responding to critical incidents in schools Flashcards
what is a critical incident
cheshire county council (1995)
- 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
could covid be considered a CI?
ONS (2020)
- 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
key questions for psychological theory, research and practice
- 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?
post-trauma stress
APA, DSM (1987)
the development of certain characteristic symptoms following a psychologically distressing event, which is outside the range of normal human experience
impact of PTS
parkinson (1993)
- flashbacks & intrusive mems
- headaches
- difficulty concentrating
- feeling guilty - e.g. ‘it was my fault’
- feeling detached from others
4 aspects of PTSD
DSM5
- re-experiencing
- avoidance
- arousal
- negative cognition and mood
PTSD in CYP
- diagnosis for children above 6 same as adults
- symptoms in younger children may differ: re-enacting events, repetitive play, emotional and/or beh difficulties
what influences ppl’s reactions
McNally (2003)
- age
- experience
- personality
- nature of incident
- degree of involvement
trauma, PTS, PTG
- 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
theoretical persectives (CI)
- life-belief model
- human needs model
life-belief model
janoff-bulman (1985)
- 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
human needs model
mccann & pearlman (1990)
- 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
crisis intervention theory
caplan (1964)
- 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
phases of grief & bereavement theory
- denial
- pain and distress
- realisation
- resolution
how do people typically respond to traumatic bereavement
queensland department of education (1998)
- pre-traumatic stability
- traumatic incident
- shock
- denial
- emotional impact
- working through
- acceptance
- normal reactions
- post trauma stability
aspects of psychosocial model/framework
joseph et al. (1997)
- event stim
- event cognitions
- appraisal mechanisms
- emotional states
- personality
- social context
- coping
what are the needs of those affected by CIs?
parkinson (1997)
- acknowledgement & recognition
- info
- opportunity to talk
- formal and informal rituals
- routines and normality
- return and reintegration
aim of CI support
warrington borough council (2007)
- 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
planning and preparation
community level (CIs)
LAs & schools should be ‘wise before event’
EP work at a LA & community level
CIs, Pousada (2006)
- 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)
plans should include
NICE (2005), CIs
- 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
components of CI management plan
mitchell & everly (2000)
- 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
how do CIs impact on schools and organisations?
cheshire county council (1995)
- 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
what is the impact of trauma on organisations
hindmarch (2002)
- 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
impact of trauma on schools/organisations
- pre-trauma context
- crisis
- retribalisation
- polarisation
- depression
- mobilisation
- breakthrough
- exhausation/elation
- post-trauma context
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
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)
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)
aims of debriefing
- to help create a shared narrative
- help integrate cog & emotional mem
- connect past, present & future
- provide psycho-education
- support normalisation
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)
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
8 core components of PfA
- contact and engagement
- safety and comfort
- stabilisation
- info gathering
- practical assistance
- connection with social supports
- information on coping
- linkage with collaborative services
goal of contact and engagement
PfA
initiate contact with or to respond to contacts by students & staff in a non-intrusive, compassionate, & helpful manner
goal of safety and comfort
PfA
enhance immediate & ongoing safety, & to provide physical & emotional comfort
goal of stabilisation
PfA
calm & orient the emotionally overwhelmed or disorientated students & staff
goal of information gathering
PfA
identify immediate needs & concerns, gather additional info & tailor PfA for school intervention to meet these needs
goal of practical assistance
PfA
offer practical help to staff & students in addressing immediate needs & concerns
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
goal of information on coping
PfA
provide info about stress reactions & coping to reduce distress & promote adaptive functioning
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)
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)
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)
what are recommended interventions for inds?
NICE (2005), CIs
- PfA
- watchful waiting
- eye movement desensitisation reprocessing (EMDR)
- trauma-focused cognitive behavioural therapy (TF-CBT)
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
TF-CBT
NICE (2005)
- help confront traumatic mems
- modify misinterpretations of threat
- develop skills to cope with stress
steps of TF-CBT
Meichenbaum (1994)
- establish a rapport, encouraging person to tell their story & express feelings
- help person make sense of story - new coping skills linked to re-experiencing, avoidance, arousal & negative cognitions/mood
- involves cog restructuring - help person obtain control, rebuild & replace shattered beliefs
- re-establish relationships & confidence
- develop strategies to prevent relapse
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)
