L6 Critical Incidents

Question 1

What is a critical incident?

Answer 1

Incident with profound emotion which may involve serious injury
Emotional reaction
Involves threat
Unusual attention from the community
Surpass normal coping mechanisms

Question 2

What are the key questions for psychological theory?

Answer 2

How do people typically respond to critical incidents?
Why are people affected differently?
What are the psychological needs created by critical incidents
How are these needs best supported and addressed

Question 3

What are the symptoms of post traumatic stress?

Answer 3

Flashbacks and intrusive memories
Headaches
Difficulty concentrating
Feeling guilty
Detached from others

Question 4

Why might symptoms be considered problematic?

Answer 4

PTSD
Occurs when symptoms of PTS
- emerge later
- persist or intensify long after the event
- disrupt normal living

Question 5

What is the DSM symptom criteria?

Answer 5

re-experiencing
avoidance
arousal
negative cognition and mood

Question 6

How do you spot PTSD in children under 6 years?

Answer 6

Re-enacting events
Repetitive play
Emotional and behavioural difficulties

Question 7

What influences people’s reaction?

Answer 7

Age
Experience
Personality
Nature of the incident
Degree of involvement

Question 8

What is the life-belief model (Jonoff Bulan 1985)?

Answer 8

People establish core beliefs
- invulnerable
- life has meaning and purpose
- we are good and respectable
Critical incidents lead people to
- question their beliefs about themselves
- become aware of their own mortality
- search for meaning

Question 9

What is the human needs model (McCann and Pearlman 1990)?

Answer 9

Core beliefs, expectation and assumptions
Critical incidents:
- Disrupt the core beliefs
- Challenge people’s ability to protect and fulfil their needs
- Leading them to question and change their view about how these needs can be met

Question 10

What is the crisis intervention theory (Caplan, 1964)?

Answer 10

Usually the cognitive-emotional aspects are in balance
A traumatic event created an imbalance leading to an emotional crisis

Question 11

What are the phases of grief and bereavement theory?

Answer 11

1. Denial - shock, disbelief = accept the reality of loss
2. Pain and distress - anger, guilt, worthlessness = experience pain of grief
3. Realisation - depression, ‘if only’ = adjust to life
4. Resolution - readiness to engage in new activities = re-invest emotional energy

Question 12

What is the psychological model by Joseph, Williams, Yule 1997?

Answer 12

Event - Event cognition (social context and coping) - Appraisal mechanisms (personality) - Emotional states (back to coping)

This explains why some people react and respond in different ways

Question 13

What are the needs of those affected by critical incidents?

Answer 13

Acknowledgement and recognition
Information
Opportunity to talk
Formal and informal rituals
Routines and normality
Return and reintegration

Question 14

What is the aim of critical incident support?

Answer 14

To help those affected to understand the impact of trauma on themselves
To plan for people’s reactions and needs
To coordinate and manage the organisation and community response

Question 15

What are the levels of support that might be needed?

Answer 15

1 - Someone there for the first few hours
2 - A listening ear for the first few days
3 - Structured support for the first weeks
4 - Specialist therapy for first months

Question 16

What is the work of EP’s at local authority and community level?

Answer 16

Training and developmental activities for staff
Links with other agencies
Simulation and practice
Involvement in emergency planning
Consider needs of the community

Question 17

What support should be offered for major disasters?

Answer 17

Immediate practical help
Support for the affected communities
Clear roles and responsibilities
Facilitate access to specialist mental health assessments and treatments

Question 18

What are the components of critical incident management plans?

Answer 18

Pre-incident education
On scene crisis intervention
Defusing
Psychoeducation
Support families and children
Follow up appropriate support services

Question 19

How do critical incidents impact on schools and organisations?

Answer 19

Can be onsite
May affect staff and senior management
May generate media interest
May generate parental reaction
May generate too many visitors and helping

Question 20

What is the impact of trauma on organisations?

Answer 20

Can bring out the best and worse in people
Magnify difficulties
Can lead to in groups and out groups
Competing pressure to stop/carry on
Shared experience creates an opportunity for people to give and seek support

Question 21

What is the EP’s role when helping organisations?

Answer 21

Develop a plan to handle reactions
Prepare media statement
Prepare information for parents, pupils an staff
Consider appropriate support for staff and people involved
Engage with critical incident support team

Question 22

What are the types of short term post incident group support?

Answer 22

Demobilising
Defusing
Debriefing
Psychological first aid
Structured group based trauma focused CBT

Question 23

What is critical incident debriefing?

Answer 23

Based on critical incident stress debriefing model and psychological debriefing
- create a shared narrative
- help interrogate cognitive and emotional memory
- connect past present and future
- support normalisation
- provide psycho-education

Question 24

What is the evidence of impact?

Answer 24

Debriefings can be effective in reducing intrusive thoughts (Stallard and Law 1993)
Adults CISD studies have found while some evidence is helpful, there is no evidence that it was effective in preventing PTSD (Van Emmerick 2002

Question 25

What is psychological first aid?

Answer 25

Non intrusive, supportive and practical assistance
Create calm conditions
Reduce initial distress
Promote functioning and coping
Flexible approach

Question 26

What are the 8components of psychological first aid?

Answer 26

1. Contact and engagement
2. Safety and comfort
3. Stabilisation
4. Information gathering: current needs and concerns
5. Practical assistance
6. Connection with social support
7. Information on coping
8. Linkage with collaborative services

Question 27

What is the effectiveness of psychological first aid?

Answer 27

Evidence based for PFA is insecure
Logical links with grief and bereavement theory
Some evidence that it promotes calm and connection

Question 28

What considerations need to be made for children affected by CI?

Answer 28

Developmental issues
Modalities of expression
Involvement of parents
Role of peer group
Level of engagement
Self-disclosure, confidentiality
Potential for secondary traumatisation

Question 29

What are recommended interventions for individuals?

Answer 29

Psychological first aid
Watchful waiting
Eye movement desensitisation reprocessing
Trauma focused cognitive behaviour therapy

Question 30

What is eye movement desensitisation and reprocessing?

Answer 30

Person recalled traumatic event
Following repetitive side to side movement as it is remembered to focus on

Question 31

What is trauma focused cognitive behavioural therapy?

Answer 31

Help confront traumatic memories
Modify misinterpretations of threat
Develop skills to cope with stress
Help a person to restructure their core beliefs, thoughts and ideas

1. Establish rapport, encourage to tell story an express feelings
2. Help person make sense of story
3. Involve cognitive restructuring
4. Re-establish relationships and confidence
5. Develop strategies to prevent relapse