Treating Children in Crisis Bobbi O’Kelley, MSCP Behavioral Health Clinician and Intake Manager North Star Hospital, Bragaw Campus April 2008. Treating Children in Crisis.
Treating Children in CrisisBobbi O’Kelley, MSCPBehavioral Health Clinician and Intake ManagerNorth Star Hospital, Bragaw CampusApril 2008
The term “Behavioral Health” has grown in popularity to describe various aspects of the psychology field including:
Typical traumatic events are natural calamities, violence, serious accidents, the death, injury, or serious illness of next of kin, and war-related stress.
Trauma is a painful emotional experience, or shock, that creates substantial and often lasting damage to the psychological development and well-being of the individual.
Hurricane Katrina (‘05)
Tsunami – Indian Ocean/SE Asia (‘04)
Earthquakes: Alaska ’64,
San Francisco, Kobe, Pakistan
Pandemic Flu – 1918, 1968
9-11 Twin Towers Attack (‘01)
Beyond natural disaster or war,
trauma comes in a variety of
“packages” including, but not limited to:
- domestic violence
- seeing someone (or animal) die or get injured
- heightened conflict between any two or more persons
- seeing or being in a vehicle, airplane or ATV accident
- experiencing or seeing abuse of any kind, including neglect
- rape or sexual exploitation
- school violence
- scary movies/films
Traumatic events are exceptional situations of helplessness & distress that a person experiences at first hand, witness or hears about, and which jeopardize the physical and/or psychological integrity of the individual or those close to him/her.
Trauma can appear after a single event, a series of events, or a particularly upsetting period of life of a traumatic nature.
How do you know when a child has PTSD?
Helpful points to remember
witnessed a life-threatening event
Scenario: Susie is 7 years old. She remembers the way the raindrops hit the harbor’s calm waters that morning. As she was getting her red rubber boots and yellow slicker on, Susie heard a loud thunderous sound followed by yelps not only in her house but out on the street. Susie dashed outside to find the villagers running and shouting “tsunami!” while the family radio reported a recent earthquake 150 miles southeast of this ordinarily peaceful community. Susie knew something was terribly wrong. It dawned on her that her dad, uncle, and little brother had left early that morning to go fishing. Susie would soon find out that they, and 15 other villagers, had perished leaving her, her mom and new baby brother...
of event i.e. images, thoughts
traumatic event was
recurring i.e. flashbacks
at exposure to cues that
of trauma may be expressed
Using Susie’s story…
Example of distressing recollections of event:
Susie cannot stop hearing the radio blaring news of the earthquake in her mind.
Example of acting or feeling as if the
traumatic event was recurring:
Susie’s heart rate begins to race at the sight of the ocean’s (usual) waves rolling in.
Example of intense psychological distress at exposure to cues:
Every time Susie puts her red boots and yellow slicker on, she feels like disaster is imminent.
Example of repetitive play in which themes
of trauma may be expressed:
Susie makes a boat out of clay and uses her Barbie doll to pretend to save her dad, uncle and brother.
Disorganized or agitated behavior
Response includes intense horror, helplessness or fear
Persistent avoidance of stimuli associated with trauma
Symptoms of increased arousal i.e. poor sleep and concentration, anger
Example of Disorganized or agitated behavior:
Upon cleaning her room, Susie experiences unexplained rage and throws all of her clothes on the floor.
Example of horror, helplessness or fear:
Susie goes for a walk with her mom and baby brother on the docks and begins screaming uncontrollably when the rain starts to fall.
Example of Persistent avoidance of stimuli associated with trauma:
Susie gets invited to go fishing every week-end for a month and vehemently refuses to go each time.
Example of Symptoms of increased arousal:
Susie establishes a pattern of not falling asleep right away at bedtime frequently calling for her mom and needing reassurance.
Onset and Duration of PTSD
Acute: when the duration of symptoms is less than 3 months.
Chronic: when the symptoms last 3 months or longer.
Delayed Onset: at least 6 months have passed between the traumatic event and the onset of the symptoms.
Questions to ask in a crisis:
- Can this crisis be
managed safely at home?
- Is the child at imminent
risk for further harm?
- What supports and/or
resources are currently in
place for this child?
* Corresponding examples on next slide…
Detailed Scenarios of High Risk Behaviors:
- Inpatient Hospitalization
- Crisis Intervention
- Safety Planning
- Outpatient Counseling/Therapy
- Play Therapy
- Art Therapy
- Family Therapy
- School Counselor
- Pastoral Counseling
Medication: a tool prescribed by a psychiatrist, or regular doctor, to stabilize mood, assist with anxiety, help sleep, and/or curb other symptoms
Crisis Intervention: provider or parental efforts to safely lessen the intensity of an emergency situation
Safety Planning: a measure or tool created in conjunction with a treatment team, i.e. nurse, doctor, & therapist, to teach a child and family how to safely manage a crisis
Play Therapy: A more natural means of expression to work through traumatic or other issues
Art Therapy: Art supplies are used to assist children work through traumatic or other issues
Family Therapy: Assist child & family members with tools, i.e. communication, to more effectively cope at home
School Counselor – this avenue provides an outlet in which to obtain support in
the school setting
Pastoral Counseling – reflective of
the family belief structure, pastoral
counseling can serve as spiritual
support and guidance
Self Time-out: Suggesting a self time-out allows the child to remove him or herself from a situation that is creating distress.
Journaling: Encouraging writing as a tool to express thoughts and feelings can be a helpful alternative to spoken communication.
Deep Breathing: Taking deep breaths is helpful to a child that is growing agitated or angry – 10 deep breaths can do wonders!
Validation of Feelings
Example of what you might say to a child by using a normalizing technique…
“Susie, it is normal to
feel angry when those you love die.”
Example of what you might say to a child by using validation of feelings…
“It’s okay to cry and
feel sad. I see that
you are upset and
having a hard time.”
Redirection: An example would be to take a child who is angry and direct them to a different activity i.e.
“let’s go over here and water paint.”
Guided Imagery: This may take a little more
prep, i.e. using a CD, to assist the child to
“visit” a place that is calm and peaceful.
Reflection: This simply means that you echo
what the child expresses, i.e. “I hear that you
feel sad, Susie…”
“The most effective kind of
education is that a child
should play amongst
If a child has been hospitalized for acute symptoms/behaviors…
- Assist family with discharge planning
- Discuss child’s support system
- Address medication and outpatient services
- Recommend family therapy
- Create a safety plan
Are there any
1.The term “behavioral health” is best
described by the following (select one):
b. psychiatric disorders
c. substance abuse and
d. b and c
e. none of the above
2. “PTSD” stands for (select one):a. post-traumatic stress
b. post test savory dessert
c. post-traumatic stress
d. post-traumatic strain
e. none of the above
3. A child that merely witnesses, but does
not experience first-hand, a traumatic
event would not develop PTSD.
4. Which of the following
PTSD types is most
pertinent to providers
intervening in a crisis?
b. delayed onset
d. b and c
e. none of the above
5. A child who sees an image of
a traumatic event in her dream
state likely suffers from…
a. behavioral impairments
b. general signs and symptoms
c. revisiting the event
d. a and b
e. none of the above
6. Examples of Imminent Risk include all
examples except the following (select one):
a. expressing wanting to die
b. consuming alcohol as a minor
c. riding a four-wheeler
d. spray-painting graffiti after curfew
e. skipping two meals a day
7. Family Therapy is only utilized in an inpatient hospital setting.
8. All of the following examples are
de-escalation techniques except
one (select one):
b. deep breathing
c. watching television
d. self time-out
9. The following statement is an example of what type of technique?
“Joey, it is common to feel sad
when your puppy runs away.”
b. guided imagery
c. validation of feelings
10. Discussing a child’s support system
is an important after-care consideration
Young Children and Trauma: Intervention and Treatment by Joy D. Osofsky
Helping Children Cope With Disasters and Terrorism by Annette M. LA Greca,
Wendy K. Silverman, Eric M. Vernberg, and Michael C. Roberts
Trauma in the Lives of Children: Crisis and Stress Management Techniques for
Counselors, Teachers, and Other Professionals by Kendall Johnson and Charles Figley
Children and Trauma: A Guide for Parents and Professionals by Cynthia Monahon
Understanding and Assessing Trauma in Children and Adolescents: Measures, Methods,
and Youth in Context (Psychosocial Stress Series) by Kathleen Nader
Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems
Therapy Approach by Glenn N. Saxe, B. Heidi Ellis,
and Julie B. Kaplow
I Am a Survivor: A Child's Workbook About Surviving
Disasters by Wendy Deaton and Kendall Johnson