Crisis Ministry

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Department of Pastoral Ministry TrainingAMEDDCS

• Crisis Ministry

Chaplain (COL) Gordon G. Groseclose Chief,
Department of Pastoral Ministry Training Fort Sam
Houston, Texas
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THE NEED

• Over 80 Americans will be exposed to a
  traumatic event (Breslau) About 9 of those
  exposed develop Post Traumatic Stress Disorder
  (PTSD) (40 - 70 IN RAPE, TORTURE) (Surgeon
  General, 1999, Report on Mental Illness)
• Disasters may create significant impairment in 40
  - 50 of those exposed (Norris, 2001, SAMHSA)

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THE NEED

• About 50 of disaster workers likely to develop
  significant distress (Myers Wee, 2005, Dis.
  Men. Health)
• Terrorism likely to affect majority of population
  (IOM, 2003) Ranges from 40 - 90 (JHCPHP,
  2005, Resource Paper)
• Dose - response relationship with exposure is a
  key factor in development of PTSD

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• PTSD PREVALENCE 10 - 15 OF LAW ENFORCEMENT
  PERSONNEL (see Everly Mitchell, 1999)
• PTSD PREVALENCE 10 - 30 OF THOSE IN FIRE
  SUPPRESSION (see Everly Mitchell, 1999)
• PTSD PREVALENCE 16 VIETNAM VETERANS (Nat PTSD
  Study)

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• PTSD PREVALENCE 12 IRAQ WAR VETERANS (Hoge,
  et al., 2004, NEJM)
• AS MANY AS 45 OF THOSE DIRECTLY EXPOSED TO MASS
  DISASTERS MAY DEVELOP PTSD or DEPRESSION
  (North, et al., 1999, JAMA)

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DEFINITIONSCRITICAL INCIDENTS are unusually
challenging events that have the potential to
create significant human DISTRESS and can
overwhelm ones usual coping mechanisms.
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DEFINITIONSThe psychological DISTRESS in
response to critical incidents such as
emergencies, disasters, traumatic events,
terrorism, or catastrophes is called a
PSYCHOLOGICAL CRISIS(Everly Mitchell, 1999)
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PSYCHOLOGICAL CRISIS

• An acute RESPONSE to a trauma, disaster,
• or other critical incident wherein
• Psychological homeostasis (balance) is
  disrupted (increased stress)
• Ones usual coping mechanisms have failed
• There is evidence of significant distress,
  impairment, dysfunction
• (adapted from Caplan, 1964, Preventive
  Psychiatry)

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IMPORTANT!Crisis intervention targets the
RESPONSE, not the EVENT, per se.Thus, crisis
intervention and disaster mental health
interventions must be predicated upon assessment
of need.
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CRISIS INTERVENTION

• An active, short - term, supportive, helping
  process.
• Acute intervention designed to mitigate the
  crisis response.
• Not psychotherapy or a substitute for
  psychotherapy.

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CRISIS INTERVENTION

• Goals
• 1. Stabilization
• 2. Symptom reduction
• 3. Return to adaptive functioning, or
• 4. Facilitation of access to continued care
• (adapted from Caplan, 1964, Preventive Psychiatry)

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Crisis Ministry

• References
• FM 4-02.51
• FM 6-22.5

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• Applying the Principles of
• B. I. C. E. P. S.
• To Crisis Ministry

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Crisis Ministry

• B revity
• Crisis intervention time as short as possible for
  quick return to duty (RTD)
• I mmediacy
• Begin ministry as soon as possible
• C ontact
• Unit maintains contact with the soldier
• E xpectancy
• Positive expectation of RTD
• P roximity
• Treat as closely as possible in a location near
  the soldiers unit
• S implicity
• Brief and straightforward methods to restore
  physical, emotional and spiritual balance and
  self-confidence.

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Crisis Ministry

• Brevity

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Crisis Ministry

• Immediacy

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Crisis Ministry

• Contact

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Crisis Ministry

• Expectancy

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Crisis Ministry

• Proximity

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Crisis Ministry

• Simplicity

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Crisis Ministry

• Simplicity
• Reassure of normality
• Rest from combat or break from work
• Replenish bodily needs, i.e. food, water,
  hygiene, sleep.
• Restore confidence
• Return to duty and Re-unite with unit
• Remind the soldier of Army values

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Questions?
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Crisis Ministry

• S.A.F.E.R. MODEL
• STABILIZE
• ACKNOWLEDGE
• FACILITATE
• ENCOURAGE
• RESTORE/REFER

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Crisis Ministry

• STABILIZE
• Remove person in crisis from stressor
• Need a break
• Need information

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Crisis Ministry

• ACKNOWLEDGE
• What is happening with you at this moment?
• What is the worst part right now?
• What will help you right now?

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Crisis Ministry

• FACILITATE
• Assist in identifying nature of crisis
• Reinforce cognitive processing
• Frame reactions as normal

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Crisis Ministry

• ENCOURAGE
• Assess ability to function (SEA-3)
• SPEECH
• EMOTIONS
• APPEARANCE
• ALERTNESS
• ACTIVITY
• Explore and identify coping skills
• Develop plans for immediate use

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Crisis Ministry

• RESTORE/REFER
• What are your resources?
• Where are they?

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Questions?
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Crisis Ministry

• ONE ON ONE INTERVENTION
• ESTABLISHING RAPPORT

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Crisis Ministry

• ACTIVE LISTENING
• Allow silence
• Attend nonverbally
• Paraphrase
• Reflect feelings
• Allow expression of emotions

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Crisis Ministry

• SOME DO SAY
• These are normal reactions to a disaster or
  abnormal situation
• It is understandable that you feel this way
• You are not going crazy
• You did the best you could
• Things may never be the same, but they can get
  betterand fell better

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Crisis Ministry

• SOME DONT SAY
• It could have been worse.
• You can always get another pet/car/house.
• Its best if you just stay busy.
• I know just how you feel.
• You need to get on with your life.

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Crisis Ministry

• PROBLEM-SOLVING
• Identify and define the problem
• Assess the survivors functioning and coping
• Evaluate available resources
• Develop and implement a plan

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Crisis Ministry

• A WORD OF CAUTION
• Because you want to help does not mean someone
  wants your help.
• Empower by helping them solve their own problems
  this is different from doing for them.

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Crisis Ministry

• CONFIDENTIALITY
• A helping person/Chaplain/Clergy is in a
  privileged position. No case should be discussed
  without consent of the person being helped.

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Questions?
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STRATEGIC PLANNING
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The challenge in crisis intervention is not only
developing TACTICAL skills in the core
intervention competencies, but is in knowing
WHEN to best STRATEGICALLY employ the most
appropriate TYPE of intervention for the
situation.
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Consider when choosing the TYPE of
intervention...
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Strategic Planning Formula6 Ts

• Threat What specific threat is the focus of
  the intervention plan, eg, hurricane,
  bioterrorism, earthquake, etc?
• Themes Themes are factors which may serve to
  modify the psychological impact of the event or
  the nature of the intervention (child fatalities,
  mass disasters, biological contagion)
• Target What target populations will most likely
  be in need of assistance / support?

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Strategic Planning Formula6 Ts

• Type What specific types of interventions will
  be needed, eg, demobilizations, town meetings,
  hotlines, CISDs, etc?
• Timing When will each of the selected
  interventions be implemented so as to be most
  effective?
• Team What resources will it take to provide the
  right interventions at the right time? Internal
  vs External resources.

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A Shortened 3 - Step PLANNING PROCESS -
-Begin a THREAT - SPECIFIC disaster plan
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Step 1 Specify (probable) THREAT
______________(e.g., earthquake, plane crash,
flood, etc.)
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Step 2 Specify TARGET POPULATION(S)
_____________(schools, first responders,
community, hospitals, assisted living facilities,
etc.)Stay in your Lane.
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Step 3 Specify what crisis INTERVENTIONS you
would utilize for the selected population(s),
and WHEN you would use them
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DONT FORGET WHO YOU ARE
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Questions?