FIRST: An Early Response Model

For On-site Individual Crisis Intervention

 

When persons are confronted by a crisis that exceeds their usual range of experience, their normal coping mechanisms may be inadequate to adapt constructively. If not addressed, this situation may result in an increased sense of threat around their current circumstances and feelings of dread about the future. An effective early intervention has as its goals the reduction of situational stress, an increased awareness regarding various trauma related symptoms, the utilization of social support and stress management techniques, an assessment and, if necessary, referral for continued acute care services.

The following intervention model is designed for on-site response with an individual in circumstances where trauma related to natural or other situational crisis has occurred. The acronym FIRST is provided to describe the five steps in the process.

1. Find a location which as far as is possible removes the person from the source(s) of greatest stress. Introduce yourself and establish your role and the purpose of your visit.

2. Inquire about what has happened. Initially focus on the cognitive aspects of experience. What happened? What do you remember? What are you doing to help yourself through this period?

3. Remind he person that what s/he is experiencing is not unusual for normal persons trying to cope with very abnormal circumstances. Provide a normalization for the range of emotions being experienced. Inquire about how the person is feeling about the memories being recalled, their sense of safety, and hopefulness.

4. Support he individual by providing information regarding the expected course of disaster response, nature of stress, basic types of stress/anxiety management, e.g., deep breathing, relaxation techniques, and the role of positive thinking in self-appraisal and problem solving.

5. Think about the future needs of the person. When necessary, plan for referral for additional acute care intervention. Talk about how the person can utilize social support and other resources available on-site. Help to develop a plan for the next several hours in order to encourage hopefulness.

A primary outcome of the early intervention model is to aid the person in restoring as much self-efficacy as possible. The capacity of the person to gain a realistic sense of control in what is happening, respond in a way that promotes their safety, and see themselves connected to others can produce a more meaningful outcome.

Wayne D. Griffin, Ph.D. 02/23/01