Psychological First Aid Trainings and Policy Development

Psychological First Aid Trainings and Policy Development A Follow-up Evaluation Survey of Psychological First Aid Trainings and Policy Development Activities by New York State Health Emergency Preparedness Coalition Partners Conducted by: Preparedness and Emergency Response Learning Center Center for Public Health Preparedness School of Public Health University at Albany August 2017 Guthrie S. Birkhead, MD, MPH 1 Brian D. Fisher, PhD 1 Mary Riley-Jacome, MA 1 Karla Vermeulen, PhD 2 Rebecca Rodriguez, MA 2 1. Center for Public Health Preparedness, University at Albany 2. Institute for Disaster Mental Health, State University of New York at New Paltz This project is supported by a Workforce Improvement Project cooperative agreement from the Centers for Disease Control and Prevention (CDC), under FOA CDC-RFA-OE12-1201 with the Association of Schools & Programs of Public Health, Washington, DC. Translation, Dissemination, and Implementation of Public Health Preparedness and Response Training. Award #3U36OE000002-04S05. Disclaimer: The content of this presentation is solely the responsibility of the authors and does not necessarily represent the official views of the CDC

Table of Contents Page Introduction and Background.. 3 Survey Methods. 4 Summary of Follow-up Evaluation Survey Findings.. 5 Conclusions 7 Appendix I: Tables of Results... 10 Appendix II: Survey Questionnaire.. 17 2

Introduction and Background Psychological First Aid (PFA) is an evidence informed approach for assisting people in the immediate aftermath of disaster to reduce initial distress and to foster short- and long-term adaptive functioning. Early interventions such as PFA can help promote a healthy recovery for individuals affected by a disaster or personal crisis. In 2015, discussions between staff at the Center for Public Health Preparedness (CPHP), University at Albany School of Public Health, and public health emergency preparedness partners participating in the NYSDOH-sponsored regional Health Emergency Preparedness Coalitions (HEPC) identified that a lack of training in PFA for response organization staff was a significant barrier to partners working with disaster survivors to most effectively meet their needs. PFA Demonstration Project In 2016, based on these discussions, the CPHP applied for and was funded by the Centers for Disease Control and Prevention (CDC) through the Association of Schools and Programs in Public Health (ASPPH) to carry out the PFA Demonstration Project. The goals of the Project were to develop a PFA Training Coordinator Guide and to deliver training in the use of the Guide for training coordinators from NYSDOH HEPC member organizations, such as county health departments, hospitals, long-term health care providers, emergency managers, emergency medical services staff and others. Needs Assessment An initial needs assessment to inform the PFA Demonstration Project was conducted of HEPC members in the spring of 2016. 1 This needs assessment showed that over two thirds of respondents either didn t know if PFA training was valuable or felt it was not applicable, probably because they had not provided PFA training recently. However, 76% of respondents whose organization had been activated in a declared emergency in the last 5 years and who had provided PFA training to their staff in the past, found PFA training valuable. In all, 91% of respondents organizations had general training policies in place, but only 8% had PFA-specific training policies. Follow-up with those reporting having PFA training policies revealed that most of these policies were not in writing. Identified barriers to PFA training included time constraints (53%), lack of subject matter expertise (37%), lack of a training guide (31%), and cost (27%). The PFA Training Coordinator Guide was designed to address these barriers. PFA Training Coordinator Guide The CPHP PFA Training Coordinator Guide (http://www.albany.edu/sph/cphp.php) assists HEPC training coordinators in the selection of appropriate online PFA course to meet the needs of their staff. The Guide also includes 10 emergency response scenarios and a facilitator s guide for conducting interactive, face-to-face scenario-based training sessions to allow staff to practice PFA skills. The CPHP trained local mental health professionals to serve as technical assistance resources for the interactive trainings. In addition, the CPHP stressed to HEPC members the importance of developing PFA-specific training policies to assure the sustainability of PFA training efforts and provided model training policies for their 1 Psychological First Aid Needs Assessment; A Baseline Survey of New York State Health Emergency Preparedness Coalition Members. Preparedness and Emergency Response Learning Center, Center for Public Health Preparedness, School of Public Health, University at Albany, Albany, New York. August 2016. (http://www.albany.edu/sph/cphp.php) 3

use. Finally, the CPHP offered technical assistance to any HEPC members to help them to plan and conduct PFA trainings and to develop PFA training policies. PFA Trainings In the late summer and fall of 2016, the CPHP delivered 2 sessions at 4 sites training 104 mental health technical assistance providers and 6 sessions training 239 HEPC training coordinators in the use of the PFA Training Coordinator Guide, including discussion of training policies. An evaluation of pre and posttraining evaluation forms 2 showed that overall confidence in knowledge of PFA and self-efficacy in applying PFA, on a scale from 1 (not at all confident) to 5 (very confident), increased among 104 mental health professionals from 4.2 to 4.5, perhaps reflecting their previous experience with PFA. Confidence among 239 HEPC organization training coordinators increased more dramatically from 3.8 to 4.5, a 25% improvement. Nearly 90% (160) of training coordinators trained said their organization would find PFA training valuable, 85% (156) said they were interested in developing PFA training policies for their organization and 82 % (150) said that could help develop those policies. Following these trainings, in early 2017, the CPHP reached out to HEPC member organization leadership in multiple settings to offer technical assistance to help them plan and conduct PFA trainings and to develop PFA training policies. Follow-up Evaluation Survey of Psychological First Aid Trainings and Policy Development The purpose of this Follow-up Evaluation Survey, conducted in June and July, 2017, was to determine the activity of HEPC member organizations in conducting PFA trainings and developing PFA training policies following the CPHP PFA Training Coordinator Guide trainings conducted in the late summer and fall of 2016. Survey Methods Survey Questionnaire A questionnaire was developed asking respondents about any PFA trainings held since the CPHP PFA Training Coordinator Guide trainings in 2016 and whether future PFA trainings were planned. If trainings were held, details were sought about whether an on-line course was used, which course was used, whether interactive, face-to-face scenario-based training sessions were conducted, if so whether technical assistance providers were utilized, and the number of staff trained. In addition, questions were asked about whether the respondent organizations had developed, were in the process of developing, or were planning to develop a PFA training policy. Details were sought about policies developed or under development. Finally, similar to the 2016 Needs Assessment (reference 1, above), barriers to developing and implementing PFA training policies were sought. Survey Distribution The final questionnaire (Appendix II) was made available on Survey Monkey in June 2016. An introductory email and survey link was sent to all 2016 PFA Training Coordinator Guide training participants. When there was more than one participant per HEPC organization, one participant was 2 Evaluation of Psychological First Aid Trainings. Preparedness and Emergency Response Learning Center, Center for Public Health Preparedness, School of Public Health, University at Albany, Albany, New York. March 2017. (http://www.albany.edu/sph/cphp.php) 4

selected, who was usually the county Public Health Emergency Preparedness (PHEP) Coordinator or hospital Emergency Manager. The survey link was also send to HEPC organizations that responded to the 2016 Needs Assessment Survey but did not send a staff member to participate in the PFA Training Coordinator training. All organizations surveyed were located in New York State outside New York City. If the targeted respondent was no longer working at the HEPC organization, an effort was made to identify another respondent from that organization. Multiple reminder emails were sent. The survey was closed on July 31, 2017. The survey data were analyzed using SAS. Summary of Follow-up Evaluation Survey Findings (See Appendix I. Results section). Characteristics of Respondents Respondents from 122 (62%) of 196 invited HEPC organizations who had participated in the PFA Training Coordinator Training or, if they did not participate in the training had responded to the 2016 PFA Needs Assessment Survey, completed the PFA Training Follow-up Evaluation Survey. Respondents represented HEPC organizations including 57 county health departments, 45 hospitals, and 20 other types (see Table 1a in Appendix I. Results section, below). The response rate for county health departments was 100% and for organizations other than county health departments was 47%. There was representation from each of the four HEPC regions (Table 1b). Participation in and Utility of the CPHP PFA Training Coordinator Training In all, 76 (62%) respondents had participated in the PFA Training Coordinator Training and 43 (35%) had not (Table 2a). A total of 78% of hospitals, 51% of county health departments and 60% of other organizations participated in the training. Use of PFA knowledge and skills in a real emergency or preparedness drill/exercise. A total of 37 (30%) of respondents said their organization had used PFA knowledge and skills in a real emergency or preparedness drill/exercise since taking the PFA Training Coordinator Training or completing the 2016 Needs Assessment (Table 2b). In all, 42% of hospitals, 28% of county health departments and 10% of other organizations had used PFA skills in these events. The circumstances of the events ranged from a NYSDOH-organized point-of-dispensing exercise (OUREx POD) conducted in March 2017, which included a PFA inject (exercise activity), and several real emergencies such as a bus accident with mass fatalities (Table 2c). Organizations whose respondents who had participated in the PFA Training Coordinator training were 3.1 times more likely (95% confidence interval (CI) 1.4-6.9, p=0.01) to have had their organization use PFA knowledge and skills in a real emergency or preparedness drill/exercise than those who did not participate in PFA Training Coordinator training (Table 2d). Of those who had used PFA knowledge and skills in a real emergency or preparedness drill/exercise, 35 (95%) found PFA training to be of value in the response (Table 2e); 89% of hospitals, 100% of county health departments and 100% of other organizations. 5

PFA Trainings Provided by HEPC Organizations PFA training conducted or planned. A total of 56 respondent organizations (45.9%) had conducted a PFA training for their staff since taking the PFA Training Coordinator Training or completing the 2016 Needs Assessment (n=20) or planned to conduct such a training in 2017 (n=20) or in 2018 (n=16) (Table 2f). In all, 42% of hospitals, 51% of county health departments and 38% of other organizations had conducted or planned to conduct PFA training. Organizations whose respondent who had participated in the PFA Training Coordinator training were 1.7 times more likely (95% CI 1.0-2.5, p=.05) to have conducted or planned to conduct a PFA training for their staff than those that did not participate in the PFA Training Coordinator training (Table 2g). Characteristics of PFA trainings conducted by HEPC agencies who had taken the CPHP Training Coordinator training. In all, 17 of 20 respondents whose organizations had provided PFA training to their staff had taken the CPHP PFA Training Coordinator training (Table 3a). These respondents reported that 7 organizations provided a single training and 7 offered 2-5 trainings. Twelve organizations trained less than 20 staff and 3 trained 20 or more. Three organizations indicated they offered PFA training to all employees, 2 trained management staff, 7 trained staff with public/patient contact during an emergency, and 3 trained all volunteers (Table 3b). Seven organizations used on online PFA training course, 10 provided an in-person didactic PFA training (Table 3a). Ten organizations conducted an in-person, PFA practice session using the CPHP scenarios. Only 3 asked for assistance from the CPHP-designated technical assistance providers. Four formally evaluated their training and 14 (82.4%) found the training to be valuable. Comments on lessons learned showed that several respondents felt the in-person practice training was more valuable than online or didactic training (Table 3c). PFA Training Policies PFA Training Policies Developed or Planned. In all, 37 (30%) respondents reported that their organization had developed a PFA training policy (n=7), was currently drafting a PFA training policy (n=6), or was planning to draft such a policy in 2017 (n=10) or 2018 (n=14) (Table 4a). A total of 17 (38%) of hospitals, 18 (32%) of county health departments and 2 (10%) of other respondents had developed or planned to develop a PFA training policy (Table 4a). Organizations whose respondent had participated in the PFA Training Coordinator training were 2.8 times more likely (95% CI 1.3-6.1, p=.01) to have developed or planned to develop a PFA training policy than those that did not participate in the PFA Training Coordinator training (Table 4b). 6

PFA Training Policy Elements. Of the 13 PFA training policies that had been finalized or were still being drafted, PFA training was required or made available/recommended for management staff (n=4 and 6, respectively), staff with contact with the public or patients in an emergency (n=5 and 6 respectively), all employees (n=3 and 7 respectively), all volunteers (n=1 and 7 respectively), contractors (n=1 and 3 respectively) (Table 4c). A total of 3 PFA training policies required renewal of PFA training and 4 recommended renewal (Table 4e). In all, 7 policies called for renewal of PFA training every 1-3 years, 2 called for renewal every 4-5 years, and 4 had no specific renewal interval (Table 4d). The following were mentioned as barriers to implementing PFA training policies all respondents: competing priorities (59%), time constraints (58%), lack of expertise in the subject matter (30%), PFA training was a lower priority for leadership (16%) and cost (8%) (Table 4f). Organizations whose respondent had participated in the PFA Training Coordinator training were 20% less likely (RR=0.8) to view lack of expertise in the subject matter as a barrier to implementing PFA policies than those who did not take the training, suggesting that the training had helped, however, this finding was not statistically significant (Table 4g). Conclusions The CPHP PFA Demonstration Project developed a PFA Training Coordinator Guide and trained 239 HEPC training coordinators in the use of the Guide. The goal was to give HEPC member organizations the skills and tools to design and conduct PFA training for their staff and to assure the sustainability of PFA training by developing PFA training policies. The before-and-after evaluation of the training sessions showed that participants increased their self-confidence in the organizing PFA trainings and expressed their interest in developing PFA training policies for their organizations (reference 2, above). However, at the time of the training whether they would follow through with these steps was not known. This Follow-up Evaluation Survey shows that, even in the brief period of 6-10 months between PFA training and this Follow-up Evaluation Survey, organizations whose training coordinator participated in the PFA Training Coordinator training were 3.1 times more likely to have had their organization use PFA in an emergency response, exercise or drill, 1.7 times more likely to have conducted or planned to conduct a PFA training for their staff, and 2.8 times more likely to have developed or planned to develop a PFA training policy than those that did not participate in the PFA Training Coordinator training. These findings were statistically significant. 7

Despite these positive findings, the number of organizations that actually conducted a PFA training (n=20) was relatively small. This may reflect, in part, the relatively short time that had elapsed between the training and this Follow-up Evaluation Survey. Also, the training coordinators who took the training are likely not the decision makers in their organizations in determining the subject and timing of trainings for their staff. The PFA training courses that were mounted used a mix of online courses and in-person didactic instruction to present the basic information about PFA. Certainly, if an organization has access to a mental health professional trained in PFA, they should utilize those resources for training and not rely on on-line courses which may be difficult to access or require payment to receive a certificate of completion. One of the follow-on activities after the PFA Demonstration Grant ends is the development of a PFA train-the-trainer curriculum by the NYSDOH and the NYS Office of Mental Health (NYSOMH), two key partners in this project. This will assure that consistent content is delivered in inperson, didactic PFA training sessions. Two thirds of organizations who conducted PFA trainings included in-person practice sessions, presumably using the preparedness scenarios and facilitator s guide contained in the CPHP Training Guide. In both the PFA training evaluations and in the text comments in this Follow-up Evaluation Survey, the scenario-based training was viewed as a very valuable part of the experience. Similarly, few organizations had developed a PFA training policy (n=7) for their employees, volunteers and contractors in the short follow-up survey interval. Policy development is county health departments and hospitals is a deliberative process that usually takes time and may be influenced by other, unrelated factors such as union contract negotiations. Again, the training coordinators who took the PFA training are not the decision makers when it comes to the development of employee training policies. However, they can be sources of institutional knowledge about PFA and how to conduct PFA trainings. The barriers to implementing PFA training policies identified by respondents are very similar to the barriers to PFA training identified in the initial needs assessment survey in 2016 (reference 1, above). Time constraints and competing priorities constitute a majority of the barriers identified. Fortunately, lack of leadership support was not identified in either survey as a major barrier. The one barrier which had the biggest decrease from the PFA Needs Assessment to the Follow-up Survey was lack of subject matter expertise, which fell from 37% to 30% (19%) between the two surveys. People who had received the PFA Training Coordinator training were less likely to view this as a barrier, but the finding was not statistically significant. Thus, this finding may reflect the impact of the PFA trainings and PFA Training Coordinator Guide, although one training may not give people the sense that they are subject matter experts in any area. 8

Limitations. This survey was limited in its response rate and in the fact that some targeted respondents had moved to new positions and substitutes had to be identified. Also, organizations that had not responded to the 2016 Needs Assessment and had not sent their training coordinator to the PFA Training Coordinator training were not asked to respond to this survey, so the results are not representative of all NYS hospitals and county health departments outside New York City. Still, there is no reason to think that the differences found in respondents who had and had not taken the PFA Training Coordinator training do not reflect true differences between these groups and the impact of the Project. Sustainability. The strong partnership between the CPHP and the Institute for Disaster Mental Health at SUNY New Paltz and the members of the Project Steering Committee, particularly the representatives of the NYSDOH, NYSOMH, the NYS Association of County Health Officials (NYSACHO) and the Healthcare Association of New York State, was a key factor not only in supporting the work of the Project, but also in assuring the sustainability of that work. The PFA Training Coordinator Guide and other Projectdeveloped materials will reside on websites hosted by the NYSDOH, NYSACHO and the IDMH. In addition, NYSDOH, NYSOMH and IDMH will develop a new PFA train-the-trainer curriculum in the next year relying heavily on the PFA Training Coordinator Guide, including the scenario-based, in-person training modules. The NYSDOH will require county health departments and hospitals who receive emergency preparedness funding to have at least one staff person take the train-the-trainer course. The PFA Training Coordinator trainings provided by this grant, or the equivalent, will be a prerequisite for taking the train-the-trainer course. With all these steps assure that the CPHP PFA Training Coordinator Guide and other materials developed under this grant will continue to be a resource for many years into the future. The activities supported by this grant including the related trainings and the education of HEPC agency leadership on the need for PFA training policies, are a strong foundation to continue the emphasis on PFA as part of public health preparedness activities and serve as a model for other training efforts. 9

Appendix I: Tables of Results Section 1. Characteristics of Respondents Table 1a. Type of Organization (Q3) n % County Health Department 57 47% Hospital 45 37% Long-term Care, Nursing Home, Community Health Center 2 2% Emergency Management 3 2% EMS 2 2% Other 13 11% Total 122 100% Table 1b. HEPC 1 Region (Q4) n % Capital 35 29% Central 27 22% MARO 2 19 16% Western 35 29% Don't know 6 5% Total 122 100% 1 Health Emergency Preparedness Coalition 2 Metropolitan Area Regional Office Section 2. Participation in and utility of Center for Public Health Preparedness (CPHP) PFA Training Coordinator training Table 2a. type Participated in CPHP PFA training Don't Yes No know PFA Training participation (Q5) by organization Total n % n % n % n % Hospital 35 46% 9 21% 1 33% 45 37% County Health Department 29 38% 27 63% 1 33% 57 47% Long-term Care, Nursing Home, Community Health Center 1 1% 1 2% - 2 2% Emergency Management 2 3% 1 2% - 3 2% EMS - 2 5% - 2 2% Other 9 12% 3 7% 1 33% 13 11% Total 76 100% 43 100% 3 100% 122 100% Participated in CPHP PFA training Don't Table 2b. Used PFA knowledge and skills in an emergency Yes No know Total or exercise/drill (Q6) by organization type n % n % n % n % Hospital 19 51% 18 27% 8 42% 45 37% County Health Department 16 43% 35 53% 6 32% 57 47% Long-term Care, Nursing Home, Community Health Center - 1 2% 1 5% 2 2% Emergency Management - 2 3% 1 5% 3 2% EMS - - 2 11% 2 2% Other 2 5% 10 15% 1 5% 13 11% Total 37 100% 66 100% 19 100% 122 100% 10

Table 2c. Explanation of emergency or exercise drill and whether PFA training was valuable: Please describe. (Selected Responses). Statewide OURex Exercise. It gave us some insight into the potential needs of staff, victims, and families. Ebola I & Q drill was valuable for RN when visiting isolated/quarantined persons The Exercise was a full scale POD exercise. The Trainers that took the PFA training said it was valuable in the planning and the actual event to be ready for any emotional distress from participants or staff. An inject was given for participants that were experiencing emotional distress and fear and the staff were able to respond appropriately to this. It was used in response to injects during the OUREx POD exercise on March 1, 2017. Information was useful in educating crisis team members giving basic information on how to manage situations. Critical patient with family/friends in the ER waiting room PFA scenario training was valuable in responding with respect and empathy while maintaining integrity of security and privacy systems. Full Scale Exercise Active Shooter OurEX POD exercise on March 1, 2017. A dedicated mental health worker was designated to provide FGA and other assistance as needed during the POD operation. We had an Infectious Disease Outbreak Exercise and had one ICS position devoted to mental health and PFA. PFA training was used during an active shooter response exercise and was valuable. Office workers who believed that they had been exposed to toxic gas during a construction/renovation of their building. It was extremely useful to know how to talk to them without upsetting them more. We practiced PFA in an Operation Red Bird simulated aircraft emergency drill we conducted on June 1. Mass fatality bus accident...several families involved. We utilized this initial training for multiple drills we've participated in and are hoping to implement it as a more permanent fixture for our Disaster Mental Health team. Internal exercises incorporated the skills and they were valuable because it provided framework for additional patient care considerations We use DMH when dispatched to an actual event, but in January 2017 during a training discussed PFA. We have utilized PFA in our policies, training, tabletop exercises, and in our state wide drills. Recently we have had a stint of traumatic events in our area in which the PFA training received was useful in getting through the events. Windstorm 2017 in March 2017 where shelter were established. Residents were in crisis having to reside in a shelter in various communities. Critical life and death emergency with multiple family members, with other multiple family responding. 11

Table 2d. Participate in CPHP PFA Training by Use of PFA in emergency/exercise/training (Q6) 1 1 Chi-Square prob. <=.01 Participated in CPHP PFA training Yes 31 41% 45 59% 76 62% No 6 13% 40 87% 46 38% Total 37 30% 85 70% 122 100% PFA training and utility: Relative Risk (RR) 1 RR lower upper prob. Used training knowledge/skills in a real emergency/drill (Q6) 3.1 1.4 6.9 0.010 1 Ratio of proportion receiving CPHP PFA training to the characteristic listed relative to the proportion of those not receiving training. RR = relative risk. 95% confidence interval and p-value given. Yes Don't know NA Total Table 2e. PFA training valuable 1 by organization type n % n % n % n % Hospital 17 49% 1 100% 1 100% 19 51% County Health Department 16 46% - - 16 43% Other 2 6% - - 2 5% Total 35 100% 1 100% 1 100% 37 100% 1 Out of those who took CPHP PFA training. No, training planned for 2017 No, training planned for 2018 Don't know Yes No Total Table 2f. Conducted training since CPHP PFA training (Q9) by organization type n % n % n % n % n % n % Hospital 5 25% 9 45% 5 31% 19 35% 7 58% 45 37% Long-term Care, Nursing Home, Community Health Center - - 1 6% 1 2% - 2 2% County Health Department 12 60% 10 50% 7 44% 23 43% 5 42% 57 47% Emergency Management - 1 5% 1 6% 1 2% - 3 2% EMS - - - 2 4% - 2 2% Other 3 15% - 2 13% 8 15% - 13 11% Total 20 100% 20 100% 16 100% 54 100% 12 100% 122 100% Used PFA in emergency/exercise/training Yes No Total n (%) n (%) n (%) Conducted/planed own training Yes No Total Table 2g. Participate in CPHP Training by Conducted/Plan PFA training (Q9) 1 n (%) n (%) n (%) Participated in CPHP training Yes 41 54% 35 46% 76 62% No 15 33% 31 67% 46 38% Total 56 46% 66 54% 122 100% 1 Chi-Square prob. <=.05 PFA training and utility: Relative Risk (RR) 1 RR lower upper prob. Conducted/Plan PFA training (Q9) 1.7 1.0 2.6 0.050 1 Ratio of proportion receiving CPHP PFA training to the characteristic listed relative to the proportion of those not receiving training. RR = relative risk. 95% confidence interval and p-value given. 12

Section 3. Characteristics of PFA trainings Table 3a. PFA trainings by organizations who received CPHP PFA Training. n (%) xxx Total respondents conducting PFA training after taking CPHP PFA training. 17 100.0% Number of trainings (Q10) 1 7 41.2% 2-5 7 41.2% Don t know 3 17.6% Number of employees trained (Q11) 5 or less 3 17.6% 6-10 2 11.8% 11-20 7 41.2% 20 or more 3 17.6% Don t Know 2 11.8% Respondent was involvement in organizing the PFA training (Q12) Yes, I led the effort 8 47.1% Yes, I helped but didn t lead the effort 5 29.4% No 4 23.5% Included online PFA training in course (Q13) Yes 7 41.2% No 7 41.2% Don't know 3 17.6% Online training selected (Q14) Psychological First Aid: A Minnesota Community Supported Model 2 11.8% Psychological First Aid Online 3 17.6% Don t know 12 70.6% Used in-person/didactic training (Q15) Yes 10 58.8% No 5 29.4% Don't know 2 11.8% In-person practice session used (Q16) Yes 10 58.8% No 5 29.4% Don't know 2 11.8% Reason for not offering in-person PFA practice session (Q17) No time 1 5.9% Too complicated to organize 13 76.5% Don't know 2 11.8% Other 1 5.9% Ask for assistance from PFA tech. advisor (Q18) Yes 3 17.6% No 7 41.2% Don't know 7 41.2% Evaluated the training (Q19) Yes, including having trainees complete a post-training questionnaire. 4 23.5% Yes, but trainees did not complete a post-training questionnaire. 4 23.5% No 4 23.5% Don t know 5 29.4% Organization found PFA training valuable (Q22) Yes 14 82.4% Don't know 3 17.6% 13

Table 3b. Workers invited to participate in PFA training (Q21) 1 n (%) All employees 3 17.6% Management staff 2 11.8% Staff w/ public/patient contact during emergency 7 41.2% All volunteers (MRC or other) 3 17.6% Contractors - - Other 15 88.2% Trained any staff 17 100.0% 1 Among organizations that participated in CPHP training before conducting their own PFA training Table 3c. Lessons learned from evaluating organization s PFA training: Please describe. (Selected responses). Evaluation for PFA 100.a is on NYS LMS. PFA is useful for everyday issues. Everyone loved the training sessions and found them very helpful. In-person training is more effective than on-line training. Group discussions and interaction were very helpful in stimulating acceptance of the training concepts, but they also helped promote teamwork and group understanding. Situational training is the best that I find is more beneficial. It prepares staff for real world events The training was offered to health department staff, school nurses & MRC members. Proposed strategies were somewhat familiar to these participants. Discussions followed regarding the numerous scenarios and situations in which PFA skills can be employed. Additional audiences were identified for training. All agreed more in-depth practice would be beneficial to becoming more proficient in providing PFA. Well received and invited to conduct larger training session for regional EMS. Post - Training evaluations of training are important and should be developed along with the training agenda The evaluation was one on one interaction with leader and assistants. It was very productive in that no one was unwilling to interact. We found a good experience which was not what we had experienced before with other efforts in the past. 14

Section 4. PFA Training Policies Table 4a Established PFA Policy (Q24) By Type of Organization Long-term County Health Emergency Hospital Care* Department Management EMS Other n (%) n (%) n (%) n (%) n (%) n (%) Established PFA policy Yes No, but a PFA Training policy is 2 4.8%.. 5 8.9%...... currently being drafted 2 4.8%.. 3 5.4% 1 33.3%.... No, but we are planning to develop a PFA training policy in 2017 6 14.3%.. 4 7.1%...... No, but we are planning to develop a PFA training policy in 2018 7 16.7%.. 6 10.7%.... 1 8.3% No 19 45.2% 1 50.0% 37 66.1% 2 66.7% 2 100.0% 7 58.3% Don t know 6 14.3% 1 50.0% 1 1.8%.... 4 33.3% Total 42 100.0% 2 100.0% 56 100.0% 3 100.0% 2 100.0% 12 100.0% * Long-term Care, Nursing Home, Community Health Center Table 4b. 1 Chi-Square prob. <=.01 Participate in CPHP Training by PFA Policy (Q24) 1 Participated in training PFA policy established/planned Yes No Total n (%) n (%) n (%) Yes 30 45% 36 55% 66 64% No 6 16% 31 84% 37 36% Total 36 35% 67 65% 103 100% 95% CI Plan or have established PFA policy: Relative Risk (RR) * RR lower upper prob. 2.8 1.3 6.1 0.010 1 Ratio of the proportion of those receiving CPHP PFA training with established/planned policy relative those not receiving training having or planning to establish a policy. RR = relative risk. 95% confidence interval (CI) and p-value given. 15

Available Recommended Required Total Table 4c PFA training requirement for personnel (Q25) n n n n Management staff 2 4 4 10 Staff in contact with public/patients. 6 5 11 All employees 4 3 3 10 All volunteers (MRC or other) 4 3 1 8 Contractors 3. 1 4 Others staff 1.. 1 Total 8 8 6 12 1 out of all who have established or have a draft policy Table 4d. Frequency of PFA training renewal (Q26) 1 n % Every 1-3 years 7 54% Every 4-5 years 2 15% There is no PFA renewal policy 4 31% Total 13 100% 1 Out of all who have established or have a draft policy Table 4e. Renewal requirement under PFA policy (Q27) 1 n % Required 3 33% Recommended 4 44% Don t Know 2 22% Total 9 100% 1 Out of all who have established or have a draft policy Table 4f PFA policy barriers (Q28) n per PFA policy barrier -Time constraints 71 58% PFA policy barrier -Competing priorities 72 59% PFA policy barrier -PFA is a lower priority to leadership 19 16% PFA policy barrier -Cost 10 8% PFA policy barrier -Lack of expertise in the subject matter 36 30% PFA policy barrier -There are no barriers 8 7% PFA policy barrier Don t know 13 11% Table 4g. Participate in UAlbany CPHP training by lack of expertise policy barrier Lack of expertise Yes No Total n (%) n (%) n (%) Participated in training Yes 21 31% 47 69% 68 63% No 15 38% 25 63% 40 37% Total 36 33% 72 67% 108 100% 95% CI Policy Barrier-lack of expertise: Rate Ratio (RR) 1 RR lower upper prob. 0.8 0.5 1.4 0.481 1 Ratio of the proportion of those receiving CPHP PFA training with lack of PFA expertise to those not receiving training having a lack of expertise. RR = relative risk. 95% confidence interval (CI) and p-value given. 16

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies Dear Psychological First Aid Training Coordinator Training Participant/2016 PFA Survey Respondent: You are receiving this survey because in 2016 you either participated in a Health Emergency Preparedness Coalition (HEPC) Training Coordinator training for psychological first aid (PFA) sponsored by the SUNY Albany Center for Public Health Preparedness (CPHP) or responded to a CPHP survey of HEPC members about PFA training at your organization, or both. First, thank you very much for your past involvement in this project. The purpose of this follow-up survey is to learn what has changed at your organization in the last year regarding your capacity to conduct PFA trainings, whether you have conducted any PFA trainings during that time period, whether your organization has developed or made any changes to its PFA training policies, and what experiences your organization has had regarding PFA. This survey will assist the CPHP to finalize it PFA Training Coordinator Guide and supporting materials, available at http://www.albany.edu/sph/cphp.php, and to gauge the extent of PFA preparedness our program has helped to foster. This survey should take about 10-15 minutes to complete. If you have any questions about this survey, please contact: Mary Riley-Jacome, M.A. Program Manager Center for Public Health Preparedness 1 University Place Rensselaer, NY 12144 phone: 518 402-0344 fax: 518 402-0345 e-mail: cphp@albany.edu Thank you in advance for your help in filling out this survey. We really appreciate your help. Gus Birkhead, MD, MPH Director, Center for Public Health Preparedness Professor, Department of Epidemiology and Biostatistics School of Public Health, University at Albany

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 1. Information about yourself Name: Title: Email address: Phone number: 2. Information about your organization Organization Name: Address: 3. Type of Organization: ( ) Hospital Long-term Care, Nursing Home, Community Health Center Public health department Emergency Management EMS Other, please specify: 4. In which HEPC region is your organization located? Capital Central MARO Western Don t know Page 1 of 6

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies Psychological First Aid Training (PFA) UAlbany CPHP PFA Training Coordinator trainings Adirondack Medical Center September 9, 2016 HANYs, Rensselaer September 26, 2016 Rosamond Gifford Zoo, Syracuse September 27, 2016 Rockland Fire Training Center November 7, 2016 Genesee Fire Training Center November 17, 2016 Nassau-Suffolk Hospital Council November 30, 2016 5. Did you participate in a UAlbany CPHP PFA Training Coordinator training? Yes No Don t know 6. Since taking the UAlbany CPHP PFA Training Coordinator training or responding to the 2016 UAlbany CPHP Needs Survey, has your organization used PFA knowledge and skills in a real emergency or a preparedness drill/exercise? Yes No Don t know... go to question 9 7. Was PFA training of value in your response? Yes No Don t know... go to question 9 Not Applicable... go to question 9 8. Please explain what the event was and why the PFA training was or was not valuable. 9. Since taking the UAlbany CPHP PFA Training Coordinator training or responding to the 2016 UAlbany CPHP Needs Survey, has your organization conducted a PFA training or had staff take a PFA training? Yes No, but PFA training is planned for 2017... go to question 24 No, but PFA training is planned for 2018... go to question 24 No... go to question 24 Don t know... go to question 24 Page 2 of 6

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 10. How many training sessions have you conducted? 1 2-5 6-10 >10 Don t know 11. In total, approximately how many people participated in these trainings? 5 or less 6-10 11-20 20 or more Don t know 12. Were you involved in the organization of the training? Yes, I led the effort. Yes, I helped but didn t lead the effort No Don't know 13. As part of this training, did you/your organization select an online PFA training for staff to complete? Yes No... go to question 15 Don't know... go to question 15 Page 3 of 6

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 14. Please indicate which online PFA training you used: Psychological First Aid: A Minnesota Community Supported Model Psychological First Aid: Helping People Cope During Disasters and Public Health Emergencies (PFA.100.A on the NYS LMS) Effects of Disasters on Mental Health for Children and Adolescents Dealing with Stress in Disasters: Building Psychological Resilience Responding to a Crisis: Managing Emotions and Stress Scenario CDR HEPC Pediatric Disaster Mental Health Psychological First Aid in Radiation Disasters Building Workforce Resilience through the Practice of Psychological First Aid -A Course for Supervisors and Leaders Psychological First Aid: Building Resiliency for "Us" and "Them" Supporting Children in Times of Crisis Introduction to Mental Health Preparedness FAST Foundations Course Overview Psychological First Aid Online Psychological First Aid: The Johns Hopkins RAPID PFA Other, please specify: Don t know 15. Did you have a PFA instructor conduct an in-person, didactic training (lecture)? Yes No Don t know 16. Did you/your organization coordinate an in-person PFA practice session as part of the training you offered? Yes No... If no: 17. If no, why not? No time No space Too complicated to organize Other, please specify: go to question 19 Don t know... go to question 19 Page 4 of 6

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 18. Did you/your organization ask for assistance from PFA technical assistance providers designated by the UAlbany CPHP to help facilitate the in-person practice sessions? Yes No Don t know 19. Did you/your organization evaluate the training? Yes, including having trainees complete a post-training questionnaire. Yes, but trainees did not complete a post-training questionnaire. No... go to question 21 20. Please share with us any lessons you learned from the evaluation of your trainings. 21. Which category of workers were invited to participate in the trainings? Please choose all that apply. All employees Management staff All Staff in contact with the public or patients during emergency responses All volunteers (MRC or other) Contractors Other please specify: Don t know 22. Has your organization found PFA training to be valuable? Yes No Don t know... go to question 24 Not applicable... go to question 24 23. Please explain why the PFA training was or was not useful. Page 5 of 6

Not Applicable Do Not Know PFA Training Available PFA Training Recommended PFA Training Required Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 24. Since taking the UAlbany CPHP PFA Training Coordinator training or responding to the 2016 UAlbany CPHP Needs Survey, has your organization established a written training policy specifically regarding PFA? Yes No, but a PFA Training policy is currently being drafted No, but we are planning to develop a PFA training policy in 2017.... go to question 28 No, but we are planning to develop a PFA training policy in 2018.... go to question 28 No... go to question 28 Don t know... go to question 28 25. Per your organization's PFA training policy (or current draft policy), who working with your organization is required or recommended to take PFA training and for whom is PFA training available? Required/Recommended/Available Management staff Staff in contact with the public or patients during emergency responses All employees All volunteers (MRC or other)* Contractors Other* If your answer included categories above marked with an asterisks (*), please specify 26. According to your organization s PFA training policy, or current draft policy, how frequently should employees renew their training in PFA? Every 1-3 years Every 4-5 years Other renewal period, specify: There is no PFA renewal policy... go to question 28 Don t know... go to question 28 27. Is the PFA renewal required or recommended under the policy or current draft policy? Required Recommended Don t know Page 6 of 6

Psychological First Aid Demonstration Project Follow-up Survey: PFA Training Capacity and Policies 28. Please indicate if you think any of the following have been or might be a barrier to implementing a PFA training policy in your organization. Choose all that apply ( ). Time constraints Competing priorities PFA is a lower priority to leadership Cost Lack of expertise in the subject matter There are no barriers Other, please specify: 29. Do you have any other information from your organization s experience for improving the PFA Training Coordinator Guide? Thank you very much for completing the survey. Page 7 of 6