1. Critical Incident Stress Management

2. Why Prepare?  “The psychological states of emergency response personnel can have a direct effect on the mental and physical health of survivors of a trauma or disaster” (Glass, 1956)

3. Crisis  An acute response to a Critical Incident wherein: – Psychological homeostasis has been disrupted – Usual coping mechanisms have failed – Some evidence of impairment is present

4. Seven Basic Truths  Many experiences can be traumatic  Some are traumatic to some, but not to all  Various factors may make some more vulnerable than others  Traumas create reactions now and later  Experiencing these reactions means the situation was serious for you  Reactions sometimes get worse before they get better  Sometimes they reappear later

5. Crisis Intervention  Urgent and acute psychological “first aid” characterized by: – Immediacy – Proximity – Expectancy – Brevity

6. Goals of Crisis Intervention  Stabilization of symptoms  Mitigation of symptoms  Restoration of independent functioning  Facilitation to higher level of care if necessary

7. Relative Intensity of Interventions Demobilization Defusing 5 Phase CISD 7 Phase CISD Reaction IntroductionInformation Exploration Reaction Fact ThoughtSymptoms Reentry Teaching

8. Common Problems  Failure to understand ingredients of CISM  Failure to understand group processes  Inappropriate timing of interventions  Group size  Group is too heterogeneous  Incomplete instructions/expectations  Participants rush from FACT to REACTION

9. Common Problems  Failure to return to the Cognitive level  Doing psychotherapy instead of Crisis Intervention – Watch the “F” word  Dwelling on past rather than current events  Failure to provide closure  Failure to follow-up

10. Children & Trauma 2 – 6 Years  Sleep disturbances  Short and frequent expressions of sadness  Tantrums  Death is temporary  Reunion fantasies  Anxious attachment  Reenactments  Mute and withdrawn  Regression

11. Children & Trauma 6 – 10 Years  Withdrawal of trust from adults  Somatic complaints  Regression/slowed maturation  Behavior problems  Expression through play and art  Concentration problems  Radical changes in behavior  Savior fantasies

12. Children & Trauma 10 – 14 Years  Suppress thoughts and feelings  Sense of meaninglessness of existence  Somatic complaints  Childlike behaviors and attitudes  Symbolic interpretations  Sense of foreshortened future

13. What to do – Ways to be helpful  Offer hope that alternatives are available. Avoid glib reassurances.  Take action. Remove means such as guns and other weapons.  Get help from persons or agencies specializing in crisis intervention and suicide prevention.

14. Intervention  Gather information: known stressors, family background, academic history, observable behaviors, child’s statements.  Approach child: establish trust, show concern, offer self as a resource.

15. Intervention  Listen. Use normal speaking pattern. Keep questions gentle and respectful. Show concern with body language: posture, eye contact, position  Do not promise confidentiality. Let him or her know what you’re going to do.