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responding to critical incidents in schools Flashcards

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1
Q

what is a critical incident

cheshire county council (1995)

A
  • incident charged with profound emotion which may involve serious injury or death
  • generates high level of immediate or delayed emotional reaction
  • involves serious threat or extremely unusual circumstances
  • attracts unusual attention from the community or media
  • surpassing an individual, group or organisation’s normal coping mechanisms
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2
Q

could covid be considered a CI?

ONS (2020)

A
  • profound emotional reaction
  • involves illness and death
  • unusual attention from media (and community)?
  • surpassing an individual, group or organisation’s ability to cope?
  • around 126 deaths of education workers (age 20-64) due to covid between 9th march & 25th may
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3
Q

key questions for psychological theory, research and practice

A
  • how do people (including CYP) “typically” respond to CI? Why do ppl respond in the way they do?
  • why are ppl affected differently?
  • what are the psych needs created by CI?
  • how are these needs best supported and/or addressed?
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4
Q

post-trauma stress

APA, DSM (1987)

A

the development of certain characteristic symptoms following a psychologically distressing event, which is outside the range of normal human experience

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5
Q

impact of PTS

parkinson (1993)

A
  • flashbacks & intrusive mems
  • headaches
  • difficulty concentrating
  • feeling guilty - e.g. ‘it was my fault’
  • feeling detached from others
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6
Q

4 aspects of PTSD

DSM5

A
  • re-experiencing
  • avoidance
  • arousal
  • negative cognition and mood
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7
Q

PTSD in CYP

A
  • diagnosis for children above 6 same as adults
  • symptoms in younger children may differ: re-enacting events, repetitive play, emotional and/or beh difficulties
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8
Q

what influences ppl’s reactions

McNally (2003)

A
  • age
  • experience
  • personality
  • nature of incident
  • degree of involvement
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9
Q

trauma, PTS, PTG

A
  • dose of trauma doesn’t necessarily mean symptoms
  • ‘the vast majority of ppl exposed to serious traumatic events don’t develop PTSD’ - McNally (2003)
  • some ppl learn & grow from experience - Joseph (2011), e.g. post-traumatic growth
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10
Q

theoretical persectives (CI)

A
  • life-belief model
  • human needs model
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11
Q

life-belief model

janoff-bulman (1985)

A
  • ppl establish core beliefs
  • CIs lead ppl to: question their beliefs about themselves; become aware of their own mortality & vulnerability; search for meaning. Asking ‘why to me?’ type questions
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12
Q

human needs model

mccann & pearlman (1990)

A
  • ppl develop core beliefs, expectations & assumptions about their life
  • CIs: disrupt these core beliefs, expectations & assumptions; challenge ppl’s ability to protect or fulfil their needs; leading them to question & change their view about how these needs can be met
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13
Q

crisis intervention theory

caplan (1964)

A
  • usually in human experience the cog-emotional aspects in balance
  • a traumatic even creates an imbalance between the 2 and leads to an ‘emotional crisis’
  • leading to a reaction to the critical incident across 4 stages: impact, withdrawal & confusion, adjustment, reconstruction
  • ppl need to work through or be supported through this process, in order that they do not get stuck
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14
Q

phases of grief & bereavement theory

A
  1. denial
  2. pain and distress
  3. realisation
  4. resolution
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15
Q

how do people typically respond to traumatic bereavement

queensland department of education (1998)

A
  1. pre-traumatic stability
  2. traumatic incident
  3. shock
  4. denial
  5. emotional impact
  6. working through
  7. acceptance
  8. normal reactions
  9. post trauma stability
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16
Q

aspects of psychosocial model/framework

joseph et al. (1997)

A
  • event stim
  • event cognitions
  • appraisal mechanisms
  • emotional states
  • personality
  • social context
  • coping
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17
Q

what are the needs of those affected by CIs?

parkinson (1997)

A
  • acknowledgement & recognition
  • info
  • opportunity to talk
  • formal and informal rituals
  • routines and normality
  • return and reintegration
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18
Q

aim of CI support

warrington borough council (2007)

A
  • help those affected to understand the impact of trauma on themselves & others
  • plan for ppl’s reactions & needs of inds & groups affected
  • coordinate & manage the organisation & community response
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19
Q

planning and preparation

community level (CIs)

A

LAs & schools should be ‘wise before event’

20
Q

EP work at a LA & community level

CIs, Pousada (2006)

A
  • training & dev activities for staff
  • links & liaison with other agencies/services
  • simulation & practice
  • involvement in emergency planning exercises
  • CI team coordination & dev considering the needs of community affected
  • supporting community and/or coordinating/responding to incidents as, and when, appropriate (& learning from them)
21
Q

plans should include

NICE (2005), CIs

A
  • immediate practical help
  • support for affected communities in caring for those involved in disaster
  • clear roles & responsibilities for all professionals involved
  • facilitate access to specialist mental health, ev-based assessment & treatment services as appropriate
22
Q

components of CI management plan

mitchell & everly (2000)

A
  • pre-incident education & mental preparedness
  • on scene crisis intervention support
  • demobilisation & defusing
  • CI support/psychoeducation
  • support for families & children
  • follow up & link to appropriate support services
23
Q

how do CIs impact on schools and organisations?

cheshire county council (1995)

A
  • directly or indirectly
  • can be onsite, offsite or multi-site
  • may affect school staff & senior managers
  • may generate a lot of media interest
  • may generate reaction in parents
  • may generate over-zealous helping, callers and visitors
24
Q

what is the impact of trauma on organisations

hindmarch (2002)

A
  • can bring out ‘best and worst’ in ppl
  • magnify difficulties or strengthens existing relationships
  • can lead to closing of ranks creating an ‘in group’ vs ‘out group’
  • competing pressure to stop or carry on as normal
  • shared experience creates opportunity for ppl to both give & seek support
25
Q

impact of trauma on schools/organisations

A
  1. pre-trauma context
  2. crisis
  3. retribalisation
  4. polarisation
  5. depression
  6. mobilisation
  7. breakthrough
  8. exhausation/elation
  9. post-trauma context
26
Q

EPs work helping schools with CIs

A
  • develop a plan for handling the feelings & reactions of ppl
  • preparing a media statement
  • preparing info for parents, pupils and staff
  • considering & arranging appropriate support for staff, parents & pupils involved
  • engaging a wider CI support team
27
Q

diff forms of short-term post-incident ‘group’ support

A
  • demobilisation
  • defusing
  • debriefing
  • psychological first aid (Brymer et al., 2006)
  • structured group-based trauma-focused-CBT (Dorsey et al., 2017)
28
Q

CI debriefing

A
  • based on models of CI stress debriefing (CISD), psychological debriefing
  • ‘a group meeting or discussing, employing both crisis intervention and educational processes, targeted towards mitigating or resolving psychological distress associated with a critical or traumatic event’ - Mitchell & Everly (1996)
29
Q

aims of debriefing

A
  • to help create a shared narrative
  • help integrate cog & emotional mem
  • connect past, present & future
  • provide psycho-education
  • support normalisation
30
Q

evidence of impact of CI debriefing

A
  • ‘psychological debriefings can be very effective in reducing intrusive thoughts’ (Stallard & Law, 1993)
  • approach criticised for not differentiating responses for inds (Bisson et al., 2009)
  • adult CISD studies: some ev of its perceived helpfulness & satisfaction of those involved, but no ev that it was effective in preventing PTSD in inds (Van Emmerick et al., 2002)
  • systematic reviews of CISD suggest ev for its use is at best inconclusive, & some argue potentially harmful for ind primary victims e.g. BPS (2002)
  • currently not recommended as a method of treating or preventing PTSD (NICE, 2018)
31
Q

psychological first aid

A
  • ‘non-intrusive, supportive and practical assistance’ (WHO, 2010)
  • aim to: create calm conditions, reduce initial distress, promote functioning & coping
  • flexible approach - acknowledges ind diffs in reactions although given in response to a group’s needs
32
Q

8 core components of PfA

A
  1. contact and engagement
  2. safety and comfort
  3. stabilisation
  4. info gathering
  5. practical assistance
  6. connection with social supports
  7. information on coping
  8. linkage with collaborative services
33
Q

goal of contact and engagement

PfA

A

initiate contact with or to respond to contacts by students & staff in a non-intrusive, compassionate, & helpful manner

34
Q

goal of safety and comfort

PfA

A

enhance immediate & ongoing safety, & to provide physical & emotional comfort

35
Q

goal of stabilisation

PfA

A

calm & orient the emotionally overwhelmed or disorientated students & staff

36
Q

goal of information gathering

PfA

A

identify immediate needs & concerns, gather additional info & tailor PfA for school intervention to meet these needs

37
Q

goal of practical assistance

PfA

A

offer practical help to staff & students in addressing immediate needs & concerns

38
Q

goal of connection with social supports

PfA

A

to help establish brief or ongoing contacts with primary support persons or other sources of support, including family, friends & other school and/or community helping resources

39
Q

goal of information on coping

PfA

A

provide info about stress reactions & coping to reduce distress & promote adaptive functioning

40
Q

goal of linkage with collaborative services

PfA

A

link students & staff with available services needed at the time or in the future (Brymer et al., 2006, 2012)

41
Q

effectiveness of PfA

A
  • ev-base is still insecure, although support expert opinion
  • has logical links with grief & bereavement theory
  • some ev that it promotes calm & connection
  • ‘ev-consistent’ rather than based (Aucott & Soni, 2016)
  • considered by some as an appropriate response to a CI (Fox et al., 2012)
  • other approaches need to address PTSD (Dorsey et al., 2017)
42
Q

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

A
  • dev issues in child
  • modalities of expression & conversation
  • involvement of parents
  • role of peer group
  • level of engagement
  • self-disclosure, confidentiality & coping skills
  • potential for secondary traumatisation & retraumatisation (Wraith, 2000)
43
Q

what are recommended interventions for inds?

NICE (2005), CIs

A
  • PfA
  • watchful waiting
  • eye movement desensitisation reprocessing (EMDR)
  • trauma-focused cognitive behavioural therapy (TF-CBT)
44
Q

EMDR

A
  • person recalls an important aspect of a traumatic event
  • whilst following repetitive side to side movements, sounds or taps as the traumatic image is remembered & focused on
45
Q

TF-CBT

NICE (2005)

A
  • help confront traumatic mems
  • modify misinterpretations of threat
  • develop skills to cope with stress
46
Q

steps of TF-CBT

Meichenbaum (1994)

A
  1. establish a rapport, encouraging person to tell their story & express feelings
  2. help person make sense of story - new coping skills linked to re-experiencing, avoidance, arousal & negative cognitions/mood
  3. involves cog restructuring - help person obtain control, rebuild & replace shattered beliefs
  4. re-establish relationships & confidence
  5. develop strategies to prevent relapse
47
Q

TF-CBT and the evidence base for CYP

A
  • intervention of choice is trauma-focused CBT for ind children of 10yrs upwards (Wolpert et al., 2006): little conclusive ev to support the efficacy of EMDR & other interventions with CYP; a need for better ev base & audit of all interventions (NICE, 2005)
  • ind trauma focused CBT could be considered for CYP age 7-17 after 3 months
  • if a large-scale trauma & shared experience - group TF-CBT could also be considered (NICE, 2018)
  • but a call for further review of ev on TF-CBT (Dorsey et al., 2017)

Educational psychology (9 decks)

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