Advanced School Crisis Training

1. Advanced School Crisis Training Marleen Wong & Melissa Brymer School Crisis and Intervention Unit National Center for Child Traumatic Stress UCLA and Duke University

2. The Educator’s Mantra There cannot be a crisis next week… My schedule is already full. -Henry Kissinger

3. US Department of EducationSCIU Priorities • Acts of Targeted Violence – Project SERV • Safe Schools/Healthy Students (SAMHSA) • National Safe and Drug Free Schools Programs • State School Safety Programs • Persistently Dangerous Schools (NCLB) • NEMS

4. Schools as Open and Closed Systems What Kind of Family System is Your School? How is it Affected by Trauma? Is there an Emergency Plan? What kind of Mutual Agreements are in Place? Is the Emergency Plan based on NEMS (National Emergency Management System)

5. SEMS and NEMSStandardized Emergency Management SystemNational Emergency Management System • Delineates the activities of the five SEMS or NEMS functions: • Management: Incident Commander • Community Operations – EOB/EOC • Emergency Operations Board/Committee • Planning/intelligence, • Logistics and • Finance/administration

6. Managing the Crisis • Crisis Levels: • Level I - Has a significant school-wide impact • Managed under the direction of the Principal or Site Incident Commander • Additional personnel may be requested by administrator through local district Operations Coordinator • School site team and other personnel work under the direction of school administrator • Level II – Does not have school-wide impact and would not be a significant threat to the survival of the students or school personnel • School administrator continues to have authority and responsibility • However, team leader and crisis team members typically will manage this level crisis • Administrator needs to be kept informed and briefed

7. School Operations • Evacuation • Search and Rescue • First Aid/Emergency Medical Response • Hazard Mitigation • Psychological First Aid/Crisis Teams • Parent/Child Reunification

8. Multi-Level Intervention Options Tier 1 – General School-Based Interventions Psychoeducation Coping Skills Support Tier 2 – Specialized School-Based Interventions Trauma / Grief - Focused Counseling Group, Individual, Family Short-Term Tier 3 – Specialized Community-Based Interventions Referral to On or Off-Site MH Services

9. Mental Health Objectives in School Settings • Restore the Learning Environment • Re-establish Calm Routine • Assist with Coping and Understanding of Reactions to Danger and Traumatic Stress • Re-unite Students with Caregivers ASAP • Support the Emotional Stabilization of Teachers and Parents

10. Secondary Adversities Compound Trauma • Loss of home, car, cherished belongings • Loss of social, personal, or familial ties • Loss of self-esteem, control over one’s life • Loss of resources such as food, money, physical abilities

11. Advantages of School Based Programs • Schools are “de facto” mental health system for many children • Large numbers of at Risk/disadvantaged children • Existing Specialized Education Programs • SED/ED students with “counseling” mandated by IEP • School-based health clinics • Co-location of community mental health providers • Expanded school mental health programs • Surgeon General’s National Action Agenda for Children’s Mental Health and President’s New Freedom Commission call for increase in school mental health programs

12. Obstacles to School Based Programs • Difficulty of Entry • Less than Ideal Clinical Conditions (Flushing Meadows) • Overcoming “Mission Creep” • Motivating and Educating Educators • Tailoring the program for schools (Bell Schedules, Tracks, Pupil Free Days)

13. Speaking the Language Impact and Outcomes of Trauma Treatment • Academic achievement • Grades and standardized tests • Average Daily Attendance (ADA) • Decreased attendance means less money • Emotionally Disabled (ED) Students and IDEA • Services come out of school general fund • Improving classroom behavior and performance

14. From the Field of Brain Research In order for children to learn… • Eliminate Threat from the Environment • Enrich the Learning Environment

15. Rates of Exposure to the Range of Traumatic Events in School Surveys Elementary and middle school children in inner city (n=500): 30% witnessed a stabbing, 26% witnessed a shooting (Bell & Jenkins, 1993). Middle and Junior High school students (n=2,248) in urban school system: 41% reported witnessing a stabbing or shooting in the past year (Schwab-Stone et al., 1995). High School students (n=3,735) in six schools in two states. Relatively high rates of exposure in the past year that varied by location and size of the high school. Males: 3%-33% reported being shot or shot at, 6% -16% attacked with knife. Females: Lower reported rates of victimization, higher rates for sexual abuse or assault (Singer et. al.,1995).

16. Link between Violence Exposure and Chronic PTSD with: • Substance Abuse • Reckless Behavior • High-risk Sexual Behavior • Gang Participation • Disturbances in Academic Functioning (Kilpatrick, Saunders & Resick, 1998)

17. Managing the Crisis • Crisis Levels: • Level I - Has a significant school-wide impact • Managed under the direction of the Principal or Site Incident Commander • Additional personnel may be requested by administrator through local district Operations Coordinator • School site team and other personnel work under the direction of school administrator • Level II – Does not have school-wide impact and would not be a significant threat to the survival of the students or school personnel • School administrator continues to have authority and responsibility • However, team leader and crisis team members typically will manage this level crisis • Administrator needs to be kept informed and briefed

18. SEMS and NEMSStandardized Emergency Management SystemNational Emergency Management System • Delineates the activities of the five SEMS or NEMS functions: • Management: Incident Commander • Community Operations – EOB/EOC • Emergency Operations Board/Committee • Planning/intelligence, • Logistics and • Finance/administration

19. School Operations • Evacuation • Search and Rescue • First Aid/Emergency Medical Response • Hazard Mitigation • Psychological First Aid/Crisis Teams • Parent/Child Reunification

20. The School in the Community Municipal, State and Federal Government Neighborhood and Greater Community Public Health Services Faith-Based Organizations Students Parents and Guardians Non- Government Disaster and Relief Organizations (i.e. American Red Cross) Principals and Administrators Teachers Law Enforcement & Emergency Services School District officials and School Board Members School Counselors, Psychologists and Social Workers Other School Staff Office and Custodial Staff, Aides Cafeteria Workers Media School Police (Resource) Officers Juvenile Justice School Nurses and Doctors Health Care Child Welfare Community Mental Health & Substance Abuse Agencies Local, State and Federal Departments of Education

21. Lead Mental Health Agency • Department of Human Services – Division of Mental Health • Responsible for the crisis counseling program • Crisis counseling is a time-limited program designed to assist victims/survivors/responders of a disaster in returning to their pre-disaster level of functioning • Two levels of grants: Immediate Services Grant Regular Services Grant

22. Homeland Security Advisory Recommendations for Schools Severe (Red) • Listen to radio, TV, and local news for current information and instructions • Be alert and immediately report suspicious activity to School Police or Sheriff’s Department • Close school if recommended to do so by appropriate authorities • 100% identification check and escort anyone entering school other than students, staff, and faculty • Offer lessons Masters of Disaster “Facing Fear: Helping Young People Deal with Terrorism and Tragic Events” curriculum • Ensure School Site Crisis Team members are available for students, staff and faculty Adapted for LAUSD based on American Red Cross Homeland Security Advisory

23. A Checklist For School Personnel To Evaluate And Implement The Mental Health Component Of Your School Crisis And Emergency Plan MITIGATION & PREVENTION Identify and Assess the Risks • Identify the most common kinds of crises and disasters that may impact your school • Identify hazards or sites that may pose a threat to your school in the event of a disaster or terrorist act

24. Checklist for Schools (Continued) PREPARATION of the MENTAL HEALTH CRISIS RESPONSE COMPONENT OF YOUR SAFE SCHOOL PLAN • Immediate & long-term mental health responses should be included in plans • Establish relationships with local community mental health agencies that specializing in disaster and trauma • Define the roles of your school staff and community partners for different types of crises and phases of response and recovery • Conduct regular annual or bi-annual crisis team practice drills • Identify students and/or staff who may have special needs or may be psychologically vulnerable during crises • Plans should be culturally and linguistically appropriate • Provide new staff and substitutes adequate background information and training regarding crisis response • Create redundant or back-up systems • Annually review your plans • Conduct staff development on selected topics

25. Checklist for Schools (continued) RESPONSE • Assess the level of student and staff exposure to violence and identify those most at risk • Activate community resources for the immediate, concrete needs of the students, families, and staff • Identify traumatic reminders of the event and monitor the range of trauma-related behaviors among students and staff • Implement a program of support and provide psychological educational materials to the school community • Develop media messages • Provide regular information updates and maintain open communication with teachers • Monitor rumors and maintain timely, accurate information • Develop a system to identify and follow psychologically vulnerable students and staff during the recovery period

26. Checklist for Schools (continued) MENTAL HEALTH RECOVERY • Identify students/staff who may need long-term mental health support and develop the school/community resources to provide these services • Monitor the effects of cumulative stress on staff • Provide information on how to cope with cumulative stress and modify work roles/ responsibilities of staff when needed • Make educational materials available to parents and staff on topics such as common symptoms and constructive ways to cope with stress • Develop short-term modifications of school curriculum as students and staff are recovering • Establish working relationship with Employee Assistance Programs • Offer school-based mental health services and identify funding to support those services (e.g., Project SERV) • Follow up with student referrals made to community agencies • Note secondary adversities • Plan a response for the anniversary period

27. Types of Interventions • Individual or group crisis counseling • Wrap-up session with crisis team • Informational staff meetings • Informational parent meetings • Pscychoeducation on the effects of trauma • Referrals to school site resources or community agencies

28. Crisis Team Review • Review the crisis actions taken and services needed • Identify strengths and weaknesses of interventions • Review and monitor status of referred students • Identify students who have not returned back to school • Prioritize intervention activities • Establish action plan and follow up

29. Staff Meeting • Provide current information and fact sheets for staff • Discuss issues or problems related to the crisis • Help crisis team assess needs of staff, student, or parents • Inform staff regarding daily school schedule and action plan • Inform staff regarding the availability and location of school and community crisis intervention services • Explain follow-up actions • Revise action plan if needed

30. General Guidelines • Expect normal recovery. • Promote normal recovery. • Assume survivors are competent. • Recognize survivor strengths. • Support survivors to master the disaster experience. • Promote resiliency. (Jon Shaw, 2004)

31. CISD Seven Steps/Phases • Introduction • Fact phase • Thought phase • Emotional Reaction Phase • Symptom phase • Information phase • Re-entry phase (Jon Shaw, 2004) Mitchell 1983

32. Psychological Debriefing Negative Dimensions: • Individuals may become more aroused • Pathologizes and medicalizes the response • Learn maladaptive behaviors • Disparate individuals pulled into a group exercise without choice • May tell their story without resolution • Does not prevent onset of PTSS or PTSD (Jon Shaw, 2004)

33. Psychological Debriefing • Who should participate? • Inclusion and exclusion criteria? • Optimal timing? • “Single stand alone session” vs. comprehensive anxiety management program? (Jon Shaw, 2004)

34. The Timing of the Debriefing • Initially recommended at 24-72 hours post-crisis • Early debriefing may be hazardous: • Stress and trauma may still be operative • Survivor may by in stage of physiological arousal • Aversive learning may take place during this period (Jon Shaw, 2004)

35. The Timing of the Debriefing • Debriefing should be provided after the arousal phase has subsided • May be more useful after the child has been reintegrated into the home or school setting • Focus on psychoeducation/ cognitive distortions (Jon Shaw, 2004)

36. Single Episodevs.Multiple Episode Debriefing

37. There is little evidence that early single session intervention prevents psychopathology or reduces risk although it is generally well received by participants (Jon Shaw, 2004) • Bison Psychiatric Annuals, 2003

38. Multiple-Session Early Psychosocial Intervention The data suggests that multiple session early psychosocial interventions targeting symptomatic individuals commencing post arousal are more effective than single session early interventions (Jon Shaw, 2004)

39. Debriefing: Helpful Guidelines • Participants should be clinically assessed • Debriefing should be part of a comprehensive intervention program—not a stand-alone intervention • Debriefing should be provided after the arousal phase has subsided (Jon Shaw, 2004)

40. Debriefing: Helpful Guidelines • Leaders should be experienced • Group format is appropriate—should not be used as an individual intervention • Debriefing should be voluntary (Jon Shaw, 2004)

41. Four Steps to Coping • Fact question • Introduce yourself • Tell us where you were when the tragedy occurred • Thought question • What was your first thought when you realized what had happened? • Feeling question • What was your worst feeling? • Assessment question • What would help you feel safer right now?

42. Provide Psychological First Aid

43. Psychological First Aid • Provide safety and security • Provide support and “presence” • Comfort and mitigate distress • Safeguard survivors from additional harm • Reduce physiological arousal • Clarify what happened • Provide reliable, credible information • Identify reminders • Reframe cognitive distortions • End with a positive or identifying restorative resources and positive coping

44. Psychological First Aid • Be proactive • Discuss developmental impact • Prosocial actions

45. Psychological First Aid Psychosocial interventions • Facilitate reunion with loved ones • Identify distressed survivors for early attention and support • Provide information for action (Jon Shaw, 2004)

46. Psychological First Aid • Routinize activities • Involve in reality-focused activities • Provide accurate disaster updates • Educate survivors on adaptive behaviors • Identify risks and resources • Use effective communication techniques (Jon Shaw, 2004)

47. Teacher Interventions • Provide structure • Stay calm • Reinforce safety and security • Be patient • Reduce class workload as needed • Be an active listener • Be sensitive to language and cultural needs • Set realistic perspectives • Be nonjudgemental • Defuse anger • Do not tolerate negative or cruel behavior • Reduce immediate reminders