Who Are You Going to Call?

Kay Rahuba, MSN, RN, CRNP; re:solve Crisis Network, Western Psychiatric Institute and Clinic

Jeffrey Magill, MS, CTR; Western Psychiatric Institute and Clinic

Focus of the Workshop

• Pre-planning and response phases of a crisis

• Identification and collaboration with community

response partners

• How to conduct a needs assessment using

strategic planning

Objectives• Identify the steps involved in conducting a needs assessment

• Identify available resources and to carry out a strategic plan geared towards acute stabilization

• Identify acute stress reactions and strategies to address them collectively and individually

DEFINITIONS

CRITICAL INCIDENTS are unusually challenging events that have the potential to create significant human distress and can overwhelm one’s usual

coping mechanisms.

DEFINITIONS

The psychological DISTRESS in response to critical incidents such as emergencies, disasters,

traumatic events, terrorism, or catastrophes is called a

PSYCHOLOGICAL CRISIS(Everly & Mitchell, 1999)

PSYCHOLOGICAL CRISIS

An acute RESPONSE to a critical incident wherein:

1. Psychological homeostasis (balance) is disrupted (increased stress)2. One’s usual coping mechanisms have failed3. There is evidence of significant distress, impairment, dysfunction

(adapted from Caplan, 1964, Preventive Psychiatry)

Terms you may hear:Trauma Membrane“New Normal”

DEFINITIONS

CRISIS INTERVENTION

A short-tem helping process.

Acute intervention designed to stabilize and mitigate the crisis

response.

Not psychotherapy.

Goals of Crisis Intervention

Normalize reactions and facilitate normal recovery processes.

Restore individuals to adaptive functions

Enhance unit cohesion and unit performance in homogeneous groups

Identify individuals who may need professional assistance and refer as necessary

Principles of Crisis

Intervention

Simplicity

Brevity

Innovative

Pragmatism

Proximity

Immediacy

Expectancy

Six Core Elements of CISMSurveillance, Assessment of the event and the

impact on the personnel

Strategic Planning

Listening, Individual support, and Crisis Intervention

Informational groups

Interactive groups

Follow-up and referral services

AssessmentCircumstances

Nature and Magnitude of event

Impact on people exposed

STOP…BREATHE…THINK…ASSESS

Crisis Needs Assessment

• Relationship of the lost person to the person in crisis

• Nature of the loss (natural, sudden, tragic, etc.)

• Was the loss witnessed by or reported to those in need?

• Cumulative effect of this loss on other losses experienced

by this person

• Shared experience of loss with others (family, community)

(Albert E. Roberts, Crisis Intervention Handbook 3rd Edition)

Characteristics of a Crisis Strategy

Full assessment

Development of goals and objectives

Select the right people to provide the services

Develop a strategic plan of action

Select the right crisis tactics

Crisis event

High anxiety

*

Denial

Anger

Remorse

Grief

Reconciliation

STAGES OF CRISIS

pre-crisis crisis post-crisis

Point of impact

Trial and error

Angle of disorganization

2. stuck

1.function3. improved

*

disorganization

EUSTRESS vs. DISTRTESS vs. DYSFUNCTION

Three intensity levels of stress, thus 3 potential groups of survivors:

Eustress = Motivating stress

Distress = Excessive stress

Dysfunction = Impairment

Tactical Components of CISM

Pre-event preparation, education, training, planning and policy development

Assessment procedures (nature and magnitude of event, impact on people)

Strategic Planning procedures (5 T’s)

Individual crisis intervention support actions

Strategic Planning Formula

Theme

Target(s)

Types

Timing

Team

ThemeWhat are the issues, concerns,

questions, threats, circumstances, and special situations that need to be

considered?

Reminder: We respond to impact not to the event, do not want to interfere

with one’s resiliency

Targets

Who needs assistance and who does not need

assistance?

Types

What types of help will be most

beneficial?

Timing

When will the assistance be most useful to those who need it?

- Immediately- End of day/shift- Within 24 hours- Next Business/School day- Post funeral- Other

Team

Who is being sent in to provide the assistance and do they have the personality, background, and

skills to provide the necessary support

Providers of Crisis Intervention• Communities - Keystone Crisis Intervention Teams (KCIT) - Disaster Crisis Outreach and Referral Team (DCORT) - Critical Incident Stress Management (CISM) - Local Crisis Agency - Red Cross - Mental Health Professionals - Salvation Army - Faith Based Community - Federal agencies - Disaster workers

• Schools - School Faculty, guidance counselors - Student Assistance Program (SAP)

- Community Mental Health • Workplace - Employee Assistance Program (EAP)