Table 1.

Phased Approach to COVID‐19 Mental Health Response (PAC)

Phase	Level	Target Population	Content	Examples
Initial phase	System supported level 1	This first level targets all healthcare and any other frontline workers in settings with heightened risk of COVID‐19 infection, such as patient care settings, as well as others impacted by COVID‐19	Resources and work policies to support staff and basic information that can be made widely available to people before the start of a shift and throughout their work with COVID‐19 patients.	Framework for organizational response to 5 requests from healthcare workers in the current pandemic:
				“Hear me”
				“Protect me”
				“Prepare me”
				“Support me”
				“Care for me”
				(Shanafelt, Ripp, & Trockel, 2020)
Initial phase	Self‐directed level	Initial phase self‐directed level targets any healthcare workers who would like self‐directed preparation and support during their work as they continue to care for or provide services for COVID‐19 patients or those who are having initial responses with low to moderate distress and/or interference in function but without imminent risk of harm to self or others	Content continues to focus on prevention of negative mental health outcomes but includes some specific direction on managing difficult emotional experiences workers (or impacted others) may be encountering	Face mask and PPE related anxiety (see framework)
				Insomnia and sleep disturbances
				General coping and distress
				Managing personal losses due to COVID‐19
Initial phase	Mental health supported brief intervention	Individuals with greater distress, impairment or risk, exacerbation of pre‐existing mental health conditions and/or lack of response to self‐directed interventions	Evidenced‐based interventions	Cognitive behavior therapy (CBT)
				Pharmacotherapy when indicated
Post‐phase	System supported level	Recommendations for leadership and organizations	Continue the resources and follow the recommendations from the initial phase system supported level. In addition, would include access to more formal employee assistance resources with providers who are trained in how to approach COVID‐19 related distress	Employee assistance and wellness resources
Post‐phase	Self‐directed level	Impacted people who would like to have a supported way to approach their experiences as well as others who are reporting early signs of difficulty, such as not being able to stop thinking about experiences, intense emotional reactions when they think about their experience	Evidence‐informed resources that individuals can work with on their own	Making meaning of the difficult days: This is a self‐directed version of the prolonged exposure for primary care written exposure protocol that has shown efficacy in military service members to reduce PTSD symptoms when provided within the primary care environment with an embedded mental health provider as support (Cigrang et al., 2017). This modified version for COVID‐19 healthcare workers and other impacted was created to provide an option for healthcare workers who want to approach difficult memories on their own (see framework)
Post‐phase	Mental health supported brief intervention level	For those reporting stress, anxiety, or depression associated with significant distress, functional impairment, or signs of risk to self or others. This intervention is for those with an identified mental health need and may occur through contact with mental health in primary care or specialty mental health settings	Evidenced‐based interventions	Modified prolonged exposure (Rothbaum et al., 2012). Early intervention may prevent the development of posttraumatic stress disorder: a randomized pilot civilian study with modified prolonged exposure
Long‐term phase	All levels	Focus more closely over time on those with identified functional impairment over time	As in earlier phases	Evidence‐based care such as CBT, or pharmacotherapy when indicated