Keeping Kids in School After Trauma

1. Keeping Kids in SchoolAfter Trauma Rod Ogilvie LCPC, CRADC Associates in Professional Counseling & Coaching rogilvie@counseling-apc.com 888-545-5707 x18

2. The Different Types of Trauma • Bullying • Assault or significant threats • Robbery • Shootings • Medical Trauma • Rape • Suicide • Accidents (auto, bus or other) • Natural Disaster • Terrorism • Other…

3. The Nature of Trauma An event or situation that has a real or perceived potential to temporarily overwhelm an individual or group’s ability to cope. Like an intruder Creates intense fear Loss of control Alienation Chaotic Creates a sense of helplessness

4. Individual Stress Response Each person’s crisis is unique. Each person is unique.

5. Physiological/Neurological Response Fight Flight Freeze

6. Impact of Trauma on an Individual Cognitive Emotional Behavioral Physical Spiritual/Worldview

7. Cognitive Impact from Trauma Confusion/Disorientation Difficulty making decisions Distractibility Inattention Difficulty with simple tasks Heightened or lowered alertness

8. Emotional Impact from Trauma • Numbness • Anger • Fear • Shock • Anxiety • Disbelief • Grief • Depression • Feeling overwhelmed • Hopelessness • Irritability • Guilt

9. Behavioral Impact from Trauma • Difficulty sleeping • Nightmares • Neglect of personal hygiene • Appetite disturbance • Hypervigilence • Startle response • Withdrawal or Isolation • Speechless/Prolonged silences

10. Physical Impact from Trauma • Rapid heart rate • Increased blood pressure • Dizziness/Light-headed • Chills • Tremors • Excessive Sweating • GI Upset • Nausea • Fatigue • Headaches • Sleep Disturbance • Chest Pains • Rapid Breathing

11. Spiritual/Worldview Impact from Trauma Questioning meaning and purpose in life Coming to terms with one’s mortality Rejection of spiritual beliefs A greater clinging to spiritual beliefs Great anger toward God A sense of meaninglessness Questioning who/what can I trust

12. Prior Trauma Abuse, violence, etc. Personality Optimistic/Pessimistic Intravert/Extravert Situational Stress: Family Disruption Money problems Recent changes/losses Physical fatigue or illness Social Connectedness Peer support Family support Others Spiritual Beliefs Developed worldview around trauma, meaning, suffering Self Esteem Confident Insecure Background Factors Impacting Stress Reaction

13. Post Traumatic Stress Exposure to a Traumatic event Intrusive memories Avoidance, numbing, depression Stress arousal symptoms

14. Post Traumatic Stress Disorder • Exposure to a Traumatic event • Intrusive memories • Avoidance, numbing, depression • Stress arousal symptoms • Symptoms have lasted >30 days • Evidence of significant impairment in important areas of functioning

15. Evolution of Best Practice in Trauma Response Support for Psychological First Aid Continuum of care: Multi-component and phase sensitive Acknowledge the value of group intervention Minimizing the risk of doing further harm

16. Evolution of Best Practice in Trauma Response Provider serves more as “consultant” and “psycho-educator” than “counselor” and the intervention as more educational than cathartic. Assumes recovery and defines that recovery in terms of return to adaptive functioning. Promotes a flexible approach that allows for unique response and taps into the strengths and resources of the individual to return to adaptive functioning. Normalizes symptoms to reduce anxiety regarding them without “prescribing” them.

17. Evolution of Best Practice in Trauma Response Positive correlation between one’s belief in personal efficacy and resilience Importance of setting in place an expectation of recovery Recognizes the role Meaning Attribution plays in recovery trajectory Provides strategies for self-care and re-entry to life and work

18. Myths Regarding Crisis Intervention People need my help One “tool” or “intervention” does it all People just need to: “Get it all out” “Feel” “Cry” Licensed clinicians have been trained to provide Crisis Intervention Only Licensed clinicians can provide Crisis Intervention Without Crisis Intervention, most people will develop PTSD

19. Core Principles re: Crisis Intervention Meaning Attribution Resistance Resilience Psychological First Aid Types of Intervention Need for Specific Training in Crisis Intervention

20. Meaning Attribution • Attribution Theory studies how people make sense of their world • Fritz Heiderposits that there is a strong need in individuals to understand transient events by making attributions of cause and effect to: • Internal Disposition – What does this say about me? • External Situation – What does this say about my environment? • The purpose is to achieve a sense of order, predictability, and cognitive control by constructing a narrative (meaning)

21. Attribution Decision Tree • Darn! Wrong place. Wrong Time vs. They picked me because I’m weak. • Whew! Grateful to be alive vs. This kind of stuff always happens to me. • Normal reaction to an abnormal event vs. I’m a weak wimp.

22. Attribution Decision Tree • We are the Hokies vs. I need to get out of here!

23. Resistance Resistance refers to the ability of an individual, a group, an organization, or even an entire population, to literally resistmanifestations of clinical distress, impairment, or dysfunction associated with critical incidents.

24. Resistance Resistance may be thought of as a form of psychological / behavioral immunity to distress and dysfunction. Resistance may be best built via pre-incident / pre-deployment training.

25. Build up Resistance • Exposure • Communicate • Proximity • Immediacy • Expectancy • Brevity • Simplicity

26. What is Resiliency? Webster’s Dictionary calls it “the ability to bounce or spring back into shape, position, etc. following extreme pressure or stress.” Resiliency is characterized by patterns of positive adaptation in the context of significant adversity or risk. (Masten and Reed, 2002) This occurs at both the Individual and Organizational levels.

27. Resilient Individuals • May experience transient alterations in normal functioning (e.g., sporadic preoccupation or restless sleep), but generally exhibit stable healthy functioning across time as well as the capacity for positive emotions (Bonanna, Papa, & O’Neill, 2001)

28. Believe in Resilience • Resilience is ordinary NOT extraordinary • It takes time • Return to Adaptive Function vs. “back to normal” • The road of Resilience involves considerable emotional distress

29. Believe in Resilience Fear and Distress Response Behavior Change Psychiatric Illness Sources: Ursano, 2002; Institute of Medicine, 2003

30. Psychological First Aid Psychological First Aid (PFA) is an evidence-informed approach by which mental health professionals can begin to look at critical incidents in an effort to determine needs and restore functionality. PFA provides an overarching framework to guide effective response services.

31. Psychological First Aid Contact and Engagement of those in need of assistance Comfort and Safety for those affected Stabilization of Situations and Reactions Information Gathering to Assess Impact Practical Assistance Connection with Social Supports Information about Coping Linkage with Collaborative Services

32. Basic Objectives of Psychological First Aid Establish a human connection in a non-intrusive, compassionate manner. Enhance immediate and ongoing safety, and provide physical and emotional comfort. Calm and orient emotionally overwhelmed or distraught survivors. Help survivors to tell you specifically what their immediate needs and concerns are, and gather additional information as appropriate. Offer practical assistance and information to help survivors address their immediate needs and concerns.

33. Basic Objectives of Psychological First Aid Connect survivors as soon as possible to social support networks, including family members, friends, neighbors, and community helping resources. Support adaptive coping, acknowledge coping efforts and strengths, and empower survivors; encourage adults, children, and families to take an active role in their recovery. Provide information that may help survivors cope effectively with the psychological impact of disasters. Be clear about your availability and EAP services in general, and (when appropriate) link the survivor to another member of a disaster response team or to local recovery systems, mental health services, public-sector services, and organizations.

34. Types of Interventions Leadership/Management Consultations Individual / 1:1 Small Group Large Group Family Response Pastoral/Chaplain/Clergy Response

35. The Need for Specific Training in Crisis Intervention Specific topics include: trauma, grief and loss, PFA, strategic planning, culture, etc… Emphasis on a multi-faceted approach to care Emphasizes more than just the model A basic understanding of the core components of CISM do not translate into proficiency Can assure greater quality control around services provided Do no harm

36. Resources for Information and/or Training International Critical Incident Stress Foundation (ICISF) www.icisf.org (410) 750-9600 Association of Traumatic Stress Specialists (ATSS) www.atss.info (973) 559-9200 National Organization of Victim Assistance (NOVA) www.trynova.org (800) TRY-NOVA

37. Resources for Information and/or Training American Red Cross (ARC) www.redcross.org (800) RED-CROSS Federal Emergency Management Agency (FEMA) www.fema.gov (202) 646-2500 Crisis Care Network (CCN) www.crisiscare.com (888) 736-0911

38. Conclusion A little help, rationally directed and purposefully focused at a strategic time is more effective than more extensive help given at a period of less emotional accessibility. (Rapoport, 1965) Rod Ogilvie LCPC, CRADC Associates in Professional Counseling & Coaching www.counseling-apc.com rogilvie@counseling-apc.com (888) 545-5707 x18