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Advanced School Crisis Training

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Management: Incident Commander. Community ... and Understanding of Reactions to Danger and Traumatic Stress ... of cumulative stress on staff ... – PowerPoint PPT presentation

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Title: Advanced School Crisis Training


1
Advanced School Crisis Training
  • Marleen Wong Melissa Brymer
  • School Crisis and Intervention Unit
  • National Center for Child Traumatic Stress
  • UCLA and Duke University

2
  • The Educators Mantra
  • There cannot be a crisis next
  • week
  • My schedule is already full.
  • -Henry Kissinger

3
US Department of EducationSCIU Priorities
  • Acts of Targeted Violence Project SERV
  • Safe Schools/Healthy Students (SAMHSA)
  • National Safe and Drug Free Schools Programs
  • State School Safety Programs
  • Persistently Dangerous Schools (NCLB)
  • NEMS

4
Schools as Open and Closed Systems
  • What Kind of Family System is Your School?
  • How is it Affected by Trauma?
  • Is there an Emergency Plan?
  • What kind of Mutual Agreements are in Place?
  • Is the Emergency Plan based on NEMS
  • (National Emergency Management System)

5
SEMS and NEMSStandardized Emergency Management
SystemNational Emergency Management System
  • Delineates the activities of the five SEMS or
    NEMS functions
  • Management Incident Commander
  • Community Operations EOB/EOC
  • Emergency Operations Board/Committee
  • Planning/intelligence,
  • Logistics and
  • Finance/administration

6
Managing the Crisis
  • Crisis Levels
  • Level I - Has a significant school-wide impact
  • Managed under the direction of the Principal or
    Site Incident Commander
  • Additional personnel may be requested by
    administrator through local district Operations
    Coordinator
  • School site team and other personnel work under
    the direction of school administrator
  • Level II Does not have school-wide impact and
    would not be a significant threat to the survival
    of the students or school personnel
  • School administrator continues to have authority
    and responsibility
  • However, team leader and crisis team members
    typically will manage this level crisis
  • Administrator needs to be kept informed and
    briefed

7
School Operations
  • Evacuation
  • Search and Rescue
  • First Aid/Emergency Medical Response
  • Hazard Mitigation
  • Psychological First Aid/Crisis Teams
  • Parent/Child Reunification

8
Multi-Level Intervention Options
  • Tier 1 General School-Based Interventions
  • Psychoeducation
  • Coping Skills
  • Support
  • Tier 2 Specialized School-Based Interventions
  • Trauma / Grief - Focused Counseling
  • Group, Individual, Family
  • Short-Term
  • Tier 3 Specialized Community-Based
    Interventions
  • Referral to On or Off-Site MH Services

9
Mental Health Objectives in School Settings
  • Restore the Learning Environment
  • Re-establish Calm Routine
  • Assist with Coping and Understanding of Reactions
    to Danger and Traumatic Stress
  • Re-unite Students with Caregivers ASAP
  • Support the Emotional Stabilization of Teachers
    and Parents

10
Secondary Adversities Compound Trauma
  • Loss of home, car, cherished belongings
  • Loss of social, personal, or familial ties
  • Loss of self-esteem, control over ones life
  • Loss of resources such as food, money, physical
    abilities

11
Advantages of School Based Programs
  • Schools are de facto mental health system for
    many children
  • Large numbers of at Risk/disadvantaged children
  • Existing Specialized Education Programs
  • SED/ED students with counseling mandated by IEP
  • School-based health clinics
  • Co-location of community mental health providers
  • Expanded school mental health programs
  • Surgeon Generals National Action Agenda for
    Childrens Mental Health and Presidents New
    Freedom Commission call for increase in school
    mental health programs

12
Obstacles to School Based Programs
  • Difficulty of Entry
  • Less than Ideal Clinical Conditions
  • (Flushing Meadows)
  • Overcoming Mission Creep
  • Motivating and Educating Educators
  • Tailoring the program for schools
  • (Bell Schedules, Tracks, Pupil Free Days)

13
Speaking the Language
  • Impact and Outcomes of Trauma Treatment
  • Academic achievement
  • Grades and standardized tests
  • Average Daily Attendance (ADA)
  • Decreased attendance means less money
  • Emotionally Disabled (ED) Students and IDEA
  • Services come out of school general fund
  • Improving classroom behavior and performance

14
From the Field of Brain Research
  • In order for children to learn
  • Eliminate Threat from the Environment
  • Enrich the Learning Environment

15
Rates of Exposure to the Range of Traumatic
Events in School Surveys
Elementary and middle school children in inner
city (n500) 30 witnessed a stabbing, 26
witnessed a shooting (Bell Jenkins,
1993). Middle and Junior High school students
(n2,248) in urban school system 41 reported
witnessing a stabbing or shooting in the past
year (Schwab-Stone et al., 1995).  High School
students (n3,735) in six schools in two states.
Relatively high rates of exposure in the past
year that varied by location and size of the high
school. Males 3-33 reported being shot or
shot at, 6 -16 attacked with knife. Females
Lower reported rates of victimization, higher
rates for sexual abuse or assault (Singer et.
al., 1995).
16
Link between Violence Exposure and Chronic PTSD
with
  • Substance Abuse
  • Reckless Behavior
  • High-risk Sexual Behavior
  • Gang Participation
  • Disturbances in Academic Functioning

(Kilpatrick, Saunders Resick, 1998)
17
Managing the Crisis
  • Crisis Levels
  • Level I - Has a significant school-wide impact
  • Managed under the direction of the Principal or
    Site Incident Commander
  • Additional personnel may be requested by
    administrator through local district Operations
    Coordinator
  • School site team and other personnel work under
    the direction of school administrator
  • Level II Does not have school-wide impact and
    would not be a significant threat to the survival
    of the students or school personnel
  • School administrator continues to have authority
    and responsibility
  • However, team leader and crisis team members
    typically will manage this level crisis
  • Administrator needs to be kept informed and
    briefed

18
SEMS and NEMSStandardized Emergency Management
SystemNational Emergency Management System
  • Delineates the activities of the five SEMS or
    NEMS functions
  • Management Incident Commander
  • Community Operations EOB/EOC
  • Emergency Operations Board/Committee
  • Planning/intelligence,
  • Logistics and
  • Finance/administration

19
School Operations
  • Evacuation
  • Search and Rescue
  • First Aid/Emergency Medical Response
  • Hazard Mitigation
  • Psychological First Aid/Crisis Teams
  • Parent/Child Reunification

20
The School in the Community
Municipal, State and Federal Government
Neighborhood and Greater Community
Public Health Services
Faith-Based Organizations
Students Parents and Guardians
Principals and Administrators
Non- Government Disaster and Relief Organizations
(i.e. American Red Cross)
Teachers
Law Enforcement Emergency Services
School
School Counselors, Psychologists and Social
Workers
District officials and School Board Members
Other School Staff Office and Custodial Staff,
Aides Cafeteria Workers
Media
School Police (Resource) Officers
Juvenile Justice
School Nurses and Doctors
Health Care
Child Welfare
Community Mental Health Substance
Abuse Agencies
Local, State and Federal Departments of Education
21
Lead Mental Health Agency
  • Department of Human Services Division of Mental
    Health
  • Responsible for the crisis counseling program
  • Crisis counseling is a time-limited program
    designed to assist victims/survivors/responders
    of a disaster in returning to their pre-disaster
    level of functioning
  • Two levels of grants Immediate Services Grant
  • Regular Services Grant

22
Homeland Security Advisory Recommendations for
Schools
  • Severe (Red)
  • Listen to radio, TV, and local news for current
    information and instructions
  • Be alert and immediately report suspicious
    activity to School Police or Sheriffs Department
  • Close school if recommended to do so by
    appropriate authorities
  • 100 identification check and escort anyone
    entering school other than students, staff, and
    faculty
  • Offer lessons Masters of Disaster Facing Fear
    Helping Young People Deal with Terrorism and
    Tragic Events curriculum
  • Ensure School Site Crisis Team members are
    available for students, staff and faculty

Adapted for LAUSD based on American Red Cross
Homeland Security Advisory
23
A Checklist For School Personnel To Evaluate And
Implement The Mental Health Component Of Your
School Crisis And Emergency Plan
  • MITIGATION PREVENTION
  • Identify and Assess the Risks
  • Identify the most common kinds of crises and
    disasters that may impact your school
  • Identify hazards or sites that may pose a threat
    to your school in the event of a disaster or
    terrorist act

24
Checklist for Schools (Continued)
  • PREPARATION of the MENTAL HEALTH CRISIS RESPONSE
    COMPONENT OF YOUR SAFE SCHOOL PLAN
  • Immediate long-term mental health responses
    should be included in plans
  • Establish relationships with local community
    mental health agencies that specializing in
    disaster and trauma
  • Define the roles of your school staff and
    community partners for different types of crises
    and phases of response and recovery
  • Conduct regular annual or bi-annual crisis team
    practice drills
  • Identify students and/or staff who may have
    special needs or may be psychologically
    vulnerable during crises
  • Plans should be culturally and linguistically
    appropriate
  • Provide new staff and substitutes adequate
    background information and training regarding
    crisis response
  • Create redundant or back-up systems
  • Annually review your plans
  • Conduct staff development on selected topics

25
Checklist for Schools (continued)
  • RESPONSE
  • Assess the level of student and staff exposure to
    violence and identify those most at risk
  • Activate community resources for the immediate,
    concrete needs of the students, families, and
    staff
  • Identify traumatic reminders of the event and
    monitor the range of trauma-related behaviors
    among students and staff
  • Implement a program of support and provide
    psychological educational materials to the school
    community
  • Develop media messages
  • Provide regular information updates and maintain
    open communication with teachers
  • Monitor rumors and maintain timely, accurate
    information
  • Develop a system to identify and follow
    psychologically vulnerable students and staff
    during the recovery period

26
Checklist for Schools (continued)
  • MENTAL HEALTH RECOVERY
  • Identify students/staff who may need long-term
    mental health support and develop the
    school/community resources to provide these
    services
  • Monitor the effects of cumulative stress on staff
  • Provide information on how to cope with
    cumulative stress and modify work roles/
    responsibilities of staff when needed
  • Make educational materials available to parents
    and staff on topics such as common symptoms and
    constructive ways to cope with stress
  • Develop short-term modifications of school
    curriculum as students and staff are recovering
  • Establish working relationship with Employee
    Assistance Programs
  • Offer school-based mental health services and
    identify funding to support those services (e.g.,
    Project SERV)
  • Follow up with student referrals made to
    community agencies
  • Note secondary adversities
  • Plan a response for the anniversary period

27
Types of Interventions
  • Individual or group crisis counseling
  • Wrap-up session with crisis team
  • Informational staff meetings
  • Informational parent meetings
  • Pscychoeducation on the effects of trauma
  • Referrals to school site resources or community
    agencies

28
Crisis Team Review
  • Review the crisis actions taken and services
    needed
  • Identify strengths and weaknesses of
    interventions
  • Review and monitor status of referred students
  • Identify students who have not returned back to
    school
  • Prioritize intervention activities
  • Establish action plan and follow up

29
Staff Meeting
  • Provide current information and fact sheets for
    staff
  • Discuss issues or problems related to the crisis
  • Help crisis team assess needs of staff, student,
    or parents
  • Inform staff regarding daily school schedule and
    action plan
  • Inform staff regarding the availability and
    location of school and community crisis
    intervention services
  • Explain follow-up actions
  • Revise action plan if needed

30
General Guidelines
  • Expect normal recovery.
  • Promote normal recovery.
  • Assume survivors are competent.
  • Recognize survivor strengths.
  • Support survivors to master the disaster
    experience.
  • Promote resiliency.
  • (Jon Shaw, 2004)

31
CISD
  • Seven Steps/Phases
  • Introduction
  • Fact phase
  • Thought phase
  • Emotional Reaction Phase
  • Symptom phase
  • Information phase
  • Re-entry phase
  • (Jon Shaw, 2004)

Mitchell 1983
32
Psychological Debriefing
  • Negative Dimensions
  • Individuals may become more aroused
  • Pathologizes and medicalizes the response
  • Learn maladaptive behaviors
  • Disparate individuals pulled into a group
    exercise without choice
  • May tell their story without resolution
  • Does not prevent onset of PTSS or PTSD
  • (Jon Shaw, 2004)

33
Psychological Debriefing
  • Who should participate?
  • Inclusion and exclusion criteria?
  • Optimal timing?
  • Single stand alone session vs. comprehensive
    anxiety management program?
  • (Jon Shaw, 2004)

34
The Timing of the Debriefing
  • Initially recommended at 24-72 hours post-crisis
  • Early debriefing may be hazardous
  • Stress and trauma may still be operative
  • Survivor may by in stage of physiological arousal
  • Aversive learning may take
  • place during this period
  • (Jon Shaw, 2004)

35
The Timing of the Debriefing
  • Debriefing should be provided after the arousal
    phase has subsided
  • May be more useful after the child has been
    reintegrated into the home or school setting
  • Focus on psychoeducation/ cognitive distortions
  • (Jon Shaw, 2004)

36
Single Episodevs.Multiple Episode Debriefing
37
  • There is little evidence that early single
    session intervention prevents psychopathology or
    reduces risk although it is generally well
    received by participants
  • (Jon Shaw, 2004)

Bison Psychiatric Annuals, 2003
38
Multiple-Session Early Psychosocial Intervention
  • The data suggests that multiple session early
    psychosocial interventions targeting symptomatic
    individuals commencing post arousal are more
    effective than single session early interventions
  • (Jon Shaw, 2004)

39
Debriefing Helpful Guidelines
  • Participants should be clinically assessed
  • Debriefing should be part of a comprehensive
    intervention programnot a stand-alone
    intervention
  • Debriefing should be provided after the arousal
    phase has subsided
  • (Jon Shaw, 2004)

40
Debriefing Helpful Guidelines
  • Leaders should be experienced
  • Group format is appropriateshould not be used as
    an individual intervention
  • Debriefing should be voluntary
  • (Jon Shaw, 2004)

41
Four Steps to Coping
  • Fact question
  • Introduce yourself
  • Tell us where you were when the tragedy occurred
  • Thought question
  • What was your first thought when you realized
    what had happened?
  • Feeling question
  • What was your worst feeling?
  • Assessment question
  • What would help you feel safer right now?

42
  • Provide
  • Psychological
  • First Aid

43
Psychological First Aid
  • Provide safety and security
  • Provide support and presence
  • Comfort and mitigate distress
  • Safeguard survivors from additional harm
  • Reduce physiological arousal
  • Clarify what happened
  • Provide reliable, credible information
  • Identify reminders
  • Reframe cognitive distortions
  • End with a positive or identifying restorative
    resources and positive coping

44
Psychological First Aid
  • Be proactive
  • Discuss developmental impact
  • Prosocial actions

45
Psychological First Aid
  • Psychosocial interventions
  • Facilitate reunion with loved ones
  • Identify distressed survivors for early attention
    and support
  • Provide information for action
  • (Jon Shaw, 2004)

46
Psychological First Aid
  • Routinize activities
  • Involve in reality-focused activities
  • Provide accurate disaster updates
  • Educate survivors on adaptive behaviors
  • Identify risks and resources
  • Use effective communication techniques
  • (Jon Shaw, 2004)

47
Teacher Interventions
  • Provide structure
  • Stay calm
  • Reinforce safety and security
  • Be patient
  • Reduce class workload as needed
  • Be an active listener
  • Be sensitive to language and cultural needs
  • Set realistic perspectives
  • Be nonjudgemental
  • Defuse anger
  • Do not tolerate negative or cruel behavior
  • Reduce immediate reminders
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