Advanced School Crisis Training

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Advanced School Crisis Training

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

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

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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

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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)

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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

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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

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School Operations

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

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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

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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

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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

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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

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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)

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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

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From the Field of Brain Research

• In order for children to learn
• Eliminate Threat from the Environment
• Enrich the Learning Environment

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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).
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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)
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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

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School Operations

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

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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
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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

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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
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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

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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

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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

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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

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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

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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

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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

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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)

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CISD

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

Mitchell 1983
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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)

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Psychological Debriefing

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

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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)

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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)

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Single Episodevs.Multiple Episode Debriefing
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• 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
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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)

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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)

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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)

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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?

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• Provide
• Psychological
• First Aid

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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

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Psychological First Aid

• Be proactive
• Discuss developmental impact
• Prosocial actions

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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)

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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)

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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