Presentation on theme: "Best Practices in Mental Health Emergency Recovery in Schools"— Presentation transcript:
1Best Practices in Mental Health Emergency Recovery in Schools Jackie Kibler, Ph.D.Department of Psychology, University of MontanaMatt Taylor, M.A.Associate DirectorInstitute of Educational Research & ServiceThe Montana Safe Schools CenterScott Poland, Ed.D.Coordinator of the Suicide & Violence Prevention OfficeCenter for Psychological Studies, Nova Southeastern University
2Presenter Disclosures 2010 NASP Annual Convention There are no financial interests to disclose, no honorarium provided for this presentation, and no funding by any publishing company.One intervention which is the focus of this presentation, CBITS, is a commercially distributed product, however the presenters have no monetary or direct research interest in this product’s distribution. PFA is in the public domain.Attendance at this conference was supported in part by a by Grant awarded by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) as part of the National Child Traumatic Stress Network. The opinions contained herein are those of the author(s) and do not necessarily represent the official position or policies of SAMHSA, The University of Montana or NOVA Southeastern University.References to specific companies, products, or services should not be considered an endorsement by the author(s) or SAMHSA.
3The Emergency Management Cycle Plan for a rapid, coordinated, effective responseDecrease the needfor responseRestore the learningenvironment; Monitorand assist the healingExecute the plan
4What is NIMS and ICS?NIMS stands for the National Incident Management System now being put into operation across the country, in part as a result of the events of September 11, 2001.NIMS is intended to create a consistent nationwide approach for federal, state, tribal, and local governmentsThe Incident Command System (ICS) is the key component of the National Incident Management System (NIMS) that is most relevant for schools.
5EMERGENCY MEDICAL SERVICES EMERGENCY MANAGEMENTLAW ENFORCEMENTFIRE DEPARTMENTSEMERGENCY MEDICAL SERVICESICSSCHOOLS
64 Main Goals of ICS and the ICS Organizational Structure: 1. Maintain a manageable span of control2. Establish predetermined incident locations and facilities3. Implement resource management4. Ensure integrated communication
7Expanded Sample School Based ICS Example Incident CommanderPublic Information OfficerLiaison OfficerSafety OfficerOperations Section ChiefPlanning Section ChiefLogistics Section ChiefFinance & Admin S. ChiefStudent SupervisionDocumentation/RecorderStaffingInsurance ClaimsTransportationFacility and MaterialsFood ServicesPersonnelSite/facility SecurityCommunicationsStudent Reunification Group SupervisorHealth Services Group SupervisorPsychological First Aid Team LeaderNote – vertical reporting lines below Section Chiefs only for space saving illustration, Supervisors report directly to Chiefs, Team leaders to supervisors etc,.Medical Triage Team Leader
8What Are the Key Components of Recovery? Physical/Structural RecoveryBusiness/Fiscal RecoveryAcademic RecoveryPsychological/Emotional Recovery
9RecoveryStrive to return to teaching and learning as quickly as possible.Recovery will not happen quickly.Recovery involves medical, psychological, infrastructure, legal, insurance, and documentation issues.Reduce fear, facilitate grieving, promote education.Conduct after action reviews with staff and first responders.
10Key Issues in the Recovery Phase: School Psychologists as Crisis Intervention Team Members How to structure recovery section of emergency management plan (EMP)Opening or closing schools after an event occursPublic, staff and student communicationsMemorials after a student or staff deathHow to handle key dates
11Crisis Intervention Planning Preparing in Advance for Recovery Outline service delivery systems (MOUs/MAAs)Template lettersAccepting donationsEmpty chairsMemorials and anniversariesThresholds and responsibility for closing & reopeningTrainingNational Organization for Victim Assistance (NOVA)National Association of School PsychologistsNational Child Traumatic Stress NetworkU.S. Department of Education
12Crisis Intervention: Working with the Media Have media policies and procedures already in place that set limits and keep media away from staff and students.Caution staff and students about speaking with mediaDesignated spokesperson should prepare written statements and rehearse sound bites for television that include mental health and safety recommendations
13School Psychologists Promote the Mental Health of Students: Considerations for Emotional Recovery Purpose: To promote coping and resiliency for students, staff, and their families following an emergency or crisisKey componentsRecovery/mental health services that are available and acceptable in your district internal and external resourcesPsychoeducationPsychological first aidIntervention strategies & modelsLong-term considerations (school board approval), recovery funding such as Project SERV and SAMHSA Crisis Counseling Grants
14Crisis Intervention Tips for Helping Students Share information in developmentally appropriate ways.No one should be lied to or misled about the circumstances. Recognize all the connections around the school system.Students need to hear sad or tragic news from trusted adults and should be able to ask questions.Turn off TVs and gather students in a circle and talk about the event and their perceptions, safety concerns and sources of help.Help everyone identify previous and current sources of support.
15Crisis Intervention: Creating a Caring Climate Know that the crisis becomes the curriculum for a few days.Provide guidance about when to resume the curriculum and when it’s okay to resume testing.K-12 schools should stay open as source of support and consistent routine after tragedies.Provide guidance about homework/tests, certain rules and expectations may need to be relaxed.Re-establishing routines is helpful to all.
16Traumatic StressTraumatic stress is an acute distress response that is experienced after exposure to a catastrophic eventTraumatic stress occurs because the event poses a serious threat to:The individual's life or physical integrityThe life of a family member or close friendOne's surrounding environmentIndividuals who have witnessed injury or death are also at risk to develop a trauma stress response.1 in 4 (61% Northern Plains Indians, in one IERS/NNCTC study 100% PTSD)
17Developmental Reactions to Traumatic Stress PreschoolersRegressive behaviorsReenacting traumatic events through playSleep disturbancesAnxious attachmentElementary School ChildrenSame as preschoolers, plus:Trouble concentratingPhysical symptoms (e.g., stomach aches, headaches, etc.)Disruptive behaviorsWithdraw from others**Importance of caretaker/adult reactions**
18Developmental Reactions to Traumatic Stress AdolescentsRegressionAngerAvoid reminders of traumatic eventLoss of hopeGuiltWithdrawalFlashbacksEating problemsSleeping problems (e.g., nightmares)
19Responding to Traumatic Stress Let’s shift gears. . .Responding to Traumatic Stress
20Multi-Level Trauma Intervention Options Tier 1 – General School-BasedPsychoeducation, triage and assessmentSupportive environmentTier 2 – School-Based, Student/Group/Staff SpecificTrauma and grief - Focused counselingShort-term group or individual counselingTier 3 – Specialized Community-BasedReferral to on or off-site mental health services
21Cognitive Behavioral Intervention for Trauma in Schools (CBITS) Lisa Jaycox, Ph.D (2004)Developed to work with inner-city children who experience trauma symptoms from exposure to violence.
22Basic Categories of Responses to Threats which CBITS addresses Shattered assumptions:I am in control (My parents are in control)I am safe (My parents will keep me safe)Bad things happen to other people, bad things can’t happen to me. (My parents won’t let bad things happen to me)I am worthy and life has meaningRe-experiencing the event and intrusive thoughts and images.HyperarousalAvoidance and numbingSense of a foreshortened future
23Treating Childhood Traumatic Stress in Schools: Summary of CBITS Cognitive Behavioral Intervention for Trauma in Schools (CBITS)Based upon Cognitive Behavioral Therapy componentsEvidence based10 session group counseling protocolEach session builds upon the previous session and allows for practiceOne to three individual sessionsParent and teacher education sessionsAges 11-15
24CBITS Screening and Intervention time line ClinicalInterviewPre-groupAssessment*ScreeningGroup not neededGroup not appropriateRefer outCBITS Group(10 weeks)Self-assessments*Post-groupAssessment** Allow tracking of outcomes.
25Special Considerations for CBITS Group Selection CBITS is not for sexual abuse if the only traumaThe traumatic event should be at least one month old (otherwise, consider Psychological First Aid)Refer children with very severe symptomsIdentify group dynamics before choosing groupUse co-facilitators if possibleCBITS manual is written for professionals with mental health intervention experienceDanger to self? Others? Cognitive impairments?Does child need Tier III treatment?
26Seeking, Supporting and Celebrating the Resiliency in Our Students and Colleagues.
27Trauma-Informed Intervention Examples Psychological First Aid PFA (Brymer et al., 2005) – PFA for schools forthcomingCognitive Behavioral Intervention for Trauma in Schools (CBITS) (Stein et al., 2003)Support for Students Exposed to Trauma (SSET) (Jaycox, 2006)Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) (Cohen, Mannarino, & Deblinger, 2006)Traumatic Grief Component Therapy for Adolescents (TGCT-A) (Saltzman et al., 2006)Child Development-Community Policing Program (CD-CP) (Maranas, Murphy, & Berkowitz, 2002)
28Considerations for Emotional Recovery: Short-Term Emotional TriageWhat is the history of the community?What is the trauma, support network and risk-taking history of the individual?Psychological First Aid (PFA-S / Listen, Protect, Connect)Initiate Group Crisis Interventions (GCI)Be cautious about Critical Incident Stress Debriefing (CISD/CISM) because of the potential to re-traumatize some individualsEducator and Provider Self Care!!Consider utilization of services for staff through district Employee Assistance Programs (EAPs)
29Emotional Triage: Circles of Vulnerability Geographical ProximityPopulation at RiskPsychosocial Proximity
30Considerations for Emotional Recovery: Psychological First Aid Psychological First Aid (PFA) is an evidence-informed modular approach for assisting children, adolescents, adults, and families in the immediate aftermath of disaster and terrorismDesigned toreduce the initial distressfoster short- and long-term adaptive functioningPFA meets four basic standardsConsistent with research evidence on risk and resilience following traumaApplicable & practical in field/school settingsDevelopmentally appropriate across the lifespanCulturally informed and adaptableSource: National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, September, 2005
31Psychological First Aid 8 Core Actions Initiate contact and engagementEnsure safety and comfortStabilizationGather information on current needs and concernsProvide practical assistanceConnect with social supportsProvide information on copingLink with collaborative servicesSource: National Child Traumatic Stress Network and National Center for PTSD, Psychological First Aid: Field Operations Guide, September, 200531
32Core Action 1: Contact and Engagement Coordinated within ICS - particularly teacher, team leader or principal (introductions)Be identifiable as an approved providerNon-intrusive, compassionate, helpfulQuick, as many contacts as possibleDo not interrupt, does not need to be verbal, don’t assume.Culturally and developmentally appropriateIs there a problem that needs immediate attention?
33Core Action 2: Safety and Comfort Engage in active, practical, familiar tasks to increase sense of controlMake the environment safeProvide directionShield students from highly distressed individuals and from reportersRecommend avoidance of repeated viewing in media33
34Core Action 3: Stabilization Avoid adding to cognitive/emotional overloadFocus on adults calming childrenAddress primary, immediate concernsHelp students and teachers understand what to expect in terms of emotional responsesSteer adolescents away from impulsive reactionsEncourage “grounding” activities34
35Core Action 4: Information Gathering The nature/ severity of experienceDeath of family member, separation from loved one or other losses, other siblings in schoolConcerns about ongoing threatPhysical Illness, medications, substance useGuilt / shameHistory of psychological problems or exposure to trauma and loss35
36Core Action 5: Practical Assistance Identify / re-clarify most immediate needsDiscuss and action planAct to address the need to the degree possibleFocus on realistic options/solutionsFocus on empowermentHelp students and staff meet their own needs so that they feel more control in an out of control situation
37Core Action 6: Connecting with Social Supports Discuss support-seeking and givingProvide comments that are1) reflective2) supportive3) empoweringUnderstand individuals may be reluctant to seek support, as appropriate, seek to understand why this isIssues related to separation, loss, and displacement.When working with young children, it is important to focus on the child in the context of the relationship.When working with adolescents, remember the importance of peer relationships.Utilize teachers who serve as primary caregivers for students
38Core Action 7: Information on Coping Basic information on stress reactionsReview common psychological reactionsProvide examples of positive coping actionsProvide examples of negative coping actionsExplain possible developmental delays/disruptions to parents and caregiversProvide teachers and staff with information about students as well as about self care and stress reactions in adults
39Core Action 8: Linkage with Collaborative Services Provide direct links to additional needed servicesPromote continuity in helping relationshipsWork closely with school / community mental health providers and document referral suggestions
40Discussion of Recovery Scenario Charleston Public Schools (fictitious)2,800 studentsScenarioIt’s early morning, December 18.School has just begun for the day.A full school bus is late arriving due to ice on the roads.40
41Discussion of Recovery Scenario The bus has 22 students from the MS/HS on board (ages 10 – 17)As the bus arrives to the middle school, approaching at an unusually high speed, the driver is unable to stop the bus.The bus skids and then crashes through the heavily windowed wall of the music room and into a room pillar.After a very brief period and a section of the roof, the pillar and 2 walls collapse onto the bus and the classroom.There are 25 students in the music room7 students are killed and 32 students are injured – four of them severelyThe bus driver was found to be intoxicatedThe school psychologist is out of the countryYour district has Mutual Aid Agreements with Valley Community Mental Health AgencyThe Superintendant, Mayor and School Board call for a community ceremony within 3 days.41
42Discussion QuestionsWhat are the first five steps you would take to activate the school’s Mental Health Recovery Plan?How do you identify the students and staff that are at different levels of risk?How to you initiate, organize and manage the PFA-S process?42