“temporary state of upset and disorganization, characterized chiefly by an individual’s inability to cope with a particular situation using customary methods of problem solving, and by the potential for a radically positive or negative outcome”
-Purpose is for victims of situational crises is to prioritize crisis interventions-goal is to provide crisis intervention services to those most in need of assistance as soon as possible-use of triage procedures is important when large numbers of students are affected by a significant trauma-triage procedures help to answer the critical question of who should be provided help first
Mass Screenings-The Classroom Crisis Intervention Procedure (Ch 8)Trauma Symptom Checklist for Children (TSC-C)Trauma Assessments: A Clinician’s Guide- book
Obtain parent permission- examples of permission forms in bookID individuals who need psychotherapeutic treatment referrals
Move away from danger and toward adaptive coping with the crisis problems-providing support, reducing lethality, and linking the individual to other resources-goal is not to cure the underlying problem, but to keep victims out of danger long enough to get them help
Key to the success of making psychological contact mnmjm
Practical when a large number of students are affected-a way to ID children who may need individual crisis intervention-15-30 students per group-should take place in regular classroom, not a traditional therapuetic setting-2 or more staff facilitate-Approach should be avoided if The class has a history of being hurtful, divisive, or nonsupportiveWhen student needs, relative to the trauma, are polarized (some students are deeply effected while other are untouched or find the crisis beneficial)When the traumatic event is politicized (e.g, gang membership had a role in the trauma)
Library computer search revealed 347 entries of books that are in some way related to the topic of crisis intervention. Since it is impossible to review each of these works, 16 books that one or more of the authors found helpful are listed.
Crisis intervention in the schools
CRISIS INTERVENTION IN THESCHOOLS Cari Fellers, Ph.D., NCSP Preparing for Crises in the Schools: A Manual For Building School Crisis Response Teams, 2nd Edition S.E. Brock, J. Sandoval, & S. Lewis
CRISIS EVENT CLASSIFICATIONSClassification ExamplesSevere Illness and Life-threatening illnesses; disfigurement andInjury dismemberment; road, train, maritime accidents; assaults; suicide attempts; fires/arson; explosionsViolent and/or Fatal illnesses; fatal accidents; homicides; suicides;Unexpected Death fires/arson; explosionsThreatened Death Human aggression (e.g., robbery, mugging, or rape);and/or Injury domestic violence (e.g., child and spouse battery/abuse); kidnappingsActs of War Invasions; terrorist attacks; hostage-talking; prisoners of war; torture; hijackingsNatural Disasters Hurricanes; floods; fires; earthquakes; tornadoes; avalanches/landslides; volcanic eruptions; lightening strikes; tsunamisMan-Made/Industrial Nuclear accidents; airline crashes; exposure to noxiousDisasters agents/toxic waster; dam failures; electrical fires; construction/plant accidents
THE CRISIS STATE It is essential to understand what it means to be in crisis in order to intervene Two main factors: Stressful or hazardous event Individual’s perception of subjective interpretation of this event Results in significant upset, discomfort, anxiety, disorganization and/or disequilibrium Inability to cope with or adapt to crisis circumstances Try several coping strategies until one is found that alleviates the discomfort Is typically accomplished within 8 weeks or less May not be adaptive
CRISIS INTERVENTION Directive, time-limited, and goal-directed procedures designed to assist individuals who have entered a crisis state Goals of crisis intervention Shield the victim from any additional stress Assist in organizing and mobilizing resources Return the victim, as much as possible, to a pre-crisis level of functioning Two types Psychological first aid Reestablishment of immediate coping All school staff members can participate Short-term crisis therapy Continue the crisis intervention process and attempt to assist the individual work through and resolve the crisis event Only mental health professionals should be involved
FIRST STEPS FOR A CRISIS PLAN Education Review of the literature Use the internet Professional development Review the works of others Form a crisis response planning committee Develop a Crisis Response Policy School-level crisis response District-level crisis response Regional-level crisis response Plan for a Crisis Response Identify crisis intervention locations Designate specific phone lines to be used for specific reasons Establishing a phone tree Establish a crisis response toolbox
COMPONENTS OF A CRISIS RESPONSE Follow a Procedural Checklist Determine the facts Assess the degree of impact Notify the crisis response team Notify the district office Notify other schools Contact the families of the crisis victims Determine what information to share and how to share it Initiate psychological triage and referral Identify high-risk students and plan interventions Staff meeting Activate a base of operations Computers, attendance registers, and student belongings Debrief and evaluate
IDENTIFYING PSYCHOLOGICAL VICTIMS OF CRISIS Initial risk screening Degree of proximity and exposure The closer the proximity to the event, the greater the likelihood of being traumatized Relationship with the victims Unique personal vulnerabilities Mental illness Developmental maturity Trauma history Lack of resources
IDENTIFYING PSYCHOLOGICAL VICTIMS OF CRISIS Secondary Risk Screening Conducted in conjunction with psychological first aid Goal is identify those who display significant crisis reactions Questions to consider: Is the event persistently experienced? Is there an avoidance of crisis event reminders? Is there a numbing of general responsiveness? Is there an increased level of arousal? Are there feelings of survivor guilt? Are there any somatic complaints? Are there self-destructive and impulsive behaviors? What is the effect of crisis reactions on daily functioning? What are some resources that are available?
MANIFESTATIONS OF ACUTE DISTRESSTypes of SymptomsReaction Reexperience Avoidance and Increased Arousal NumbingSomatic • Reactivity to reminders • Sensory numbing • Abdominal • Sweating distress • Rapid heart beat • Hot flashes or • Nausea chills • Dizziness • Frequent • Dry mouth urination • Difficulty breathing • Trouble swallowingBehavioral • Insomnia • Avoidance of • Insomnia • Increased activity trauma reminders • Exaggerated • Agression • Decrease interest in startle • Repetitive play significant activities • Act as if the trauma • Social withdrawal were recurring
MANIFESTATIONS OF ACUTE DISTRESSTypes of SymptomsReaction Reexperience Avoidance and Increased Arousal NumbingCognitive • Intrusive recall • Amnesia • Poor concentration • Flashbacks • Sense of • Hypervigilance • Trauma nightmares foreshortened futureEmotional • Psychological • Emotional • Irritability distress with numbing • Outburst of anger exposure to • Impaired affect reminders modulation • Anxiety • Anger • Guilt • Shame • Hopelessness
CONDUCTING INITIAL PSYCHOLOGICAL FIRST AID INTERVENTIONS Determine whether or not the individual viewed the event as threatening Determine if the crisis reactions include any degree of lethality Homicide and/or suicidal thoughts or plans Immediate referral to a mental health professional Mass screenings Observation of signs, child paper-and-pencil products, anxiety scales, absenteeism, etc. Establish referral procedures Distribute referral forms to all staff members and parents Should educate others about what to look for following a crisis Student self-referral procedures
FREDERICK’S (1985) LIST OF SIGNS THAT SUGGEST A NEED FOR INTERVENTION1. Sleep disturbances that continue for more than several days, wherein actual dreams of the trauma may or may not appear2. Separation anxiety or clinging behavior, such as a reluctance to return to school3. Phobias about the distressing stimuli (e.g., a school building, TV scene, or person) that remind the victim of the traumatic event4. Conduct disturbances, including problems that occur at home or at school, which serve as responses to anxiety and frustration5. Doubts about the self, including comments about body confusion, self-worth, and desire for withdrawal
SUMMARY OF BEHAVIOR SYMPTOMS SEEN AND TREATMENT OPTIONS Behavior Symptoms Treatment OptionsAges Regressive Body Emotions1-5 • Resumption of • Loss of • Nervousness • Give additional bedwetting appetite • Irritability verbal assurance and • Thumb sucking • Indigestion • Disobedienc ample physical • Fear of • Vomiting e comfort darkness • Bowel or • Tics • Give warm milk and bladder • Speech comforting bedtime problems difficulties routines • Refusal to • Permit child to sleep leave in parents’ room proximity of temporarily parents • Provide opportunity and encouragement for expression of emotions through play activities
Behavior SymptomsAges Regressive Body Emotions Treatment Options5-11 • Increased • Headaches • School phobia • Give attention and competition • Complaints • Withdrawal from consideration with of visual or play group and • Temporarily lessen younger hearing friends requirements for siblings for problems • Withdrawal from optimum performance parent’s • Persistent family contacts in school and home attention itching and • Unusual social activities scratching behavior • Encourage verbal • Sleep • Loss of interest expression of disorders in previously thoughts and feelings preferred about disaster activities • Provide opportunity • Inability to for structured but concentrate demanding chores • Drop in level of and responsibilities at achievement home • Rehearse safety measures to be taken in future disasters
Behavior SymptomsAges Regressive Body Emotions Treatment Options11-14 • Competing • Headaches • Loss of • Give attention and with younger • Complaints interest in consideration siblings for of vague peer social • Temporarily lower parental aches and activities expectations of attention pains • Loss of performance at school • Failure to carry • Loss of interest in and home out chores appetite hobbies and • Encourage verbal • School Phobia • Bowel recreations expression of feelings • Reappearance problems • Increased • Provide structure but of earlier • Sudden difficulty in undemanding speech and appearance relating with responsibilities and behavior habits of skin siblings and rehabilitation activities disorders parents • Encourage and assist • Sleep • Sharp child to become disorders increase in involved with same- resisting age group activities parental or • Rehearse safety school measures for future authority disasters
Behavior Symptoms Regressive Body Emotions Treatment Options14- • Resumption • Bowel and • Marked • Encourage discussion of18 of earlier bladder increase or disaster experiences with behaviors complaints decline in peers and extrafamily significant others and attitudes • Headaches physical activity • If adolescent chooses to • Skin rash level discuss disaster fears within • Sleep • Frequent family setting such disorders expression of expression is to be • Disorders feelings of encouraged but not insisted of digestion inadequacy upon • Increased • Reduce expectations for difficulties in level of school and general performance temporarily concentration • Provide opportunity for on planned involvement in rehabilitation activities planning and participation to fullest extent possible • Encourage and assist in becoming fully involved in peer social activities • Rehearse safety measures for future
SLAIKEU’S (1990) PRACTICAL PRINCIPLES OF CRISIS INTERVENTION Short-term, time-limited procedure Less than 6 weeks Goal: reestablishing immediate coping and assist the individual to regain a precrisis level of functioning Administered at the time and place where the need for it arises Lasts from several minutes to several houses1. Facilitate the reestablishment of a social support network2. Engage in focused problem solving3. Focus on self-concept4. Encourage self-reliance
STEP 1: MAKING PSYCHOLOGICAL CONTACT Carkhuff’s (1993) Responding Skills Empathy Understanding facts and feelings Listening to what the individual is saying and trying to identify the feelings associated with the information Paraphrasing, summarizing, and perception-checking Respect Faith in the individual’s ability to overcome the crisis problem Pausing to listen Not trying to smooth things over Not dominating the conversation Warmth Nonverbal communication Congruent with verbal communication Gesture, posture, tone of voice, touch, facial expression Touch Used carefully Can have a calming effect
STEP 2: EXPLORING DIMENSIONS OF THE PROBLEM Direct inquiry about: Immediate past – crisis precursors Further clarify the events that led up to the crisis Explore pre-crisis level of functioning Present – the crisis story Assessment of present functioning Listen and ask about personal and social resources Immediate future – crisis problems Main objective: Identify the apparently unsolvable problem(s) Rank order the person’s needs within 2 categories Issues which need to be addressed immediately Issues which can be postponed until later
STEP 3: EXAMINING POSSIBLE SOLUTIONS Goal: Identify solutions for the immediate and later needs that were just identified Ask about coping attempts already made Facilitate exploration of additional copies strategies Propose other problem-solving options
STEP 4: TAKE CONCRETE ACTION Assist the person-in-crisis with taking action to address the immediate needs identified If lethality is low (i.e., little or no danger of injury, suicide, or homicide) Facilitate implementation of solutions to crisis problems Person-in-crisis is primarily responsible for taking action If lethality is high (i.e., danger of injury, suicide, or homicide) Direct implementation of solutions to crisis problems Crisis intervenor is primarily responsible for taking action
STEP 5: FOLLOW-UP Develop a plan to follow up on the crisis victim Get identifying information Specify follow-up procedures Obtain a contract for recontact Assess attainment of goals Is support provided? Is lethality reduced? Are linkages to helping resources made? Recycle the first aid process if necessary.
COMPLETED SUICIDE Goals of crisis intervention Reestablish immediate coping Minimize identification with and glorification of the suicide victim Failure to achieve these goals creates the potential for a suicide cluster Point out how survivors are different from the suicide victim Point out that suicide is a poor choice Davidson (1989) suggests small-group counseling sessions to be best Important concepts 1. Death is permanent 2. Suicide can be portrayed as a permanent solution to temporary problems for which help is available 3. Many people have suicidal thoughts when a suicide has occurred. Students should understand that having thoughts of suicide does not mean that they are “crazy.” Persistent and intrusive suicidal thoughts are a signal that something important is troubling the person and he/she should seek help. Teachers can provide information about available services. 4. The student who committed suicide can be portrayed as seriously disturbed and as someone who, sadly, had not found an avenue to effectively work on his/her problems. Students can be helped to disidentify with the decedent without abusing the victim’s character.
OTHER ITEMS ADDRESSED IN BOOK Media Relations Security and Safety Procedures General safety plans and considerations Intervening with fights and assaults Characteristics of effective schools Characteristics of secure and safe classrooms School crime assessment tool Possible interventions for improving school safety Types of School Security w/ advantages and disadvantages Working with Potentially Violent Students Early warning signs Suicide warning signs Imminent warning signs of violence Interventions Causal factors associated with school violence Societal violence prevention/intervention strategies
CONTINUED…. Emergency Medical and Health Procedures Evaluating and Debriefing the Crisis Response Appendices: School Crisis Intervention: An In-Service for Educators Tips for Teachers in Times of Disaster: Taking Care of Yourselves and Each Other Helping Your Child in a Disaster Strategies for Informing Others of Crisis Events: Sample Letters and Announcements Memo Requesting Teacher Assistance in Assessing Student Need for Psychological First Aid Following a Crisis Safe Schools Questionnaire
LITERATURE RESOURCES Aguilera, D.C. (1998). Crisis intervention: Theory and Methodology (8th edition). Brooks, B., & Siegal, P.M. (1996). The scared child: Helping kids overcome traumatic events. Canter, A.S., & Carroll, S.A. (Eds.) (1999). Crisis prevention and response: A collection of NASP resources. Carlson, E.B. (1997). Trauma assessments: A clinician’s guide. Fairchild, T.N. (Ed.). (1997). Crisis intervention strategies for school-based helpers. (2nd ed.). Johnson, K. (1993). School crisis management: A hands-on guide to training crisis response teams. Lindemann, E. (1979). Beyond grief: Studies in crisis intervention. Matsakis, A. (1994). Post-traumatic stress disorder: A complete treatment guide.
LITERATURE RESOURCES CONTINUED Mitchell, J.T., & Everly, G.S. (1996). Critical incident stress debriefing: An operations manual for the prevention of traumatic stress among emergency services and disaster for workers (2nd ed., rev.). Monohan, C. (1997). Children and trauma: A guide for parents and professionals. National School Safety Center. (1990). School safety check book. Petersen, S., & Straub, R.L. (1992). School crisis survival guide: Management techniques and materials for counselors and administrators. Poland, S., & McCormick, J.S. (1999). Coping with crisis: Lessons learned. Sandoval, J. (Ed.). (1988). Crisis counseling, intervention, and prevention in the schools. Slaikeu, K.A. (1990). Crisis intervention: A handbook for practice and research (2nd ed.).
INTERNET RESOURCES American Academy of Child and Adolescent Psychiatry www.aacap.org The American Academy of Experts in Traumatic Stress www.aaets.org The American Psychological Association www.apa.org South Carolina Children’s Law Office www.childlaw.law.sc.edu/manuals/user/crisisi National Center for PTSD www.ncptds.org U.S. Department of Education www.ed.gove/offices/oese/sdfs/ Federal Emergency Management Agency www.fema.gov
INTERNET RESOURCES CONTINUED Hogrefe & Huber Publisher’s Journal “Crisis: The Journal of Crisis Intervention and Suicide Prevention” www.hhpub.com/journals/crisis International Critical Incident Stress Foundation www.icisf.org The International Society for Traumatic Stress Studies www.istss.org National Association of School Psychologists www.naspweb.org National School Safety Center www.nssc1.org American Psychiatric Association www.psych.org
INTERNET RESOURCES CONTINUED National PTA: Violence, Kids, Crisis. What You Can Do. www.pta.org/programs/crisis American Red Cross www.redcross.org National School Safety and Security Services www.schoolsecurity.org American Association of Suicidology www.suicidology.org National Organization for Victim Assistance www.try-nova.org School Violence Virtual Library www.uncg.edu/edu/ericcass/violence/index.htm The Training and Technical Assistance Center at the College of William and Mary www.wm.edu/ttac