Presentation given for a professional development

1. CRISIS INTERVENTION IN THE
SCHOOLS
Cari Fellers, Ph.D., NCSP
Preparing for Crises in the Schools: A Manual For Building
School Crisis Response Teams, 2nd Edition
S.E. Brock, J. Sandoval, & S. Lewis

2. CRISIS EVENT CLASSIFICATIONS
Classification Examples
Severe Illness and Life-threatening illnesses; disfigurement and
Injury dismemberment; road, train, maritime accidents; assaults;
suicide attempts; fires/arson; explosions
Violent and/or Fatal illnesses; fatal accidents; homicides; suicides;
Unexpected Death fires/arson; explosions
Threatened Death Human aggression (e.g., robbery, mugging, or rape);
and/or Injury domestic violence (e.g., child and spouse battery/abuse);
kidnappings
Acts of War Invasions; terrorist attacks; hostage-talking; prisoners of
war; torture; hijackings
Natural Disasters Hurricanes; floods; fires; earthquakes; tornadoes;
avalanches/landslides; volcanic eruptions; lightening
strikes; tsunamis
Man-Made/Industrial Nuclear accidents; airline crashes; exposure to noxious
Disasters agents/toxic waster; dam failures; electrical fires;
construction/plant accidents

3. THE CRISIS STATE
 It is essential to understand what it means to be in crisis in
order to intervene
 Two main factors:
 Stressful or hazardous event
 Individual’s perception of subjective interpretation of this event
 Results in significant upset, discomfort, anxiety,
disorganization and/or disequilibrium
 Inability to cope with or adapt to crisis circumstances
 Try several coping strategies until one is found that
alleviates the discomfort
 Is typically accomplished within 8 weeks or less
 May not be adaptive

4. CRISIS INTERVENTION
 Directive, time-limited, and goal-directed procedures
designed to assist individuals who have entered a crisis
state
 Goals of crisis intervention
 Shield the victim from any additional stress
 Assist in organizing and mobilizing resources
 Return the victim, as much as possible, to a pre-crisis level of
functioning
 Two types
 Psychological first aid
 Reestablishment of immediate coping
 All school staff members can participate
 Short-term crisis therapy
 Continue the crisis intervention process and attempt to assist the
individual work through and resolve the crisis event
 Only mental health professionals should be involved

5. GETTING STARTED

6. FIRST STEPS FOR A CRISIS PLAN
 Education
 Review of the literature
 Use the internet
 Professional development
 Review the works of others
 Form a crisis response planning committee
 Develop a Crisis Response Policy
 School-level crisis response
 District-level crisis response
 Regional-level crisis response
 Plan for a Crisis Response
 Identify crisis intervention locations
 Designate specific phone lines to be used for specific reasons
 Establishing a phone tree
 Establish a crisis response toolbox

7. COMPONENTS OF A CRISIS RESPONSE
 Follow a Procedural Checklist
 Determine the facts
 Assess the degree of impact
 Notify the crisis response team
 Notify the district office
 Notify other schools
 Contact the families of the crisis victims
 Determine what information to share and how to share it
 Initiate psychological triage and referral
 Identify high-risk students and plan interventions
 Staff meeting
 Activate a base of operations
 Computers, attendance registers, and student belongings
 Debrief and evaluate

8. PSYCHOLOGICAL TRIAGE AND
REFERRAL

9. IDENTIFYING PSYCHOLOGICAL
VICTIMS OF CRISIS
 Initial risk screening
 Degree of proximity and exposure
 The closer the proximity to the event, the greater
the likelihood of being traumatized
 Relationship with the victims
 Unique personal vulnerabilities
 Mental illness
 Developmental maturity
 Trauma history
 Lack of resources

10. IDENTIFYING PSYCHOLOGICAL
VICTIMS OF CRISIS
 Secondary Risk Screening
 Conducted in conjunction with psychological first aid
 Goal is identify those who display significant crisis reactions
 Questions to consider:
 Is the event persistently experienced?
 Is there an avoidance of crisis event reminders?
 Is there a numbing of general responsiveness?
 Is there an increased level of arousal?
 Are there feelings of survivor guilt?
 Are there any somatic complaints?
 Are there self-destructive and impulsive behaviors?
 What is the effect of crisis reactions on daily functioning?
 What are some resources that are available?

11. MANIFESTATIONS OF ACUTE DISTRESS
Types of Symptoms
Reaction
Reexperience Avoidance and Increased Arousal
Numbing
Somatic • Reactivity to reminders • Sensory numbing • Abdominal
• Sweating distress
• Rapid heart beat • Hot flashes or
• Nausea chills
• Dizziness • Frequent
• Dry mouth urination
• Difficulty breathing • Trouble
swallowing
Behavioral • Insomnia • Avoidance of • Insomnia
• Increased activity trauma reminders • Exaggerated
• Agression • Decrease interest in startle
• Repetitive play significant activities
• Act as if the trauma • Social withdrawal
were recurring

12. MANIFESTATIONS OF ACUTE DISTRESS
Types of Symptoms
Reaction
Reexperience Avoidance and Increased Arousal
Numbing
Cognitive • Intrusive recall • Amnesia • Poor concentration
• Flashbacks • Sense of • Hypervigilance
• Trauma nightmares foreshortened
future
Emotional • Psychological • Emotional • Irritability
distress with numbing • Outburst of anger
exposure to • Impaired affect
reminders modulation
• Anxiety
• Anger
• Guilt
• Shame
• Hopelessness

13. CONDUCTING INITIAL PSYCHOLOGICAL FIRST
AID INTERVENTIONS
 Determine whether or not the individual viewed the event
as threatening
 Determine if the crisis reactions include any degree of
lethality
 Homicide and/or suicidal thoughts or plans
 Immediate referral to a mental health professional
 Mass screenings
 Observation of signs, child paper-and-pencil products, anxiety
scales, absenteeism, etc.
 Establish referral procedures
 Distribute referral forms to all staff members and parents
 Should educate others about what to look for following a crisis
 Student self-referral procedures

14. FREDERICK’S (1985) LIST OF SIGNS THAT
SUGGEST A NEED FOR INTERVENTION
1. Sleep disturbances that continue for more than several
days, wherein actual dreams of the trauma may or may
not appear
2. Separation anxiety or clinging behavior, such as a
reluctance to return to school
3. Phobias about the distressing stimuli (e.g., a school
building, TV scene, or person) that remind the victim of
the traumatic event
4. Conduct disturbances, including problems that occur at
home or at school, which serve as responses to anxiety
and frustration
5. Doubts about the self, including comments about body
confusion, self-worth, and desire for withdrawal

15. CRISIS INTERVENTION

16. SUMMARY OF BEHAVIOR SYMPTOMS SEEN AND
TREATMENT OPTIONS
Behavior Symptoms Treatment Options
Ages
Regressive Body Emotions
1-5 • Resumption of • Loss of • Nervousness • Give additional
bedwetting appetite • Irritability verbal assurance and
• Thumb sucking • Indigestion • Disobedienc ample physical
• Fear of • Vomiting e comfort
darkness • Bowel or • Tics • Give warm milk and
bladder • Speech comforting bedtime
problems difficulties routines
• Refusal to • Permit child to sleep
leave in parents’ room
proximity of temporarily
parents • Provide opportunity
and encouragement
for expression of
emotions through
play activities

17. Behavior Symptoms
Ages Regressive Body Emotions Treatment Options
5-11 • Increased • Headaches • School phobia • Give attention and
competition • Complaints • Withdrawal from consideration
with of visual or play group and • Temporarily lessen
younger hearing friends requirements for
siblings for problems • Withdrawal from optimum performance
parent’s • Persistent family contacts in school and home
attention itching and • Unusual social activities
scratching behavior • Encourage verbal
• Sleep • Loss of interest expression of
disorders in previously thoughts and feelings
preferred about disaster
activities • Provide opportunity
• Inability to for structured but
concentrate demanding chores
• Drop in level of and responsibilities at
achievement home
• Rehearse safety
measures to be taken
in future disasters

18. Behavior Symptoms
Ages Regressive Body Emotions Treatment Options
11-14 • Competing • Headaches • Loss of • Give attention and
with younger • Complaints interest in consideration
siblings for of vague peer social • Temporarily lower
parental aches and activities expectations of
attention pains • Loss of performance at school
• Failure to carry • Loss of interest in and home
out chores appetite hobbies and • Encourage verbal
• School Phobia • Bowel recreations expression of feelings
• Reappearance problems • Increased • Provide structure but
of earlier • Sudden difficulty in undemanding
speech and appearance relating with responsibilities and
behavior habits of skin siblings and rehabilitation activities
disorders parents • Encourage and assist
• Sleep • Sharp child to become
disorders increase in involved with same-
resisting age group activities
parental or • Rehearse safety
school measures for future
authority disasters

19. Behavior Symptoms
Regressive Body Emotions Treatment Options
14- • Resumption • Bowel and • Marked • Encourage discussion of
18 of earlier bladder increase or disaster experiences with
behaviors complaints decline in peers and extrafamily
significant others
and attitudes • Headaches physical activity
• If adolescent chooses to
• Skin rash level discuss disaster fears within
• Sleep • Frequent family setting such
disorders expression of expression is to be
• Disorders feelings of encouraged but not insisted
of digestion inadequacy upon
• Increased • Reduce expectations for
difficulties in level of school and general
performance temporarily
concentration
• Provide opportunity for
on planned involvement in rehabilitation
activities planning and participation to
fullest extent possible
• Encourage and assist in
becoming fully involved in
peer social activities
• Rehearse safety measures
for future

20. SLAIKEU’S (1990) PRACTICAL PRINCIPLES OF
CRISIS INTERVENTION
 Short-term, time-limited procedure
 Less than 6 weeks
 Goal: reestablishing immediate coping and assist the
individual to regain a precrisis level of functioning
 Administered at the time and place where the need for it
arises
 Lasts from several minutes to several houses
1. Facilitate the reestablishment of a social support network
2. Engage in focused problem solving
3. Focus on self-concept
4. Encourage self-reliance

23. STEP 1: MAKING PSYCHOLOGICAL CONTACT
 Carkhuff’s (1993) Responding Skills
 Empathy
 Understanding facts and feelings
 Listening to what the individual is saying and trying to identify the
feelings associated with the information
 Paraphrasing, summarizing, and perception-checking
 Respect
 Faith in the individual’s ability to overcome the crisis problem
 Pausing to listen
 Not trying to smooth things over
 Not dominating the conversation
 Warmth
 Nonverbal communication
 Congruent with verbal communication
 Gesture, posture, tone of voice, touch, facial expression
 Touch
 Used carefully
 Can have a calming effect

26. STEP 2: EXPLORING DIMENSIONS OF THE PROBLEM
 Direct inquiry about:
 Immediate past – crisis precursors
 Further clarify the events that led up to the crisis
 Explore pre-crisis level of functioning
 Present – the crisis story
 Assessment of present functioning
 Listen and ask about personal and social resources
 Immediate future – crisis problems
 Main objective: Identify the apparently unsolvable
problem(s)
 Rank order the person’s needs within 2 categories
 Issues which need to be addressed immediately
 Issues which can be postponed until later

28. STEP 3: EXAMINING POSSIBLE SOLUTIONS
 Goal: Identify solutions for the immediate and later needs
that were just identified
 Ask about coping attempts already made
 Facilitate exploration of additional copies strategies
 Propose other problem-solving options

30. STEP 4: TAKE CONCRETE ACTION
 Assist the person-in-crisis with taking action to address
the immediate needs identified
 If lethality is low (i.e., little or no danger of injury, suicide,
or homicide)
 Facilitate implementation of solutions to crisis problems
 Person-in-crisis is primarily responsible for taking action
 If lethality is high (i.e., danger of injury, suicide, or
homicide)
 Direct implementation of solutions to crisis problems
 Crisis intervenor is primarily responsible for taking action

32. STEP 5: FOLLOW-UP
 Develop a plan to follow up on the crisis victim
 Get identifying information
 Specify follow-up procedures
 Obtain a contract for recontact
 Assess attainment of goals
 Is support provided?
 Is lethality reduced?
 Are linkages to helping resources made?
 Recycle the first aid process if necessary.

35. SPECIAL ISSUES

36. COMPLETED SUICIDE
 Goals of crisis intervention
 Reestablish immediate coping
 Minimize identification with and glorification of the suicide victim
 Failure to achieve these goals creates the potential for a suicide cluster
 Point out how survivors are different from the suicide victim
 Point out that suicide is a poor choice
 Davidson (1989) suggests small-group counseling sessions to be best
 Important concepts
1. Death is permanent
2. Suicide can be portrayed as a permanent solution to temporary problems
for which help is available
3. Many people have suicidal thoughts when a suicide has occurred.
Students should understand that having thoughts of suicide does not
mean that they are “crazy.” Persistent and intrusive suicidal thoughts are a
signal that something important is troubling the person and he/she should
seek help. Teachers can provide information about available services.
4. The student who committed suicide can be portrayed as seriously
disturbed and as someone who, sadly, had not found an avenue to
effectively work on his/her problems. Students can be helped to disidentify
with the decedent without abusing the victim’s character.

39. OTHER ITEMS ADDRESSED IN BOOK
 Media Relations
 Security and Safety Procedures
 General safety plans and considerations
 Intervening with fights and assaults
 Characteristics of effective schools
 Characteristics of secure and safe classrooms
 School crime assessment tool
 Possible interventions for improving school safety
 Types of School Security w/ advantages and disadvantages
 Working with Potentially Violent Students
 Early warning signs
 Suicide warning signs
 Imminent warning signs of violence
 Interventions
 Causal factors associated with school violence
 Societal violence prevention/intervention strategies

40. CONTINUED….
 Emergency Medical and Health Procedures
 Evaluating and Debriefing the Crisis Response
 Appendices:
 School Crisis Intervention: An In-Service for Educators
 Tips for Teachers in Times of Disaster: Taking Care of
Yourselves and Each Other
 Helping Your Child in a Disaster
 Strategies for Informing Others of Crisis Events: Sample
Letters and Announcements
 Memo Requesting Teacher Assistance in Assessing Student
Need for Psychological First Aid Following a Crisis
 Safe Schools Questionnaire

41. RESOURCES

42. LITERATURE RESOURCES
 Aguilera, D.C. (1998). Crisis intervention: Theory and
Methodology (8th edition).
 Brooks, B., & Siegal, P.M. (1996). The scared child: Helping
kids overcome traumatic events.
 Canter, A.S., & Carroll, S.A. (Eds.) (1999). Crisis prevention
and response: A collection of NASP resources.
 Carlson, E.B. (1997). Trauma assessments: A clinician’s
guide.
 Fairchild, T.N. (Ed.). (1997). Crisis intervention strategies for
school-based helpers. (2nd ed.).
 Johnson, K. (1993). School crisis management: A hands-on
guide to training crisis response teams.
 Lindemann, E. (1979). Beyond grief: Studies in crisis
intervention.
 Matsakis, A. (1994). Post-traumatic stress disorder: A
complete treatment guide.

43. LITERATURE RESOURCES CONTINUED
 Mitchell, J.T., & Everly, G.S. (1996). Critical incident stress
debriefing: An operations manual for the prevention of
traumatic stress among emergency services and disaster for
workers (2nd ed., rev.).
 Monohan, C. (1997). Children and trauma: A guide for parents
and professionals.
 National School Safety Center. (1990). School safety check
book.
 Petersen, S., & Straub, R.L. (1992). School crisis survival
guide: Management techniques and materials for counselors
and administrators.
 Poland, S., & McCormick, J.S. (1999). Coping with crisis:
Lessons learned.
 Sandoval, J. (Ed.). (1988). Crisis counseling, intervention, and
prevention in the schools.
 Slaikeu, K.A. (1990). Crisis intervention: A handbook for
practice and research (2nd ed.).

44. INTERNET RESOURCES
 American Academy of Child and Adolescent Psychiatry
 www.aacap.org
 The American Academy of Experts in Traumatic Stress
 www.aaets.org
 The American Psychological Association
 www.apa.org
 South Carolina Children’s Law Office
 www.childlaw.law.sc.edu/manuals/user/crisisi
 National Center for PTSD
 www.ncptds.org
 U.S. Department of Education
 www.ed.gove/offices/oese/sdfs/
 Federal Emergency Management Agency
 www.fema.gov

45. INTERNET RESOURCES CONTINUED
 Hogrefe & Huber Publisher’s Journal “Crisis: The Journal
of Crisis Intervention and Suicide Prevention”
 www.hhpub.com/journals/crisis
 International Critical Incident Stress Foundation
 www.icisf.org
 The International Society for Traumatic Stress Studies
 www.istss.org
 National Association of School Psychologists
 www.naspweb.org
 National School Safety Center
 www.nssc1.org
 American Psychiatric Association
 www.psych.org

46. INTERNET RESOURCES CONTINUED
 National PTA: Violence, Kids, Crisis. What You Can Do.
 www.pta.org/programs/crisis
 American Red Cross
 www.redcross.org
 National School Safety and Security Services
 www.schoolsecurity.org
 American Association of Suicidology
 www.suicidology.org
 National Organization for Victim Assistance
 www.try-nova.org
 School Violence Virtual Library
 www.uncg.edu/edu/ericcass/violence/index.htm
 The Training and Technical Assistance Center at the College
of William and Mary
 www.wm.edu/ttac