L6 Critical Incidents Flashcards
What is a critical incident?
Incident with profound emotion which may involve serious injury
Emotional reaction
Involves threat
Unusual attention from the community
Surpass normal coping mechanisms
What are the key questions for psychological theory?
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
What are the symptoms of post traumatic stress?
Flashbacks and intrusive memories
Headaches
Difficulty concentrating
Feeling guilty
Detached from others
Why might symptoms be considered problematic?
PTSD
Occurs when symptoms of PTS
- emerge later
- persist or intensify long after the event
- disrupt normal living
What is the DSM symptom criteria?
re-experiencing
avoidance
arousal
negative cognition and mood
How do you spot PTSD in children under 6 years?
Re-enacting events
Repetitive play
Emotional and behavioural difficulties
What influences people’s reaction?
Age
Experience
Personality
Nature of the incident
Degree of involvement
What is the life-belief model (Jonoff Bulan 1985)?
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
What is the human needs model (McCann and Pearlman 1990)?
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
What is the crisis intervention theory (Caplan, 1964)?
Usually the cognitive-emotional aspects are in balance
A traumatic event created an imbalance leading to an emotional crisis
What are the phases of grief and bereavement theory?
- Denial - shock, disbelief = accept the reality of loss
- Pain and distress - anger, guilt, worthlessness = experience pain of grief
- Realisation - depression, ‘if only’ = adjust to life
- Resolution - readiness to engage in new activities = re-invest emotional energy
What is the psychological model by Joseph, Williams, Yule 1997?
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
What are the needs of those affected by critical incidents?
Acknowledgement and recognition
Information
Opportunity to talk
Formal and informal rituals
Routines and normality
Return and reintegration
What is the aim of critical incident support?
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
What are the levels of support that might be needed?
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
What is the work of EP’s at local authority and community level?
Training and developmental activities for staff
Links with other agencies
Simulation and practice
Involvement in emergency planning
Consider needs of the community
What support should be offered for major disasters?
Immediate practical help
Support for the affected communities
Clear roles and responsibilities
Facilitate access to specialist mental health assessments and treatments
What are the components of critical incident management plans?
Pre-incident education
On scene crisis intervention
Defusing
Psychoeducation
Support families and children
Follow up appropriate support services
How do critical incidents impact on schools and organisations?
Can be onsite
May affect staff and senior management
May generate media interest
May generate parental reaction
May generate too many visitors and helping
What is the impact of trauma on organisations?
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
What is the EP’s role when helping organisations?
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
What are the types of short term post incident group support?
Demobilising
Defusing
Debriefing
Psychological first aid
Structured group based trauma focused CBT
What is critical incident debriefing?
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
What is the evidence for debriefing?
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
What is psychological first aid?
Non intrusive, supportive and practical assistance
Create calm conditions
Reduce initial distress
Promote functioning and coping
Flexible approach
What are the 8components of psychological first aid?
- Contact and engagement
- Safety and comfort
- Stabilisation
- Information gathering: current needs and concerns
- Practical assistance
- Connection with social support
- Information on coping
- Linkage with collaborative services
What is the effectiveness of psychological first aid?
Evidence based for PFA is insecure
Logical links with grief and bereavement theory
Some evidence that it promotes calm and connection
What considerations need to be made for children affected by CI?
Developmental issues
Modalities of expression
Involvement of parents
Role of peer group
Level of engagement
Self-disclosure, confidentiality
Potential for secondary traumatisation
What are recommended interventions for individuals?
Psychological first aid
Watchful waiting
Eye movement desensitisation reprocessing
Trauma focused cognitive behaviour therapy
What is eye movement desensitisation and reprocessing?
Person recalled traumatic event
Following repetitive side to side movement as it is remembered to focus on
What is trauma focused cognitive behavioural therapy?
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
- Establish rapport, encourage to tell story an express feelings
- Help person make sense of story
- Involve cognitive restructuring
- Re-establish relationships and confidence
- Develop strategies to prevent relapse
