Who Are You Going to Call? Kay Rahuba, MSN, RN, CRNP; re:solve Crisis Network, Western Psychiatric Institute and Clinic Jeffrey Magill, MS, CTR; Western Psychiatric Institute and Clinic

Focus of the Workshop Pre-planning and response phases of a crisis Identification and collaboration with community response partners How to conduct a needs assessment using strategic planning

Objectives Identify the steps involved in conducting a needs assessment Identify available resources and to carry out a strategic plan geared towards acute stabilization Identify acute stress reactions and strategies to address them collectively and individually

DEFINITIONS CRITICAL INCIDENTS are unusually challenging events that have the potential to create significant human distress and can overwhelm one’s usual coping mechanisms.

DEFINITIONS The psychological DISTRESS in response to critical incidents such as emergencies, disasters, traumatic events, terrorism, or catastrophes is called a PSYCHOLOGICAL CRISIS (Everly & Mitchell, 1999)

PSYCHOLOGICAL CRISIS An acute RESPONSE to a critical incident wherein: 1. Psychological homeostasis (balance) is disrupted (increased stress) 2. One’s usual coping mechanisms have failed 3. There is evidence of significant distress, impairment, dysfunction (adapted from Caplan, 1964, Preventive Psychiatry) Terms you may hear: Trauma Membrane “New Normal”

DEFINITIONS CRISIS INTERVENTION A short-tem helping process. Acute intervention designed to stabilize and mitigate the crisis response. Not psychotherapy.

Goals of Crisis Intervention Normalize reactions and facilitate normal recovery processes. Restore individuals to adaptive functions Enhance unit cohesion and unit performance in homogeneous groups Identify individuals who may need professional assistance and refer as necessary

Principles of Crisis Intervention Simplicity Brevity Innovative Pragmatism Proximity Immediacy Expectancy

Six Core Elements of CISM Surveillance, Assessment of the event and the impact on the personnel Strategic Planning Listening, Individual support, and Crisis Intervention Informational groups Interactive groups Follow-up and referral services

Assessment Circumstances Nature and Magnitude of event Impact on people exposed STOP…BREATHE…THINK…ASSESS

Crisis Needs Assessment Relationship of the lost person to the person in crisis Nature of the loss (natural, sudden, tragic, etc.) Was the loss witnessed by or reported to those in need? Cumulative effect of this loss on other losses experienced by this person Shared experience of loss with others (family, community) (Albert E. Roberts, Crisis Intervention Handbook 3 rd Edition)

Characteristics of a Crisis Strategy Full assessment Development of goals and objectives Select the right people to provide the services Develop a strategic plan of action Select the right crisis tactics

Crisis event High anxiety * Denial Anger Remorse Grief Reconciliation

STAGES OF CRISIS pre-crisis crisis post-crisis Point of impact Trial and error Angle of disorganization 2. stuck 1.function 3. improved * disorganization

EUSTRESS vs. DISTRTESS vs. DYSFUNCTION EUSTRESS vs. DISTRTESS vs. DYSFUNCTION Three intensity levels of stress, thus 3 potential groups of survivors: Eustress = Motivating stress Distress = Excessive stress Dysfunction = Impairment

Tactical Components of CISM Pre-event preparation, education, training, planning and policy development Assessment procedures (nature and magnitude of event, impact on people) Strategic Planning procedures (5 T’s) Individual crisis intervention support actions

Strategic Planning Formula Theme Target(s) Types Timing Team

Theme What are the issues, concerns, questions, threats, circumstances, and special situations that need to be considered? Reminder: We respond to impact not to the event, do not want to interfere with one’s resiliency

Targets Who needs assistance and who does not need assistance?

Types What types of help will be most beneficial?

Timing When will the assistance be most useful to those who need it? - Immediately - End of day/shift - Within 24 hours - Next Business/School day - Post funeral - Other

Team Who is being sent in to provide the assistance and do they have the personality, background, and skills to provide the necessary support

Providers of Crisis Intervention Communities - Keystone Crisis Intervention Teams (KCIT) - Disaster Crisis Outreach and Referral Team (DCORT) - Critical Incident Stress Management (CISM) - Local Crisis Agency - Red Cross - Mental Health Professionals - Salvation Army - Faith Based Community - Federal agencies - Disaster workers Schools - School Faculty, guidance counselors - Student Assistance Program (SAP) - Community Mental Health Workplace - Employee Assistance Program (EAP)