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TEAM RESPONSIBILITIES: School Mental Health Crisis Intervention Teams

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Title: TEAM RESPONSIBILITIES: School Mental Health Crisis Intervention Teams


1
TEAM RESPONSIBILITIESSchool Mental Health
Crisis Intervention Teams
  • Eric M. Vernberg, Ph.D.
  • University of Kansas
  • Clinical Child Psychology Program
  • Terrorism and Disaster Branch, NCTSN

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

3
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

4
Four Phases of Disasters
5
Mitigation
  • The First Purpose Outlined in the EOP
  • Prevent avoidable disasters prevention and
    reduce the vulnerability mitigation of
    students, faculty, administration, and school
    property to any disaster that may strike
  • Pre-emergency mitigation involves the on-going
    efforts to reduce hazards, the likelihood of
    their occurrence, and/or the severity of their
    impact if experienced.

6
Current Mitigation Measures - Examples
  • Bomb Threat
  • Minimizing the presence of hazardous
    flammable/explosive materials in the
    buildings/schools
  • Bus Accident
  • Buses are well maintained
  • Earthquake
  • Reinforcing the connection of light fixtures to
    the ceiling

7
Mitigation Measures - Mental Health
  • Build community at school
  • Identify, monitor, and support at-risk students
    and staff
  • Develop ties with mental health resources
  • Work to develop resilient students and staff
  • Obtain parental consent prior to traumatic event
  • for screening students

8
From the Field of Brain Research
  • In order for children to learn
  • Eliminate Threat from the Environment
  • Enrich the Learning Environment

9
Rationale for Screening Children
  • Exposure can affect childrens behavior,
    emotions, learning
  • Trauma-related symptoms often go unnoticed
    untreated
  • Symptoms do not necessarily go away on their own
  • School-based screenings can effectively identify
    children who may benefit from treatment
  • Effective, relatively brief treatment produce
    positive results that last
  • School- community-based mental health
    clinicians can provide these treatments

10
Important Aspects of Good Screenings
  • Confidentiality assured (how will data be used?)
  • Tied to organizations that provide for basic
    needs after disasters
  • Assessment linked to low-or no-fee services
  • Clear rationale for screening provided
  • Endorsed by a well-known, trusted organization

11
Resilience
  • Adapting in a positive manner or thriving in the
    face of great stress or adversity
  • Helping students bend - not break


12
Resilience
  • Remember Most students will recover well with
    the support of family, friends, and community
    organizations
  • What began as a quest to understand the
    extraordinary has revealed the power of the
    ordinary.
  • - Masten, 2001

13
Resilient Characteristics
  • Optimistic - enduring hope
  • Self-efficacy -belief they have needed skills
  • Sense of mastery - problem solving, achieving
    goals
  • Personal competencies - academic or social skills
  • Cohesive families - includes connectedness to
    school
  • Coping skills - modeled by adults in their
    environment
  • Hardiness - active, see change as a challenge
  • Resilience info from www.apahelpcenter.org


14
Actions to Promote Resilience - Examples
Goal Increasing connectedness to others
  • Preparedness
  • Assess and address social isolation and bullying
  • Classroom projects that promote teamwork,
    respect, and bonding to the school
  • During Response
  • Keep students grouped with familiar peers
  • Have distraught students comforted by familiar
    adults
  • Reunification plan

15
Actions to Promote Resilience - Examples
Goal Increasing feelings of empowerment (active
coping)
  • Preparedness
  • Practice safety plans
  • Find ways to help others as a class (e.g.,
    raising , writing letters)
  • During Response
  • Ask students to help you w/ a manageable task
  • Give students age-appropriate duties (handing out
    water, comforting younger students)

16
Actions to Promote Resilience - Examples
Goal Maintaining consistency and predictability
  • Preparedness
  • Keep a daily routine
  • Encourage family members to provide structure for
    students
  • During Response
  • Remind students about safety plan
  • Keep students informed using easy-to-understand
    language

17
Actions to Promote Resilience - Examples
Goal Take a break
  • Preparedness
  • Help students focus on positive images in the
    media
  • Brainstorm healthy activities that are not
    associated with anxious feelings
  • During Response
  • Limit graphic talk or media exposure of the
    trauma
  • Shield students from further exposure to
    traumatic stimuli/scenes

18
Actions to Promote Resilience - Examples
Goal Teach self-care skills
  • Preparedness
  • Teach basic relaxation skills (e.g., test
    preparation)
  • Encourage healthy habits exercise, eating, and
    sleeping
  • During Response
  • Shield students from further exposure to
    traumatic stimuli/scenes
  • Prompt students to use positive coping skills
    (relaxation, verbalizing feelings, social
    support)

19
Promoting Resilience -What Doesnt Work
  • Forcing students to talk about feelings
  • Avoiding all discussion about traumatic event
  • Being a poor model
  • Allowing your personal resources to be drained
  • Using negative coping
  • Showing uncontrolled emotions in front of
    students

20
Risk Factors
  • Greater exposure to traumatic event or graphic
    media coverage
  • Lack of family cohesion or parental distress
  • Financial or marital problems in family
  • Socially-isolated or bullied students
  • Exposure to previous traumas
  • Previous mental health or behavioral pxs
  • Recent life stressors or major changes
  • Community disruption

21
Types of Exposure
  • Bereavement
  • Injury to self or family member
  • Panicking, feelings of dissociation during
    disaster
  • Horror/ gruesome scenes
  • Property damage or financial loss
  • Relocation
  • Entrapment
  • Separation from family

22
Exposure Screening
  • Adults tend to minimize or underestimate
    students responses to trauma
  • Prevents traumatized students with internalizing
    symptoms from being overlooked
  • Helps tailor intervention to students needs
  • Shields low-exposure students from being exposed
    to graphic discussions of high-exposure students
    in group discussions/interventions

23
Threat Assessment - Overview
  • Step One Receipt of information by the schools
    multidisciplinary threat assessment team and
    notification of the district office
  • Step Two Assess the threat itself
  • Step Three Conduct a 4-pronged assessment if the
    ID of the threatener is known
  • Step Four Involve law enforcement in conducting
    a threat investigation and in deciding on the
    threat level and appropriate response

24
Threat Assessment Step 1
  • Multidisciplinary Team
  • School administrator
  • Faculty member
  • School resource officer (where available)
  • Counselor
  • Mental health professional

25
Threat Assessment Step 1
  • Information will be organized into 4 categories
  • Information about the individual suspected
  • Information about attack-related behavior
    (planning, weapons acquisition/ practice, casing
    out possible sites, rehearsing, etc.)
  • Motives
  • Target selection

26
Threat Assessment Step 2
  • Low Level the threat is vague/lacks detail
    contains inconsistent information not
    plausible
  • Medium Level threatener has given thought to how
    the act will be carried out general info about
    place time, but no strong indication of
    preparatory steps having been taken
  • High Level wording is direct, specific and
    plausible suggests that concrete steps have
    been taken toward carrying out the act

27
Threat Assessment Step 3
  • 4-pronged Assessment Model (FBI)
  • Assess the personality of the threatener (how
    s/he copes with conflict, expresses anger,
    responds to rules, etc.)
  • Assess the family dynamics
  • Assess the school dynamics
  • Assess the social dynamics

28
Threat Assessment Step 3
  • Assess the personality of the threatener
  • Frustration tolerance
  • Coping skills/resiliency
  • Relationships with others (romantic platonic),
    alienation
  • Response to rules, authority figures
  • Desire for control, attn., respect, admiration,
    confrontation
  • Expression of empathy
  • General attitude toward others
  • Leakage

29
Threat Assessment Step 3
  • Assess the family dynamics
  • Traditions, roles, customs, values
  • Relationships between family members, who is in
    charge?
  • Any disruptions to family system
  • How does family handle conflict or stressors
  • Access to weapons or violent media

30
Threat Assessment Step 3
  • Assess school dynamics role in those dynamics
  • Beliefs, traditions, roles, customs, values
  • To what clique does student belong?
  • Relationships with peers
  • Relationships with teachers
  • Bullying - perpetrator or victim

31
Threat Assessment Step 3
  • Assess social dynamics
  • Beliefs, traditions, roles, customs, values of
    larger community
  • What is neighborhood like? Are neighbors close to
    one another?
  • Safety of neighborhood
  • Choice of friends, activities, attitudes
  • Drug/alcohol use
  • Media (TV, computer games, internet, books, etc.)
  • Role models

32
Threat Assessment Step 4
  • Involve law enforcement
  • conducting a threat investigation as appropriate
  • deciding on the threat level and appropriate
    response

33
TEAM RESPONSIBILITIESDuring the Disaster
  • Eric M. Vernberg, Ph.D.
  • University of Kansas
  • Terrorism and Disaster Branch, NCTSN

34
Four Phases of Disasters
35
TriageFrench to sort
  • Victims are sorted/tagged into four categories
  • Immediate (Red) - life-threatening injuries
    requiring rapid tx
  • Delayed (Yellow) - injuries do not jeopardize the
    victims life if treatment is delayed
  • Non-emergent (Green) - no need to be transported
    by ambulance, the walking wounded
  • Dead (Black) - no respiration after 2 attempts to
    open the airway

36
First Aid Team Duties
  • Establish triage location
  • Establish four treatment areas
  • Red area for victims with life-threatening
  • Yellow area for victims without immediate
    life-threatening injuries
  • Green area (away from other areas) for victims
    with minor injuries
  • Black area (away from other areas) for the dead
    or mortally wounded
  • Assign a triage team leader if Nurse is not
    available

37
Triage
PERSONNEL STATUS
Injured/Sick as of time/date___________ Location
________________ Number of personnel in
attendance this date Students_____ Staff_____
38
Triage
Triage Accountability Form
39
The First Few Hours On Your Own
  • Schools will be highly prioritized by emergency
    responders
  • Should be prepared to manage on their own for 3
    or more hours when involved in an area-wide
    disaster
  • You could find yourself on the front lines of a
    mental health response to a disaster

40
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

41
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

42
The First Few Hours What Students Will Need to
Know
  • Adults are in control and will help keep them
    safe
  • What happened and the order of events
  • (keep it simple, no graphic details)
  • What will happen, especially how they will be
    reunited with caregivers
  • That what they are feeling in response to the
    disaster is normal
  • Words to help them organize their thoughts about
    the events and their feelings

43
The First Few Hours What to Do
  • In the event of an evacuation, keep each
    classroom grouped together
  • Keep students near familiar peers and adults
  • Keep students grouped with their classroom rather
    than putting them into a larger group of
    students or letting them detach themselves from
    the classroom
  • Shield students from seeing damage or severe
    injuries if possible

44
The First Few Hours What to Do -2
  • Use distraction techniques (snacks, songs, games)
    to help reduce focus on traumatic scenes or
    events
  • If a student becomes distraught, have an adult
    who knows the student provide comfort
  • Model good coping. Use the buddy system to take
    time away from the student if needed to cope
    with your own stress/emotional response
  • Meet students physical needs (bathroom breaks,
    snacks) - helps reassure them that adults will
    take care of them

45
The First Few Hours What to Say
  • Provide clear, simple explanations for what
    happened and what will happen
  • Acknowledge students feelings and help them
    label them
  • If you do not know the answers to the students
    questions, admit it and tell them how you can
    find out the answers

46
The First Few Hours What to Say - 2
  • Reflect students feelings, but redirect them
    from talking excessively about gruesome or
    terrifying details
  • Praise students for their bravery, helping peers,
    following your directions, etc.
  • Before students are released to caregivers,
    summarize the disaster and its resolution to the
    class.

47
Goals at Disaster Site
  • PROTECT - shield children from
  • Bodily harm
  • Exposure to traumatic stimuli (sights, sounds,
    smells)
  • Media exposure
  • DIRECT - ambulatory students in shock,
    dissociative
  • Use kind and firm instruction
  • Move away from danger, destruction, severely
    injured
  • CONNECT
  • To you - be a supportive presence
  • To caregivers
  • To accurate information
  • (Young, Ford, Ruzek, Friedman Gusman,
    National Center for PTSD)

48
Crisis Response
  • Triage for signs of stress that jeopardize safety
  • Segregate survivors based on exposure level
  • Control flow of information and limit unnecessary
    re-exposure
  • As appropriate, activate the Regional Homeland
    Security Mental Health Response System
  • Begin psychological first aid (reestablish the
    perception of security and sense of power)
  • The majority of children will display normal
    stress reaction

49
Immediate Crisis Intervention
  • To help manage intense feelings of panic or
    grief
  • Signs of panic - trembling, agitation, rambling
    speech,
  • becoming mute, or erratic behavior
  • Signs of intense grief - loud crying, rage, or
    catatonia
  • Attempt to quickly establish rapport
  • Ensure the students safety and offer empathy
  • Remain with the student in acute distress or find
    someone to remain with him or her until initial
    stabilization
  • (Young, Ford, Ruzek, Friedman Gusman
  • National Center for PTSD)

50
Psychological First Aid
  • Psychosocial interventions
  • Facilitate reunion with loved ones
  • Identify distressed survivors for early attention
    and support
  • Provide information for action

51
Crisis Intervention for Acute Stress Reactions
Definition
  • Frontline interventions delivered during
    the emergency phase to individuals
    experiencing acute stress reactions or who
    appear to be at risk for not being able to
    regain sufficient functional equilibrium on
    their own.

52
On-Scene Support and Psychological First Aid
What would you expect to observe in individuals
experiencing acute stress reactions or in people
who appear to be at risk for not being able to
regain sufficient functional equilibrium on their
own?
53
On-Scene Support and Psychological First Aid
Signs of Acute Stress Reactions and Insufficient
Functional Equilibrium
  • Extreme anxiety (e.g., fear, panic, worry).
  • Dissociative reactions (e.g., experiencing the
    world as dreamlike, marked detachment,
    depersonalization).
  • Uncontrollable intense grief (i.e., incongruent
    with cultural norm.
  • Marked sleep difficulties, loss of appetite, or
    poor hygiene.
  • Extreme cognitive impairment (e.g., confusion,
    poor concentration, poor judgment and poor
    decision-making, inability to make decisions,
    overwhelming feelings of helplessness resulting
    compromised self-care.
  • Marked intrusive thoughts including traumatic
    imagery.

54
On-Scene Support and Psychological First Aid
When acute stress reactions or insufficient
functional equilibrium are present, what might be
the the objectives of providing support and
psychological first aid? That is, what would you
try to do?
55
On-Scene Support and Psychological First Aid
PRIMARY GOALS
  • Establish safety and security
  • Reduce stress-related reactions
  • Connect to restorative resources

56
On-Scene Support and Psychological First Aid
  • Establishment of safety and security

GOAL
Principal Interventions
Direct survivors to safe and secure areas If
first on-scene give direction to areas away
from life threatening danger, toxic and harsh
elements, and exposure to additional traumatic
stimuli.
57
On scene Support and Psychological First Aid
  • Stress-related reaction reduction

GOAL
Principal Interventions
Protect survivors from exposure to traumatic
stimuli Examples of traumatic
stimuli Witnessing grotesque death, dead bodies,
strong odors, frightening sounds (including those
from dying, injured, or emotionally distressed
survivors), and disturbing media coverage (e.g.,
extensive print media/television coverage).
58
On-scene Support and Psychological First Aid
  • Reducing stress-related reactions

GOAL
Principal Interventions
Educate survivors about common stress
reactions Mental health responders must become
familiar, (i.e., memorize) types of common and
acute stress reactions to be able to validate
survivor reactions and to be able to provide
anticipatory guidance about what survivors can
expect over the course of time in themselves,
significant others, and children.
59
On-scene support and Psychological First Aid
GOAL
  • Reducing stress-related reactions

Instruct survivors how to use breathing
techniques to lower arousal
60
  • Reducing stress-related reactions

GOAL
Coping With Distressing Intrusive
Thoughts Arrange an activity that orients the
individual to the the present, such as After
acknowledging distress, gently suggest an
activity (e.g., walking, washing face and hands,
deep breathing, eating), and redirect attention
to the experience of the activity to disrupt the
flow of intrusive thoughts or distressing
anxiety. Give person something to hold or to
touch, (e.g., a pen, a purse, a book, clothing,
chair) and ask him or her to describe what each
feels like. Give orientation to environment
(date, time, and place) and ask the person repeat
back his or her orientation to the environment.
61
On-scene support and Psychological First Aid
  • Reducing stress-related reactions

GOAL
Reframing cognitive distortions It is not
uncommon for clinicians to encounter survivors
who have quickly developed cognitive distortions
related to helplessness, fear, guilt, anger and
rage. Such encounters present an opportunity for
mental health responders to deliver an early
intervention, that is, cognitive restructuring or
reframing to counter such distortions.
62
Reframing cognitive distortions
THEME Guilt and thoughts about self
  • NEGATIVE THOUGHTS
  • I was a coward.
  • Because of me, other people died.
  • I should this have gotten over this by now.

REFRAME You felt afraid, but your actions kept
you from further injury. Many factors beyond
your control resulted in the deaths that
occurred. You feel inpatient with yourself. It
takes time get through something like this.
Many other survivors are at the same place that
you are right now.
63
Reframing cognitive distortions
Theme Helplessness and fear
  • REFRAME
  • You felt helpless, and your actions saved your
    life and it appears that you continue to help
    yourself.
  • Fear is natural and helped you to survive.
    Gradually you can ease out of it.
  • You feel it is important to protect your family.
    There will be times when you need to be on guard
    but there are times that when you wont. You
    dont always have to be on guard.

NEGATIVE THOUGHTS I was helpless then I wont be
able to cope with future events either. Its
unacceptable to experience fear The world is
extremely dangerous. I must constantly be on
guard to protect myself and family.
64
Psychological First Aid
  • Connection to restorative resources

GOAL
Principal Interventions
In addition to directing survivors to restorative
resources, there are times when the mental health
responder takes a more active role (than
conventional clinical work) to ensure the linkage
or connection to restorative resources.
65
On-scene support and Psychological First Aid
GOAL
  • Connection to restorative resources
  • Examples of active help (i.e. problem solving)
  • Helping survivor to obtain food, liquid,
    necessary clothing
  • Helping survivor to replace or obtain new
    medications
  • Arranging transportation for survivor to a
    shelter, emergency mental health services
    clinic (ER), or relief and information centers
  • Helping survivor to connect to social support
    (family, significant others,
    friends) making phone calls for survivor
  • Helping survivor to link to information providers
  • Advocating on behalf of the survivor
  • Referring survivor

66
Psychological First Aid for Children Preschool
Through Second Grade
  • Provide support, rest, comfort, food, opportunity
    to play
  • or draw
  • Reestablish adult protective shield reassure
    that adults will keep them safe and meet their
    needs
  • Give repeated concrete clarifications for
    anticipated
  • confusions
  • Provide emotional labels for common reactions
  • Help to verbalize general feelings/complaints so
    they will not feel alone with their feelings

67
Psychological First Aid for Children Preschool
Through Second Grade
  • Separate what happened from physical reminders
    (e.g., monkey-
  • bars, parking lot) to counter children
    attributing magical
  • qualities to traumatic reminders
  • Encourage them to let their parents and teachers
    know when
  • thoughts and feelings interfere with learning
  • Provide consistent caretaking (e.g. assurance of
    being picked up
  • from school, knowledge of caretakers
    whereabouts)
  • Tolerate regressive symptoms in a time-limited
    manner
  • Give explanations about the physical reality of
    death

68
Psychological First Aid for Children Third
Through Fifth Grade
  • Help to express their secretive imaginings about
    the event
  • Help to identify and articulate traumatic
    reminders and anxieties
  • encourage them not to generalize
  • Permit them to talk and act it out address
    distortions, and
  • acknowledge normality of feelings and reactions
  • Encourage expression of fear, anger, sadness, in
    your supportive
  • presence
  • Encourage to let teachers know when thoughts and
    feelings interfere
  • with learning
  • Support them in reporting dreams, provide
    information about why we
  • have bad dreams

69
Psychological First Aid for Children Third
Through Fifth Grade
  • Help to share worries reassurance with realistic
    information
  • Help to cope with the challenge to their own
    impulse control (e.g.
  • acknowledge It must be hard to feel so angry)
  • Offer to meet with children and parent(s) to help
    children let parents
  • know how they are feeling
  • Encourage constructive activities on behalf of
    the injured or deceased
  • Help to retain positive memories as they work
    through the more
  • intrusive traumatic memories

70
Psychological First Aid for Children Sixth Grade
and Up
  • Encourage discussion of the event, feelings about
    it, and realistic
  • expectations of what could have been done
  • Help them understand the adult nature of these
    feelings
  • Encourage peer understanding and support
  • Help to understand their acting out behavior as
    an effort to numb their
  • responses to, or to voice their anger over, the
    event
  • Address the impulse toward reckless behavior in
    the acute aftermath
  • link it to the challenge to impulse control
    associated with violence

71
Psychological First Aid for Children Sixth Grade
and Up
  • Discuss the expectable strain on relationships
    with family and peers
  • Elicit their actual plans of revenge address the
    realistic consequences
  • of these actions encourage constructive
    alternatives that lessen the traumatic sense of
    helplessness
  • Link attitude changes to the events impact
  • Encourage postponing radical decisions in order
    to allow time to work
  • through their responses to the event and to
    grieve

72
Student/Family Reunification Team
  • Responsible for supervising the reunification
    site and the releasing of students to their
    parents/guardians
  • Oversee location where students assemble
  • Attend to student needs when providing shelter
  • Reunite students with their parents or guardians
    in an efficient and orderly manner
  • Materials needed Radios/pagers, cell phones,
    clipboards, paper, pens, markers, rosters,
    student emergency medical cards, yellow caution
    tape or portable plastic construction fencing

73
Student/Family Reunification
Adult Report Point
Runner
Student Holding Area
Runner
Student Release Point
Mental Health Team
Security Team
74
Student/Family Reunification
Adult Report Point
Runner
Student Holding Area
Runner
Student Release Point
Mental Health Team
Security Team
75
Adult Report Point
  • 2 or more members of the Student/Family
    Reunification Team will greet arriving adults
  • Provide the adult a copy of the Student Release
    Form, adult completes the first section
  • Confirm the adults id (government issued picture
    identification)
  • Confirm that the adult is listed on the emergency
    data card for the student as being authorized to
    pick up the student
  • Complete the second section of the Student
    Release Form, hand it to a Runner to be carried
    to the Student Holding Area
  • Adult will step around to the Student Release
    Point and wait for the Runner to return

76
Student/Family Reunification
Adult Report Point
Runner
Student Holding Area
Runner
Student Release Point
Mental Health Team
Security Team
77
Student Holding Area
  • Runner will deliver the Student Release Form to
    the 2 or more members working at the entrance to
    the Student Holding Area.
  • If the requested student is present in the
    holding area
  • Requested student will report to team members
  • Record on roster that the student has been
    released
  • Check off the Sent with Runner entry in the
    third section of the Student Release Form
  • Send the student with a Runner to the Student
    Release Point
  • If the student is not available for pickup or is
    missing
  • Make the appropriate entry in third section of
    the Student Release Form
  • Enter comments to clarify the status
  • Runner will deliver the Student Release Form to
    the Student Release Point.

78
Student/Family Reunification
Adult Report Point
Runner
Student Holding Area
Runner
Student Release Point
Mental Health Team
Security Team
79
Student Release Point
  • If the student is available for pickup
  • When the Runner delivers the Student Release
    Form to the Student
  • Release Point, the Team Members will call for
    the adult
  • Adults id will again be confirmed (govt issued
    picture id)
  • Adult will sign for the student and depart the
    area with the student
  • If the student is not available for pickup
  • Team member will link the adult with a MH Team
    Member
  • MH team member will make the notification
    privately based on the information provided in
    the third section of the Student Release Form
  • The MH Team will be responsible for helping the
    adult and finding answers to the resulting
    questions

80
Psychological First Aid for the Bereaved
  • Possible talking points
  • When did you and your family get the news of the
    death(s)?
  • How were you notified?
  • Who told you?
  • Are you in touch with relatives or friends who
    are able to provide emotional support and help?
  • Do you need assistance in contacting relatives
    and friends either to notify them or ask for
    help.
  • Have strategy in place to make it easier for
    contact. Have phones available in quiet place.

81
Psychological First Aid for the Bereaved
  • INITIAL CONTACT
  • Do you know anyone who was killed or injured?
  • Be prepared to be present with survivors intense
    emotions and stay with them as a steady and safe
    personal presence.
  • Acknowledge the relationship and seriousness of
    the loss.

82
Psychological first aid for the bereaved
  • Things to Say and Do
  • I am sorry that she/he is gone.
  • I cant imagine what you are going through.
  • Mention the name of the deceased during
    conversations.
  • Continue to offer your presence to help.
  • Acknowledge the degree of distress and painful
    emotion that the survivor is willing to express.
  • Respect the way in which the survivor is coping
    with his/her emotions. Some avoidance and denial
    may be expected according to cultural or gender
    differences.

83
Psychological first aid for the bereaved
  • INITIAL CONTACT Things not to say
  • I know how you feel.
  • It was probably for the best.
  • She/Hes happy now.
  • It is Gods will.
  • It was his or hers time to go.
  • Lets change the subject.
  • You should work towards getting over this/you are
    strong enough to deal with it.
  • You should be glad the deceased passed quickly.

84
Psychological first aid for the bereaved
  • THINGS TO REMEMBER
  • Respect individual timing
  • Avoidance may be a way to cope with grief
    intensity
  • Be ready to offer supportive listening
  • Encourage bereaved to talk with other survivors
    who are suffering losses
  • Enhance realistic beliefs
  • Help the bereaved to identify their resilience
    including past successful coping, support and
    spirituality
  • Encourage positive memories of the deceased

85
Psychological first aid for the bereaved
  • Educate
  • Intense emotions may come and go like waves
  • Self-care
  • It is normal to feel and express intense emotions
    at this time
  • Do not feel guilty to take a time-out to restore
    yourself
  • Avoidance and distraction in the early stages can
    be positive coping tools in the early stages
  • Make sure you are eating well
  • Social support is important
  • Do not feel bad calling on others for support for
    emotional comfort or current needs
  • Give feedback to your supporters so that they
    know the best way to help you

86
Student Release Form
First section completed by the adult picking up a
student Please Print Students Name
__________________________________________________
________ Teacher ______________________________
Grade _________________________ Name of
Adult Picking Up the Student ____________________
___________________ ------------------------------
--------------------------------------------------
---------------------------------------------- To
be filled in by Reporting Point staff Proof of
I.D. Yes ______ No ______ Emergency
card gives permission for pickup by this adult
Yes ______ No ______ To be taken by
Runner -------------------------------------------
--------------------------------------------------
--------------------------------- Students
Status To be filled in by Holding Area staff Sent
with Runner ? Not Available for Release
? Absent ? First Aid ? Hospital ?
Missing ? Other Comments -------------------
--------------------------------------------------
--------------------------------------------------
------- To be filled in by Release Point
staff Confirm the student is being matched with
the correct adult. Have the requesting adult
sign for the student. Parent/Guardian/Care
Giver Signature _________________________________
_______ Date ___________________ Time
_____________________ Form adapted from
Multi-Hazard Emergency Planning for Schools
Participant Handbook, FEMA, p. E-12.
87
Child-Caregiver Reunification
Family Reunification as of time/date___________

88
Incident Management System
89
Requesting Support and Managing Resources
90
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

91
Regional Homeland Security Mental Health
Activation
1. First Responder system or by Emergency
Management notifies the Red Cross 2. Red Cross
contacts Heart of America Family Services (HAFS)
- requests activation of the RHSMH Response
System. 3. HAFS contacts each agency and tells
them who to call at Red Cross and what telephone
numbers to use. 4. Each agency (including
HAFS) contacts Red Cross with their response
capability. 5. Responders from each agency
may be instructed to report to a designated
location or to be on stand by for activation
92
Team Exercise
Scenario 1 Your class has been evacuated to a
secure location. While the rest of the students
are asking you questions or talking amongst
themselves, you notice one student sitting
quietly apart from the group. This student does
not respond when you call his name.
93
Team Exercise
Scenario 2 You class has been evacuated to a
safe location. It seems likely that you all will
be in that location for several hours before the
students can be reunited with their parents. How
do you keep your class calm and pass the time?
94
Team Exercise
Scenario 3 During the crisis, one of your
students sustained a compound fracture in her
leg. She is crying uncontrollably. How do you
handle the situation?
95
Team Exercise
Scenario 4 The classrooms have been evacuated
to a safe location for a tornado, you notice a
fellow teacher across the room. This teacher
appears to be checking out, not responding to
student needs or giving the students directions.
What should you do?
96
Team Exercise
Scenario 5 There is a lockdown situation in
your school due to a possible armed intruder. You
are beginning to feel extremely panicked (heart
racing, sweating, difficulty breathing). What
should you do?
97
Extra Slides
98
Bioterrorism and Children
  • Physical/Medical Considerations
  • Increased respiratory exposure (? respiration,
    closer to ground)
  • Gas masks risk of poor fit, suffocation
  • Increased dermal exposure (thinner, more
    permeable skin)
  • Problems using bleach solutions to decontaminate
  • Increased risk of dehydration
  • Increased risk of hypothermia during
    decontamination
  • Increased susceptibility to certain agents

99
Bioterrorism and Children
  • Emotional/Behavioral Considerations
  • Agents may cause reactions that mimic psychiatric
    symptoms
  • Less ability to escape physically
  • Greater reliance on caregivers who may be injured
    or dead
  • Fewer or less developed coping skills
  • Greater anxiety over reported incidents, hoaxes,
    media coverage
  • Difficulty adequately describing symptoms
  • Problems understanding commands from safety
    personnel
  • Scared of responders dressed in protective suits

100
Bioterrorism and Children
  • Suggestions for Children and Painful Procedures
  • Children show more distress behaviors with
    caregivers present, but they generally prefer to
    have caregivers present
  • Distraction is more effective than reassuring
    children or providing no intervention in
    reducing distress
  • Effective distractions appeal to multiple senses,
    motor skills
  • playing with developmentally appropriate toy or a
    pager/flashlight as opposed to looking at a
    poster or listening to a story

101
Controlling Your Own Arousal
  • Step 1 Slow Down (Take a Time Out Calm Your
    Body One Thought at a Time)
  • Start by telling yourself Slow down--I can
    deal with this if I just do one thing a time.
  • Step 2 Orient Yourself (Bring Your Mind Body
    Back to the Present Time/Place)
  • Talk to yourself calmly and gently I can look
    around and see that Im in a safe and familiar
    place. I can feel my body sitting in this chair
    and feel the floor under my feet. I can see the
    people Im with, and I know who they are and that
    I can trust them.

102
Step 3 Self Check (How Much Distress? How Much
Control? The Worst Ever?) Ask yourself calmly
and supportively, Is this the worst Ive ever
felt? Are there still some ways in which I still
feel in control and can deal with this situation
effectively? Tell yourself, calmy and
supportively, If Ive gotten through other times
feeling as bad or worse than this, I can get
through this! I am still in control in some
important ways, so I can handle this! There are
people in my life who are helping me to get
through this okay!
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