Crisis Care San Diego, California

Dale Walker, MD Oregon Health and Science University

The American Indian/Alaska Native National Resource Center for Substance Abuse

and Mental Health Services

For more information, contact us at503-494-3703

E-mail Dale Walker, MDonesky@ohsu.edu

Or visit our website:

www.oneskycenter.org

Crisis CareCrisis Intervention:

> Focus on immediate emotional support> The person’s resources for coping have failed> The design of your intervention is to assist in coping

Critical Incident Stress:> Reactions to a “stressor”> Could be during> Could be after

Crisis Care

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

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

Crisis Care

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.

Stages of Grief• DENIAL• ANGER• BARGAINING• DEPRESSION• ACCEPTANCE

NOTE: People MAY go through these and they may go through them differently

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

Stages of DisasterThe 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.

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.

Symptoms of trauma

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

Providing Support

The 6 “T’s”Tears It’s Ok to cryTouch Hand or shoulder, supportive

(Always ask first!)Talk With you, family, friendsTrust Be non-judgmentalToil It will take work, but not to

rushTime Recovery takes time, so

you must take time to be with them

Helping Children/Teenagers

Children: Birth to 5 years oldfear of being separated from parentcryingscreamingregressive behaviorsclinging behaviors

NOTE: How the parent reacts will strongly influence how the child will react at this age.

Helping Children/Teenagers

Children: 6-12 yearswithdrawal and depressiondisruptive behaviorsregressive behaviorsirrational fears or guiltrefusal to attend schoolanger and fightingbodily complaints and symptoms

Helping Children/Teenagers

Adolescents: 12-17 years oldadult-like symptomsemotional numbingsuicidal thoughts and depressionconfusion and memory problemsfeelings of “they could have stopped it”isolationavoidance and/or substance abuse

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.

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.

Post-Traumatic Stress Disorder

• Using the Diagnostic and Statistical Manual1. Witnessed, experienced, or confronted with

trauma2. Intense fear, helplessness, or horror in their

response3. Re-experiencing4. Avoidance5. Persistent symptoms (many already

discussed)

PTSD-continued

• Cognitive-Behavioral Therapies.• Group Therapy can be used.• Trauma/Grief-focused psychotherapy is being

used, as well.