RESPONDING TO Critical incidents:

1. RESPONDING TO Critical incidents: Helpful Tips and Lessons From the Field

2. Objectives • Define a critical incident • List two important steps to take following a critical incident • List three normal post-trauma reactions • Identify those at higher risk of negative effects • Know where to find handouts and helpful resources on supporting staff/students post-trauma • Describe some of the challenges and lessons from the field following critical incidents at Job Corps

3. Critical Incident • Any type of traumatic or distressing event or disaster that may overwhelm normally effective coping skills • List several critical incidents that have occurred on your center…

4. Types of Critical Incidents May Include… • Natural disaster (hurricane, earthquake, flood) • Death of a student or staff member (accidental death, illness, suicide) • Disease outbreak • Large scale human created disaster (shooting, bombing, terrorist attack) • Interpersonal violence (rape, stabbing, violent attack) • Sudden loss (center closure, wide scale layoffs)

5. Why Respond Following A Critical Incident? Psychological impacts extend far beyond the medical ones… While most people naturally recover following a trauma and don’t develop PTSD… Improve outcome by supporting the natural recovery process and providing additional support for vulnerable students and staff **Psychological and Medical Footprint: Source: Shultz JM, et al., Behavioral Health Awareness Training for Terrorism and Disasters, Miami FL, DEEP Center, 2003 Psychological “Footprint” Medical “Footprint”

6. JC Critical Incident Crisis Intervention Plan • Located on the JC Health and Wellness Website • Helps identify steps to take following a critical incident that will help foster resilience in students and staff • Describes benefit of identifying Critical Incident Crisis Intervention Team, including roles of key staff in advance of events

7. Overview: Phases of Responding Post-Trauma • Initial/Shock Phase (day 1-2) • Center is vulnerable and fragile • Focus on safety and immediate needs • Impact Phase (day 2-6) • Shock is lessoning, acceptance of situation • Address emotional and physical reactions; additional support to vulnerable individuals • Integration Phase (day 6 and on) • Moving towards closure. Center may benefit from memorial or assembly • Some individuals will need ongoing support

8. Shock PhaseDay 1-2 • Help CD assess immediate impact of event and how to best support center • Support CD in providing necessary staffcrisis briefing and information on how staff can best support students Center is in shock Distress is high Need to focus on safety and immediate needs (stabilization)

9. Shock Phase, Day 1-2 (Continued) • Provide guidance to CD regarding how to communicate information to students • Ideal Situation: • Have known staff inform students in small groups (e.g., dorm staff, trade staff, classroom staff) • Include information such as: • Facts around crisis (provide staff written talking points) • Security measures being taken (if relevant) • Normal range of reactions (Coping After Trauma handout) • Support available (encourage drop-ins) • Plan for day/week • Staff should identify students who appear to have strong reactions and provide additional support and follow up with student’s counselor or CMHC to ensure they are aware student may need more support

10. Shock Phase, Day 1-2 (continued)Coping After Trauma: Normal Reactions • Emotional Changes • Feeling anxious, fearful, or overwhelmed • Feeling sad or tearful • Feeling angry • Feeling guilty • Feeling numb • Feeling tired or unable to relax • Feeling on an emotional rollercoaster • Physical Changes • Stomachaches or diarrhea • Headaches or physical pain for no reason • Eating too much or too little • Feeling shaky or jumpy • Sweating or feeling chilled

11. Shock Phase, Day 1-2 (continued)Coping After Trauma: Normal Reactions • Cognitive  Changes • Nightmares or flashbacks • Disturbing thoughts related to the event • Trouble thinking clearly • Trouble remembering things • Difficulty talking about the event • Worrying a lot about safety • Behavioral Changes • Difficulty falling or staying asleep • Sleeping too much • Feeling unable to relax or sit still • Having outbursts • Withdrawal • Difficulty trusting others or accepting help

12. Shock Phase, Day 1-2 (continued)Taking Care of Yourself Post-Trauma • Talk: ask for support, attend drop-in sessions, talk with someone you trust (counselor, RA, trusted staff, CMHC, TEAP, etc) • Care for Your Physical Self: eat healthy, drink water, get rest • Calm Your Nervous System: deep breaths, massage, stretch, yoga, walk, or do some other relaxing, calming activity • Give Yourself a Break: Stay informed, but take breaks from watching news coverage/listening to reports about event • Get Back to Normal Routine: Structure and doing normal activities helps you heal • Stay Active: Keep doing healthy activities you enjoy like listening to music, exercising, reading book, playing sports, journaling • Help Others: It can be healing to help others when we’re in distress

13. Shock Phase, Day 1-2 (continued) • Establish Drop-In Room • Identify room where students can stop-in to speak with counselor, CMHC, or individual trained in mental health support • In preparation of critical events, consider training interested and/or key staff in Psychological First Aid (PFA) • Contact regional health consultant for support and other community resources, as needed. If outside resources used, make sure clear communication around what services are needed and chain of command

14. Shock Phase, Day 1-2 (continued) • Identify Vulnerable People • Close to victim • Directly involved/witnessed traumatic event • Indirectly involved in event • History of trauma • History of vulnerability or mental health difficulties • Exhibited strong reaction to hearing about trauma • Exhibiting change in behavior since trauma • Don’t assume vulnerable people will seek help. We need to identify and actively offer support.

15. Impact Phase Day 2-6 • Continue to identify and follow up with vulnerable individuals • Informal “check-ins” in form of walking around center to touch base with students • Counseling staff/trade instructors/academic staff can provide informal check-ins also • Continue to support CD in providing updated information to staff and students • Continue to support CD in continuing center routine as much as possible (holding classes, extracurricular activities) Initial shock of event is decreasing Individuals begin focusing on meaning of event, the personal impact, the “what ifs” Distress continues

16. Integration Phase Day 6 and on Center finding closure Ongoing support needed for vulnerable individuals Commemorative events/memorials Ongoing awareness more support may be needed on anniversary, court date, media stories, etc.

17. Integration Phase, day 6 and on (cont.) • Commemorative/Memorial Services Guidelines • Goal should be to treat all deaths similarly (reinforces stigma and worsens pain to commemorate student who died in car crash and not one who died of accidental drug overdose or suicide) • In general, better to avoid physical memorialization (not naming park bench, tree, building after person) • Encouraged friends, peers, SGA, parents (if appropriate) to help plan how to best memorialize the person • Memorials may take different forms: center assembly, day of service, identifying a place where students can come and talk about deceased and express feelings creatively (writing, drawing, so forth).

18. Integration Phase, day 6 and on (cont.) • Special Considerations in Instances of Suicide • Important to commemorate student who dies by suicide • Adolescents may be more vulnerable following a suicide • Finding a meaningful and safe way to commemorate student without glorifying suicide • Recommended memorial include common connection between suicide and underlying mental health problems, ways to seek help, and that treatment can help • After a suicide, important to provide staff and students information on warning signs of suicide and how to get help

19. Integration Phase, day 6 and on (cont.) • Event Debriefing • Key staff meet to discuss what went well and changes to be made

20. Lessons from the Field • We developed a letter to all Students, offering additional services: • This email is being sent to all of the Los Angeles Job Corps students from your Emotional Wellness staff (Dr. Joe Grillo, Dr. Merilee Oakes, and the Psychology Interns Kim, Lindsay, Ashley and Tanya) to help you and your family and friends understand some of the things you may be experiencing as a result of the tragedy we’ve been through. • There are many emotions that are triggered during and after a crisis and loss. Sometimes we don’t understand some of the very normal reactions we are having. We may worry about feelings or thoughts we have. In addition, the people close to us may also have a hard time understanding changes in our mood or behavior. • So we are sending you this information to read and also to share with your family and friends to help you to understand more about reactions you may be having and to find healthy ways of coping with them. • We want to remind you that your Career Managers and the Dorm Staff are here to help you as well as our Health and Wellness staff.

21. Lessons from the Field • Letter to all Students, offering additional services (cont.): • Next week, we will be having drop in hours for group counseling: • Monday to Friday at 12 noon in the 9th Floor Day Room • Monday to Thursday at 4 p.m. in Room 207 • Tuesday & Wednesday at 6 p.m. in Room 207 • The groups will give you a chance to express feelings and thoughts, reduce stress, process any reactions you may be having, and support each other. • If you want an individual counseling session, please just tell your Career Manager or call Dr. Oakes who will be handling the schedules for Dr. Joe and the Interns as well as for herself. Dr. Oakes’ phone number is (213) 741-5482.

22. Lessons from the Field • We attached one of our brochures to the email and also did a mass printing so copies would be easily available throughout the center:

23. Lessons from the Field • We also revised a staff presentation we had done the previous year and presented it to all staff members:

24. Lessons from the Field • Other Considerations • Managing and supporting current Interns • Their reactions to the incident • Impact of potential lost time on training • Impact of participating in providing additional unplanned services • Impact on recruitment of future Interns • Impact on contractual hours of CMHC

25. Resources Job Corps Specific Resources Other Helpful Resources • On the Health and Wellness Website, “Responding to a Crisis” tab on left side includes: • JC Critical Incident Crisis Intervention Plan • JC Coping After a Traumatic Event Handout • Many additional resources Psychological First Aid Resources • The National Child Traumatic Stress Network http://www.nctsn.org/content/psychological-first-aid • WHO Guide for Fieldworkers http://whqlibdoc.who.int/publications/2011/9789241548205_eng.pdf • Responding to Critical Incidents in Schools: A Behavioral Health Plan http://www.nh.gov/safety/divisions/hsem/documents/school_plan.pdf • American Foundation for Suicide Prevention. After a Suicide: A Toolkit for Schools http://www.sprc.org/sites/sprc.org/files/library/AfteraSuicideToolkitforSchools.pdf