Crisis Care

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• The American Indian/Alaska Native National
  Resource Center for Substance Abuse and Mental
  Health Services

• Crisis Care
• Red Lake, Minnesota
• Dale Walker, MD
  
• Oregon Health and Science
  University

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• For more information, contact us at
• 503-494-3703
• E-mail
• Dale Walker, MD
• onesky_at_ohsu.edu
• Or visit our website www.oneskycenter.org

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Crisis Care

• Crisis Intervention
• gt Focus on immediate emotional support
• gt The persons resources for coping have failed
• gt The design of your intervention is to assist
  in coping

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Crisis Care

• Critical Incident Stress
• gt Reactions to a stressor
• gt Could be during
• gt Could be after

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Crisis Care

• Defusing
• gt On-scene intervention
• gt Help client to vent feelings
• gt Begin the task of starting coping strategies
• gt Begin the task of reducing stress

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Crisis Care

• Debriefing
• gt Organized approach by mental health
  professionals
• gt Supportive of the disaster workers who had
  helped in the time of crisis
• gt Usually done towards the end to bring closure
  to their experiences

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Loss, Grief, and Mourning

• Grief is both an ADAPTIVE and NORMAL process.
• NORMAL Because it is a reaction that helps us
  confront the loss.
• ADAPTIVE Because, while it is painful to go
  through, it can be productive in that we learn
  something through it.

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Stages of Grief

• DENIAL
• ANGER
• BARGAINING
• DEPRESSION
• ACCEPTANCE
• NOTE People MAY go through these and they may go
  through them differently

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Stages of Grief

• Typical reactions
• Drained of energy, purpose, and faith.
• Feel like they are dead.
• Mistake denial for recovery (too quick)
• Focus only on the LOSS, not their recovery
• Cant focus on working through the grief, because
  of all the other things that must be done.
• Re-experience emotions at the anniversary," and
  other tribal times

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Stages of Disaster

• The community response in grief.
• HEROIC From impact to about one week out.
• HONEYMOON Lasts several weeks and there is a
  sense of the community pulling together.
• DISILLUSIONMENT One month to even a couple of
  years. Hype is gone and questions are
  unanswered.
• RECONSTRUCTION Final stage with realization of
  what has been experienced and what they can do to
  restore the community.

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Symptoms of trauma

• Vary related to age, background, prior history of
  personal trauma.
• May apply to BOTH, victims and trauma workers.
• Many of these expressions are suggestive of the
  fact the trauma has not been handled well.

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Symptoms of trauma

• Phobias
• Exaggerated startle response
• Hyper-vigilance
• Encounter reminders
• Memory problems
• Anger, rage

• Nightmares
• Report stress
• Depression
• Anxiety
• Preoccupation with death, injury, and
  separation.
• Avoidance reactions

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Providing Support

• The 6 Ts
• Tears Its Ok to cry
• Touch Hand or shoulder, supportive
• (Always ask first!)
• Talk With you, family, friends
• Trust Be non-judgmental
• Toil It will take work, but not to rush
• Time Recovery takes time, so you must take
  time to be with them

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Helping Children/Teenagers

• Children Birth to 5 years old
• fear of being separated from parent
• crying
• screaming
• regressive behaviors
• clinging behaviors
• NOTE How the parent reacts strongly influences
  how the child will react at this age.

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Helping Children/Teenagers

• Children 6-12 years
• withdrawal and depression
• disruptive behaviors
• regressive behaviors
• irrational fears or guilt
• refusal to attend school
• anger and fighting
• bodily complaints and symptoms

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Helping Children/Teenagers

• Adolescents 12-17 years old
• adult-like symptoms
• emotional numbing
• suicidal thoughts and depression
• confusion and memory problems
• feelings of they could have stopped it
• isolation
• avoidance and/or substance abuse

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Helping Children/Teenagers

• Create a sense of safety.
• Use multiple reassurances.
• Convey you understand what they are feeling.
• Convey it is normal to feel that way.
• Talking about the feelings and a return to
  normal.
• Keep families together as much as possible.
• Dont criticize for babyish behaviors.
• Use the 6 Ts.

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Helping Children/Teenagers

• Encourage that they take control.
• Parents need to care for themselves, in order to
  care for the children.
• Dont rush back to the routine, thinking it will
  get their minds off of it.
• Hold meetings with leaders in the community,
  schools, and churches to create awareness and
  networking.

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Post-Traumatic Stress Disorder

• Using the Diagnostic and Statistical Manual
• Witnessed, experienced, or confronted with trauma
• Intense fear, helplessness, or horror in their
  response
• Re-experiencing
• Avoidance
• Persistent symptoms (many already discussed)

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PTSD-continued

• Cognitive-Behavioral Therapies.
• Group Therapy can be used.
• Trauma/Grief-focused psychotherapy is being used,
  as well.