Prehospital and Disaster Medicine

Original Research

Psychological First-Aid Training for Paraprofessionals: A Systems-Based Model for Enhancing Capacity of Rural Emergency Responses

O. Lee McCabea1a2 c1, Charlene Perrya3, Melissa Azura4, Henry G. Taylora5, Mark Baileya6 and Jonathan M. Linksa7

a1 Department of Mental Health and the Preparedness and Emergency Response Research Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA

a2 Department of Psychiatry and Behavioral Sciences, The Johns Hopkins School of Medicine, Baltimore, Maryland USA

a3 Kent County Health Department, Maryland Department of Health and Mental Hygiene, Chestertown, Maryland USA

a4 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA

a5 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

a6 Office of Preparedness and Response, Maryland Department of Health and Mental Hygiene, Baltimore, Maryland USA

a7 Preparedness and Emergency Response Research Center and the Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA


Introduction: Ensuring the capacity of the public health, emergency preparedness system to respond to disaster-related need for mental health services is a challenge, particularly in rural areas in which the supply of responders with relevant expertise rarely matches the surge of demand for services.

Problem: This investigation established and evaluated a systems-based partnership model for recruiting, training, and promoting official recognition of community residents as paraprofessional members of the Maryland Medical Professional Volunteer Corps. The partners were leaders of local health departments (LHDs), faith-based organizations (FBOs), and an academic health center (AHC).

Methods: A one-group, quasi-experimental research design, using both post-test only and pre-/post-test assessments, was used to determine the feasibility, effectiveness, and impact of the overall program and of a one-day workshop in Psychological First Aid (PFA) for Paraprofessionals. The training was applied to and evaluated for 178 citizens drawn from 120 Christian parishes in four local health jurisdictions in rural Maryland.

Results: Feasibility—The model was demonstrated to be practicable, as measured by specific criteria to quantify partner readiness, willingness, and ability to collaborate and accomplish project aims. Effectiveness—The majority (93–99%) of individual participants “agreed” or “strongly agreed” that, as a result of the intervention, they understood the conceptual content of PFA and were confident about (“perceived self-efficacy”) using PFA techniques with prospective disaster survivors. Impact—Following PFA training, 56 of the 178 (31.5%) participants submitted same-day applications to be paraprofessional responders in the Volunteer Corps. The formal acceptance of citizens who typically do not possess licensure in a health profession reflects a project-engendered policy change by the Maryland Department of Health and Mental Hygiene.

Conclusions: These findings are consistent with the conclusion that it is feasible to consider LHDs, FBOs, and AHCs as partners to work effectively within the span of a six-month period to design, promote, conduct, and evaluate a model of capacity/capability building for public mental health emergency response based on a professional “extender” rationale. Moreover, consistently high levels of perceived self-efficacy as PFA responders can be achieved with lay members of the community who receive a specially-designed, one-day training program in crisis intervention and referral strategies for disaster survivors.

(Received May 25 2010)

(Accepted June 08 2010)

(Revised June 28 2010)


c1 Correspondence: Dr. McCabe Hampton House 624 N Broadway, Ste 390 Baltimore, MD 21205 E-mail:


McCabe OL, Perry C, Azur M, Taylor HG, Bailey M, Links JM: Psychological first-aid training for paraprofessionals: A systems-based model for enhancing capacity of rural emergency responses. Prehosp Disaster Med 2011;26(4):1–8.