Crisis Care San Diego, California Dale Walker, MD

1. The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Crisis Care San Diego, California Dale Walker, MD Oregon Health and Science University

2. For more information, contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit our website: www.oneskycenter.org

3. Crisis Care Crisis Intervention: > Focus on immediate emotional support > The person’s resources for coping have failed > The design of your intervention is to assist in coping

4. Crisis Care Critical Incident Stress: > Reactions to a “stressor” > Could be during > Could be after

5. Crisis Care Defusing: > On-scene intervention > Help client to vent feelings > Begin the task of starting coping strategies > Begin the task of reducing stress

6. Crisis Care Debriefing: > Organized approach by mental health professionals > Supportive of the disaster workers who had helped in the time of crisis > Usually done towards the end to bring closure to their experiences

7. Loss, Grief, and Mourning • Grief is both an ADAPTIVE and a NORMAL process. • NORMAL: Because it is a reaction that helps us confront the loss. • ADAPTIVE: Because, while it is painful to go through, it can be productive in that we learn something through it.

8. Stages of Grief • DENIAL • ANGER • BARGAINING • DEPRESSION • ACCEPTANCE NOTE: People MAY go through these and they may go through them differently

9. Stages of Grief • Typical reactions: • Drained of energy, purpose, and faith. • Feel like they are “dead.” • Mistake denial for recovery (too quick) • Focus only on the LOSS, not their recovery • Can’t focus on working through the grief, because of “all the other things” that must be done. • Re-experience emotions at the “anniversary," and other tribal times

10. Stages of Disaster The community response in grief. • HEROIC: From impact to about one week out. • HONEYMOON: Lasts several weeks and there is a sense of the community “pulling together.” • DISILLUSIONMENT: One month to even a couple of years. Hype is gone and questions are unanswered. • RECONSTRUCTION: Final stage with realization of what has been experienced and what they can do to restore the community.

11. Symptoms of trauma • Vary related to age, background, prior history of personal trauma. • May apply to BOTH, victims and trauma workers. • Many of these expressions are suggestive of the fact the trauma has not been handled well.

12. Phobias Exaggerated startle response Hyper-vigilance Encounter “reminders” Memory problems Anger, rage Nightmares Report stress Depression Anxiety Preoccupation with “death,” “injury,” and “separation.” Avoidance reactions Symptoms of trauma

13. Providing Support • The 6 “T’s” • Tears It’s Ok to cry • Touch Hand or shoulder, supportive (Always ask first!) • Talk With you, family, friends • Trust Be non-judgmental • Toil It will take work, but not to rush • Time Recovery takes time, so you must take time to be with them

14. Helping Children/Teenagers • Children: Birth to 5 years old fear of being separated from parent crying screaming regressive behaviors clinging behaviors NOTE: How the parent reacts will strongly influence how the child will react at this age.

15. Helping Children/Teenagers • Children: 6-12 years withdrawal and depression disruptive behaviors regressive behaviors irrational fears or guilt refusal to attend school anger and fighting bodily complaints and symptoms

16. Helping Children/Teenagers • Adolescents: 12-17 years old adult-like symptoms emotional numbing suicidal thoughts and depression confusion and memory problems feelings of “they could have stopped it” isolation avoidance and/or substance abuse

17. Helping Children/Teenagers • Create a sense of “safety.” • Use multiple reassurances. • Convey you understand what they are feeling. • Convey it is “normal” to feel that way. • Talking about the feelings and a return to normal. • Keep families together as much as possible. • Don’t criticize for “babyish” behaviors. • Use the 6 T’s.

18. Helping Children/Teenagers • Encourage that they “take control.” • Parents need to care for themselves, in order to care for the children. • Don’t rush back to the routine, thinking it will “get their minds off of it.” • Hold meetings with leaders in the community, schools, and churches to create awareness and networking.

19. Post-Traumatic Stress Disorder • Using the Diagnostic and Statistical Manual • Witnessed, experienced, or confronted with trauma • Intense fear, helplessness, or horror in their response • Re-experiencing • Avoidance • Persistent symptoms (many already discussed)

20. PTSD-continued • Cognitive-Behavioral Therapies. • Group Therapy can be used. • Trauma/Grief-focused psychotherapy is being used, as well.