JONATHAN: So good afternoon. 

I'm Jonathan Lynch, a health communications specialist in CDC's center for preparedness and response division of emergency operations. Thank you for joining us for today's EPIC webinar titled psychological first aid, addressing mental health distress during disasters. Today, we're going to hear from Megan Griffin from SAMHSA. 

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Closed captions are available for this webinar. Meg han Griffin is a public health advisor in SAMHSA's center for mental health services. She serves as a federal project officer responsible for planning, managing, and evaluating grants for the crisis counseling training and assisting program and presidentially declared disasters by directly supporting services to survivors and providing training and technical assistance on disaster, mental health issues, and response management. 

Meghan, please begin. 

     MEGHAN: Thank you so much for that introduction. As stated, once again my name is Meghan Griffin and I'm a public health advisor in SAMHSA, and today, I'll be providing you with a brief overview of psychological first aid, and how we implement that in the field. Next slide, please. 

So first, I'm going to introduce to you the definition of disaster behavioral health that we use at SAMHSA and across HHS, and then I'm going to talk about psychological first aid or PFA as it's more commonly called and I want to make note that this will not be a full training on PFA. The course itself is typically a full day in person and a few hours online, but I hope to introduce some of those main topics and inspire you to take the course yourself. And later on in this presentation, I will provide you the links for where you can go to do that. 

And then I'm going to differentiate between public health first aid and mental health first aid. That's one of the most frequently asked questions we often get at SAMHSA is to talk a little bit about the difference between those two courses. They are commonly confused for one another, but they serve two different purposes and I think they're two very important courses to be aware of. 

And then I'm going to follow up with a few other classes that I think might be useful for anyone working in the disaster behavioral health field. Next slide, please. So before I begin, I just want to highlight SAMHSA's mission, which is to reduce the impact of substance abuse and mental illness on America's communities. 

Next slide, please. And so, the definition that you see here of disaster behavioral health comes from the office of the assistant secretary for preparedness and response, or ASPR at health and human services and while there are probably several of it -- different working definition, the one we use at SAMHSA includes the -- to survivors and responders. And we provide a gamut of disaster behavioral health services that can run from basic support to education about common reactions to disasters and coping mechanisms and then linkages to resources to further -- professional behavioral health services that can be beneficial to disaster services. 

Next slide, please. So SAMHSA's primary program for disaster behavioral health is formally known as the crisis counseling assistance and training program, but it's Richard to as the crisis counseling program or the CCP and this program is funded by FEMA, the federal emergency management agency and administered through an interagency federal partnership between FEMA and SAMHSA. It is a grant program and eligible grantees are the states, U. 

S. territories and federally recognized tribes, who received a major disaster declaration that includes individual assistance. And when this grant program is activated, the assist -- in providing short-term behavioral health support when the disaster response exceeds the capacity to serve the citizens within the declared disaster declaration. 

Typically, these programs are funded for up to one year, but can go a little bit longer, depending on the size and scope of the disaster. And in order to implement these programs, states often partner with contracted community health service agencies, or behavioral health providers locally in order to reach the community. So it's important to note that within this program, we use a paraprofessional model, so clinical behavioral health treatment and diagnostic services are not funded under this grant program. 

Next slide, please. So all of the resources that SAMHSA has developed about disaster behavioral health can be found on our disaster technical assistance center website, as well as the SAMHSA store, but I did want to also highlight our mobile app, the SAMHSA disaster app, that we have which can be downloaded to a smart phone and is a really great resource to be able to use if you are responding in the field, so you have everything that you need right on your phone, available for you. And the other resource that I wanted to highlight here, that unfortunately, I didn't have a separate slide prepared for, and especially because we're in the environment that we're in right now with social distancing is the disaster distress help line. 

This is a 24/7, 365 day a year hotline that's available to provide immediate crisis counseling for anyone experiencing emotional distress during any type of natural or human-caused disaster. The phone number is 1-800-985-5990. And this is a fabulous resource that can be used all across the country, any time, day or night. 

I highly recommend that you utilize this resource, as well. Next slide, please. So psychological first aid or PFA was first developed by the national child traumatic stress network and the national center for post-traumatic stress disorder with contributions from individuals involved in disaster research and response. 

And it was designed to reduce the initial distress caused by traumatic events, and to foster both short-term and long-term adaptive functioning and coping. Now, PFA does not assume that all survivors will develop a severe mental health problem or have long-term difficulties in recovery but is instead based on an understanding that disaster survivors are often affected by the experiences -- by events and will experience a broad range of reactions in both the physical, psychological, behavioral, and spiritual realms and some of these reactions will cause enough stress to actually interfere with their adaptive coping. And so you know, recovery can best be helped and supported by compassionate and caring disaster responders. 

Now, the two manuals that you see here on the screen were first published in 2006, and they did go much more in-depth into the information that I'm going to be able to have time to share on this presentation. Specifically about the eight core actions that make up the core content of psychological first aid, and I'm going to go briefly into those a little bit later in this presentation. But what's also great about these manuals is they have an accompanying handout in their appendices for adults, adolescents, parents, caregivers and providers. 

And they are currently available in English, Spanish, Chinese, and Japanese. Next slide, please. So one of the great benefits of the psychological first aid model is its flexibility. 

PFA can be used by paraprofessionals who are responding to the needs of their community, in addition to the mental health and substance use professionals, but it doesn't require you to be a clinician. It can also be delivered in a variety of settings. We often see it being implemented in healthcare settings, camps, shelters, schools, food distribution sites, emergency operation centers, so it really can be adapted to where -- where the services are needed and where you best need to implement them. 

What's also great is that it's offered in a variety of formats. So prior to the current situation, I would have highly encouraged everyone to take the class in person. It is a full-day course, and I think, you know, depending on your learning style, that in-person is the best way to take the class. 

However, that's not possible right now and I don't think there are any classes that could be offered in person for quite a while. So you can take it online. It is completely free. 

The online version of the course is about six hours in length which was first published in 2009. And there is currently a PFA in Spanish course that is also available in the learning center. And what's also great about the online version of the course is that especially if you're brand-new to disaster response, this will give you a great introduction to the core goals and how best to implement it. 

And if you're a more seasoned practitioner, just looking for a refresh or review, this is a great way to get back up to speed on some of the techniques and tips that you may need in order to help refresh some of your activities. The course itself provides a lot of innovative activities and video disseminations, as well as mentor tips from trauma experts and survivors who have implemented the program in the field and there's also an online learning community, where you can share your experiences about PFA and receive guidance during times of disaster and also some other resources and training materials that may be helpful to you, depending on the type of disaster or situation that you find yourself in. Next slide, please. 

So if you're working with a specific population or are interested in a more tailored program, there are also a few options available on how PFA has been modified over the years and implemented in different scenarios. There have been specific courses that have been geared to using PFA in schools and with faith-based communities. There was also a course specifically designed with WHO during the Ebola virus response, which could be quite beneficial for many people right now with the current isolation and quarantine orders that we have been experiencing. 

But what I think is most important is if you consider the population that you're serving and what kind of tools you will need in order to serve that population, so you can really think of PFA as your toolbox, and you can pull out the tools that you would need at the time that you may need them, but you may not need all of the tools all of the time. Next slide, please. So now, I won't have a lot of time to go into all of the research that is the basis for PFA, but there is a citation that you see there at the bottom of the slide that you can -- if you are interested in learning more about the research that goes into this, you can identify that there. 

But the foundational elements for PFA are safety, calming, connectedness, self and community efficacy and then finally hope. So I can just touch briefly on each one of these. So when we talk about safety, this is the biological reaction to a threat or extreme stress that is deeply embedded in our brains. 

So one of the core actions is to focus on giving survivors that sense of safety, so that their biological reaction can relax and allow them to maintain a sense of being in control over the situation. Therefore, you won't to try to help bring the survivor out of the line of fire, so to speak in whatever way you can do that. Sometimes, that means when working with a larger community is to address rumors or stories that might be spreading, which can be unproductive to the recovery process. 

And also protecting survivors from that repeated exposure to the events that may be occurring. And I think that's one thing that's really difficult right now with the 24/7 news cycle. Every time you turn on the television or try to listen to the news, everything is always going to be about discussing the particular event that's occurring. 

And so you're repeatedly exposed to that trauma. The second step that I mentioned is the promotion of calming. So this is promoting individual calming, which helps the frontal lobe come back online and promote reasoning skills, problem solving, focus and decision making and memory recall. 

The normal responses we often see to a disaster or a community in crisis are things like anxiety, fear, anger and frustration, but these responses are not beneficial to the normal functions that we need to operate, like sleep, eating, hydration, performance of daily tasks. So you really want to try to help people return to the state of whatever is as close to their normal as possible to ensure that they're able to attain the higher level of functioning. And really help people get grounded. 

So you can do this through things like deep breathing techniques, muscle relaxation, problem solving and allowing them to process the experience that they've been through can all be positive ways of providing support. The next level is connectedness. Right now, we're experiencing a challenging time of figuring out how we can connect with one another when we are physically separate and distant from each other. 

But being able to connect to loved ones, neighbors and community members is one of the best ways that we can reassemble that natural social network that helps us facilitate the communication processes that we build throughout our community. And you might not be aware of other material assistance that can be provided to other survivors if you don't have the connection to your social support network. So you can -- you really want to make sure that you're able to re-establish those connections, whenever possible. 

The next step is promoting self-efficacy and this is one of the most important things that we've learned within the field of disaster behavioral health, and if it's anything, it's that you don't want to do anything for the survivor that they can do for themselves. You really want to promote the idea that individuals can take responsibility for themselves and control over their situation to help instill that sense of empowerment and ownership over the situation. That will really help build their resiliency and recovery in this process. 

And then finally, instilling hope. The individuals who will remain optimistic always have a more favorable outcome after experiencing a crisis. So anything we can do to reinstill that sense of hope is going to be the most beneficial for everyone involved. 

Next slide, please. So now, I'm going to dive briefly into the eight core actions that are used to implement these concepts in the field and I do want to note this chart was adapted from the Colorado department of public health and environment, and I think they've done a great job with their stick figures here. So I want to give them a quick shout-out. 

And their step one is contact and engagement. So we want to acknowledge that it's very important to initiate contact with as many people as possible when you're implementing PFA in the field. This is again one of the most challenging situations that we're in right now, identifying how best to implement that given the current situation the we're in. 

But we do want to acknowledge that there is still a stigma around mental health and mental health services and, you know, being able to address that stigma. But also understanding that we shouldn't assume that people are going to come to us for help when we need it. So it's important to remain respect for the individual and the cultural needs and norms and also the emotional states that a person may be in. 

When they've just experienced a crisis. So whenever possible, as you are initiating contact and engagement, you always want to introduce yourself, your role in your team, and be respectful of the person's boundaries, if they don't want to receive your contact and engagement, you don't want to force it upon a survivor, if possible. So the second step in line with that is safety and comfort. 

And this is ensuring that an individual's basic needs are met. So you ensure that a person's immediate physical safety to whatever sense possible is -- that they are in a safe place. And regarding comfort, you want to remember that whatever comforts -- you may not comfort someone else and right now since it's best not to be in physical contact with other people, how best to provide that comfort from a distance and still ensure that you're able to have that connection with them, I think is an important thing to keep in mind. 

So the third step may not be necessary in all situations, but I still want to touch base on it briefly. So when we say stabilization, it's ensuring that the person that you are working with is oriented to place, time, date, and event. We know that whenever a disaster occurs, it's extremely stressful event and so there can be some disorientation or sense of feeling overwhelmed or disassociating yourself with the event that's taken place. 

So it's not entirely uncommon, but you do want to be observant if a person is experiencing a rush of emotions and they're not able to identify where they are or what has occurred. And so really this is also going back to the previous ideas of ensuring that they are in a safe place, and if you need to remove a person or move to a more quiet and calm environment before you can engage with them further to really ensure that you're addressing their primary concern. So you can help a person ground themselves in the here and now by using some of the relaxation techniques like deep breathing and muscle relaxation that I had mentioned previously. 

The next step is to gather some information about their current needs and concerns. So as you're starting to interact with a person, you're engaging them in conversation, and helping guide the conversation to identify what further actions may need to take place. So you can inquire about a person's experiences by asking questions like would it be helpful to talk about what you've been through? And really creating the space to give them an opportunity to share their experiences, without being intrusive or asking too many probing questions. 

Really let the survivor guide the conversation. You want to try to identify what they need right now in the immediate sense, but also understanding that within the first few hours or days of an event, it's typically too soon for someone to go really in-depth about the experience that they've been through. So you don't want to retraumatize anyone by going too deep. 

Really allowing the survivor to guide the conversation. And then be on the lookout for particular concerns about things like traumatic loss, immediate threats to them or their loved ones, separation from loved ones, physical illness or the need for medication, anything around feelings of guilt or shame or suicidal or homicidal thoughts. The lack of a natural support system. 

And any current or past issues that they may recall with regards to alcohol or substance use, prior traumas, and current and prior mental illness, as well. So then once you've identified what some of those needs may be, you can provide practical assistance in a supportive and guiding way to identify what the survivor considers to be their most pressing need in that moment. And so you want to try to clarify with them what that need entails and then what you can do to help them create an action plan to address those specific needs. 

And finally support them in taking that action and following that plan because remember, we don't want to do anything for them that they can do for themselves. So it's helping them identify what they can do and then helping to enforce that sense of empowerment over that situation to really help them get through to the next step. And connect them with their natural social networks and supports that already exist. 

So reuniting their natural sources of connectedness within the community and friends and family is going to be one of the most important interventions that anyone can do, really in any situation. And for information on coping, this is where you can give survivors information on what they should expect from themselves and from others in the next days, weeks, and months following an event. We had some great resources at SAMHSA's disaster technical assistance center, as well as the national center for traumatic stress network, which gives guides and tip sheets that can be very helpful and as I mentioned with the disaster app, you want to make sure you have these available for you before you're going out into the field or speaking with anyone, so that you can share that information. 

You may also have some great information available locally with your local emergency management or department of mental health, or also at the state level, that can be shared, which can direct you to some more local resources that are available, as well. And on all of our tip sheets, you can address such issues like stress reactions, common reactions to trauma and loss, as well as some tips and tricks to help you overcome some of those types of reaction. The other thing that you want to be able to be informed about as well as some of the positive coping reactions that we talked about, like relaxation and breathing techniques, you also want to be aware of some of the problematic responses that may arise in certain situations, that we see regarding alcohol and substance use. 

So where you can best make referrals for further services that may come up with questions about things like that, as well. So when I talk about referrals, linkage with other collaborative services or when we talk about -- when we say referrals to other services, because those that are implementing PFA in the field cannot be all things to all people all the time. So you want to be able to rely on the other great services and experts that are critical to any part of the response out in the field and so you can make referrals to other agencies or other groups in communities that are helping with the response to be able to provide those services directly to a survivor to best meet their needs. 

So I know that was quite a lot of information to go over. And again, I want to reiterate that the in-person class as well as the online course will go much more into detail about every single one of these -- the core elements that make up psychological first aid. This was just a very brief overview of each one of the vectors and there's quite a lot of information and tips or tricks that they provide in the class so I really think it will be best to utilize the resources that are available online at this time, if you're interested in learning more there. 

Now, next slide, please. So they have also created a mobile app that is specific to PFA and you can access this both through the SAMHSA disaster app as well as through this app here. And it is a great resource to take with you, if you are implementing this in the field. 

They provide some breakout of the different tips, depending on the types of survivor groups that you may come into contact. So if you're working with younger children, there's specific information that's identified for infants, toddlers, preschool, school age, adolescents, all the way up to adults. They also provide some tracking tools that help you keep track of survivors' concerns and referral needs, and there's a place where you can access resource linkages to facilitate the referral process, as well. 

So there's a lot of great resources that are embedded within the app and I would highly recommend you check that out, too, if you are implementing this in the field. And next slide, please. So as I mentioned, earlier, one of the most frequently asked questions that we get whenever we talk about PFA is what is the difference between mental health first aid and psychological first aid, and which class should I actually be taking? Because they sound very similar to one another. 

They do actually have two very different focuses. So mental health first aid was first developed for people to become more aware about mental illness and give people the skills to help someone who is developing a mental health problem or experiencing a mental health crisis and when it's best to intervene during that crisis. So it's not based on a specific disaster event that's occurred. 

It's more specifically focused on mental illness. And if you take this course, you will learn how to identify some of the common mental health disorders and what signs and symptoms to be aware of, so you can help someone who may be experiencing things like depression, anxiety, psychosis, substance use disorders or eating disorders. Now, as far as I am aware, this case is only offered in person. 

I don't know if they have been making arrangements to provide this online, but when I was first putting these slides together, the current situation that we were in was only just starting. So I'm not aware if they're changing their service model at the moment, but if you go to the website for it, www. mentalhealthfirstaid. 

org, that is listed there, they will have the most up-to-date information on how they are providing their services. I do also want to note there are two different versions of the mental health first aid course. There is one for adults and the adult course is for anyone who is experiencing a mental health disorder or in crisis, ages 18 and older, and that course is both available in English and in Spanish. 

And then there is the youth mental health first aid course, which is also primarily attended for adults to take -- intended for adults to take, but it's to learn about how young people experience mental health crises and challenges, especially from 12 to 18 where they have some unique risk factors and warning signs for mental health problems that just start to emerge during that time. And really emphasizes the importance of early intervention in that time period. Next slide, please. 

So the other course that I want to highlight is skills for psychological recovery, because this course also builds upon all of the core concepts of psychological first aid and is widely used within the crisis counseling program that I work with and is often one of the most -- the best reviewed of the courses that we highlight in that program. This course first came out in 2011 and was actually just very recently updated online, so if you haven't taken it recently, I would recommend that you go and check it out again. It's been completely revamped, and should have a much, you know -- a newer look to it. 

But the disaster behavioral health research that we use suggests that the skills-building approach is actually even more beneficial than the supportive counseling after a disaster. So I would highly recommend that anyone working in the disaster behavioral health field also look into taking the skills for psychological recovery. This class is also offered online and in person, and usually in person, it goes over the course of a few days. 

So it's a much longer and in-depth course that really provides some great information for anyone working in the disaster field. And next slide, please. So that actually brings me to the end of my formal presentation. 

I want to thank everyone for your attention and with time permitting, I believe we have a little bit of time to take a few questions. I do want to note that the contact information that you see here is for our disaster technical assistance center. Given the influx of disaster response work that we're doing at the moment, they are helping us immensely in trying to be able to collect all of the questions and responses that we may have that are coming in while we are both managing our regular workload and all of the disasters on top of that. 

But I believe we have a little bit of time for questions. I think I can turn it back over to Jonathan to help me facilitate that process. 

     JONATHAN: Thank you, Meghan. This is a top that can seems to evoke a lot of passion from people. Before we go straight to the Q&A, I wanted to ask, can you repeat the psychological distress phone number? 

     MEGHAN: Yes. It is -- the helpline is 1-800-985-5990. 

     JONATHAN: Okay. And we also posted that in the chat section. So hopefully people got that, but several people were asking for that. 

The courses you mentioned. Are they -- do they cost money? 

     MEGHAN: No -- well, yes. They are all free. So especially the ones that you take online, if you follow the link to NCTSN. 

org, their learning center, the courses that are offered there are free. I believe mental health first aid through www. mentalhealthfirstaid. 

org is also free. Especially the online versions. If you are making arrangements to have a trainer come to your organization or to work directly with you, then there may be some costs associated with that. 

But if you work directly with the organizations and agencies themselves, they can help you best facilitate how to identify trainers that may be available in your area and how to set up those courses. 

     JONATHAN: Great, thank you. So our first question. The definition of PFA says it is meant to be used in the aftermath of a disaster. 

Is there any value in implementing in the midst of a crisis, such as this pandemic? 

     MEGHAN: Yeah, absolutely. I mean, we're using it right now, and it doesn't just have to be used after a disaster or a traumatic event. We are using it kind of all the time. 

So you know, we've both used it after natural disasters that we see, like hurricanes, floods, tornadoes. We still have those happening. And other types of traumatic events, like -- unfortunately, we do see a number of mass shooting events and things like that, which are extremely traumatic events that have occurred in a community. 

So it doesn't just have to be a natural disaster, but also a human-caused disaster. What I think is great about the PFA model is that it is so flexible to the event that's occurring. And so you know, while there are some challenges right now in how best to implement that from a social distance perspective, we are seeing a lot of states come up with some really great alternatives of using things like telemedicine and the hot lines that are available to be able to reach out and make those connections to community members and survivors in any type of incident that you're in. 

     JONATHAN: Thank you. We have a lot of professionals and response personnel here. So we have this question which I think a lot of people are interested in. 

How would one become an instructor for psychological first aid? 

     MEGHAN: So I think all of the information for that -- and they do offer some "train the trainer " courses. I don't know if those are available online at the moment. That may be something we're going to have to spend a little bit more time working on developing some more opportunities for remote learning, given this current environment that we're in. 

But there are some great resources on the website about that, and so I would recommend if you are interested in becoming a trainer in any one of these courses, that you look there for some more information and updates on that as those opportunities are coming about. 

     JONATHAN: The next question is incredibly relevant. Can you provide thoughts on practical advice slash guidelines for engaging patients' social support under the current social distancing guidelines? 

     MEGHAN: So you know, that's one thing that I think we are working very diligently on at the federal level and as for specific guidances and, you know, information about that, you know, we have some resources that are available on the SAMHSA. gov website, SAMHSA. gov/coronavirus is where we're posting all of the guidance relevant to the current situation that we're in. 

And there's a lot of resources about the use of telemedicine and telehealth and how best to engage the community, and I think that's one of the greatest lessons learned that we're also collecting through this time is seeing what is working and the most beneficial way to implement some of these services and how best to share those lessons with everyone else as we're all kind of going through this together. 

     JONATHAN: Thank you. The next question -- we've actually received multiple questions related to faith-based interventions, to prayer, to praying with  people, to offering sort of chaplaincy counseling. Can you speak to that and how that fits? 

     MEGHAN: As I mentioned before, there have been some PFA courses that have looked very specifically and worked very closely with the faith-based communities, and so I think it certainly is possible and relevant to provide psychological first aid in that way. I think it's also important to be respectful of, you know, cultural beliefs and norms. And so you know, however best to -- to reach to the survivors and to ensure that they are feeling respected and comfortable in that situation. 

It's appropriate to best fit the needs of the people that you are working with. So I think there is some more specific information about working with faith-based communities on the NTSN. org website, as well. 

     JONATHAN: Thank you. The next question comes from Alan. I'm going to read his question out and ask you to expand the scope a little bit. 

Alan asked how do you relate slash help with someone who has pre-existing conditions, such as ASD/Aspergers? There are several sort of cognitive conditions that can make it harder to connect with people. Is there a good methodology for that? 

     MEGHAN: So I think that's where, you know, it comes into -- with connecting with the social support network that currently exists and also being aware of the referrals that may be necessary or beneficial to work with in that type of a situation. So you want to hopefully be able to rely on friends and family members that may be available to help you facilitate any types of conversation or the implementation of the PFA as you're engaging with a survivor who may be also experiencing those co-occurring conditions like that. And then ensuring that you have the proper referrals to further services, because remember, we would not necessarily be clinicians ourselves if we're implementing PFA, but that may be a great opportunity to try to connect the survivor or their family members with other clinicians and professionals within the community that can provide some really great services that you may not be able to provide yourself. 

     JONATHAN: Thank you. Our next question comes from Barbara. When offering practical assistance and counseling, are families helped together, or are the children given care for their needs separately? 

     MEGHAN: So you know, I think it really depends on the situation that you're in, and how best to provide the services. I think you also need to be respectful of the current, you know, family situation and the age of the children, as well, so it may or may not be appropriate to include the children, if you're providing services to their parents. But, you know -- so we often implement in the -- the crisis counseling program, there's individual and family services that can be provided and so you know, it really does vary based on the specific needs that have been identified throughout the course of the conversation that you're working with, so you do want to be respectful of the age and experience of the child, but, you know, also being able to ensure that you're providing appropriate resources and services based on the situation that they're in. 

     JONATHAN: Great. Thank you. Can you share more about what is meant by paraprofessionals? What they're asking is who can be trained as an expert or a provider of PFA? 

     MEGHAN: So yeah. So I think that's a great question. And really the idea of this is that anyone can be trained to provide that supportive connection to another person and that's why we have so many resources that are available to help you feel comfortable in providing that support. 

But I think it's also important to recognize that it's not for everyone. You know, not everyone feels comfortable to be able to initiate that contact and provide services to their friends and family members, their community members, their neighbors, whoever needs the services. So there's training available to help people understand what skills and tips and techniques and different types of implementation are out there. 

But you are not required to be a clinician, so you don't have to have any type of degree or background in order to provide that support. What's really most important, especially in disaster behavioral health is that we often look to survivors themselves, to provide that supportive contact to one another because, you know, no one really knows what you're going through, like the person who has also gone through it. They may be very close to you right there. 

It's your community members that are going to know the most about what services are available to other community members who are right there with them. So I think anyone who feels comfortable providing psychological first aid should -- should take the course and look more into it and if you determine that it's not the right step for you, then you can encourage someone else to take it and maybe, you know, you can help spread the word that way. But I think anyone is capable of providing these services if they feel comfortable doing so. 

     JONATHAN: Thank you. This next question is one that has to be addressed given the current pandemic. Can you speak to how to help grieving families who have lost a loved one due to COVID-19? Especially if they weren't able to say goodbye, if they're experiencing anger over the situation. 

     MEGHAN: Yeah, so I think that's one of the, you know, greatest challenges that we're in right now is that community connectedness and ensuring that we're still reaching out and providing these services when necessary and when possible. And so it's ensuring that initial contact still occurs, but it's so easy for us to, you know -- well, it's not really so easy for us all to stay home, but it's become the situation that we're in right now where we're physically separated from one another, and it's difficult to reach out when you may need that assistance. So you know, we have some of those resources available like the disaster distress helpline where you can call and receive immediate counseling services from licensed clinicians, 24 hours a day, seven days a week. 

So we really encourage the utilization of services like that where they can help also then make referrals to agencies that may be, you know, closer by to wherever that person is and help facilitate some of those difficult conversations that people are experiencing. But I think it's just continuing to encourage folks to maintain their social networks that they have right now and reach out to one another and make that contact and especially if you know -- you have a friend or family member that may be going through a difficult time, but doesn't want to put that burden on someone else, be willing to listen and hear what they have to say and just being able to provide the opportunity to share their experiences can be one of the most beneficial things that we can do for each other right now. So you know, we may have to do that through platforms like this one, or just you know, over the phone. 

We all carry around cell phones in our pockets, but we have a tendency to forget they're phones, too, and we can use them to call one another. So you know, this is a great time to actually pick up the phone and reach out and make that connection with those that are around you. 

     JONATHAN: Thank you. Okay we've had a couple of questions related to PFA models for law enforcement and the military. Can you speak to that? 

     MEGHAN: So I'm actually not familiar with all of the different types of PFA models that are out there. There have been, you know, many different implementation models or ways that PFA has been adapted to best fit the needs of the community that you're working with, or, you know, the community that -- that, you know -- specific communities like that, like law enforcement and the military. So there should be some more information about that on the website, because I know even beyond just a few that I had mentioned, there are many, many more models that are out there. 

So I would point you in that direction first and if there's any follow-up information I can provide to that, I can try to get that to the CDC to push out as well, because yeah, the good thing about PFA and the model is that it has been adapted for many different audiences and many different communities. I'm just not an expert on every single one of them, unfortunately. So we'll see if we can find some more information about that. 

     JONATHAN: Of course. And actually, anybody here can send an e-mail to EPIC@CDC. gov and we can follow up on questions for you. 

We have actually had in the same vein, multiple comments related to PFA for teens, for children. One person even mentioned young children as young as 5. Can you speak to that? 

     MEGHAN: Yeah, so again -- and I'm trying to think if I know -- if if the courses that are offered online -- I believe it's just the generalized all-ages kind of model. I don't think they have a specific course that is available right now online specifically for the younger age groups. I believe it's all incorporated into the general course so I think that is something I would have to follow up on as well if I can find some more specific information about that and how that is best incorporated into the courses that are currently online. 

     JONATHAN: Thank you. You mentioned -- this is a question from Dean Russell. You mentioned that we shouldn't assume people will come to us for help. 

How do we go to people in need, given the social distancing needs during this pandemic, and recognizing that is a very difficult challenge? 

     MEGHAN: It really is! So another wing we're working with a lot of the -- another thing we're working with a lot of the states on is advertising, getting the word out there, who they can contact, and who they can reach out to, if you've able to identify a need within yourself. But I think it's just ensuring that we are, you know, as human beings reaching out to one another and making those connections as best as possible and, you know, the impetus really falls to the individual responders to make that connection right now, because we have to initiate that contact. We can't assume that survivors are going to come to us and ask us for help all the time. 

So it's putting as much information out there as possible to let folks know that you are willing to listen and have resources and information that can be shared and, you know, really taking that extra step to initiate that contact in any way that's possible. 

     JONATHAN: Meghan, most of the questions coming in now are related to where to get the slides and where to follow up with questions. Slides are always posted before our webinars and they're available on our website. So since we're nearing the end, we're going to close things out. 

Thank you, again for joining us for today's webinar. If you have additional questions, you may e-mail them to EPIC@CDC. gov. 

As a reminder, today's presentation has been recorded and you can earn continuing education for your participation. If you go to emergency. CDC. 

gov/EPIC, you'll find instructions that will tell you how to follow up with continuing education and on the website, we will have the recording posted in the next few days. The course access code is EPIC0422. That's with all letters capitalized. 

So I want to say thank you to everyone for coming, thank you, Meghan for coming, and thank you everyone for all the help you're giving to the public in this difficult time. Goodbye. 

     MEGHAN: Bye-bye.