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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 failed3. 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 CISMSurveillance, 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
AssessmentCircumstances
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 3rd 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.function3. improved
*
disorganization
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
ThemeWhat 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)