When a situational crisis occurs, staff members can easily become overwhelmed by the need to provide support and guidance to large numbers of students. Initially identified by Brock and colleagues as Classroom Crisis Counseling or Classroom/Group Crisis Intervention, the early development of this model was influenced by Terr (1992), the American Red Cross training in "Disaster Mental Health Services," Mitchell and Everly's concepts of Critical Incident Stress Management (1996a, 1996b), and the National Community Crisis Response Team Regional Training Institute (Young, 1998). As its name implies, Group Psychological First Aid (GPFA) is considered a form of first aid.

Although mental health professionals should play a leadership role in GPFA, it is not psychotherapy, nor is it a substitute for professional mental health interventions. It is designed as an immediate helping response for groups of students who have been exposed to a common stressor. As a rule, GPFA groupings are homogeneous and identified according to categories such as classroom, age, and degree of exposure to the traumatic event. In addition to providing support, GPFA is also a way to identify students who may be in need of mental health assistance.

GPFA is not considered an appropriate intervention for acute trauma victims (e.g., those who were physically injured and or personally threatened). Research suggests that single-session crisis intervention has limited benefit and may be potentially harmful to acute trauma victims. In addition, it is important to acknowledge that single-session group crisis interventions are likely insufficient for high-risk trauma survivors (e.g., those with poor pre-trauma mental health).

General GPFA Issues and Procedures

What is the optimal size of the GPFA group?

Groups ranging from 15-30 students are optimal. Larger groups may limit sharing and interfere with the expression of feelings.

When should GPFA be offered?

GPFA should be a priority following a crisis event. If it is impossible or inappropriate for GPFA to be held immediately, school officials should acknowledge the magnitude of the crisis and inform students as to when GPFA (or other supportive interventions) will be offered. GPFA should not be initiated at the end of a school day; doing so interferes with the ability to identify and work with upset and anxious students.

Where should GPFA be offered?

Crisis interventions should be provided close to the scene of the crisis event. Providing GPFA in the school environment, with its naturally occurring social supports, is optimal. It is recommended that GPFA take place in the students' classroom.

Who are GPFA facilitators?

Ideally, at least one of the facilitators is familiar to students. It is recommended that two or more staff members facilitate GPFA. A ratio of one facilitator for every 10 students is required. The lead facilitator should be a crisis intervention team member who has training and experience in working with trauma survivors. The lead facilitator is responsible for directing progress through GPFA.


Support facilitators help identify students in need of further crisis intervention support, may also provide emotional and practical support to the lead facilitator, and attend to students who unexpectedly leave the classroom.

What is the role of the teacher?

It is recommended that the classroom teacher take an active role in GPFA. Ideally, the teacher will help to facilitate GPFA by supporting the lead facilitator. When the teacher is having significant difficulty coping with the crisis, crisis interveners will need to take responsibility for GPFA. It is important for the crisis team to establish an environment that makes it easy for teachers to acknowledge their limitations and ask for help.

When would GPFA be innappropriate?

Group crisis intervention approaches should be avoided under the following circumstances: (a) when the group has a history of being hurtful and/or not supportive of one another; (b) when student needs, relative to the trauma, are very different; and (c) when the traumatic event is politicized (e.g., gang membership had a role in the trauma). Students who are prospective witnesses might need to be excluded from GPFA sessions. Students who were directly exposed to the crisis, who were physically injured, or who have significant pre-existing mental health problems should be offered individual crisis intervention.

The GPFA Model

GPFA has the following six steps: (a) introduction, (b) providing facts and dispelling rumors, (c) sharing stories, (d) sharing reactions, (e) empowerment, and (f) closing. GPFA is ideally completed in one session lasting approximately three hours. The length of GPFA must be tailored to the developmental level of the classroom (i.e., older students will be able to participate in sessions for longer uninterrupted periods). Regardless of developmental level, this intervention should be offered within one school day. If session breaks are required, they should be given before students begin sharing stories or after they have completed empowerment discussions. Some closing activities (e.g., the actual completion of memorial projects) can be reserved for another school day.

Introduction

The first step lasts approximately 10-15 minutes and includes the identification of the GPFA group leader and support facilitators, and explanation of the purpose, sequence, and rules of the session. Perhaps most importantly, students are told that they are not allowed to leave the room without permission. However, students are told that active participation is voluntary and students who do not want to be in the room during discussion should be given an alternative activity. In addition, while students should be given permission to discuss whatever they want, it will be important to acknowledge that verbal or physical violence or abuse will not be tolerated. Students may participate in the creation of the rules to facilitate the sense that they are capable problem-solvers.

Providing facts and dispelling rumors

This step lasts approximately 30 minutes. When providing facts about the crisis, it is important to be sensitive to the developmental level of the students. For example, with intermediate-grade students, carefully selected, well-written newspaper articles about the trauma may be helpful. Younger students, however, need simpler descriptions of the event. It is important to remember that the novelty of the situation may make it difficult for students to understand the facts, and facilitators should be prepared to repeat them frequently.

Sharing stories

The sharing of crisis experiences is the next step and can last from 30 to 60 minutes. While everyone should be given a chance to share their stories, no one should be required to do so. Specific questions to facilitate this step include:

• "Where were you when it happened?"
• "Who were you with?"
• "What did you see, hear, smell, taste, or touch?"
• "How did you react?"

Facilitators should validate experiences and help students feel more connected to each other by explicitly pointing out their common experiences.

Sharing reactions

This step lasts approximately 30 minutes. Approaches include:

• Stating common reactions
• Asking those who have experienced each reaction to raise their hand
• Asking for individual examples
• Anticipating reactions that may arise in the future

During this step, facilitators should state that initial trauma reactions are normal. Crisis reactions can be very unsettling, and it is not uncommon for students to fear that they are "going crazy." Group sharing and facilitator anticipation of trauma reactions helps normalize these frightening feelings. Facilitators should also let students know that, with time, for most people, reactions will go away; however, students should be informed of what to do if they feel that they are unable to manage reactions. This is a natural time to ensure that students are aware of self-referral procedures for obtaining one-on-one crisis intervention. As this step ends, asking future-focused questions may help students to predict experiences they will have and coping skills they may need.

Empowerment

This step may last up to 60 minutes. The primary goal is to help students to begin to participate in activities that help them regain a sense of control. Important to the attainment of this goal is the identification of coping strategies. Facilitators may begin this step by identifying previously developed coping strategies. The facilitator should reinforce those strategies that are adaptive and offer alternatives when maladaptive strategies are proposed. During this step facilitators might review basic stress management techniques (e.g., getting needed sleep, food, exercise, and talking to friends and family). Alternatively, they might encourage students to work together on developing strategies to gradually desensitize each other to trauma-related fears, instruct students in how to respond to intrusive thoughts and images, or ask students to brainstorm strategies to prevent re-occurrence of the traumatic event.

Closing

This step may last up to 30 minutes. Activities may include the development of memorials, preparation for attending or participating in funerals, the writing of get-well cards and letters to victims, and, if the class has experienced the death of a classmate or teacher, discussion of what to do with the deceased's desk and belongings.

In concluding GPFA, facilitators should answer any remaining questions. In their closing comments facilitators should remind students that they are experiencing normal reactions to abnormal circumstances. Facilitators should acknowledge that, for some students, it might be some time before they are truly able to place the crisis event in their past and move on with their lives and that for some students, their lives might never be the same. At the same time, however, facilitators should be positive about the future and remind students that, while memories will remain, with time, crisis reactions will typically disappear. Finally, the facilitators should reassure students that additional crisis intervention services are available and reiterate self-referral procedures.

Post-GPFA Activities

Recommendations for caregivers

Following the GPFA session, all caregivers need to be informed about how they can help students cope. Recommendations, which should be provided to the families of all GPFA participants, include:

• Listen to and spend time with your child
• Offer, but do not force, discussion about the trauma
• Reassure your child that he or she is safe
• Offer assistance with everyday tasks and chores
• Respect your child's privacy
• Do not take anger or other reactions personally

Be available

After GPFA has ended, at least one, but preferably all, of the facilitators should remain with the students. At the very least, a facilitator should be available to students throughout the remainder of the school day, either in a specifically designated area, on the playground, or in classrooms, to allow students additional opportunities to seek out support and to have questions answered. This also gives facilitators additional opportunities to assess how individual students are coping.

Debrief

Finally, as soon as possible after GPFA, facilitators should debrief the session. This debriefing typically occurs at the end of the school day and serves two important purposes. First, it allows discussion of student reactions and decisions regarding who will need additional crisis intervention. Second, it allows facilitators to focus on their own reactions and coping. In particular, special attention needs to be directed toward the classroom teacher(s). If needed, crisis intervention services should be made available to teachers and other GPFA team members.

REFERENCES AND RESOURCES

Brock, S. E., Sandoval, J., & Lewis, S. (1996). Preparing for crises in the schools: A manual for building crisis response teams. New York: Wiley. ISBN: 0471384232.

Brock, S. E. (1998). Helping classrooms cope with traumatic events. Professional School Counseling, 2, 110-116.

Brock, S. E. (2002). Group crisis intervention. In S. E. Brock, P. J. Lazarus, & S. R. Jimerson, (Eds.), Best practices in school crisis prevention and intervention (pp. 385-403). Bethesda, MD: National Association of School Psychologists. ISBN: 0932955843.

Mitchell, J. T., & Everly, G. S. (1996a). Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster workers (2nd ed., rev.). Ellicott City, MD: Chevron. ISBN: 1-883581-02-8.

Mitchell, J. T., & Everly, G. S. (1996b). Critical incident stress management: The basic course workbook. Ellicott City, MD: International Critical Incident Stress Foundation. ISBN 0-9646356-0-7.

Terr, L. C. (1992). Mini-marathon groups: Psychological “first aid” following disasters. Bulletin of the Menniger Clinic, 56, 76-86.

Young, M. A. (1998). The community crisis response team training manual (2nd ed.). Washington, DC: National Organization for Victim Assistance. (www.trynova.org)

Editor's Note: Adapted from Brock, S. E. (2002) "Group crisis intervention" in S. E. Brock, P. J. Lazarus, & S. R. Jimerson (Eds.), "Best practices in school crisis prevention and intervention" (pp. 385-403). Bethesda, MD: National Association of School Psychologists. This article will appear in the upcoming publication, Helping Children at Home and School II: Handouts for Families and Educators, to be published by NASP in spring 2004.