRST AID 

FOR SCHOOLS 

Appendices

Skills Materials Page

A: Recommendations for 

School Staff 

Appendix A Contents 77

Principals and Administrators 79

Teachers 83

Health-Related Professionals 87

Support Staff 91

B: Guidelines for Using PFA-S 

in a Group Format 

Appendix B Contents 93

Assemblies 95

Classrooms 97

Small Groups: Students/Staff with Varied Experiences 101

Small Groups: Students/Staff with Similar Experiences 105

C: Handouts and Worksheets Appendix C Contents 109

Provider Worksheet—Survivor Current Needs 111

Provider Care 113

Connecting with Others: For Adults 117

Connecting with Others: For Students 119

When Terrible Things Happen: For Adults 121

When Terrible Things Happen: For Students 125

Helping Your Family Cope: For Parents 127

Tips for Relaxation 129

Psychological First Aid for Schools Field Operations Guide 77

Appendix A: 

Recommendations for 

School Staff 

Materials Page

Principals and Administrators 79

Teachers 83

Health-Related Professionals 87

Support Staff 91

Psychological First Aid for Schools Field Operations Guide 79

Recommendations for School Staff

Providing Psychological First Aid: 

Principals and Administrators

During and following an emergency, you will be responsible for the health and safety of your students and 

staff. They will look to you for guidance on how best to proceed. You may need to coordinate assistance from 

city, state, county, and/or federal agencies. You may be overwhelmed by the need to make myriad immediate 

decisions, predict unknown variables, and be accountable to the district and the community at large. Below 

are suggestions for how to implement PFA-S.

PFA-S Core Action 1: Contact and Engagement

Provide Leadership: To be most effective, be visible to the school community, delegate extensively, and 

provide steady, reassuring, and accessible leadership. Call on your school’s district and community partners 

for their help and resources. Avoid closing off the school to agencies that can help in recovery. When you 

delegate specific and appropriate roles to your staff, they will feel more empowered and better able to 

stabilize students, parents, and others. 

Reach out to Those Affected: Make contact with groups most affected by the incident, including family 

members of deceased students/staff, injured and hospitalized individuals, and staff members who have been 

directly affected. If you are unable to make contact, assign an administrative designee. In addition, assign a 

staff member to act as the Liaison Officer with community services (e.g., police, fire, mental health) and other 

response organizations. 

Consider Consultation: If your safety plan does not apply to the incident at hand, contact the school district’s 

emergency office, other local and state resources, or other administrators familiar with similar events to help 

you with the series of decisions you will have to make. You might also contact disaster mental health experts 

who have developed school-based recovery programs. Your state education agency, the US Department of 

Education, or local professional organizations can help identify such experts. 

PFA-S Core Action 2: Safety and Comfort

Provide Regular Updates: Communicate regularly about the situation and services offered at the school or 

in the community. Set up mechanisms, such as staff meetings, to get updates from teachers and other staff 

members about ongoing safety concerns. 

Address Identified Safety Concerns: Use a multidisciplinary team (including police, legal advisor, and 

school counselor) to assess and address the safety concerns of students, staff, and/or families. Consider 

developing a Threat Assessment Team, if your school does not already have one, so that students, staff, and 

parents have a reporting system through which they can anonymously share critical, sensitive information or 

report rumors. 

Limit Media Access: Work with the district or your Public Information Officer on which messages will be 

released about the event, when, and how. Maintain a good working relationship with local media and provide 

regular updates in a pre-designated location during and after the emergency. Enforce policies to limit the 

amount of media exposure on school grounds. Monitor media stories to see how they may influence the 

safety concerns of the school community. 

Help Manage Grief: Give special attention to those affected directly by the incident. Form a group of 

representative administrators, teachers, student leaders, community leaders, and parents to decide about 

memorial events, displays, or other ways to honor those who died, when temporary displays should be 

removed, and what information to include in the yearbook or how to honor the deceased at graduations. 
National Child Traumatic Stress Network National Center for PTSD 80

Recommendations for School Staff

PFA-S Core Action 3: Stabilization

Stabilize the School Environment: You can be a calming influence in the days and weeks after an incident. 

Stay visible. Try to greet students and staff as they enter school, visit classrooms, attend student gatherings 

or activities and/or community meetings.

Identify Possible Reminders: Meet with staff as soon as possible to discuss possible reminders of the 

incident within the school setting. Sounds, sights, or specific areas of the school may cause significant 

distress to others. Take steps, to the extent possible, to eliminate potential reminders. Remember: what 

serves as a memorial for some may serve as a trauma/loss reminder for others.

Identify Students at Risk: Make sure there are mechanisms in place to monitor those who need additional 

mental health support and other services. Encourage trainings be offered to all staff highlighting the common 

courses of recovery, signs of risk, and how to promote recovery. 

PFA-S Core Action 4: Information Gathering

Become Fully Informed about the Incident: Take the time to understand fully what happened. When 

“mapping” the event, identify which groups may have been more affected than others. Obtain information 

from interviews, attendance records, nursing and/or teacher reports, police reports, and crisis team debriefing 

meetings. In a multi-agency response to an emergency, make sure a member of your administration is part of 

the Incident Command System.

Actively Reach out to Students: Work actively with your staff to identify how students are coping. Establish 

clear lines of communication and referral between staff and school counselors. You may want to encourage 

your health-related staff to conduct brief screenings to proactively identify students who are in need of 

additional support. 

PFA-S Core Action 5: Practical Assistance

Coordinate Donations and Volunteers: Other schools and community agencies may offer their assistance, 

and donations may arrive from various sources. Assign a staff member to monitor and coordinate these 

efforts; otherwise, you may be overwhelmed trying to manage such donations. 

PFA-S Core Action 6: Connection with Social Supports

Integrate New Students: Students who have been through an emergency may transfer to your school 

temporarily or permanently. Encourage staff to integrate these students into the school culture and orient 

them to the school procedures as quickly as possible. Avoid singling out these students in a way that 

alienates them from the rest of the student body. 

Establish Peer-to-Peer Programs: Help students reach out to each other. Peer-to-peer programs facilitate a 

sense of belonging among students and help connect incoming students to peers. 

Maintain School Community Connections: If your school is unable to reopen immediately, establish ways 

students can get in contact with each other (e.g., website, social media, an event). 
Psychological First Aid for Schools Field Operations Guide 81

Recommendations for School Staff

PFA-S Core Action 7: Information on Coping

Provide Psychoeducation and Information: Hold staff and parent meetings as soon as possible. Clarify 

what happened, describe available resources, and explain next steps. Be prepared for intense conversations 

and questions that you do not have answers to yet. Have a team, that includes police (when relevant) and mental 

health professionals, with you to address these questions. 

Promote Your School as an Environment for Recovery: Stress that there are different courses of recovery 

and that you are doing your best to put in place policies and procedures that will support recovery and 

promote learning and academic functioning. Let individuals know if the school will continue to provide services 

for those having difficulties in the future or will provide additional support (staff, respite, resources) for staff 

dealing with their own recovery. 

Maintain School/Academic Routines: Students do better when they can return to their regular routine. 

Reopen school as quickly as possible, help reestablish school routines, and make modifications as needed. 

For example, advise teachers if they should consider adjusting their teaching plan and to be prepared to 

postpone some events if safety concerns remain.

PFA-S Core Action 8: Link with Collaborative Services

Activate Mutual Aid Agreements: Contact agencies with whom your school has preexisting mutual aid 

agreements and identify others needed to assist in your school’s recovery. 

Seek and Apply for Funding: Financial resources may be available to provide services to those affected 

by the crisis (e.g., Victims of Crime, American Red Cross) or to your school (e.g., Dept. of Ed Project SERV 

grants; SAMHSA SERG grants). Research the agency’s sites regarding eligibility requirements and assign 

staff to work on the applications. 

In the days and weeks following an emergency, the school becomes a recovery milieu. Due to your leadership 

role, you will be under extraordinary stress at this time. Secondary traumatic stress is common for those in 

these positions. As you create an environment to promote recovery in those around you, be sure to practice 

self-care. In doing so, you will model self-care for your staff and students, and you will be able to meet your 

responsibilities most effectively. 

Psychological First Aid for Schools Field Operations Guide 83

Recommendations for School Staff

Providing Psychological First Aid: 

Teachers

During an emergency, your primary responsibility is the safety and welfare of you and your students. When 

classes resume, you may feel the need to return to academics quickly. However, to best promote long-term 

recovery and to help students return to their pre-crisis ability to concentrate and function academically, be 

sure to talk to them about the recovery process and address any safety concerns. You may want to modify the 

classroom curriculum temporarily, take extra time to cover certain material, or postpone possibly distressing 

subject matter. Below are suggestions on how to implement PFA-S.

PFA-S Core Action 1: Contact and Engagement

Take the Initiative: Students may withdraw or have other difficulties recovering from the crisis and fail to seek 

help. Actively reach out to students, especially those you have a good relationship with. If they aren’t willing 

to talk with you, seek out another staff member who may be able to help. Speak in private if you can and be 

discreet. 

Seek Consultation: It is impossible to prepare for every scenario that may occur or every concern students 

may have. Consult the school’s mental health professional or have him/her visit your class to give information 

and answer students’ questions.

PFA-S Core Action 2: Safety and Comfort

Reassure Students: In the days and weeks after the incident, students may continue to show signs of 

emotional distress or concern. Reassure them that they can come to you with such concerns and/or inform 

them of the procedures in place to get help.

Report Safety Concerns: Be alert to safety concerns about subsequent incidents or rumors, and report any 

such rumors or threats immediately to the school’s Safety Officer or administration. 

Help Manage Grief: If a student is struggling with the death of a friend or loved one, provide appropriate 

emotional support. After identifying the needs of the student, notify the school’s mental health professional of 

the situation and modify academic assignments as needed.

Provide Information about the Event: Consider these guidelines when talking with students:

4 Be truthful and share information in a developmentally appropriate way.

4 Discourage discussion about details of any death or disturbing aspects of the event.

4 Provide a timeline of upcoming school activities (clearing of debris, removal of memorial displays, 

rebuilding efforts).

4 Work with the students in planning memorial tributes or displays. Inform them about any applicable school 

procedures or restrictions. 

4 Encourage students to participate in prosocial service activities (volunteer days, fund raising events). Help 

students assemble cards, letters, and memory books for the families of the victims, but ensure that the 

content of such materials is appropriate.
National Child Traumatic Stress Network National Center for PTSD 84

Recommendations for School Staff

PFA-S Core Action 3: Stabilization

Stabilize the School Environment: Calmly convey to your students that the staff and administration are 

continuing to monitor the situation and will attempt to address any concerns they might have. Students are often 

anxious when facing trauma-related chaos, changes, and transitions. Providing them with a calm, supportive 

environment with clear rules and expectations will help them regain a sense of security and normalcy.

Identify Possible Reminders: Take steps, to the extent possible, to eliminate potential reminders in your 

classroom that may cause distress (e.g., substitute potentially distressing lesson plans, remove hanging pictures of 

the crisis on the walls). If a student does become reactive, calmly provide emotional support or refer him/her 

to the school’s health/mental health professional.

PFA-S Core Action 4: Information Gathering

Know Common Signs of Distress: Watch and listen for any students who show signs of distress or changes 

in behavior and refer them to the appropriate professionals. Signs of distress vary by age and developmental 

level and can include:

• Poor control of emotions

• Anger and moodiness

• Frustration and anxiety

• Social withdrawal

• Change in academic performance or in attendance

• Trouble with concentration, memory, cognition, and organization

• Physical symptoms like headaches and stomachs

• Risk-taking, unpredictable, and/or impulsive behavior

• Intense reactions to reminders of the event

Identify Students Needing Services: If you see changes in a student, ask directly how he/she is doing. Many 

students will not tell someone they are having difficulty until they are directly asked. Also ask the student if he/

she knows of any classmates who may need help. They are often aware of changes in their peers.

PFA-S Core Action 5: Practical Assistance

Identify Students with Resource Needs: Help to identify students’ needs, such as school supplies, tutoring, 

or uniforms. If a student has transferred from another school system, find out if they have an IEP, whether 

there are accommodations to meet personalized plans, or other academic needs.

Help Families: You may be able to help students’ families with their needs and concerns by directing them 

to appropriate support staff and resources. Reassure them of the steps the school is taking to promote 

recovery. Use a part of staff meetings to discuss some of these needs and concerns so that administration 

can problem-solve ways how to address them (e.g., identify additional community resources, use of donation 

funds). 
Psychological First Aid for Schools Field Operations Guide 85

Recommendations for School Staff

PFA-S Core Action 6: Connection with Social Supports

Integrate New Students: Students from other schools may transfer to your school temporarily or 

permanently. Attempt to integrate new students into your class as soon as possible. Introduce them to other 

students with similar interests (sports, arts, clubs) or from similar neighborhoods. Avoid singling out these 

students in a way that could alienate them from the rest of the student body. Be aware that they will be 

missing their old friends and strategize ways to reconnect them if possible. 

Increase In-Class Interaction: You will want to encourage interaction among students to facilitate social 

support. Increase the number of group activities and collaborative assignments. Encourage reconnection 

with family, friends, and members of their faith communities. Provide information about upcoming community 

events and give details about these events with added precautions. Thus, give details about events and add 

precautions if you are concerned that some students may not be ready for some events (e.g., memorials).

PFA-S Core Action 7: Information on Coping

Address Concerns: Schedule time with students to listen to their concerns about the incident. Correct 

misconceptions they may have about recovery. Schedule this discussion early in the day and when there is 

enough time to address all concerns. 

Maintain Structure: Help students’ recovery by keeping to the regular classroom structure as best you 

can. Students benefit from predictability and consistency. When children need to change teachers and/or 

classrooms, make the new setting as similar as possible to the previous one. If this is not possible, discuss 

the losses and changes as a group. 

Provide Support: Students may exhibit more defiant, hyperactive, and/or distractive behaviors in your 

classroom. Remain calm and provide clear instructions of the behavior you expect. Praise students for 

appropriate, on-task behavior and for using effective coping skills. To assist students to be more organized, 

breakdown assignments into manageable parts and encourage them to write them in their planners. 

PFA-S Core Action 8: Link with Collaborative Services

Provide Information on Available Services: All families, students, and staff need to know the location of 

school and community services and the steps required to access these services. If you are unsure of the 

appropriate and available resources, refer the individual in need to support staff who hve that information. 

Have psychoeducational and informational materials available for parents in order to address their questions. 

Follow up on Recommendations: Check in with students and parents to make sure that they are getting the 

services or resources you have recommended. If not, review the plan and adjust it accordingly.

In the days and weeks following an emergency, the school often becomes a recovery milieu. You play a 

vital role in the recovery of the students and the school community. You serve as the primary contact person 

for students throughout the course of the day by watching out for the welfare of students, identifying those 

who are struggling and getting them help, and providing updated and accurate information which you obtain 

through staff meetings and from the school administration. By utilizing the suggestions in this handout, you 

can help students recover and succeed academically, psychologically, and socially. These strategies can also 

help you and your family. Most importantly, don’t forget to take care of yourself during these stressful times.

Psychological First Aid for Schools Field Operations Guide 87

Recommendations for School Staff

Providing Psychological First Aid: 

Health-Related Professionals

You play a unique role in caring for the needs of the school community during and after times of crisis. The 

acute phase is not the time to provide therapy. It is the time for immediate assistance to those affected by 

the emergency. If you are called to a situation that is beyond your usual scope of practice, do not hesitate to 

consult providers more experienced in this type of event. If you are from an outside agency responding to a 

school crisis, you may be more helpful by assisting staff and parents than providing direct care to those most 

impacted, freeing the school health and mental health staff to provide the direct support needed after such 

events. 

PFA-S Core Action 1: Contact and Engagement

Be Aware of Cultural and Developmental Issues: Before working directly with students and staff, learn 

about the school culture and the cultural and developmental issues of the survivors to whom you will be 

providing services. Modify contact based on these factors.

Reach out to Those Affected: Outreach to students and staff, even though they may avoid asking for or 

seeking help. If you are new to the school, work with teachers or other staff who are more familiar with the 

school community. At a minimum, talk to school officials about the individuals who were most impacted in the 

emergency, and find out if there are prior events or situations that may put this group at increased risk for 

distress.

Work as a Team: Always work within the Incident Command System and within a team, so that you can 

utilize each member’s unique skill sets. Communicate frequently with your team to learn about changing 

needs and concerns.

Plan for Students’ Ongoing Needs: Students with the greatest exposure and those who have experienced 

a death or witnessed the death of a friend or loved one will need continuing support at school. Make sure a school 

staff member is assigned to support these individuals, rather than a PFA provider from the community who may not 

be able to assist the students’ long-term needs. 

PFA-S Core Action 2: Safety and Comfort

Ensure Safety: Ask staff and students if they have any current safety concerns at school. Listen for rumors 

or threats of subsequent incidents, and report any such rumors or threats immediately to the school’s Safety 

Officer or administration. 

Watch for High-Risk Behavior: Students may increase substance use or participate in other high-risk 

behaviors (e.g., driving recklessly, initiating fights), endangering themselves or others. Students are the first 

to know if a peer is troubled, so ask them directly if they are concerned about anyone’s safety. Address these 

concerns immediately. Seek additional assistance if needed (e.g., school resource officer, threat assessment 

team).

Support Those Overwhelmed with Grief: Support and comfort those overwhelmed with the death of a friend 

or family member. You might work with teachers on how to talk to their class about the death of a student or 

staff member, help administration with memorial events and displays, and/or assess at-risk students. 
National Child Traumatic Stress Network National Center for PTSD 88

Recommendations for School Staff

PFA-S Core Action 3: Stabilization

Identify Vulnerable Students and Staff: Those with a history of prior mental health problems or who have 

had similar past traumas may have more difficulty in the current crisis. Be sure to ask about prior experiences 

and coping strategies. Check in with these individuals frequently, particularly if there are continuing safety 

concerns at the school. Be aware that they may have distressing reactions to reminders of former traumatic 

events or may become unstable, more so than the rest of the school population. Offer to guide them in 

relaxation and grounding techniques, and check back with them to assess how they are doing.

Differentiate between Physical and Emotional Distress: Some students and staff members may present 

with physical reactions and may have frequent visits to the nurse or a medical doctor. Ask about their 

experience during the crisis and how they are coping. Find out if the physical reactions are related to the 

recent trauma (e.g., Did the symptoms start around the time of the event? Do they become more severe when 

the person is reminded of the event?), and consider a referral to a mental health specialist.

PFA-S Core Action 4: Information Gathering

Know All You Can about the Incident: Find out what happened during the event and who was affected. 

When “mapping” the event, learn which individuals may have been more impacted than others. Obtain 

information from interviews, attendance records, nursing and/or teacher reports, police reports, and crisis 

team debriefing meetings.

Develop a Referral System: Educate staff members as to how they can refer students for evaluation or 

services. Provide staff psychoeducation on common risk factors and developmentally-specific signs that a 

student is at risk. Routinely ask teachers about how their students are behaving in the classroom and whether 

they have any concerns.

Proactively Screen/Assess Students and Staff: Use standardized measures to screen students and staff 

in terms of their experiences during the event in order to identify those in distress. Systematic screening is the 

most effective way to identify those who are at risk or who need additional services.

PFA-S Core Action 5: Practical Assistance

Don’t Underestimate the Importance of Practical Assistance: Assisting with practical needs is a protective 

factor that enhances recovery. You are in a key position to identify the needs of students and staff and to 

identify barriers to obtaining resources. Link staff and students to support staff or to an agency contact who 

can provide these services. 

Coordinate Needs: Work with your team leader to ensure that requests for supplies (food, water, toys) 

are relayed up the chain of command. Also work with families to help with such things as transportation, 

recouping costs from recovery, and so forth. While some of these activities may be beyond your typical job 

responsibilities, coordinating practical needs is essential and may require you to expand your role. 

PFA-S Core Action 6: Connection with Social Supports

Establish Social Connectedness Programs: Develop venues to increase interaction among students 

and staff. You might facilitate group discussions on various health- or mental health-related topics pertinent 

to the crisis, or you might help publicize upcoming, supportive community events. Encourage individuals 

to reconnect with their family members, friends, and members of their faith community or other social or 

community organization. For students, make recommendations specific to extramural student group activities 

or facilitate a peer-to-peer program that may provide a venue for social support.
Psychological First Aid for Schools Field Operations Guide 89

Recommendations for School Staff

Integrate New Students: Students may transfer to other schools temporarily or permanently. Attempt to 

integrate these students into the school culture and orient them to the school procedures as quickly as 

possible. Avoid singling out these students in ways that might alienate them from the rest of the student body. 

For example, too much attention from faculty and staff may result in peers distancing themselves from the 

new students. Do try to connect these students with former friends or classmates, as connectedness is an 

important protective factor.

PFA-S Core Action 7: Information on Coping

Meet with Parents: Attend the parents’ meetings and provide information about common reactions, address 

safety concerns, and discuss available resources. Be prepared for these meetings to be stressful, as parents 

will be anxious and may have significant safety concerns. Parents, like students and staff, cope best when 

provided with support. School-sponsored meetings can provide parents with the opportunity to build their 

own social support network. Always conduct these meetings in partnership with the administration and law 

enforcement. 

No One Way to Recover: You will often get questions about the natural course of recovery. Emphasize that 

there is no one “right” way to recover and that different people will recover at different points in time. Most 

importantly, emphasize that everyone should respect individual differences. To this end, teach students and 

staff about typical reactions after emergencies, trauma/loss reminders, reestablish schedules and routines, 

and effective coping strategies. 

PFA-S Core Action 8: Link with Collaborative Services

Provide Information on Available Services: Inform families, students, and staff about the location of mental 

health and other services and the steps required to access them. You may have to broaden your list of 

community services to fully address the students’ and staff members’ current needs.

Update the Referral List to Include Trauma and Loss-Informed Services: Do the research to make 

sure that the providers on the referral list have experience in the type of event that occurred. If you have 

or are given a standard referral list, review it in light of the situation; and do your best to add the names 

of professionals who can offer more specialized, developmentally appropriate, and trauma/loss-informed 

services. 

Facilitate Access to Services: To ensure that students and staff are connected with relevant services, help 

make the calls, double-check that the agency is accepting referrals, and address any concerns students or 

staff members might have about the services. 

In the days and weeks following an emergency, the school becomes a recovery milieu. Health-related 

professionals play an important role in monitoring the course of recovery of the students and staff. By actively 

reaching out to the school community, creating a referral system, and providing state-of-the art services and 

programs, health-related professionals can help the school stabilize and accelerate recovery. Secondary 

traumatic stress is common for those in the helping professions and in leadership roles. As you create an 

environment to promote recovery in those around you, be sure to practice your own self-care. 

Psychological First Aid for Schools Field Operations Guide 91

Recommendations for School Staff

Providing Psychological First Aid:

Support Staff

You are a valuable resource in times of crisis and an integral part of the school’s recovery. Prior to any crisis, 

it is important that you know your school’s emergency plan. Be familiar with the Incident Command Structure 

and procedures. Know where to ask questions or seek more information. School Resource Officers should 

coordinate plan with community responders to make sure that plans are familiar to all who may respond and 

are consistent. Below are ways that you can implement PFA-S.

PFA-S Core Action 1: Contact & Engagement

Remain Calm: In your various duties, you will be around students, parents, and other adults who may be in 

distress or expressing strong emotions. By remaining calm, this can help others calm. 

Take the Initiative: Initiating contact and conversation can help to identify students or adults who may need 

assistance. Conversation starters can be as simple as “Do you need anything?” or “Are you ok?” Offering 

practical assistance (food, water) can help to initiate contact.

Monitor Changes in Others: Be watchful of changes in behavior in students or staff (e.g., not as talkative, 

changes in attire, less social, appears more angry). Report your concerns to the appropriate person at the 

school, such as a health-related professional or administration.

PFA-S Core Action 2: Safety & Comfort

Reassure Current Safety: Inform students that the adults are there to protect them and keep them safe. If 

the emergency is over, students, especially younger children, may need to be repeatedly told of their safety. 

Even when the emergency is still ongoing, children need to be assured that everything possible is being done 

to keep them safe.

Ensure Continued Safety: This may include assisting in the evacuation of a school or monitoring the 

interactions of others in a reunification area. When children are anxious, they often act out. If students 

are behaving in an unsafe manner, calmly convey the rules and what is expected of them. If the behavior 

continues, alert the school resource officer or administration.

Watch for High-Risk Student Behavior: After a crisis, students may increase substance use or participate 

in other high-risk behaviors (e.g., driving recklessly, initiating fights), endangering themselves or others. If you 

see this behavior or hear such concerns, report the matter to administration or school resource officer. 

PFA-S Core Action 3: Stabilization

Support Those Overwhelmed: Some students and staff may show signs of distress. Remain calm and see if 

the person calms after a few minutes. See if you can assist with any current needs or reassure current safety. 

If the individual has difficulty calming, seek out a health-related professional to provide further assistance.

Stabilize the School Environment: Calmly convey to the students that the staff and administration are 

continuing to monitor the situation and will address any concerns they might have. Students are often 

anxious when facing trauma-related chaos, changes, and transitions. Providing them with a calm, supportive 

environment with clear rules and expectations will help them regain a sense of security and normalcy. 

Identify Possible Reminders: Take steps, to the extent possible, to eliminate potential reminders in the 

school that may cause distress to others (e.g., not using the same signal to call the custodian that was used 

in the emergency). 
National Child Traumatic Stress Network National Center for PTSD 92

Recommendations for School Staff

PFA-S Core Action 4: Information Gathering

Identify Current Needs: Ask simple, respectful questions to determine how you may help. If the person 

needs assistance beyond what you can offer, connect them to a teacher, health-related professional, or 

whoever else is needed.

Know the Referral System: Make sure you are educated about how to refer students who need help. Learn 

about the warning signs and developmentally-specific signs that a student is at-risk.

PFA-S Core Action 5: Practical Assistance

Don’t Underestimate the Importance of Practical Assistance: Assisting with practical needs is a protective 

factor that enhances recovery. You can play an important role in identifying the needs of students and staff 

and to identify barriers to obtaining resources. Link students and staff to those who are coordinating services 

at the school or an agency contact who can provide these services in the community. 

Attend to Needs: Ensure that requests for supplies and delivery of items requested are coordinated 

and communicated throughout the staff. Work with other staff to help with such things as transportation, 

monitoring the reunification site, and so forth. While some of these activities may be beyond your typical job 

responsibilities, helping with practical needs is essential and may require you to expand your role. 

PFA-S Core Action 6: Connection with Social Supports

Help to Connect with Supports: Help students to connect with family members, teachers, aides, coaches, 

or those they find as a comfort. Also help students to gather together and encourage them to support each 

other. You can make recommendations specific to extramural student group activities that may provide a 

venue for social support.

Keep Watch for Withdrawn Students: Observe students who may be isolating or limiting their social 

interactions with others. Check in with students and ask if they are okay. For new students, introduce yourself 

and welcome them. 

PFA-S Core Action 7: Information on Coping

Provide a Recovery Milieu: After a crisis, all at the school should create an environment that enhances 

recovery. Encourage those that need help to seek support or other assistance during the school day as 

needed. 

No One Way to Recover: You could often get questions from others about the natural course of recovery. 

Emphasize that there is not one way to recover and that different people will recover at different points in time. 

Most importantly, emphasize that everyone should respect individual differences. 

PFA-S Core Action 8: Link with Collaborative Services

Provide Information on Available Services: In coordination with school policy, pass out handouts or know the official 

websites that will list available services at the school and in the community and the steps required to access them.

Facilitate Access to Services: To ensure that students and staff get connected to relevant services, help 

make the calls, double-check that the agency is accepting referrals, and address any concerns students or 

staff might have about the services.

In the days and weeks following an emergency, the school often becomes a recovery milieu. Everyone plays 

an important role in the recovery of the students and the school community. By utilizing the suggestions in 

this handout, you can help students recover and succeed academically, psychologically, and socially. These 

strategies can also help you and your family. Most importantly, don’t forget to take care of yourself during 

these stressful times.
Psychological First Aid for Schools Field Operations Guide 93

Appendix B: 

Guidelines for 

Using PFA-S 

in a Group Format 

Materials Page

Assemblies 95

Classrooms 97

Small Groups: Students/Staff with Varied Experiences 101

Small Groups: Students/Staff with Similar Experiences 105

Psychological First Aid for Schools Field Operations Guide 95

Guidelines for Using PFA-S in a Group Format 

PFA Guidelines for Assemblies

Following a school emergency, school leaders may hold an assembly to present themselves to staff and 

students to reassure those in attendance that the leadership is actively involved and in control. At an 

assembly, school leaders should (1) provide information about the event, (2) describe available resources, 

and (3) give psychoeducation about potential reactions. Do not implement PFA in an assembly or other large 

group format. You may describe the basic elements of PFA-S during an assembly, and then apply PFA-S 

techniques in smaller follow-up groups.

Caution:

If a school chooses to have an assembly, assign non-distressed adults to watch for students who appear 

emotionally overwhelmed. Be prepared to make alternative arrangements for these students, such as 

having adults accompany them to a safe, supervised location, if they cannot or choose not to participate 

in the assembly. Students who find it difficult to sit still and pay attention in large groups will likely find it 

even harder to do so during a time of emotional stress. 

If a student has died, speak with the family before sharing information. As time passes, continue to talk to 

the family about any additional information you wish to share with the students and staff. Notify the school 

community of the death of a student or staff member only in small groups, not in a large assembly.

Follow these steps when leading an assembly:

Step 1: Preparation and Introduction

• Don’t do it alone! No one person should run an assembly. In addition to speakers, have at least one adult 

assistant per 10-20 students. Assistants can stand at the periphery of the auditorium and provide support 

to students who become distraught or try to leave.

• Be sensitive to the needs of young children, who can be overstimulated by the crowding and noise or large 

auditorium settings. Allow parents to attend an assembly with young children to provide them with comfort 

and support.

• Have PFA-S providers and/or mental health professionals on hand to support those students and staff who 

need it.

• Introduce yourself and highlight the strengths of the school.

• Introduce any new staff members or resource persons who are part of the recovery efforts (e.g., PFA-S 

providers, mental health professionals, additional security).

• Point out the assistants and explain their role.

Step 2: Describe the Purpose

• Explain that the purpose of the assembly is to provide information about what is happening and to describe 

the resources that are available to help in the school’s recovery.

• If the assembly is open to parents or other community members, announce this and welcome them.
National Child Traumatic Stress Network National Center for PTSD 96

Guidelines for Using PFA-S in a Group Format 

Step 3: Provide Information

• Report only the facts about the incident that have been validated by emergency command. 

• Be aware of the developmental level of the students in the assembly and target your information to their 

level. 

• Address and dispel rumors. 

• Provide psychoeducation about the types of reactions that students and staff can expect to experience 

now and in the near future.

• When appropriate, have experts present who can describe technical aspects of the situation (e.g., a police 

officer can describe the safety procedures; an engineer can address air quality concerns).

• Limit the information to that which the school community needs to know and can handle. Do not discuss 

the event in detail. Make sure you get parent consent before giving any information about a particular child.

• Identify any changes to the school routine or environment (e.g., more security on campus, modified test 

schedules, that the gym is being used as a shelter).

Step 4: Moments of Silence

• Consider a moment of silence near the beginning of the assembly in honor of those impacted by the event.

• Do not have a moment of silence at the end of an assembly. 

• Do not let the assembly become a memorial service. Memorials may occur later in a more appropriate 

setting. 

Step 5: Discuss the Resources Available

• Describe the assistance available at the school and in the community.

• Describe the referral process and any funding options for additional services (e.g., Victims of Crime, 

American Red Cross).

• Review the steps that the community and responders are taking to address safety concerns.

• Briefly describe PFA-S; describe when and where PFA-S services are available.

Step 6: Describe How the School Will Move Forward

• Discuss the steps the school and the district will take to recover and the ways that administrators, staff, 

and students can actively participate.

• Provide a concrete plan for how students and staff can get ongoing assistance.
Psychological First Aid for Schools Field Operations Guide 97

PFA Guidelines for Classroom Interventions

The classroom is a familiar setting that helps reestablish routine and fosters students’ supporting one another. 

Take into account the developmental level of the students and modify interventions accordingly. Where a 

classroom has been the site of a violent incident or the death of a student or teacher, modify these guidelines 

to address this and spend more time with this group. Try to implement PFA-S early in the day, so that 

teachers and staff can observe student reactions and provide appropriate support.

Classroom Alert:

Providing PFA-S in the classroom can give students the information they need and teach them 

ways to cope, while allowing them to support and comfort each other. Although they are in the same 

class and know each other, students may have vastly different experiences of the event. Structure 

the session so that students do not become distressed by their classmates’ descriptions of their 

experience. If students do spend time talking or drawing pictures about the event, reserve time 

before the group ends to focus on more hopeful thoughts and to teach them skills for coping with 

their feelings.

Structure the group by saying something like: 

“Even though you all are part of the same class and you all went through the event, you each had 

a different experience. Because the group is time limited, we won’t be able to hear in detail what 

happened to each of you. What’s actually more helpful is for you to problem-solve with each other 

and to learn helpful ways to cope with the feelings and thoughts you are having. We will update you 

about what has been happening and about the kinds of resources available to help you during this 

difficult time.” 

Core Action 1: Contact and Engagement

• Conduct the group with another provider. 

• Before the group, have the teacher identify any student who may need to be excused from this intervention 

or who is the subject of concern.

• Include the teacher in the discussion so that s/he can address questions that may arise at a later 

date. When a teacher has died, have a staff member who knows the students well participate in the 

intervention. 

• Introduce yourself and explain the purpose of the meeting. Have the other provider introduce him/herself.

• If a student is highly emotional or needs to leave the classroom, assist him/her privately. Have a “safe 

room” or other setting in the school where students can go for respite or support.

Guidelines for Using PFA-S in a Group Format 
National Child Traumatic Stress Network National Center for PTSD 98

Guidelines for Using PFA-S in a Group Format 

Core Action 2: Safety and Comfort

• Provide information about the event and attempt to dispel rumors and clarify any misunderstandings.

• Announce support services that the school and/or community are currently offering or will offer in the near 

future.

• Discuss the steps the district and/or school are taking to recover from the incident and answer any 

questions the students have.

• Address safety concerns and describe safety procedures that the school is implementing.

• Indicate how challenging a time it may be for some students.

• If a death has occurred, acknowledge that some individuals may be grieving and will express their grief in 

a variety of ways. Validate and facilitate the normal process of grieving, and inform students how to obtain 

continuing support and services.

• Discourage memorial displays within the classroom, as students may have very different reactions to them. 

Allow discussion on handling the deceased’s belongings (e.g., artwork may go to a girl’s parents; a boy’s 

picture may remain up for a period of time).

Core Action 3: Stabilization

• If a student needs stabilization, assist him/her individually.

• Have enough adults on hand to escort overwhelmed students to a quiet, private place outside the group 

setting, at which time a PFA-S provider can work to stabilize the student.

• Help students put words to their feelings and concerns. Answer any questions they have; help them to 

understand their own emotions and reduce their distress about their overwhelmed classmates. 

Core Action 4: Information Gathering

• Your ability to gather information is more limited in a classroom than in a small group or one-on-one setting.

• Remind students that you do not need in-depth descriptions of what happened but some basic information 

to address their current needs and concerns.

• Ask questions that encourage yes or no responses to help limit too much discussion.

• Redirect students who provide too many details of the event by reminding them of the purpose of this 

meeting.

• Keep the group focused on the task at hand, and do not allow one student or a small group of students to 

divert the conversation.

Core Action 5: Practical Assistance

• Problem-solve and address students’ practical needs, especially those related to academic and school 

functioning.

• Demonstrate how students can reach out to others so that their needs can be met.

• Tell students where they can find donated resources or services they need.

• Encourage the teacher to develop goals for the classroom and a way to chart the class’s progress as they 

move forward. Help the students to see that they may have resources to share with others in the school 

community or that they could lend a helping hand. 
Psychological First Aid for Schools Field Operations Guide 99

Guidelines for Using PFA-S in a Group Format 

Core Action 6: Connections with Social Supports

• Discuss ways that students can help each other.

• Inform students of activities and recovery efforts for which they may volunteer.

• Stress the importance of mutual aid among the students. Brainstorm ways students can work together to 

help themselves and others.

• Urge students to alert a teacher, parent, or other adult when concerned about a peer. Help them to identify 

an adult who can be alerted and give them that adult’s contact information.

Core Action 7: Information on Coping

• Provide psychoeducation about the range of responses students might have in a crisis.

• Describe coping strategies that other students have found effective. 

• Provide referrals for one-on-one services to those wishing more individualized attention.

• Encourage self-care practices and routines.

• Address potential problems related to sleep, mood, and academic functioning.

• Discuss the role of reminders and ways of managing them.

• Reestablish the learning environment by returning to the pre-event schedule and routine as much as 

possible. 

Core Action 8: Linkages with Collaborative Services

• Let students know the ways they can obtain individualized services.

• Connect students with appropriate support persons and relief or social assistance agencies.

• Finish the intervention with a discussion of constructive and/or prosocial activities that can promote 

recovery. 

• Follow up with the teacher to monitor any significant emotional reactions the students may display after 

their participation in the group. Make appropriate referrals as needed. 

• Encourage the teacher to schedule regular times to answer students’ questions and to discuss recovery 

efforts. 

• Select someone (possibly the co-leader) to follow up with students regarding any referrals or linkages with 

other services that you gave. 

After conducting classroom interventions, always remember to take time for yourself. Be a good role-model, 

practice good self-care!

Psychological First Aid for Schools Field Operations Guide 101

PFA Guidelines for Small Groups: 

Students/Staff with Varied Experiences

You may use PFA-S with small groups to provide information, address safety issues, provide 

psychoeducation, enhance coping, encourage members of the group to support each other, and review 

services offered by the school and community. Groups may form spontaneously or you may group students 

(or staff) together, but individual members will have had vastly different experiences of the emergency 

(life threat, only media exposure, death of a close friend, etc.). Because the group members have had 

varying experiences, do not allow them to discuss their individual experiences in detail. Instead, focus on 

the purpose of the meeting, and encourage understanding and respect for the different experiences and 

reactions. 

Caution:

The small group format allows students (or staff) with varied experiences to support one another during 

this crisis phase and the recovery period to follow. Take precautions, however, to protect individuals 

with low levels of exposure from hearing others describe their traumatic experience in detail. Interrupt 

such discussions and refocus group members on learning ways to cope with their feelings and 

thoughts. Tell them to alert you or the co-leader if they begin to experience intense negative emotions. 

(Have an adult available to escort the person to a private area where s/he can recover). Likewise, let 

group members know how to get one-on-one support outside of the group if they want to talk more 

about their experiences. 

Group students together who are close in age and at a similar maturity level. Whenever possible, meet with 

children in preschool and kindergarten in their own classroom with their teacher (in this case, use handout 

PFA – Guidelines for Classroom Intervention). Keep in mind that young children seek more physical comfort 

than older students, need frequent snack and restroom breaks, require more help with tasks, and need 

information presented to them in simple, concrete terms. 

You can introduce and structure the group by saying something like: 

“Members of this group had very different experiences during the event. Because of this and the limited

time we have, we will not talk in detail about what happened to each of you. Instead, we’ll do what will 

be most helpful: update you about what has been happening, teach you practical ways to cope with the 

feelings you are having, and tell you about the support services that are available to help you during 

this difficult time.” 

Guidelines for Using PFA-S in a Group Format 
National Child Traumatic Stress Network National Center for PTSD 102

Guidelines for Using PFA-S in a Group Format 

The following is a structure for conducting a small group of individuals with varied experiences. It's imporant to note that it 

is not necessary to implement all of the bulleted items in each core action, or even to implement all the core actions. 

Engage the students, observe what is being shared, and utilize different core actions to be assist with their concerns. 

Core Action 1: Contact and Engagement

• Conduct the group with another provider, preferably someone familiar to the students/staff.

• Introduce yourself and the purpose of the meeting. Have the other provider introduce him/herself. 

• Create a comforting presence in the room that encourages participation and acceptance of others’ 

thoughts, emotions, and behavior.

• Have each of the members introduce him- or herself.

• Let group members know that if a student or staff member feels overwhelmed, the co-leader will help him/

her individually.

Core Action 2: Safety and Comfort

• Provide information about the event and the available services. Dispel rumors and clarify 

misunderstandings or misinformation.

• Address any safety concerns and identify any new safety procedures in place.

• Acknowledge that it is a hard time for everyone.

• Discuss the steps that the district and/or school are taking to recover from the incident, and answer any 

questions the group may have.

• Answer younger children’s questions simply. Tell them only what they need to know.

Core Action 3: Stabilization

• Meet individually with any student/staff needing stabilization.

• Have enough adults on hand to escort an overwhelmed student or staff member to a quiet, private place 

outside of the group, at which time, a PFA-S provider can stabilize him/her.

 • Encourage the remaining individuals to talk about their feelings and concerns, so that they can understand 

 and gain control of their emotions. Monitor the concerns and contain them if they go beyond what is helpful for the 

 group. 

Core Action 4: Information Gathering

• If members of the group appear distressed, conduct a neutral group activity, such as a relaxation exercise.

• Use a screening form or ask specific (yes/no) questions to determine the group members’ needs and 

concerns. 

• Keep the group focused on the task, identifying needs and providing information. 

• Redirect students who provide too many details of the event by reminding them of the purpose of the 

meeting. 



Core Action 5: Practical Assistance

• Problem-solve and address students’ and staff members’ practical needs.

• Suggest ways they can reach out to others to meet their needs.

• Tell them where they can find donated resources or services that they need.
Psychological First Aid for Schools Field Operations Guide 103

Guidelines for Using PFA-S in a Group Format 

Core Action 6: Connections with Social Supports

• Discuss ways that group members can help each other. 

• Inform them of activities and recovery efforts for which they may volunteer.

• Stress the importance of mutual aid among the members. Brainstorm ways that they can work together to 

help themselves and others. 

• Identify resources available if they start feeling overwhelmed when supporting their peers. 

• Help identify an adult that they can alert if they become concerned about another peer. 

Core Action 7: Information on Coping

• Provide psychoeducation about the range of responses students/staff can have in a crisis.

• Describe coping strategies that other people have found effective. 

• Encourage self-care practices and routines.

• Address potential concerns related to sleep, mood, and academic functioning.

• Discuss the role of reminders and ways to manage them.

Core Action 8: Linkages with Collaborative Services

• Remind students/staff that they may feel better after the group, but that some of their difficult feelings (such 

as sadness, worry) may return and that they should practice good self-care. 

• Identify ways to access more individualized services.

• Connect members to appropriate support persons and relief or social assistance agencies.

• Check with teachers following the group session to monitor students who display significant emotional 

reactions after group. Make appropriate referrals.

• Follow up (or have the co-leader do so) with students/staff regarding referrals you gave.

• Delineate the resources and expertise available within the school community. 

• End the intervention with a discussion of constructive and/or prosocial activities that can promote recovery, 

including ways members can support each other.

After conducting the group intervention, always remember to take time for yourself. Be a good role-model 

practice good self-care!

Psychological First Aid for Schools Field Operations Guide 105

PFA Guidelines for Small Groups: 

Students/Staff with Similar Experiences

You may use PFA-S with small groups of students/staff to provide information, address safety issues, provide 

psychoeducation, enhance coping, encourage members of the group to support each other, and review services 

offered by the school and the community. When the groups are comprised of students or staff who have had 

similar traumatic experiences, you can tailor the intervention to address the common experiences that they 

share (e.g., all are friends of a student who committed suicide or all suffered injuries when a building collapsed). 

The small group format allows students/staff members who have shared traumatic experiences to 

support each other and to feel less isolated. The group also provides a forum to discuss reactions to the 

event. Although students/staff members may have been similarly exposed, their responses may vary 

greatly depending on their personal characteristics and previous experiences. Thus, this group is not an 

appropriate forum for disclosing in depth or for discussing vivid details. Keeping the students/staff members 

on task may become challenging as individuals start to share the specifics of the event and their emotions 

heighten. Focus the group on learning practical ways to help themselves and each other cope. 

Group students together who are close in age and at a similar maturity level. Whenever possible, meet with 

children in preschool and kindergarten in their own classroom with their teacher (in this case, use handout 

PFA – Guidelines for Classroom Intervention). Keep in mind that young children seek more physical comfort 

than older students, need frequent snack and restroom breaks, require more help with tasks, and need 

information presented to them in simple, concrete terms. 

A shared-experience group may require more careful planning to keep individuals from feeling overwhelmed. 

You might (1) plan your agenda, including defining your responsibilities and those of your co-leader; (2) think 

through specific language to use to refocus group members as needed; (3) select a relaxation skill to teach—

such as a breathing exercise—to calm and refocus the group, and (4) locate a nearby “break area.” Agree 

to facilitate these groups ONLY if you have time to plan, are not currently feeling overwhelmed yourself, and 

have a support system or coping plan to help you manage the difficult emotions that often arise after leading 

such a group. If you have not led groups, try to co-lead with someone who is experienced.

Introduce the group by explaining its purpose:

“We are going to find helpful ways to cope with the terrible thing that has happened and to help each other 

solve the immediate problems you face. You may want to talk about what happened to you—what you saw, 

heard, and felt. Right now, however, what will help you the most is to learn how to deal with the intense 

feelings and thoughts, rather than dwell on them. Today we want each of you to leave the group with some 

specific tools to help you cope with these intense feelings and thoughts. Also, we will update you about 

what has been happening and what support services are available. By the way, it is common for people in 

a group like this to feel emotional or need to take a break. If this happens to you, just signal a group leader, 

and one of us will show you where to go. You can come back to the group when you’re ready.” 

Guidelines for Using PFA-S in a Group Format 
National Child Traumatic Stress Network National Center for PTSD 106

The following is a structure for conducting a small group with shared experiences. It's imporant to note that it is not 

necessary to implement all of the bulleted items in each core action, or even to implement all the core actions. Engage 

the students, observe what is being shared, and utilize different core actions to be assist with their concerns. 

Core Action 1: Contact and Engagement

• Conduct the group with another provider, preferably someone who is familiar to the students/staff.

• Introduce yourself and the purpose of the meeting. 

• Acknowledge to group members that, while they have had similar experiences, their responses may be 

very different.

• Create a comforting presence in the room that encourages participation and acceptance of others’ 

thoughts, feelings, and behavior.

• Have each of the members introduce him- or herself.

• In a group where all the members are grieving or have had a life-threatening event, expect some 

individuals to express intense negative reactions. To make sure that group members do not become too 

overwhelmed, set parameters at the beginning by describing how you will handle these situations (i.e., if 

someone feels overwhelmed, there’s a place he/she can go to take a break; if the discussion gets sidetracked, you will refocus the group; if a student or staff member needs individual support, the co-leader will 

provide that).

• Maintain a calm and comforting presence at all times. Young children, in particular, are keenly aware of 

adults’ stress or fear.

Core Action 2: Safety and Comfort

• Provide information about the event and the available services. Dispel rumors and clarify any 

misunderstanding or misinformation in an age-appropriate manner.

• Address safety concerns and identify what safety procedures are being implemented.

• Acknowledge that it is a hard time for everyone.

• Discuss the steps the district and/or school are taking to recover from the incident and answer any 

questions the group may have.

• Answer younger children’s questions simply. Tell them only what they need to know.

• If a death has occurred, acknowledge that some individuals are grieving and that they will express that 

grief in a variety of ways. Validate and facilitate the normal process of grieving and tell group members 

how to access continuing support and services. 

• Acknowledge if group members have specific concerns that are not shared by others (e.g., part of criminal 

proceedings, medical treatment needs, grieving best friend).

Core Action 3: Stabilization

• If a student/staff member needs stabilization, see him/her individually.

• If many group members are upset, have them do a neutral activity such as a relaxation exercise.

• Have enough adults on hand to escort an overwhelmed student or staff member to a quiet, private place 

outside of the group setting, at which time a PFA-S provider can stabilize him/her.

• Encourage the remaining individuals to talk about their feelings and concerns, so that they can understand 

and gain control of their emotions. 

Guidelines for Using PFA-S in a Group Format 
Psychological First Aid for Schools Field Operations Guide 107

Guidelines for Using PFA-S in a Group Format 

Core Action 4: Information Gathering

• Facilitate a discussion to determine the group members’ needs and concerns. 

• Redirect students who provide too many details of the event by reminding them of the purpose of the 

meeting. Though this is not the setting to discuss individual’s unique experiences in detail, working with 

small groups with similar experiences decreases the likelihood that they will be exposed to details of the 

event with which they were not previously familiar.

Core Action 5: Practical Assistance

• Problem-solve and address students’ and staff members’ practical needs.

• Suggest ways they can reach out to others to have their needs met.

• Tell them where they can find donated resources or services that they need.

• Address the unique needs of the group (e.g., discuss the medical issues of students with serious injuries or 

provide resources for students/staff members whose homes were destroyed).

Core Action 6: Connections with Social Supports

• Discuss ways that group members can help each other. 

• Inform them of activities and recovery efforts for which they may volunteer.

• Stress the importance of mutual aid among the members. Brainstorm ways that they can work together to 

help themselves and others. 

• Identify resources available if they start to feel overwhelmed when supporting their peers. 

• Help identify an adult to alert if an individual becomes concerned about another peer. 

Core Action 7: Information on Coping

• Provide psychoeducation about the range of responses students can have in a crisis.

• Describe coping strategies that others have found effective. 

• Encourage self-care practices and routines.

• Address potential problems related to sleep, mood, and academic functioning.

• Discuss the role of reminders and ways to manage them.

Core Action 8: Linkages with Collaborative Services

• Remind students/staff that they may feel better after the group, but that some of their difficult feelings (such 

as sadness, worry) may return and to practice good self-care. 

• Identify ways that they can get more individualized services.

• Connect members to appropriate support persons and relief or social assistance agencies.

• Follow up with teachers after group to monitor students who displayed significant emotional reactions. 

Make appropriate referrals as needed.

• Follow up (or have the co-leader do so) with students/staff regarding referrals you gave them.

• End the intervention with a discussion of constructive and/or prosocial activities that can promote recovery, 

including ways members can support each other.

Always remember to take time for yourself. Be a good role-model practice good self-care!

Psychological First Aid for Schools Field Operations Guide 109

Appendix C: 

Handouts and 

Worksheets 

Materials Page

Provider Worksheet—Survivor Current Needs 111

Provider Care 113

Connecting with Others: For Adults 117

Connecting with Others: For Students 119

When Terrible Things Happen: For Adults 121

When Terrible Things Happen: For Students 125

Helping Your Family Cope: For Parents 127

Tips for Relaxation 129

Psychological First Aid for Schools Field Operations Guide 111

Handouts and Worksheets 

Provider Worksheet

Survivor Current Needs

Date: ____________________________________ Provider: __________________________________

Survivor Name: ____________________________ Location: __________________________________

This session was conducted with (check all that apply): 

o Child o Adolescent o Adult o Family o Group

Provider: Use this form to document what the survivor needs most at this time. This form can be used to 

communicate with referral agencies to help promote continuity of care.

1. Check the boxes corresponding to difficulties the survivor is experiencing.

Behavioral Emotional Physical Cognitive

o Disorientation 

o Increased drug, 

alcohol, or 

prescription drug use

o Isolation/withdrawal

o High-risk behavior

o Regressive behavior

o Separation anxiety

o Violent behavior

o Maladaptive coping

o Other ____________

o Acute stress reactions

o Acute grief reactions

o Sadness, tearfulness

o Irritability, anger

o Anxiety, fear

o Despair, 

hopelessness

o Guilt or shame

o Feeling emotionally 

numb, disconnected

o Other ___________

o Headaches

o Stomachaches

o Sleep difficulties

o Difficulty eating

o Worsening of health 

conditions

o Fatigue/exhaustion

o Chronic agitation

o Other ___________

o Inability to accept/

cope with death of 

loved one(s)

o Distressing dreams or 

nightmares

o Intrusive thoughts or 

images

o Difficulty concentrating

o Difficulty remembering 

o Difficulty making 

decisions

o Preoccupation with 

death/destruction

o Difficulties completing 

assignments or chores

o Other ___________

2. Check the boxes corresponding to other specific concerns.

o Past or preexisting trauma/psychological 

problems/substance abuse problems 

o Injured as a result of the emergency

o At risk of losing life during the emergency

o Loved one(s) missing or dead

o Displaced from home

o Assisted with rescue/recovery

o Pets missing/injured/dead

o Other_____________________________

o Living arrangements

o Lost job or school

o Financial problems 

o Physical/emotional disability

o Medication stabilization 

o Concerns about child/adolescent (for parent)

o Separation from primary caregiver (for child)
National Child Traumatic Stress Network National Center for PTSD 112

Handouts and Worksheets 

3. Please make note of any other information that might be helpful in making a referral. 

4. Referral

o Within school (specify) __________________ o Substance abuse treatment

o Community response agencies o Other community services

o Professional mental health services o Medical treatment

o Other ______________________________

5. Was the referral accepted by the individual? o Yes o No
Psychological First Aid for Schools Field Operations Guide 113

Handouts and Worksheets 

PFA-S Provider Care 

Providing support in the immediate aftermath of crisis can be an enriching professional and personal 

experience that enhances satisfaction through helping others. It can also be physically and emotionally 

exhausting. The following provides information to consider when responding to an emergency at a school. 

Common Stress Reactions

You may experience a number of stress responses, which are considered common when working with 

survivors:

• Increase or decrease in activity level

• Difficulties sleeping

• Substance use

• Disconnection and numbing

• Irritability, anger, and frustration

• Vicarious traumatization in the form of shock, 

fearfulness, horror, helplessness 

• Confusion, lack of attention, and difficulty making 

decisions 

• Physical reactions (headaches, stomachaches, 

easily startled)

• Depressive or anxiety reactions

• Decreased social activities

• Diminished self-care

Extreme Stress Reactions

You may experience more serious stress responses that warrant seeking professional support or monitoring 

by a supervisor. These include:

Sense of helplessness

Preoccupation or compulsive re-experiencing of trauma experienced either directly or indirectly

Attempts to over-control in professional or personal situations, or act out a “rescuer complex” 

Social withdrawal and isolation

Chronic exhaustion

Survival coping strategies like relying on substances, overly preoccupied by work, or drastic changes in 

sleeping or eating patterns 

Serious difficulties in interpersonal relationships, including domestic violence

Depression accompanied by hopelessness

Suicidal ideation or attempts

Unnecessary risk-taking

Illness or an increase in levels of pain

Changes in memory and perception

Disruption in your perceptions of safety, trust, and independence
National Child Traumatic Stress Network National Center for PTSD 114

Handouts and Worksheets 

School administration and leadership can help support providers by reducing the risk of extreme stress 

through implementing procedures and policies. Consider:

• Encouraging work breaks

• Rotating of providers from the most highly exposed assignments to lesser levels of exposure

• Identifying enough supports to meet the needs of administration, staff, students, and families

• Encouraging peer partners and peer consultation

• Monitoring providers who meet certain high risk criteria, such as: those who have been directly exposed 

to the event, those having regular exposure to severely affected individuals or families, those with multiple 

stresses (e.g., family changes, health problems)

• Ensuring regular supervision, case conferencing, staff appreciation events 

• Conducting trainings on stress management practices and encourage the use of such practices

• Supporting open communication 

Self-Care

Self-care is the ability to engage in helping others without sacrificing other important parts of one’s life. It’s 

taking responsibility for job functions you have control over, the ability to maintain a positive attitude towards 

the work despite challenges, and your right to be well, safe, and fulfilled. 

It’s important to remember that self-care is not an emergency response plan to be activated when stress 

becomes overwhelming or that having a good self-care plan means you are acting selfishly. Healthy self-care 

can renew our spirits and help us become more resilient. 

Think of self-care as having three basic aspects:

Awareness The first step is to seek awareness. This requires you to slow down and focus 

inwardly to determine how you are feeling, what your stress level is, what types of 

thoughts are going through your head, and whether your behaviors and actions are 

consistent with the who you want to be.

Balance The second step is to seek balance in all areas of your life including work, personal 

and family life, rest, and leisure. You will be more productive when you’ve had 

opportunities to rest and relax. Becoming aware of when you are losing balance in 

your life gives you an opportunity to change.

Connection The final step is connection. It involves building connections and supportive 

relationships with your co-workers, friends, family, and community. One of the most 

powerful stress reducers is social connection.
Psychological First Aid for Schools Field Operations Guide 115

Handouts and Worksheets

Self-Care Checklist

There are several ways you can find balance, be aware of your needs, and make connections. Use this list to 

help you decide which self-care strategies will work for you. 

Make every effort to:

o Seek out and give social support

o Check in with other colleagues to discuss the 

response to the emergency

o Schedule time for a vacation or gradual 

reintegration into your normal life

o Prepare for worldview changes that may not be 

mirrored by others in your life

o Participate in formal help if extreme stress 

persists for greater than two to three weeks

o Increase leisure activities, stress management, 

and exercise

o Pay extra attention to health and nutrition

o Self-monitor and pace your efforts 

o Maintain boundaries: delegate, say “no,” and avoid 

getting overloaded with work

o Pay extra attention to rekindling close 

interpersonal relationships

o Practice good sleep routines

o Make time for self-reflection

o Find things that you enjoy or make you laugh

o Try at times not to be in charge or the “expert”

o Increase experiences that have spiritual or 

philosophical meaning to you

o Access supervision routinely to share concerns, 

identify difficult experiences and strategize to solve 

problems

o Anticipate that you will experience recurring 

thoughts or dreams, and that they will decrease 

over time

o Keep a journal to get worries off your mind

o Ask for help in parenting, if you feel irritable or are 

having difficulties adjusting back to your routine

o Plan for family/home safety, including making child 

care and pet care plans

o Practice brief relaxation techniques during the 

workday 

o Use a buddy system to share upsetting emotional 

responses 

o Stay aware of limitations and needs 

o Recognize when one is Hungry, Angry, Lonely or 

Tired (HALT), and take the appropriate self-care 

measures

o Increase activities that are positive

o Practice religious faith, philosophy, spirituality

o Spend time with family and friends

o Learn how to “put stress away”

o Write, draw, paint

o Limit caffeine, cigarettes, and substance use

Be careful of engaging in activities that can hinder your attempts at good self-care. Avoid: 

• Extended periods of solo work without colleagues or working “round the clock” with few breaks

• Negative self-talk that reinforces feelings of inadequacy or incompetency

• Common attitudinal obstacles to self-care (e.g., “It would be selfish to take time to rest.”)

• Negatively assessing your contribution 

• Use of excessive use of alcohol, illicit drugs, or excessive amounts of prescription drugs

Psychological First Aid for Schools Field Operations Guide 117

Handouts and Worksheets 

Connecting with Others: For Adults 

SEEKING SOCIAL SUPPORT

• Making contact with others can help reduce feelings of distress

• can benefit from spending time with other similar-age peers

• dults need the support of familiar adults to cope with traumatic events

• Support can come from family, friends, teachers, or others coping with the same traumatic event 

Social Support Options

• Spouse or partner • Clergy • Support group

• Trusted family member • Doctor or nurse • Co-worker/Teacher

• Close friend • Counselor • Pet

Do . . .

✔	Decide carefully whom to talk 

to

✔	Decide ahead of time what 

you want to discuss

✔	Choose the right time and 

place

✔	Start by talking about practical 

things

✔	Let others know you need to 

talk or just to be with them

✔	Talk about painful thoughts 

and feelings when you’re 

ready

✔	Ask others if it’s a good time 

to talk

✔	Tell others you appreciate 

their listening

✔	Tell others what you need or 

how they can help—name 

one main thing that would 

help you right now

Don’t . . .

✘	 Keep quiet because you don’t want to upset 

others

✘	 Keep quiet because you’re worried about being 

a burden

✘	 Start by talking about practical things

✘	 Let others know you need to talk or just to be 

with them

Ways to Get Connected

• Call friends or family on the phone

• Increase contact with the acquaintances and 

friends you have now

• Renew or begin involvement with a church, 

synagogue, mosque, temple, or other group

• Get involved with a support group

• Get involved in community recovery activities
National Child Traumatic Stress Network National Center for PTSD 118

Handouts and Worksheets 

Connecting with Others: For Adults 

GIVING SOCIAL SUPPORT

You can help family members and friends cope with the emergency by spending time with them and listening 

carefully. You may also feel better yourself when you give support to others. Most people recover best when 

they feel connected to people who care about them. Some people choose not to talk about their experiences 

very much, while others do need to discuss their experiences. For some, talking about what happened can 

help those events seem less overwhelming. For others, just spending quiet time with people who are close 

and accepting can feel best. Here is some information about giving social support to other people. 

Reasons Why People May Avoid Social Support

• Not knowing what they need

• Feeling embarrassed or “weak”

• Feeling they will lose control

• Not wanting to burden others

• Doubting it will be helpful or 

thinking that others won’t 

understand

• Having tried unsuccessfully to 

get help in the past

• Wanting to avoid thinking or 

feeling about the event

• Feeling that others will be 

disappointed or judgmental 

• Not knowing where to get help

Good Things to Do When Giving Support

• Show interest, attention, and 

that you care

• Find a time and place to talk 

without interruption

• Have no expectations; don’t 

judge

• Show respect for the person’s 

reactions and ways of coping

• Acknowledge that this type of 

stress can take time to resolve 

• Help brainstorm positive ways 

to deal with his/her reactions

• Talk about expected reactions 

to traumatic events and healthy 

coping 

• Express belief that the person 

is capable of recovery

• Offer to talk or spend time 

together as many times as is 

needed

Things That Interfere with Giving Support

• Rushing to tell someone that he/she will be okay 

or that he/she should just “get over it”

• Discussing your personal experiences without 

listening to the other person’s story

• Stopping the person from talking about what is 

bothering him/her

• Acting like someone is weak or exaggerating, 

because he/she isn’t coping as well as you are

• Giving advice without listening to the person’s 

concerns or asking what works for him/her

• Telling the person he/she was lucky it wasn’t 

worse

Ways to Get Connected

• Let the person know that experts think persistent

avoidance and withdrawal are likely to increase 

distress, while social support helps recovery

• Encourage the person to join a support group 

with others who have had similar experiences

• Encourage the person to talk with a counselor, 

clergy, or medical professional, and offer to 

accompany him/her

• Enlist help from others in your social circle, so 

that you all take part in supporting the person
Psychological First Aid for Schools Field Operations Guide 119

Handouts and Worksheets 

Connecting with Others: For Students 

• Talking or hanging out with other people can help you feel better.

• It is important to get support from both adults (family members and teachers) and peers your age (friends 

and classmates).

• It may help to spend time with other people who have been through similar experiences.

Those who can support you include:

• Family who live with you

• Extended family members who 

don’t live with you

• Adults at school (teachers, 

coaches, aides, administrators)

• Close friends/boyfriends/

girlfriends

• Classmates or others your age 

who have had experiences like 

yours

• School counselors or other 

counselors

• Religious leaders

• Doctors or nurses

• Pets

When you want to talk to someone:

✔	Decide carefully whom to talk 

to by thinking about a person 

you trust, who listens to you, 

and who can help you.

✔	Choose the right time and 

place to talk. 

✔	For example, a teacher may 

not be able to talk to you while 

she is teaching class, but may 

be happy to talk to you after 

class.

✔	Ask the person if it’s a good 

time to talk.

✔	Let the person know that you 

want to talk. 

✔	If you don’t feel like talking, 

tell the person that you just 

want to spend time with them.

✔	Start by telling the person 

what you need.

✔	If you feel ready, you may talk 

about sad or scary thoughts 

or feelings, but you don’t have 

to talk about anything if you 

don’t want to.

Sometimes students don’t want to talk about what happened because they worry that:

• Other people won’t want to listen or don’t have 

time to listen.

• Other people will be upset if they hear about 

what happened.

• Adults will be mad if you talk about bad things 

that happened.

• They will look like they are weak or scared if 

they ask for help.

• If they let themselves feel sad or scared, they 

will never feel better. 

– For example, some people are scared that if 

they start crying, they won’t stop. This is not 

true; it actually helps to talk, as long as you 

wait until you are ready.
National Child Traumatic Stress Network National Center for PTSD 120

Handouts and Worksheets

Do not let your worries stop you from talking to family and friends. They want to be there for you, and 

you will feel better if you spend time with them.

What to do: 

✔	Tell a family member or friend that you would like to talk about what happened and your feelings about 

it.

✔	Tell family members or friends if you don’t feel like talking about what happened, but want to spend 

time and do fun things with them.

✔	Remember that after something bad happens, it is ok to have many different feelings.

✔	Know that it is ok to spend time with people and to have fun, even during a sad time.

✔	Reach out to friends or family members by phone or internet.

✔	Get involved in support groups and community, school, or religious activities (sports, volunteering, 

youth groups).

✔	Support others; sometimes it will help you feel better, too.

Good things to do when giving support to other people: 

• Let people know that you are interested in how they are feeling.

• Understand that people have all different kinds of feelings after a traumatic event. There is no right or 

wrong way to react. Some people cry when they are sad; other people may feel sad, but respond by being 

quiet, laughing, or seeming angry. 

• Listen to the other person, respect his/her feelings, never make fun of the person, and encourage friends 

to seek support from adults when you think it might help. It always helps to be a good friend.
Psychological First Aid for Schools Field Operations Guide 121

When Terrible Things Happen: For Adults 

Immediate Reactions

There are a wide variety of positive and negative reactions that survivors can experience during and 

immediately after an emergency. These include: 

Domain Negative Responses Positive Responses

Cognitive Confusion, disorientation, worry, 

intrusive thoughts and images, selfblame

Determination and resolve, sharper 

perception, courage, optimism, faith

Emotional Shock, sorrow, grief, sadness, fear, 

anger, numbness, irritability, guilt, and 

shame

Feeling involved, challenged, 

mobilized

Social Extreme withdrawal, interpersonal 

conflict

Social connectedness, altruistic 

helping behaviors

Physiological Fatigue, headache, muscle tension, 

stomachache, increased heart 

rate, exaggerated startle response, 

difficulties sleeping

Alertness, readiness to respond, 

increased energy

Common Negative Reactions That May Continue

Intrusive reactions

• Distressing thoughts or images of the event while awake or dreaming

• Upsetting emotional or physical reactions to reminders of the experience

• Feeling as if the experience is happening all over again (“flashbacks”)

Avoidance and withdrawal reactions

• Avoiding talking, thinking, or having feelings about the traumatic event

• Avoiding reminders of the event (places and people connected to what happened)

• Restricted emotions, feeling numb

• Feelings of detachment and estrangement from others, social withdrawal

• Loss of interest in usually pleasurable activities

Handouts and Worksheets
National Child Traumatic Stress Network National Center for PTSD 122

Handouts and Worksheets

Physical arousal reactions

• Constantly being “on the lookout” for danger, startling easily, or being jumpy

• Irritability or outbursts of anger, feeling “on edge”

• Difficulty falling or staying asleep, problems concentrating or paying attention

Reactions to trauma and loss reminders

• Reactions to places, people, sights, sounds, smells, and feelings that are reminders of the traumatic event

– Reminders can bring on distressing mental images, thoughts, and emotional/physical reactions

– Common examples include sudden loud noises, sirens, locations where the event occurred, seeing 

people with disabilities, funerals, anniversaries of the event, birthday of the deceased, and media 

reports about the event or its aftermath

Positive changes in priorities, worldview, and expectations

• Enhanced appreciation that family and friends are precious and important

• Meeting the challenge of addressing difficulties (by taking positive action steps, changing the focus of 

thoughts, using humor, acceptance) 

• Shifting expectations about what to expect from day to day and about what is considered a “good day” 

• Shifting priorities to focus more on quality time with family or friends

• Increased commitment to self, family, friends, and spiritual/religious faith

Common Reactions When a Loved One Dies

• Confusion, numbness, disbelief, bewilderment, feeling lost

• Feeling angry at the person who died or at people considered responsible for the death

• Strong physical reactions, such as nausea, fatigue, shakiness, and muscle weakness

• Feeling guilty for still being alive

• Intense emotions, such as extreme sadness, anger, or fear

• Increased risk for physical illness and injury 

• Decreased productivity or difficulty making decisions

• Having thoughts about the person who died, even when you don’t want to

• Longing for, missing, and wanting to search for the person who died

• Worry that they themselves or another loved one might die

• Anxiety when separated from caregivers or other loved ones

• Heightened sense of the role of spirituality and/or religion
Psychological First Aid for Schools Field Operations Guide 123

Handouts and Worksheets

✔ Talking to another person to get support or spending time with others

✔ Focusing on something practical to do right now to manage the situation

✔

Scheduling and engaging in positive activities (sports, hobbies, reading)

✔

Using relaxation methods (breathing exercises, meditation, calming self-talk, soothing music)

✔

Getting adequate rest and eating healthy meals

✔

Participating in a support group

✔

Trying to maintain a normal schedule

✔ Exercising in moderation

✔

Keeping a journal

✔

Taking breaks

✔

Seeking counseling

✔

Positive reminiscing about a loved one who has died 

✔

Seeking a community religious professional

What Helps

What Doesn’t Help

✘

Using alcohol or drugs to cope

✘

Working too much

✘

Extreme avoidance of thinking or talking about the event or the death of a loved one

✘ Extreme withdrawal from family or friends

✘

Violence or conflict

✘

Not taking care of yourself 

✘

Overeating or not eating

✘

Doing risky things (driving recklessly, substance abuse, not taking adequate precautions)

✘

Excessive watching television or spending time on the internet

✘

Withdrawing from pleasant activities

✘ Blaming others

Psychological First Aid for Schools Field Operations Guide 125

When Terrible Things Happen: For Students

When a bad thing happens, people have many different kinds of thoughts and feelings. There is no right or 

wrong way to feel. Some of the ways we respond may be helpful like how being around family and friends can 

help us feel happy or safe, while some of the ways we respond can make us feel very sad, scared, or angry. 

A crisis can affect how you feel, how you think, and how you act. 

You may feel confused, worried, shocked, sad, scared, angry, guilty, or numb. Maybe even scared about 

things that you weren’t scared of before, such as being alone, being in the dark, or getting hurt.

You may have feelings in your bodies, such as:

• Being tired 

• Headaches or stomachaches 

• A fast heart beat

• Feeling jumpy 

• Having problems sleeping

You may have thoughts, such as:

• Believing that what happened was your fault 

• Images of the bad thing repeatedly popping into your head

• Nightmares

• Worrying that bad things will happen again

You may act differently:

• You may not want to be around family or friends

• You may get into more fights

• You may have a hard time concentrating or getting schoolwork done

• You may not want to talk about, think about, or have any feelings about the bad thing that happened

• You may not have as much fun as you used to

• You may not want to be around things that remind you of what happened

Many of these thoughts, feelings, and behaviors may occur when your reminded of the bad thing that 

happened. Reminders may include places, people, sights, sounds, smells, and feelings related to the event.

Handouts and Worksheets
National Child Traumatic Stress Network National Center for PTSD 126

Handouts and Worksheets

What helps when you are affected by a crisis:

✔ Talking to and spending time with family and friends

✔ Doing fun things with family and friends

✔ Eating well, getting enough sleep, and exercising

✔ Getting back to a regular schedule—doing things that you would usually do

✔ Playing outside 

✔ Listening to music

✔ Keeping a journal

✔ Giving yourself extra time to do homework

✔ Accepting that you may need extra help temporarily and being willing to ask others for support

What does NOT help when you are affected by a crisis:

✘

✘ Avoiding thinking about what happened

Fighting

✘ Staying away from family and friends

✘

Staying away from fun activities

✘

✘ Taking risks, such as climbing too high, being careless crossing the street, or driving recklessly

Using drugs or alcohol

✘

Avoiding asking for help when you need it

It is okay to feel sad or scared after a bad thing happens, but if these feelings get in the way of getting along 

with family or friends or schoolwork, talk to an adult about your feelings.
Psychological First Aid for Schools Field Operations Guide 127

Handouts and Worksheets

Helping Your Family Cope: For Parents 

Reestablish Family Routines

Reestablish family routines to the extent possible after an emergency. Try to maintain routines such as meal 

times, bedtime, reading time, and playtime, and to set aside time for the family to enjoy activities together. 

Develop Tolerance among Family Members

Assist family members in developing a mutual understanding of their different experiences, reactions, and 

course of recovery. Encourage family members to be understanding, patient, and tolerant of differences in 

their reactions to the event, and to talk about things that are bothering them, so that the others will know when 

and how to support them.

Family members can help each other by:

 Listening and trying to understand

 Comforting with a hug

 Doing something thoughtful like writing a note 

 Getting the child’s mind off the event by playing a game

Pay special attention to your children’s behavior. Out of control or unusual behavior could mean that your 

children are troubled by reminders and hardships from the event. For example, children may look as if they 

are having a temper tantrum, when actually they are acting out because they have been reminded that a 

friend was hurt or killed. 

Give Special Attention to Adolescents

Adolescents may find that you are more anxious about their safety and, consequently, more restrictive in what you 

allow your teens to do, after the family has faced a crisis. Help adolescents to understand that this increase in your 

protective behaviors is common and usually temporary. Knowing that the “strictness” will not last forever will help 

teenagers avoid unnecessary conflict as the family recovers.

Common Caregiver Reactions:

 Setting earlier curfews

 Limiting adolescents from going off by themselves without 

adult supervision

 Insisting that teens call in frequently to let you know that 

they are safe

 Restricting “everyday” risks (driving a car or doing 

skateboarding tricks) even if you formerly permitted it 

Even though family members have 

gone through the same crisis, they 

may have very different feelings and 

reactions to it. These differences 

can lead to misunderstandings, 

arguments, and an inability to 

support each other well.

Parents worry more about their kids’ 

safety after a crisis, so they often 

have more restrictions. Remind 

teens to cut you some slack. 

This increase in supervision is 

usually only temporary, and will 

probably drop off as things start to 

settle down. 

Psychological First Aid for Schools Field Operations Guide 129

Handouts and Worksheets

Tips for Relaxation

Tension and anxiety are common feelings after crises. These feelings can make it more difficult to cope with 

the many things that must be done to recover. Using relaxation exercises to calm yourself during the day may 

make it easier to sleep, concentrate, and have energy for coping with life. These exercises can include slow 

breathing, meditation, swimming, stretching, yoga, prayer, listening to quiet music, spending time outdoors. 

Here are breathing exercises that may help:

Adults and Teens 1. Inhale slowly (one-thousand one, one-thousand two, one-thousand three) 

through your nose or mouth, and comfortably fill your lungs. 

2. Silently and gently say to yourself, “I’m filling my body with calm.” 

3. Exhale slowly (one-thousand one, one-thousand two, one-thousand three) 

through your mouth, and comfortably empty your lungs.

4. Silently and gently say to yourself, “I’m letting the tension drain away.” 

5. Repeat five times slowly.

Children

(practice with 

your child)

Let’s practice a different way of breathing that can help calm our bodies down. 

1. I want each of you to think about your favorite color. Okay, we are going to 

breathe in through our noses or mouths. When we breathe in, we are going 

to think about our favorite color and the beautiful things you connect with that 

color.

2. Next, we will breathe out through our mouths. When we breathe out, we are 

going to breathe out the gray and the uncomfortable feelings that have been 

building up. Let out the air, slowly and quietly.

3. Let’s try it together. Breathe in really slowly and inhale thinking about your 

favorite color and the beautiful things connected to this color, while I count to 

three. One, two, three. Good job. Now, while I count again, slowly let the air out 

while thinking about the color gray and all the unpleasant feelings. One, two, 

three. Great job. Let’s try it together again. [Remember to praise children for 

their efforts.]

Tips for Families:

• Find a room where everyone can spread out and have his/her own space.

• Some family members will want to lie down, others will want to sit. Some will want to close their eyes, and 

some will want to keep them open. Encourage everyone to find a way that feels most comfortable to them.

• Take time to practice this when everyone is calm. That way, everyone will be better able to use the 

breathing exercise when they are feeling upset.

• For young children, turn the breathing exercise into a game. Blow soap bubbles with a wand or blow cotton 

balls across a tabletop. Get creative and make it fun.