Joan Reed, MSW, ACSW, LCSW Director of School Services Erica Muhlenkamp, MSW, LCSW Program Manager School Services Community Health Network Behavioral.

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<ul><li><p>Joan Reed, MSW, ACSW, LCSWDirector of School ServicesErica Muhlenkamp, MSW, LCSW Program Manager School ServicesCommunity Health Network</p><p>Behavioral Health Services</p><p>Crisis Intervention in Violent Times</p></li><li><p>Crises are dangerous opportunities. Chinese Proverb </p></li><li><p> Fear Words</p><p> CrisisTragedyEmergencyTraumaCatastrophe</p></li><li><p>CRISIS .....</p><p>OCCURS WHEN A PERSONS STRESSORS OUTWEIGH THEIR ADAPTIVE CAPACITIES</p></li><li><p> Crisis is. </p><p> Any situation a person finds themselves in, in which their traditional ways of coping are ineffective or maladaptive. </p></li><li><p>Feeling Helpless and Hopeless</p></li><li><p>Types of Crises</p><p>Events that threaten a persons well beingDeath related to suicide of a friendGang activitySnipersHostage-takingRapeAccidental or expected deathNatural DisastersEarthquakesFires</p></li><li><p>ADAPTIVECAPACITIESSTRESSORSBASIC HUMAN NEEEDSSELF -ACTUALIZATIONINTELLECTUAL &amp; SPIRITUAL GROWTHLOVE &amp; BELONGINGNESSCOGNITIVE FUNCTIONINGSAFETY &amp; SECURITYWell Functioning</p></li><li><p>Adaptive Capacities in Daily Life</p><p>Physical healthPhysical abilitiesCognitive IQEmotional IQSpiritual connectionEducation or experienceCommunity or family supportPersonality</p></li><li><p>Sources of StressorsFinancialAddictionsResidual past traumas or lossWork dissonanceFamily discordPhysical or mental illnessOthers???????????????</p></li><li><p>ADAPTIVECAPACITIESSTRESSORSBASIC HUMAN NEEEDSSELF -ACTUALIZATIONINTELLECTUAL &amp; SPIRITUAL GROWTHLOVE &amp; BELONGINGNESSCOGNITIVE FUNCTIONINGSAFETY &amp; SECURITYCrisis / Trauma</p></li><li><p>Soooooooooo.</p><p>HOW MUCH OF WHAT YOU DO </p><p>DO IS REALLY </p><p>CRISIS INTERVENTION?</p></li><li><p>Crisis Intervention is NOTPsychotherapy</p><p>Therapy is inappropriate in crisis situations because1. people have already been bombarded with overwhelming change2. people in crisis are highly stressed by events and conditions around them3. people in crisis are often out of touch with their coping skills4. people in crisis do not feel safe -- therapy depends on people feeling safe enough to explore the possibility of personal change</p></li><li><p>SELF ACTUALIZATIONINTELLECTUAL &amp; SPIRITUAL GROWTHLOVE AND BELONGINGNESSCOGNITIVE FUNCTIONING (ACTIVITIES OF DAILY LIVING)SAFETY &amp; SECURITYBASIC HUMAN / SURVIVAL NEEDSMaslows Basic Hierarchy of Human Needs</p></li><li><p>What People in Crisis NeedTo talk about what happenedTo relate what has happened to other events in their livesTo explain to themselves what has happened so they can acknowledge itTo reconnect with positive coping skillsTo be given a list of resources for further helpTo be encouraged to attempt to continue their usual routine.</p></li><li><p>Crisis ResponseCRISIS AFFECTS THE WHOLE PERSON !</p><p>CognitivePhysicalEmotionalBehavioralSpiritual</p></li><li><p>Responding to a Person in Crisis1) Managing the situationA person who is upset can produce a form of emotional contagion.To counter this, one must present a calm, reassuring demeanorClarify that the person is upsetIf possible, indicate why the person is upset (correct rumors and distorted information)State what can and will be done to help the person</p></li><li><p>Responding continued2) Mobilizing SupportThe person needs support and guidance.Staff can try to engage the person in a problem-solving dialoguenormalize the reaction facilitate emotional expression (e.g., through use of empathy, warmth, and genuineness)facilitate cognitive understanding by providing information</p></li><li><p>Responding continuedfacilitate 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) encourage their buddies/friends to provide social support contact the person's family to discuss what's wrong and what to do refer the person to a specific counseling resource</p></li><li><p>Responding ContinuedMove the person from Victim to ActorPlan with the person promising, realistic, and appropriate actions they will pursue when they leave you</p><p>Build on coping strategies the person has displayed</p><p>If feasible, involve the person in assisting with efforts to restore equilibrium</p></li><li><p> Responding ContinuedConnect the person with Immediate Social SupportPeer buddies, other staff, family -- to provide immediate support, guidance, and other forms of immediate assistance</p><p>Provide for Aftermath Interventions Be certain that individuals needing follow-up assistance receive it</p></li><li><p> Responding continued3) Following-upOver the following days (sometimes longer), it is important to check on how things are progressing.Has the person gotten the necessary support and guidance?Does the person need help in connecting with a referral resource?Is the person feeling better? If not, what additional support is needed and how can you help make certain that the person receives it?</p></li><li><p>Major Facets of Crisis Response in the CommunityDuring the emergencyCommunication sounding the alarm if necessary clarifying additional steps providing information about the event the location of first aid stations if needed rumor control dealing with the media keeping track of students and staff responding to families interfacing with rest of the district and community</p></li><li><p>Major Facets ContinuedDirection and Coordination running an emergency operations center monitoring problemsproblem solving</p><p>Health and Safety mitigating hazards to protect people providing them with medical and psychological first aid providing for search and rescue, security, evacuation</p></li><li><p>Aftermath Response Immediate aftermathCommunication clarifying causes and impact and debunking rumors providing information about available resources for medical and psychological help Direction and coordinationdetermining need to maintain emergency operations centercontinuing to monitor problems and problem solveHealth and safetycontinuing with activities initiated during the event</p></li><li><p>Crisis Mode----Hyper-vigilance</p></li><li><p>Aftermath ResponseRestoring EquilibriumBe calm, direct, informative, authoritative, nurturing, and problem-solving orientedCounter denial by encouraging people to deal with facts of the eventGive accurate information and explanations of what happened and what to expect -- never give unrealistic or false assurances</p></li><li><p>Minimizing</p></li><li><p>Aftermath ResponseTalk about their emotional reactions </p><p>Encourage them to deal with such reactions as another way of countering denial and other defenses that interfere with restoring equilibrium</p></li><li><p>How the crisis is handled determines whether growth or disorganization will result</p><p>A CRISIS CANLEAD TO PERSONAL GROWTH</p></li><li><p>Convey a sense of hope and positive expectation -- that while crises change things, there are ways to deal with the impact.</p></li><li><p> The Crisis Reaction: Minds Response</p><p>Initial cognitive reaction of shock, denialRegression</p><p>Cataclysm of emotionsFear and terrorAnger, fury, and outrageConfusion and frustration Guilt or self-blameShame or humiliationGrief or sorrow </p><p>Reconstruction of new life equilibrium</p></li><li><p>A Crisis Changes Things</p></li><li><p>BRAIN 101</p><p>ANATOMY &amp; PHYSIOLOGY </p><p>YOUR BRAIN..IN CRISIS</p></li><li><p>Pg. 2-14PARIETALOCCIPITALCEREBELLUMFRONTALPRE FRONTALBRAIN STEM</p></li><li><p>The Brains StructureLimbic system: capacity for emotion, differentiation of perceptions and response</p><p>Hippocampus: perceives, registers and associates data; provides context</p><p>Amygdala: adds emotional content to the sensory information </p></li><li><p>The Brains Structure </p><p>Cortex / Neocortex: connects, comprehends, plans</p><p>Thalamus: internal alarm system (sends alarms to amygdala more quickly than to neocortex)</p></li><li><p>Cognitive Processing 101Normal Processing</p><p>Receive sensorial stimuliStimuli is determined not to be threatening or dangerous (thalamus)Organize and interpret information as usual (cortex and neo-cortex)Emotional content added (limbic system)</p></li><li><p>Cognitive Processing 101Traumatic Processing</p><p> Receive sensorial stimuli Stimuli is determined to be threatening or dangerous (thalamus) Emotions trigger physical and emotional reactions that override cognitive processing (limbic system) Scattered emotional information interferes with cognitive processing (cortex and neo-cortex)</p></li><li><p>The Shifting Balance of Thought &amp; Emotion</p></li><li><p>Traumatic and Narrative Memory: TraumaticNarrativeimages, sensation, affectivesemantic and symbolicand behavioral states</p><p>does not change over timesocial and adaptive</p><p>state-dependent; cannot be evoked at willcan be evoked at will</p><p>automatically evoked in can be condensed or expandedspecial circumstanceson social demandsNo condensed in time</p></li><li><p>Elements of Crisis Intervention</p><p>THE NOVA MODEL</p><p>Safety and Security</p><p>Ventilation and Validation</p><p>Prediction and Preparation</p></li><li><p>SafetySafety is a physical issue </p><p>Address physical safety or medical needs</p><p>Address survival needs such as food, clothing or the need for warmth and sleep</p><p>Provide information and a source of communication</p></li><li><p>Security - An Emotional Issue</p><p>To promote security a caregiver needs to:</p><p>Privacy for the expression of emotions.Confidentiality of communication.Reassurance Sense of control Sense of emotional safety.Page 4 - 3 thru 7Be certain that support systems are in place for care givers </p></li><li><p>RememberIn the midst of a crisis, it is hard to remember all the specific steps and preparatory plans that have been discussed.</p><p>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</p></li><li><p>Tools for Understanding and Responding: Safety and SecurityHelp 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.</p><p>Page 4 - 7</p></li><li><p>Ventilation</p><p>LET THEM TELL THEIR STORY</p><p>Compassionate presence</p><p>Effective LISTENING</p></li><li><p>Processing</p></li><li><p>ValidationVALIDATE THEIR REACTIONS</p><p>Focus on the commonality of reactions</p><p>Let survivors use and identify their own words for their crisis and reactions</p><p>Repeat key elements of the story</p></li><li><p>Tools for Understanding and Responding: Ventilation &amp;ValidationAsk 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.Dont 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.</p><p>Pages 4 - 7 thru 18</p></li><li><p>A Sense That One Can Never Do Enough </p></li><li><p>PredictionAsk what problems will be faced in the next days and how the individual plans to cope</p><p>Identify practical issues that may arise</p><p>Identify emotional reactions that might occur</p><p>One of the most important concerns of survivors is what is going to happen next?</p></li><li><p>Tools for Understanding and Responding: Preparation &amp; Prediction</p><p>Provide information on practical issuesProvide referralsExplain specifically how long assistance might be availableIdentify solvable problems &amp; solve themDont make promises that cant be keptPossible emotional &amp; physical reactions should also be predicted.</p></li><li><p>So.Two most important things that people in crisis need that each of you can do..</p><p> Let them tell their story</p><p> Validate their crisis reactions</p><p>AND THAT GOES FOR US AS CAREGIVERS TOO!</p></li><li><p>Care of the CaregiversCARE OF OTHERS CANNOT EXCEED CARE OF THE CAREGIVERS</p><p>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</p></li><li><p>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.</p><p>Lattanzi, M. (1984). Professional Stress: Adaption, Coping, and Meaning. Family Therapy Collections.</p></li><li><p>8. What bothers you the most about what happened?9. Do you think anyone could have done something to prevent it?Yes NoWho?10. Thinking back on what happened, </p><p>not at all a little more than a little very muchHow angry do you feel about it? 1 2 3 4How sad do you feel about it? 1 2 3 4How guilty do you feel about it? 1 2 3 4How scared do you feel? 1 2 3 4</p></li><li><p>Questions for Briefing1. Where were you when the event occurred? (Directly at the site? nearby? out of the area?)</p><p>2. What did you see or hear about what happened?</p><p>3. How are you feeling?</p><p>4. How well do you know those who were involved?</p><p>5. Has anything like this happened to you or any of your family before?</p><p>6. How do you think this will affect you/your family in the days to come? (How will your life be different now?)</p></li><li><p>Finding BalanceIntention 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 dont I need to carry with me for another day? Put it down, and dont pick it up again the next day. </p></li><li><p>Finding BalanceGratitudeAt both the beginning and end of your work day, take a distinct moment to think of one thing you are grateful for. </p><p>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.</p><p>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. </p></li><li><p> 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.</p></li><li><p>Finding BalanceIn addition to your day of rest, allot some time for yourself each day when you dont 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. </p></li><li><p>Local Response Needs?</p><p>Contact I-CARTIndiana Crisis Assistance Response Team317-596-2202www.i-cart.org</p><p>*19*Page 45-6*Page 4--7</p></li></ul>

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