Crisis Response: developing confidence, capability and collaboration '

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• Crisis Response developing confidence,
  capability and collaboration .
• Paul Rees, Niels Seaton, Sam Methuen, Suzie Lisk
• RCT MT Ed. Child Psychology Service
• in collaboration with
• University of Manchester
• ISPA
• July 2007

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Introductions Paul Rees, Niels Seaton, Sam
Methuen, Suzie Lisk From Wales in the UK (small
nation approx 3 million) 21 Psychology services
in Wales We are from the largest of these
services (22 full time equivalents) Ratio
approx 1 psych to every 3,000 young people (aged
0-19)
P
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• Plan!
• Why we are interested/became involved with CR -
  context
• Steps we have taken (Partnership exploration and
  training)
• Is it just us? (survey of psychologists, schools)
• Survey findings
• Schools (NS SL)
• Psychologists (PR SM)
• Issues (developing confidence, capability,
  collaboration)
• Discussion

P
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• Why we are interested/became involved with CR
  context
• CR training during initial training
• ISPA pre-colloquium workshop on CR
• Requests from senior managers 9.11
• Requests from schools
• Nagging concerns?

P
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• National review of psychology services in UK
• Similar work CR was reported in many other
  local authorities (LAs) where the EPs have led
  the development of a planned response to provide
  emotional support following critical incidents
  and emergencies, alongside a range of partners
  including social services, LA personnel, NHS
  accident and emergency and ambulance services,
  police and fire services.
• (p.43)
• (Farrell, Woods, Lewis, Rooney, Squires and
  OConnor, 2006)

P
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• Questionnaire respondents identified services
  which EPs manage, including critical incident
  response teams (CRITs) (p.77)
• (Farrell, Woods, Lewis, Rooney, Squires and
  OConnor, 2006)
• Maybe our interest in CR is about a yearning to
  return to psychology

P
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• Steps we have taken (partnership exploration and
  training)
• Psychology service working group (2 DPECPs, 4
  ECPs, 2 AECPs 1 teacher)
• Group invited Emergency Planning Dept to join
  (sensitivities)
• Group extended to include school staff
• First draft of school guidance produced

P
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• Training
• National training in York jointly funded by
  Emergency Planning (DPECP, ECP, Headteacher and
  team member from Emergency Planning)
• ISPA Exeter whole service CR junkies
• Commissioned 3 SPs to go on ISPA CR training in
  Athens (4th this year)
• Disseminated ISPA CR training through in house
  training day (also delivered training to several
  other services around the UK)
• Built CR training into induction programme for
  all new members of staff
• Held regional CR training day speaker Bill
  Pfohl (USA)

P
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• Is it just us?
• Self reflection
• confidence, capability, collaboration.
• Interested to know
• about schools views on CR and our input
• about the experience of other psychologists
  (training, confidence, capability,
  collaboration),

P
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Definition of school crisis By a school crisis
we mean any incident that has a dramatic and
potentially traumatising impact on school aged
children or school personnel, for example, a
sudden death, extreme violence (including
shootings/knife attacks), suicide, bullying,
bombings, terrorism, accidents or disasters such
as floods, storms and fires.
PR
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Results- Teacher Questionnaire

• Aimed to gain an understanding of teachers
  perceived confidence levels, experience of
  training and view of the Educational and Child
  Psychology Service (ECPS) with regard to school
  crises.
• The term school crisis was defined as any
  incident that has a dramatic and potentially
  traumatising impact on school aged children or
  school personnel, for example, a sudden death,
  extreme violence, suicide or disasters such as
  storms floods and fires.
• The questionnaire was given to a number of
  schools in our LEA and we received 40 returns
  (n40).
• The sample were asked to use a rating scale
  (1-10) for a number of questions. In order to
  analyse the results effectively, the scale has
  been banded into 1-3negative, 4-6neutral and
  7-10positive.

SL
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Had training
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• None of the sample had received any training
  before or as part of their teacher training and
  only 18 have received any training at all.
• Of the 18 that have had training 29 consider
  they have had enough. This does not correlate
  with the average number of days training for each
  group. May be quality not quantity?
• Half of the teachers in who rated themselves as
  confident in dealing with school crises have not
  received any training at all.

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Experienced a crisis
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• At least half of the sample have experienced at
  least 1 school crisis in the last 5 years. With
  11 experiencing 10 incidents.
• Of those who experienced a school crisis, 32
  had a response from the ECPS. Did schools refuse
  support or was there a lack of awareness?
• None of the sample gave negative responses when
  rating the response from the ECPS. Over 80 of
  the sample were satisfied with response from the
  ECPS in each domain.

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No plan
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Has a plan
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Overview of school survey results

• A need for CI training to be included in teacher
  training and whole school training for all staff
• Teachers need to feel more confident and
  competent in dealing with CI
• ECPS need to make schools more aware of the
  support they can offer regarding CI
• High levels of satisfaction from schools when
  they did receive a response from ECPS in order to
  assist with CI
• Majority of sample do not have an emergency plan
  to deal with CI, despite experiencing a number of
  CI in the past
• Most schools would welcome input from ECPS in
  devising an emergency plan.

SL
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Survey of psychologists Context Contacted 8
psych services in England and Wales Decided to
keep survey brief and anonymous (self addressed
envelopes attached to each survey form) Response
rate estimated to be approx 80 (n70) Years of
experience as a qualified psychologist
PR
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Do you consider crisis response to be an area
of work that SPs should be involved in?
SM
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Have you ever been asked to offer crisis
support?
SM
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Psych survey results Training Percentage of
respondents having received training in
CR
SM
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Total number of training days received? Mean
2.8 days Median 2.0 days Mode 2.0 days Range
0-20
SM
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Confidence On first qualifying as a SP how
confident were you that you would be able to
respond to a crisis affecting one of your
schools?
SM
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THE PERSPECTIVE OF A NEWLY QUALIFIED EDUCATIONAL
PSYCHOLOGIST RESPONDING TO A CRITICAL INCIDENT

• BEFORE FIRST RESPONSE
• Initial panic. Question own competence.
• De-skilled. Do I know how to respond? What am I
  going to Say? (Resources-script)
• Ability to maintain professionalism.
• Would my own personal experience of trauma and
  death affect my ability to be an effected
  practitioner?
•  
• Knowledge of death beliefs and culture.
• How should questions regarding afterlife be
  answered?
• (Important to know the facts of a case,
  rumours)
• (Using appropriate language, terms and help
  understanding of the age range working with)
•  
• Sense of safety in numbers.
• Confidence raised by pairing with more
  experienced ECP

SM
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THE PERSPECTIVE OF A NEWLY QUALIFIED EDUCATIONAL
PSYCHOLOGIST RESPONDING TO A CRITICAL INCIDENT.

• AFTER FIRST RESPONSE
• Fear of the unknown
• The reality of responding to a CI is less
  daunting than imagined. General ECP skills are
  useful as well as more specific CI training.
•  
• Debriefing
• Sharing the experience with colleagues is an
  important part of the process. Need to look after
  the person that is behind the ECP.
• Broadened concept of CI work
• Understanding of CI work increased. Become less
  naive. Realise CI are more common than perceived
  to be. Help understand the ECP role in CI and
  view of CI as an important part of ECP work.

SM
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Do you feel youve had enough training in how to
respond to a SC?
SM
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SM
29
What kind of incidents are psychologists being
asked to respond to? 14 different types of
incidents cited
SM
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What is the average number of days of your time
each incident consumed? Mode, mean and median
3 Lowest 1 Highest 6
PR
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Confidence How confident are you now that you
would be able to respond to a crisis affecting
one of your schools?
PR
32
Is there a relationship between length of time a
person has been qualified and confidence
levels? We think so
PR
33
Is there a relationship between the number of
incidents a person has been asked to respond to
and their level of confidence? We think so
PR
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• Did you work on your own or as a team?
• 22 report only ever working on their own on CR
  incidents
• If they did, who did SPs work with?
• More experienced SPs or SPs
• Primary mental health team
• School nurse / counsellor
• Police and social services

PR
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• What psychological theories, models or materials
  do psychologists recall drawing on when
  responding to CIs?
• CI training? Bereavement training?
  Service materials/protocols
• NOVA
• BASIC Ph
• ACI
• OHeare work
• Reflecfive listening
• Solution focused approach
• Humanistic psychology
• Group processes
• Cognitive Behavioural Therapy
• Counselling skills
• Knowledge of PTSD
• Psychodynamic principles

PR
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What advice, information or support from
colleagues have psychologists found personally
helpful when responding to CIs? Working with
others following examples and more experienced
SPs Debriefing Having protocols and
Guidelines Meeting to preplan response Training
and refreshing skills
PR
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Key issues from psychologists survey CR is an
area of work psychologists think they should be
involved in Confidence levels are generally low
on first qualification but improve with
experience general level of confidence positive
Collaboration with other agencies in planning
is improving but partnership in relation to
particular events less well developed Length of
training tends to be quite limited especially
within professional training. With the
introduction of doctoral training this could be
increased? Is there a need for specialist
training / posts in CR?
PR
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UK Civil Contingencies Act 2004

• Local Authorities will from time to time
• Assess the risk of an emergency
• Maintain plans as far as is reasonably practical
  to enable services to what they need to do
• Maintain plans to ensure if an emergency
  threatens, services can perform functions as far
  as necessary or desirable to
• - prevent the emergency
• - reduce, control or mitigate its effects
• - take other action in connection with it

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• Key event for changing attitudes in UK
• Dunblane, Scotland 1996
• Cullen Report recommendation
• - every school should have a management
• plan at hand in the event of a critical
  incident

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• Wise before the event (Yule Gold 1993)
• given to all UK schools
• Quality of LEAs guidance to schools on drawing
• up and maintaining plans from mid 90s varied
• Extensive detailed (will they read it ?)
• Short leaflets (are they sufficient?)
• (Kibble 1999)

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• UK Central Government issued guidance
• to schools on emergency planning for CIs
• BUT
• No statutory requirement for schools to have
• a management plan for emergencies / CIs

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• LEAs believe that schools should remain in
• control of CI management H/T central role
• H/Teacher and SMT are main people to take
• school through crisis and beyond
• LEAs need to offer support promptly when it is
• needed and requested
• ECPs have become core part of this support

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National Professional Qualification for Headship
(NPQH)

• Now mandatory in Wales for new H/Ts
• Managed by Welsh Assembly Government
• Mandatory in England from 2009

44
NPQH Programme between 12 and 20 months

• Creating strategic direction
• Leading teaching learning
• Developing working with others
• Managing the school
• Securing accountability
• Strengthening the community focus
• CRISIS MANAGEMENT NOT IN THE PROGRAMME

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• Too few H/Ts have training in CI Management
• Too few have experience of drawing up
• and maintaining CI plan
• High percentage see the need for training
• High percentage think ECPs can train them

46

• Common factors H/Ts and ECPs for training are
• that both groups need to know
• right things to do
• right things to say
• how to maintain balance between
• keeping things running normally yet being
• flexible responsive enough to meet needs

47
s

• Matters of concern from this survey
• - No H/Teachers were very confident
• - Only 18 had any training in CI management
• - 20 ECPs not confident and had
• relatively very little training CI response work

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• There have to be minimum standards of
• training, supervision and support for all crisis
• response workers including H/Ts and ECPs
• COLLABORATION
• The models we use and the delivery methods
• need to be consistent to give better monitoring
• and evaluation of what works best
• Little or no room for idiosyncratic ad hoc
• working

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We need to build effective teams - Pfohl

• Select team leader
• Establish timelines
• Identify relevant policies
• Community involvement
• TRAIN MEMBERS
• Solicit feedback
• BE INCLUSIVE INVOLVE MANY

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• Need models that develop resilience in school
• communities then train these communities
• e.g.NOVA training
• Natural support systems have advantages
• over outside providers (Walsh 2007)
• Learned resourcefulness rather than learned
• helplessness aids recovery

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What NOVA teams do

• support local caregivers
• plan with community leaders how to deal with
  event
• TRAIN LOCAL CAREGIVERS
• identify high risk groups
• provide Group Crisis Intervention
• Primary purpose is educative rather than
  therapeutic

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• Essential components of successful
• interventions include
• Planning
• Education
• Training
• People have always told their stories after CIs
• Used to be within extended families friends
• Now the professional has taken on the role of
• the extended family (Mirzamani, 2006)

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• Our recent experience in Wales has been
• large demand within short period of time for
• crisis response work word has got around!
• Overstretched the capabilities of ECPS
• Need to train schools to be more self-sufficient
• in this work, e.g. managing sad events

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• Increasing schools competence and confidence
• increases their capability
• Schools need to have protective measures as
• part of emergency plan drawing up a plan can
• bring up issues that can be preventative
• One plan does not fit all schools each school
  needs
• its own plan to meet its own needs

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• In summary
• there is a need for Crisis Response to be part
• of H/T training
• there is a need for Crisis Response to be part of
  ECP training in the new doctoral courses
• At present the former does not happen and the
  latter varies between courses from none to a
  fair amount (better than it was!)

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• Training Levels
• Head Teachers ECPs
• School level Service / LA level
• Area cluster / LA level Regional
  level
• National NPQH level National level
• - 3 year training courses
• - National Assoc level BPS
• - International level ISPA

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• There needs to be skills training for ECPs
• This does not come through single day awareness
• raising events
• Training needs to include skills development
• to increase confidence and capabilities
• Practice - practice - practice
• Its not a case of being ready if it happens
• but when it happens - and it will.. (Pfohl)

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Questions! Contact details paul.g.rees_at_rhondda-
cynon-taff.gov.uk niels.dr.seaton_at_rhondda-cynon-t
aff.gov.uk Samantha.methuen_at_rhondda-cynon-taff.go
v.uk Suzanne.c.lisk_at_rhondda-cynon-taff.gov.uk
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References Farrell, P. Woods, K. Lewis, S.
Rooney, S. Squires, G. and O Connor, M. (2006).
A review of the Functions and Contribution of
Educational Psychologists in England and Wales in
light of Every Child Matters Change for
Children. DFES, Research Report RR792