Transcript Slide 1
Crisis Intervention in Violent Times
Joan Reed, MSW, ACSW, LCSW Director of School Services Erica Muhlenkamp, MSW, LCSW Program Manager School Services Community Health Network
Behavioral Health Services
Crises are dangerous opportunities. Chinese Proverb
Fear Words
Crisis
Tragedy Emergency Catastrophe T r a u m a
CRISIS .....
OCCURS WHEN A PERSON’S
STRESSORS
OUTWEIGH THEIR
ADAPTIVE CAPACITIES
Crisis is….
Any situation a person finds themselves in, in which their traditional ways of coping are ineffective or maladaptive .
Feeling Helpless and Hopeless
Types of Crises Events that threaten a person’s well being o o Death related to suicide of a friend Gang activity o Snipers o Hostage-taking o Rape o o Accidental or expected death Natural Disasters Earthquakes o Fires
ADAPTIVE CAPACITIES
Well Functioning
STRESSORS
Adaptive Capacities in Daily Life
• Physical health • Physical abilities • Cognitive IQ • Emotional IQ • Spiritual connection • Education or experience • Community or family support • Personality
Sources of Stressors
• Financial • Addictions • Residual past traumas or loss • Work dissonance • Family discord • Physical or mental illness • Others???????????????
ADAPTIVE CAPACITIES
Crisis / Trauma
STRESSORS
Soooooooooo….
HOW MUCH OF WHAT YOU DO DO IS REALLY CRISIS INTERVENTION?
Crisis Intervention is NOT Psychotherapy
Therapy is inappropriate in crisis situations because 1. people have already been bombarded with overwhelming change 2. people in crisis are highly stressed by events and conditions around them 3. people in crisis are often out of touch with their coping skills 4. people in crisis do not feel safe -- therapy depends on people feeling safe enough to explore the possibility of personal change
Maslow’s “Basic Hierarchy of Human Needs”
SELF ACTUALIZATION INTELLECTUAL & SPIRITUAL GROWTH LOVE AND BELONGINGNESS COGNITIVE FUNCTIONING (ACTIVITIES OF DAILY LIVING) SAFETY & SECURITY BASIC HUMAN / SURVIVAL NEEDS
What People in Crisis Need
1. To talk about what happened 2. To relate what has happened to other events in their lives 3. To explain to themselves what has happened so they can acknowledge it 4. To reconnect with positive coping skills 5. To be given a list of resources for further help 6. To be encouraged to attempt to continue their usual routine.
Crisis Response
CRISIS AFFECTS THE WHOLE PERSON !
Cognitive Physical Emotional Behavioral Spiritual
Responding to a Person in Crisis
1) Managing the situation A person who is upset can produce a form of emotional contagion.
o
To counter this, one must present a calm, reassuring demeanor
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Clarify that the person is upset
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If possible, indicate why the person is upset (correct rumors and distorted information)
o
State what can and will be done to help the person
Responding continued…
2) Mobilizing Support The person needs support and guidance.
Staff can
o try to engage the person in a problem-solving dialogue o normalize the reaction o facilitate emotional expression (e.g., through use of empathy, warmth, and genuineness) o facilitate cognitive understanding by providing information
Responding continued…
o facilitate personal action by the person (e.g., help them do something to reduce the emotional upset and minimize threats to competence, self determination, and relatedness) o encourage their buddies/friends to provide social support o contact the person's family to discuss what's wrong and what to do o refer the person to a specific counseling resource
Responding Continued…
Move the person from Victim to Actor
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Plan with the person promising, realistic, and appropriate actions they will pursue when they leave you
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Build on coping strategies the person has displayed
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If feasible, involve the person in assisting with efforts to restore equilibrium
Responding Continued…
Connect the person with Immediate Social Support Peer buddies, other staff, family -- to provide immediate support, guidance, and other forms of immediate assistance Provide for Aftermath Interventions Be certain that individuals needing follow-up assistance receive it
Responding continued…
3) Following-up Over the following days (sometimes longer), it is important to check on how things are progressing.
o Has the person gotten the necessary support and guidance?
o Does the person need help in connecting with a referral resource?
o Is the person feeling better? If not, what additional support is needed and how can you help make
certain that the person receives it?
Major Facets of Crisis Response in the Community
During the emergency Communication
o sounding the alarm if necessary o clarifying additional steps o providing information about the event o the location of first aid stations if needed o rumor control o dealing with the media o keeping track of students and staff o responding to families o interfacing with rest of the district and community
Major Facets Continued…
Direction and Coordination
o running an emergency operations center o monitoring problems o problem solving
Health and Safety
o mitigating hazards to protect people providing them with medical and psychological first aid o providing for search and rescue, security, evacuation
Aftermath Response
Immediate aftermath
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Communication
clarifying causes and impact and debunking rumors providing information about available resources for medical and psychological help o
Direction and coordination
determining need to maintain emergency operations center continuing to monitor problems and problem solve o
Health and safety
continuing with activities initiated during the event
Crisis Mode----Hyper-vigilance
Aftermath Response
Restoring Equilibrium
o Be calm, direct, informative, authoritative, nurturing, and problem-solving oriented o Counter denial by encouraging people to deal with facts of the event o G ive accurate information and explanations of what happened and what to expect -- never give unrealistic or false assurances
Minimizing
Aftermath Response
o Talk about their emotional reactions o Encoura ge them to deal with such reactions as another way of countering denial and other defenses that interfere with restoring equilibrium
How the crisis is handled determines whether growth or disorganization will result A CRISIS CAN LEAD TO PERSONAL GROWTH
Convey a sense of hope and positive expectation -- that while crises change things, there are ways to deal with the impact .
The Crisis Reaction: Mind’s Response
Initial cognitive reaction of shock, denial Regression Cataclysm of emotions
• Fear and terror • • • • • Anger, fury, and outrage Confusion and frustration Guilt or self-blame Shame or humiliation Grief or sorrow
Reconstruction of new life equilibrium
A Crisis Changes Things
BRAIN 101 ANATOMY & PHYSIOLOGY
YOUR BRAIN…..IN CRISIS
PRE FRONTAL FRONTAL PARIETAL
Pg. 2-14
OCCIPITAL BRAIN STEM CEREBELLUM
The Brain’s Structure
• Hippocampus: perceives, registers context
The Brain’s Structure
Cognitive Processing 101
“ Normal” Processing Receive sensorial stimuli Stimuli is determined not to be threatening or dangerous (thalamus) Organize and interpret information as usual (cortex and neo-cortex) Emotional content added (limbic system)
Cognitive Processing 101
“ Traumatic” Processing
dangerous (thalamus)
reactions that override cognitive processing (limbic system)
Receive sensorial stimuli Stimuli is determined to be threatening or Emotions trigger physical and emotional Scattered emotional information interferes with cognitive processing (cortex and neo cortex)
The Shifting Balance of Thought & Emotion
70 60 50 40 30 20 10 0 Everyday Trauma After Crisis Emotion Thought
Traumatic and Narrative Memory:
Traumatic
images, sensation, affective and behavioral states
Narrative
semantic and symbolic does not change over time social and adaptive state-dependent; cannot be evoked at will automatically evoked in expanded special circumstances No condensed in time can be evoked at will can be condensed or on social demands
Elements of Crisis Intervention
THE NOVA MODEL
Safety and Security Ventilation and Validation Prediction and Preparation
Safety
• Safety is a “physical” issue
Security - An Emotional Issue
Be certain that support systems are in place for care givers
To promote security a caregiver needs to:
• Privacy for the expression of emotions.
• Confidentiality of communication.
• Reassurance • Sense of control • Sense of emotional safety.
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Remember
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In the midst of a crisis, it is hard to remember all the specific steps and preparatory plans that have been discussed.
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Each site and each person responsible for crisis response needs to have a checklist that provides a ready and visible reference guide for use during a crisis
Tools for Understanding and Responding: Safety and Security
Help survivors contact loved ones.
Help with immediate problem-solving.
Help re-establish a sense of control over small things first, then go on to larger things.
Use “reactions” and “responses” rather than “feelings” and “sharing.” Sit down to talk.
Help them obtain information they need.
Give permission for crisis reactions.
Promote physical comfort.
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Ventilation
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LET THEM TELL THEIR STORY
• Compassionate presence • Effective
LISTENING
Processing
Validation
•
VALIDATE THEIR REACTIONS
• Focus on the commonality of reactions • Let survivors use and identify their own words
for their crisis and reactions
• Repeat key elements of the story
Tools for Understanding and Responding: Ventilation &Validation
Ask survivors to describe the event.
Ask them to describe reactions/responses.
Let them talk as long as they need to.
Validate when there are natural pauses.
Don’t ask “why” questions.
Avoid interruptions whenever possible.
Let them know you care.
Avoid telling of your own experiences.
Be alert to signs that survivor plans to harm self or others.
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A Sense That One Can Never Do Enough
Prediction
• Ask what problems will be faced in the
next days and how the individual plans to cope
• Identify practical issues that may arise • Identify emotional reactions that might
occur
• One of the most important concerns of
survivors is “what is going to happen next?”
Tools for Understanding and Responding: Preparation & Prediction
• Provide information on practical issues • Provide referrals • Explain specifically how long assistance
might be available
• Identify solvable problems & solve them • Don’t make promises that can’t be kept • Possible emotional & physical reactions
should also be predicted.
So…….
Two most important things that people in crisis need that each of you can do…………..
•
Let them tell their story
•
Validate their crisis reactions
•AND THAT GOES FOR US AS CAREGIVERS TOO!
Care of the Caregivers
CARE OF OTHERS CANNOT EXCEED CARE OF THE CAREGIVERS
Caregivers need to talk about: • what happened • what they did • what they thought or felt • what the experience means to them • stress reactions • how they coped or are coping • what went well and what could be done
differently
“I can be most present by being close enough to the fire to empathetically feel the heat, and yet separate enough to not be singed or need to flee.”
Lattanzi, M. (1984). Professional Stress: Adaption, Coping, and Meaning. Family Therapy Collections.
8. What bothers you the most about what happened?
9. Do you think anyone could have done something to prevent it?
Yes No Who?
10. Thinking back on what happened, not at all a little more than a little very much 1 1 1 1 How angry do you feel about it? 2 3 How sad do you feel about it? 2 How guilty do you feel about it? 2 How scared do you feel?
2 3 3 3 4 4 4 4
Questions for Briefing 1. Where were you when the event occurred? (Directly at the site? nearby? out of the area?) 2. What did you see or hear about what happened?
3. How are you feeling?
4. How well do you know those who were involved?
5. Has anything like this happened to you or any of your family before?
6. How do you think this will affect you/your family in the days to come? (How will your life be different now?)
Finding Balance
Intention When your day begins, close your eyes, take several deep breaths, and ask yourself, “What is my intention for today?” If you have small children or loud chickens demanding your attention before you are conscious, ask yourself this while you are feeding your children or gathering your eggs, but create an intention for the day. At the end of your day, before sleep overtakes you, ask yourself, “What can I put down? What am I ready to be done with? What don’t I need to carry with me for another day?” Put it down, and don’t pick it up again the next day.
Finding Balance
Gratitude At both the beginning and end of your work day, take a distinct moment to think of one thing you are grateful for. Every single day, think of one person you are grateful to and tell that person so. You can start with those close to you and slowly branch out to expressing your gratitude for all the “teachers” in your life.
Advocate for your workplace to create a forum where you and your colleagues can express gratitude to one another. Take the lead in thanking others.
Finding Balance
Mindfulness Designate a day of rest. Whether you identify is as Shabbat or the Sabbath or simply a day off, designate a weekly day of non-obligation for yourself. This will serve to remind us that if we are truly to reconnect with ourselves, work and creation must stop. Our day of rest will also remind us that who we are as individuals and as members of society is about our deepest essence and not about what we produce during the week.
Finding Balance
In addition to your day of rest, allot some time for yourself each day when you don’t obligate yourself to anything, but instead give yourself total freedom to delight in one of your favorite states of being. Be present with this for however long you are able. Notice how you feel when you free yourself from obligation and allow yourself to be centered within.
Local Response Needs?
Contact I-CART
• Indiana Crisis Assistance Response Team • • 317-596-2202 www.i-cart.org