Crisis Intervention

Contents:
What is an Emotional Crisis?
General Principles of Crisis Intervention
The Crisis Plan, Crisis Team, and Crisis Intervention
ACTION CHECKLIST
Pre-School and Kindergarten Elementary School Secondary School
SYMPTOMS OF DEPRESSION AND SUICIDE
Know What To Watch For Know What To Do
Common Misconceptions About Suicide
Suggested Roles For School Crisis Team Members
Structuring a School Day Following a Crisis

What is an Emotional Crisis?

The aftermath following:

A natural disaster, for example, a fire or an earthquake.
An accident on school grounds, for example, a plane crashes on the playground during recess.
An accident near school grounds, for example, a tanker truck overturns on the freeway nearby and is leaking gas.
A violent incident in or near the school, for example, a high school student shoots another on campus.
A violent incident involving a student or staff member off school grounds, for example, a teacher is murdered by a family member.
The suicide of a student or staff member, for example, during the school year, a fifth-grader commits suicide by taking pills.
The suicide of a family member of a student or staff member, for example, the brother of a student shoots himself.
The accidental death of a student or staff member, for example, an eighth grader drowns in an irrigation canal.
The accidental death of a family member of a student or staff member, for example, a teacher's daughter is killed in a car accident.
The terminal illness of a student or staff member, for example, a second grade student dies of cancer during the school year.

General Principles of Crisis Intervention

Intervene immediately: Be direct, active, authoritative.
The sooner the student is assisted in coping with the crisis situation, the better the chances are of restoring equilibrium. The longer the student remains in a state of confusion or unable to take some sort of action to address the situation, the more difficult it will be to intervene.
Keep the focus of the intervention on the precipitating situation.
Help the student to accept that the crisis has occurred, by encouraging the student to express the facts of the situation as well as expressing feelings.
Provide accurate information about the situation.
Give a realistic assessment of what has occurred, and what might be the expected outcomes.
Do not give false reassurance. Always remain truthful and realistic.
Recognize the anxiety, depression, or tension, but at the same time, provide some sense of hope and expectation that the person will ultimately overcome the crisis.
Recognize the primacy of taking action.
Every crisis counseling interview should have an ultimate outcome of some action that the student can take. Restoring the student to the position of actor rather than victim is critical to success.
Provide emotional support for the student.
Find a group of peers, a group of school staff members, or a family member who can provide both support and temporary assistance to the student during the crisis. Implement a buddy system so that the student isn't left alone.
Focus on self-concept.
Emphasize how the student has coped with the situation so far and how he or she has already used strategies for moving forward. Encourage the student to implement solutions or strategies that have a high probability of success.

The Crisis Plan, Crisis Team, and Crisis Intervention

A psychological or emotional crisis may be the resulting trauma or personal tragedy that causes human suffering.

The School Crisis Plan

Updated annually
Staff roles delineated
Adaptable to fit the crisis
Copy distributed to every staff member
Evaluated periodically

The School Crisis Team

Members designated annually by administrator, usually the principal, assistant principal, counselor, nurse, school psychologist (if appropriate).
Responsibilities clear and understood

District Crisis Team

If a site needs additional crisis support, the District Crisis Team can be activated by calling Rebecca Benner at (760) 726-2170 Ext. 2377

Common Feelings of Students When in Crisis

Fear
Helplessness
Loss
Sadness
Shock
Worry about self

Possible Behaviors of Students When in Crisis

Irritability
Restlessness
Moodiness
Agitation
Difficulty concentrating, eating, and/or sleeping
Nausea
Diarrhea

Needs of Students When in Crisis

Physical
Psychological
Emotional

Crisis Counseling

Short term
Classroom announcement and activities when necessary
Small groups of students
Small groups of parents and staff when appropriate
Individual students as needed
Follow-up
Referrals

Process of Crisis Counseling

Learn the facts about the situation
Assess severity objectively and subjectively
Learn how each student is feeling
Assess each student's ability to cope
Learn each student's symptoms:
- Health, insomnia, nightmares
- Irritability, worrying, grades
Teach common reactions to crises
Discuss how responses are helpful or not
Summarize
Develop action plans
Encourage support for each other
Ensure physical, emotional and psychological safety
Plan and conduct a follow-up 3 to 5 days later
Arrange for individual counseling as needed
Make referrals as needed

ACTION CHECKLIST

Pre-School and Kindergarten
Somatic Reactions	Emotional/Behavior Reactions	Suggested Interventions
Loss of appetite	Generalized fear (darkness, strangers, "monsters")	Provide physical comfort such as food, rest, holding, bedtime routine
Overeating	Regressive symptoms (thumb sucking, bedwetting, immature speech)	Assure adult protection
Indigestion	Repetitive play in which the traumatic event is reenacted	Give repeated concrete clarifications of events
Vomiting	Appears helpless and passive	Encourage communication with teachers and parents
Bowel or bladder problems (e.g. diarrhea, constipation, loss of sphincter control)	Repetitive talking about experience or lack of verbalization	Provide help in verbalizing general feelings and complaints
Sleep disturbances and nightmares	Short attention span	Explain the physical reality of death
	Irritability
	Overactivity
	Exhibits anxious attachments such as clinging, not wanting to be away from parents
	Demonstrates cognitive confusion (does not understand the danger is over)
	Develops anxieties related to incomplete understanding about death, fantasizes about repairing the situation

Elementary School
Somatic Reactions	Emotional/Behavior Reactions	Suggested Interventions
Headaches	Inability to concentrate, drop in level of school achievement	Reassure with realistic information
Complaints of visual or hearing problems	Irritability	Permit acting out the experience - acknowledge the normalcy of the feelings
Persistent itching and scratching	Aggressive behavior	Temporarily lessen requirements for optimum performance in school and home
Nausea	Disobedience	Encourage verbal expression of thought and feelings about disaster/loss
Sleep disturbances, nightmares, night terrors	Sadness over losses of possessions	Provide opportunity for structured, but not demanding chores and responsibilities
	Regressive reactions (excessive need for adult's attention, clinging, crying, whimpering)	Encourage physical activity
	Resistance to going to school	Give older children useful tasks to perform
	Preoccupation with own actions during event as they relate to responsibility and guilt	Encourages constructive activities on behalf of the injured or deceased
	Retells and replays the event; distorts the event cognitively; obsessively details the event
	Is concerned about own safety and safety of others such as siblings
	Is afraid of feelings (to cry, to be angry)
	Is concerned for other victims and their families

Secondary School
Somatic Reactions	Emotional/Behavior Reactions	Suggested Interventions
Headaches	Antisocial behavior: aggression rebellion withdrawal attention seeking	Provide assurance that feelings and fears are normal
Vague complaints of pains	Use of drugs, sexual acting out	Encourage group discussion about the event
Overeating/loss of appetite	Sibling rivalry	Initiate resumption of routine activities
Bowel irregularities	Drop in level of school performance	Discuss/address relationship between acting out and impact of event
Sleep disturbances	Sadness, depression, apathy	Rehearse safety measures to be taken in future disasters
	Guilt about survival	Encourage physical activity
	Is self-conscious about fears and sadness	Encourage taking part in home or community recovery efforts
	Preoccupation with own actions during event as they relate to responsibility and guilt
	Enters prematurely into adulthood (leaves school, gets married)

SYMPTOMS OF DEPRESSION AND SUICIDE

KNOW WHAT TO WATCH FOR:

Symptoms of Depression

Persistent sad or empty mood
Feelings of hopelessness, helplessness, guilt, pessimism, or worthlessness.
Chronic fatigue or loss of interest in ordinary activities, including sex.
Disturbances in eating or sleeping patterns.
Irritability, increased crying; generalized anxiety (may include chronic fear of dying/convinced dying of incurable disease), panic attacks.
Difficulty concentrating, remembering, or making decisions.
Persistent physical symptoms or pains that do not respond to treatment - headaches, stomach problems, neck/back pain, joint pain, mouth pain.

If you are concerned about any of these symptoms, ask the person how he or she is feeling. Getting help is key to suicide prevention....the earlier, the better.

Warning signs of suicide

Thoughts of suicide; suicide plans or attempts.
Talking or joking about suicide. Statements about being reunited with a deceased loved one.
Statements about hopelessness, helplessness, or worthlessness. Example: "Life is useless." "Everyone would be better off without me." "It doesn't matter. I won't be around much longer anyway." "I wish I could just disappear."
Preoccupation with death. Example: recurrent death themes in music, literature, or drawings. Writing letters or leaving notes referring to death or "the end".
Suddenly happier or calmer.
Loss of interest in things one cares about.
Unusual visiting or calling people one cares about - saying their good-byes.
Giving possessions away, making arrangements, setting one's affairs in order.
Self-destructive behavior (alcohol/drug abuse, self-injury, mutilation, or promiscuity).
Risk-taking behavior (reckless driving/excessive speeding, carelessness around bridges, cliffs or balconies, or walking in front of traffic).
Having several accidents resulting in injury, close calls or brushes with death.
Obsession with guns or knives.

KNOW WHAT TO DO:

If you see possible warning signs of suicide....

It's okay to ask the person, "Do you ever feel so badly that you think of suicide?"
Don't worry about planting the idea in someone's head. Suicidal thoughts are common with depressive illnesses, although not all people have them. If a person has been thinking of suicide, they will be relieved and grateful that you were willing to be so open and nonjudgmental. It shows a person you truly care and take them seriously.
If you get a yes to your question, question the individual further. Ask, "Do you have a plan?" If yes, ask, "Do you know when you would do it?" (today, next week?) "Do you know how?" "Do you have access to what you would use?"
Asking these questions will give you an idea if the person is in immediate danger. Do not leave the person alone! A suicidal person must see a doctor or psychiatrist immediately. You may have to take the person to the nearest hospital emergency room or call 911. Always take thoughts of or plans for suicide seriously.
Never keep a plan for suicide a secret.
Don't worry about breaking a bond of friendship at this point. Friendships can be fixed. And never call a person's bluff, or try to minimize the person's problems by telling the person they have everything to live for or how hurt their family would be. This will only increase the person's guilt and feelings of hopelessness. The person needs to be reassured that there is help that what they are feeling is treatable, and that their suicidal feelings are temporary.
If you feel the person isn't in immediate danger, you can say things like, "I can tell you're really hurting", and "I care about you and will do my best to help you."
Then follow through - help the person find a doctor or mental health professional. Be by the person's side when they make that first phone call, or go along with the person to the first appointment. It's not a good idea to leave it up to a person to get help on their own. A supportive person can mean so much to someone who is in pain.

Common Misconceptions About Suicide

"People who talk about suicide won't really do it."
NOT TRUE
Almost everyone who commits or attempts to commit suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out," - no matter how casually or jokingly said may indicate serious suicidal feelings.
"Anyone who tries to kill him/herself must be crazy."
NOT TRUE
Most suicidal people are not psychotic or insane. They must be upset, grief-stricken, depressed or despairing, but extreme distress and emotional pain are not necessarily signs of mental illness.
"If a person is determined to kill him/herself, nothing is going to stop him/her."
NOT TRUE
Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever.
"People who commit suicide are people who were unwilling to seek help."
NOT TRUE
Studies of suicide victims have shown that more than half had sought medical help within six months before their deaths.
"Talking about suicide may give someone the idea."
NOT TRUE
You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true - bringing up the subject and discussing it openly is one of the most helpful things you can do.

* From the National Association for Mental Health.

School Crisis Team Leader

Call the team together to plan response.
Summarize the crisis situation.
Facilitate development of the crisis response plan.
Respond to requests from media for information either personally or through district's public information officer or other designee (rumor control).
Act as liaison with district officers.
Conduct debriefing or evaluation of crisis response plan.
Act as liaison with police, fire, and/or other outside sources.

Staff Liaison

Keep staff informed of progress of crisis response plan and events of crisis.
Coordinate classroom activities dealing with trauma.
Coordinate referral system for highly traumatized students.
Conduct staff debriefing meeting.

Community Liaison

Network with community agencies that are involved in the plan.
Coordinate community involvement with school psychologist.
Keep records of all community agency involvement at site.
Update other team members, as necessary.

Counselor/Nurse/School Psychologist

Act as referral resource for students and staff.
Serve as intake counselor for highly traumatized students.
Consult with staff.
Help screen students at risk.
Develop support systems, as needed.
Conduct group meetings with parents and staff, as needed.

Structuring a School Day Following a Crisis

Have a Staff Pre-meeting:
- Invite all the staff who are affected by the crisis. Be sure to include part-time teachers, bus drivers, playground supervisors, janitors, secretaries, and so on.
- Keep communications open and give facts on the situation, as appropriate within the bounds of confidentiality. Prepare a handout for staff not in attendance.
- Share reactions and feelings with one another, taking time for mutual support. The school crisis team shares information on grief, and answers the questions and concerns of the staff.
- Give a plan for the day that has been prepared by the crisis team.
The School Day:
How to tell Students
- Decide which students are to be told.
- Confirm what information they will be told.
- Decide who will tell the students.
- Outline the procedures for how they will be told.
- Discuss how they may react and what to do.
The Debriefing Meeting:
A meeting with staff at the end of the day to discuss how the day went for both students and staff.
Activities to Discourage
- Large assemblies or public address announcements - these make it difficult to provide support to students on an individual basis.
- Student and staff contact with the media while at school - media contacts can be disruptive and sometimes insensitive. Direct all media to the public information officer or representative.
- Removing belongings of the deceased- this is best done gradually and can include family members and friends. Having concrete reminders in the classroom can help teachers and students let go gradually.
- Staying rigid with regard to curriculum and scheduling - reactions will vary, from needing flexibility to needing structure. Decisions must be made on an individual basis.
- Not communicating with students, staff, parents and community on unfolding events.
- Treating the death of students differently because of status or community position, etc.
Safety Valves
- Make sure there are enough staff and school crisis team members to support all who may need it. It's much better to have more than you need, than to need, more than you have.
- Designate a safe room for anyone wanting a place to go to, if needed. Make sure everyone knows its purpose and location.
- Hold a debriefing meeting at the end of the day to give people a place to process the day and receive support and validation.