responding to critical incidents in schools Flashcards
(47 cards)
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
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
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?
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
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
6
Q
4 aspects of PTSD
DSM5
A
- re-experiencing
- avoidance
- arousal
- negative cognition and mood
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
8
Q
what influences ppl’s reactions
McNally (2003)
A
- age
- experience
- personality
- nature of incident
- degree of involvement
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
10
Q
theoretical persectives (CI)
A
- life-belief model
- human needs model
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
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
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
14
Q
phases of grief & bereavement theory
A
- denial
- pain and distress
- realisation
- resolution
15
Q
how do people typically respond to traumatic bereavement
queensland department of education (1998)
A
- pre-traumatic stability
- traumatic incident
- shock
- denial
- emotional impact
- working through
- acceptance
- normal reactions
- post trauma stability
16
Q
aspects of psychosocial model/framework
joseph et al. (1997)
A
- event stim
- event cognitions
- appraisal mechanisms
- emotional states
- personality
- social context
- coping
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
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
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
impact of trauma on schools/organisations
1. pre-trauma context
2. crisis
3. retribalisation
4. polarisation
5. depression
6. mobilisation
7. breakthrough
8. exhausation/elation
9. post-trauma context
26
EPs work helping schools with CIs
* 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
diff forms of short-term post-incident 'group' support
* demobilisation
* defusing
* debriefing
* psychological first aid (Brymer et al., 2006)
* structured group-based trauma-focused-CBT (Dorsey et al., 2017)
28
CI debriefing
* 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
aims of debriefing
* to help create a shared narrative
* help integrate cog & emotional mem
* connect past, present & future
* provide psycho-education
* support normalisation
30
evidence of impact of CI debriefing
* '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
psychological first aid
* '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
8 core components of PfA
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
goal of contact and engagement
| PfA
initiate contact with or to respond to contacts by students & staff in a non-intrusive, compassionate, & helpful manner
34
goal of safety and comfort
| PfA
enhance immediate & ongoing safety, & to provide physical & emotional comfort
35
goal of stabilisation
| PfA
calm & orient the emotionally overwhelmed or disorientated students & staff
36
goal of information gathering
| PfA
identify immediate needs & concerns, gather additional info & tailor PfA for school intervention to meet these needs
37
goal of practical assistance
| PfA
offer practical help to staff & students in addressing immediate needs & concerns
38
goal of connection with social supports
| PfA
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
goal of information on coping
| PfA
provide info about stress reactions & coping to reduce distress & promote adaptive functioning
40
goal of linkage with collaborative services
| PfA
link students & staff with available services needed at the time or in the future (Brymer et al., 2006, 2012)
41
effectiveness of PfA
* 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
what considerations need to be made for children affected by CI?
* 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
what are recommended interventions for inds?
| NICE (2005), CIs
* PfA
* watchful waiting
* eye movement desensitisation reprocessing (EMDR)
* trauma-focused cognitive behavioural therapy (TF-CBT)
44
EMDR
* 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
TF-CBT
| NICE (2005)
* help confront traumatic mems
* modify misinterpretations of threat
* develop skills to cope with stress
46
steps of TF-CBT
| Meichenbaum (1994)
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
TF-CBT and the evidence base for CYP
* 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)
