1. The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services
Crisis Care
Red Lake, Minnesota
Dale Walker, MD
Oregon Health and Science University
2/24/2019

2. For more information, contact us at 503-494-3703 E-mail
Dale Walker, MD
Or visit our website:
2/24/2019

3. Crisis Care Crisis Intervention:
> Focus on immediate emotional support
> The person’s resources for coping have failed
> The design of your intervention is to assist in coping
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4. Crisis Care Critical Incident Stress: > Reactions to a “stressor”
> Could be during
> Could be after
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5. Crisis Care Defusing: > On-scene intervention
> Help client to vent feelings
> Begin the task of starting coping strategies
> Begin the task of reducing stress
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6. Crisis Care Debriefing:
> Organized approach by mental health professionals
> Supportive of the disaster workers who had helped in the time of crisis
> Usually done towards the end to bring closure to their experiences
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7. Loss, Grief, and Mourning
Grief is both an ADAPTIVE and NORMAL process.
NORMAL: Because it is a reaction that helps us confront the loss.
ADAPTIVE: Because, while it is painful to go through, it can be productive in that we learn something through it.
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8. Stages of Grief DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE
NOTE: People MAY go through these and they may go through them differently
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9. Stages of Grief Typical reactions:
Drained of energy, purpose, and faith.
Feel like they are “dead.”
Mistake denial for recovery (too quick)
Focus only on the LOSS, not their recovery
Can’t focus on working through the grief, because of “all the other things” that must be done.
Re-experience emotions at the “anniversary," and other tribal times
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10. Stages of Disaster The community response in grief.
HEROIC: From impact to about one week out.
HONEYMOON: Lasts several weeks and there is a sense of the community “pulling together.”
DISILLUSIONMENT: One month to even a couple of years. Hype is gone and questions are unanswered.
RECONSTRUCTION: Final stage with realization of what has been experienced and what they can do to restore the community.
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11. Symptoms of trauma
Vary related to age, background, prior history of personal trauma.
May apply to BOTH, victims and trauma workers.
Many of these expressions are suggestive of the fact the trauma has not been handled well.
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12. Symptoms of trauma Phobias Exaggerated startle response
Hyper-vigilance
Encounter “reminders”
Memory problems
Anger, rage
Nightmares
Report stress
Depression
Anxiety
Preoccupation with “death,” “injury,” and “separation.”
Avoidance reactions
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13. Providing Support The 6 “T’s” Tears It’s Ok to cry
Touch Hand or shoulder, supportive
(Always ask first!)
Talk With you, family, friends
Trust Be non-judgmental
Toil It will take work, but not to rush
Time Recovery takes time, so you must take time to be with them
2/24/2019

14. Helping Children/Teenagers
Children: Birth to 5 years old
fear of being separated from parent
crying
screaming
regressive behaviors
clinging behaviors
NOTE: How the parent reacts strongly influences how the child will react at this age.
2/24/2019

15. Helping Children/Teenagers
Children: 6-12 years
withdrawal and depression
disruptive behaviors
regressive behaviors
irrational fears or guilt
refusal to attend school
anger and fighting
bodily complaints and symptoms
2/24/2019

16. Helping Children/Teenagers
Adolescents: years old
adult-like symptoms
emotional numbing
suicidal thoughts and depression
confusion and memory problems
feelings of “they could have stopped it”
isolation
avoidance and/or substance abuse
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17. Helping Children/Teenagers
Create a sense of “safety.”
Use multiple reassurances.
Convey you understand what they are feeling.
Convey it is “normal” to feel that way.
Talking about the feelings and a return to normal.
Keep families together as much as possible.
Don’t criticize for “babyish” behaviors.
Use the 6 T’s.
2/24/2019

18. Helping Children/Teenagers
Encourage that they “take control.”
Parents need to care for themselves, in order to care for the children.
Don’t rush back to the routine, thinking it will “get their minds off of it.”
Hold meetings with leaders in the community, schools, and churches to create awareness and networking.
2/24/2019

19. Post-Traumatic Stress Disorder
Using the Diagnostic and Statistical Manual
Witnessed, experienced, or confronted with trauma
Intense fear, helplessness, or horror in their response
Re-experiencing
Avoidance
Persistent symptoms (many already discussed)
2/24/2019

20. PTSD-continued Cognitive-Behavioral Therapies.
Group Therapy can be used.
Trauma/Grief-focused psychotherapy is being used, as well.
2/24/2019