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Crisis intervention in schools today is still in its infancy. No single model has been adopted because of the lack of scientific investigate indicating a reckon to do so. We naturally do not yet know what works best with students in schools. We grapple with what will work most effectively, as we continue to rely on cognitive approaches or so-called "talking cures" that ignore the physiology of trauma. Modern scientific investigate has not supported the use of what is still a widely adopted emergency intervention model: Jeffrey T. Mitchell's model of critical-incident stress debriefing (Cisd). Some studies have found Mitchell's model to be no more productive than no intervention at all, and in some cases, found it indeed increased posttraumatic stress symptoms in a amount of the recipients.
Within almost forty-five minutes, with up to thirty individuals at a time, Cisd involves a "fact phase" while which basic facts is in case,granted to warn those complicated of what to expect. Facts disseminated comprise common stress reactions and other more debilitating symptoms. This is followed by a "feeling phase" while which, the up to thirty participants are encouraged to reply such questions as "What was the worst part of the incident for you personally?" This phase is followed by suggestions for coping with stress and then "reentry" into the world.
At a presentation Mitchell made of his model that I attended with school district personnel and state group reasoning health workers, I was most struck by how uncomfortable the audience was as they listened to his proposal. The body language of the audience members indicated that their own stress levels were increased when only watching the video shown of a debriefing session. Many audience members indeed rose and left the presentation visibly shaking their heads. while the video, we watched Some habitancy delve into the worst part of the trauma for them, clearly becoming aroused physiologically and emotionally, yet within moments, the time was up and the group was left with one last caution. "Be faithful driving home," they were warned, "as you may still be upset" after leaving the intervention.
Individuals have spoken out about their experiences participating in debriefing sessions. After 9-11, for example, many participants indicated that the intervention was not helpful. One participant said that he was "numb" throughout the session and that, weeks later, he was still having nightmares and often felt as though he was choking (Groopman, 2004). Other participant said that hearing other victims present what they saw and what they suffered was too much. He had to flee the session when Other participant described finding a body part roll down a sidewalk (Begley, 2003). After an earthquake in Turkey, a recipient said, "It was as if the debriefers opened me up as in surgical operation and didn't stitch me back up (Begley, 2003, p. 1)."
Cognitive approaches, such as Mitchell's, that ignore the body's physiology have the potential to create hysteria because of how facilely the body experiences overwhelm. When the body goes straight through a flooding of stress and emotion, which often happens as one recalls the worst part of the trauma, it protects itself by creating Other reality or dissociated state. Hysteria is a form of dissociation. Participants who become hysterical while debriefing sessions are removed from the group so they do not distract other group members (Mitchell & Everly, 1996a). Rather than accept this as an predicted outcome of emergency intervention, however, we can bring our new knowledge of the brain and body to the work we do to preclude such responses.
Adaptations of Mitchell's model are what many educators in the field of emergency intervention rely upon. Some hesitate to make broad conclusions that the model is not helpful (Brock & Jimerson, 2002) despite the growing amount of studies that sustain abandoning debriefing approaches (Gist & Devilly, 2002). Practitioners "remain committed to the principle of debriefing" because "clinical experience" suggests value in the "opportunity to express feelings (Deahl, Gillham, Thomas, Searle, & Srinivasan, 1994, p. 64)." Others consider economic reasons for the continued use of the arrival (Arendt & Elklit, 2001). We need something, and it seems we lack any other productive model to work from. Why else would we continue to use debriefing techniques when calls for caution and restraint have been heard from so many responsible scientists and practitioners (Gist & Devilly, 2002)?
Instead of heeding the many warnings to abandon, debriefers continue their work by creating adaptations of their model. The concern with that response, however, is that without faithful notice of how crises impact the brain and body's physiology, intervention models continue to be developed and implemented that have the potential to cause the harm described by too many recipients.
In a present of Modern developments in the field of emergency intervention, I was alarmed to find how itsybitsy argument there was of how the brain and body are impacted by trauma. Crises are repeatedly referred to as psychological events that have to be intervened with psychologically, as though trauma happens to the mind alone. We seem to be determined that our cognitive mind is the most considerable tool we have for healing, when in fact, it is the body, mediated by the aged reptilian brain, that has the wisdom to know how to naturally recover from trauma and heal itself.
Most habitancy recover from catastrophic events naturally and artlessly over time. In fact, any "abnormal" behavior witnessed in the aftermath of trauma is indeed part of a wholesome process of saving (Groopman, 2004) while which the body does what it knows how to do to process stress to its natural completion. Recall the impala that takes moments to shake off the stress from its attack and then carries on (see lesson four). Whether we are aware of it or not, in most cases, our body naturally finds a way to do the same. It is only a small ration of habitancy who sense a catastrophic event that will require formal intervention. This small ration is comprised mostly of individuals with old histories of trauma, with "fragile emotional profiles and few available resources (Torem & DePalma, 2003, p. 12)." For example, we know that students with old exposure to traumatic events are more at risk due to the accumulation succeed of stress on the nervous system. "The new [traumatic] vigor necessitates the formation of more symptoms...[so that the traumatic] response not only becomes chronic, it intensifies" (Levine, 1997, p. 105).
More vulnerable students will likely need formal aid in recovering from a emergency at school. For the majority, however, we know that the body has the capacity to heal itself, and that healing from stress and trauma is potential naturally by being in society with others. These are foremost points to keep in mind when creating an productive emergency intervention model for schools. Dr. Steven Hyman, the provost of Harvard University, reminds us that the rituals we have adopted straight through our discrete cultures can be supportive in our healing and saving from emergency events. He makes note of shivahs in Jewish cultures and wakes among Catholics. Dr. Hyman stated that, "No one should have to tell whatever anything! Particularly not in the scripted way of a debriefing." Dr. Hyman has argued that when facing crises it is the power of our communal networks that helps us create a sense of meaning and safety in our lives (Groopman, 2004).
Dr. Hyman is not the only responsible academic production statements that "no one should have to tell whatever anything." A panel of eminent researchers assembled by the American Psychological society - Richard McNally of Harvard University, Richard Bryant of the University of New South Wales, and Anke Ehlers of King's College London - has reached a clear conclusion: "Pushing habitancy to talk about their feelings and thoughts very soon after a trauma may not be beneficial...For scientific and ethical reasons, professionals should cease compulsory debriefing of trauma-exposed habitancy (Begley, 2003, p. 2).
With a growing amount of studies cautioning us to abandon debriefing approaches, why is telling the story and verbally going over the details of a emergency still determined helpful? Why are cognitive and description approaches to emergency intervention gaining sustain in some professional circles? This trend may be part of a prevailing cultural bias that we can talk our way out of anything. Talking is, for most counselors, the best-known and most comfortable mode of operation. However, no explanation seems to guarantee that, as ethical professionals, we ignore a remarkable body of evidence. Exposure techniques used in cognitive approaches to trauma are "not good for habitancy with brains and not good for habitancy with bodies;" telling the "story will re-traumatize and make things worse (van der Kolk, 2002)."
Dr. Van der Kolk, when recently speaking at a professional conference, was open about the fact that like most counselors, he did not know how to pace the work he did with trauma survivors. Like most counselors today, he said he "wasn't mindful about the succeed of having habitancy talk about these very scary things." studying about trauma's impact on the brain is what prompted him to speak colse to the world educating professionals about the dangers of re-telling the story and the so-called "talking cure." emergency intervention specialists working in schools are starting to reply the dangers. School emergency supervision investigate summaries in case,granted in the official newspaper of the National relationship of School Psychologists (Nasp) stated that early emergency interventions enchanting detailed verbal recollections of events may not be helpful and may place those with high arousal at greater risk (Brock & Jimerson, 2002).
What seems to be most helpful about current approaches in managing crises is meeting in a group and disseminating information. Litz and colleagues published a study comparing the Cisd model with cognitive-behavioral therapy (Cbt) (Litz, Gray, Bryant, & Adler, 2002). common in the middle of the approaches was schooling on typical reactions and schooling in coping skills for stress and anxiety. Results indicated that meeting in a group is what helped to avow morale and cohesion. Group interventions seemed to serve as an chance for those in the group to feel less stigmatized, more validated, and empowered. Psycho-education or dissemination of facts about what to expect was also cited as a helpful part of these emergency approaches. Even single sessions when they were supportive rather than therapeutic were helpful when they (a) assessed for the need for sustained treatment, (b) in case,granted psychological first aid, and (c) offered schooling about trauma and medicine resources.
Some group interventions have been found to cut anxiety, improve self-efficacy, and improve group cohesion (Shalev, Peri, Rogel-Fuchs, Ursano, & Marlowe, 1998). They have also been found to play a role in reducing alcohol misuse (Deahl, Srinivsan, Jones, Thomas, Neblett, & Jolly, 2000). However, it has also been found that single-session group emergency interventions are insufficient for high-risk trauma survivors, those with poor pre-trauma reasoning health (Larsson, Michel, & Lundin, 2000). Individuals with old traumas, such as burns, accidents or violent crime, may indeed be harmed by single-session group emergency intervention (Bisson, Jenkins, Alexander, & Bannister, 1997; Mayou, Ehlers, & Hobbs, 2000). This facts is invaluable as we continue to work together as educators to build an productive emergency intervention model.
Common Myths About Crises
It is foremost to address some of the myths that persist today about the impact of trauma on our students. These myths are pervasive and stem from outdated beliefs about children that we now have the brain investigate to refute.
Some Events are More Traumatic than Others
I have witnessed professionals in the field of emergency intervention delve into lengthy presentations about distinct events being more traumatic than others. For the most part, these discussions are not helpful. I listened to one presenter talk extensively about a broken arm from a corporal attack being more traumatic than a broken arm from a car accident, and about war being more traumatic than an earthquake. It is not a matter of some events being more traumatic than others. Trauma is not in the event; it is in the nervous ideas (Levine, 1997). Depending on the health of the individual's nervous ideas and available resources before, during, and after the event, what may seem benign to some can be very debilitating to another. Believing that some events can be objectively judged for every person as more or less traumatic leads to very risky assumptions about private students. We cannot expect that some students will be less traumatized by what we have judged as a less frightening event. This is how we misunderstand students and fail to see their trauma-related symptoms after an event that was terrifying to them.
Trauma Causes Psychological Injury
While it is true that trauma has the potential to induce psychological injury, such a statement does not reflect the whole truth about the damage caused by traumatization. When habitancy who are traumatized learn that crises are not naturally psychological events but physiological ones, they sense relief. What they are going straight through is not "in their head;" it is the natural response of the body. habitancy suffer years of anguish following a car accident, for example, or a surgery, believing that they must be going crazy. Their healing doctors tell them that there is nothing physically wrong with them, that there is no reckon for their suffering. No one talks to them about what their brain and body have gone straight through so they terminate that the problem must be in their head. With that windup comes the reliance that they must be in need of some form of talk therapy. I have seen firsthand how this windup leads to hopelessness, as traumatized habitancy make numerous attempts at discrete forms of therapy with itsybitsy or no success. They know they do not feel the same inside. They know they have applied all the cognitive techniques they were taught by their well-meaning therapists. They naturally do not get better.
Medical tests cannot detect the problem and psychological approaches that do not intervene with the body's response to trauma leave traumatized habitancy feeling like they are going crazy. When we look at physiology, however, we find answers. We learn that, among other physiological changes, traumatization increases resting heart rates and decreases cortisol levels. Hormones and neurotransmitters are altered in the short term or long term depending upon old history and resources. Physiological symptoms require a physiological approach. This is what is missing from the emergency intervention programs used today.
Children Look to Adults to conclude How Threatening an Event Is
No matter how young children are, pre-verbal or verbal, they have their own nervous system, their own brain, their own body and mind, and they sense life and its events as much as whatever else. They may not have words for their experiences, and they may look to adults for relieve and comprehension in the face of a frightening event, but they do not need to be guided when to feel fear. We cannot tell a student that they are fine and what happened is "no big deal" if, in fact, it was a big deal to them. We stand the risk of shutting down their body's natural healing mechanism when we do so. There are ways to sustain the natural process of healing and there are ways to undermine it. Telling students how to feel is an example of how our cognitive mind can interfere with the body's capacity to heal.
A colleague of mine once shared that when she was a young girl she fell from her bike and badly hurt her knee. She was so stunned from the fall that she could not cry. She realized as an adult finding back on the event that she must have been in a state of shock because all she felt was numb. When she arrived at the door of her home and her mother saw that she had been injured but was not crying she was praised for being such a brave girl. "Look at what a good girl you are," her mother said, "You are not even crying." After that incident, my colleague said that she made sure she did not cry no matter what else came her way. She used her words, the power of her cognitive mind, to shut down her body's natural responses so that she would be regarded as brave and strong.
Adults have no way of knowing how threatening or frightening an event is to a child. If we think we can conclude objectively what a student's subjective sense will be, we have no chance of comprehension or intervening with students in crisis.
Developmental Immaturity Can be Protective
Some believe that the younger a student is, the less the student will sense fear and terror. This is not supported by scientific evidence. One Nationally Certificated School Psychologist (Ncsp) made a presentation at my school district encouraging us to utilize his emergency intervention model. As part of the introduction to his work, he said that both developmentally mature and gifted students are more vulnerable and impacted by crises than their less well-developed peers. Smarter students can be more traumatized than less enchanting students because they comprehend the event was threatening, he said. They comprehend the event was traumatic because they are cognitively sophisticated sufficient to judge the event as threatening. According to this presenter, "Developmentally adolescent students don't understand the event, so it is not traumatic for them."
Trauma is a physiological event that impacts every person in its wake (to varying degrees) regardless of level of intellect. The school psychologist's statements demonstrate a risky ignorance of science and what the brain and body sense in the face of threat.
Current Attempts at emergency Intervention in Schools
Several educational professionals from discrete areas of expertise have attempted to build emergency intervention models that will meet the needs of schools. Three separate men who each developed their own arrival presented to my school district on three cut off occasions. I will present each of their proposals: (1) Bill Saltzman from the National center for Child Traumatic Stress, (2) Michael Hass from Chapman University in Orange County, California, and (3) Stephen Brock, a nationally credited school psychologist and coordinator of the emergency supervision in the Schools Interest Group.
Saltzman
Dr. Bill Saltzman's arrival emphasizes the need to tailor emergency intervention to the developmental level of the students being served (Saltzman, 2003). He reminds us that students' responses may be exact to their age and stage of development. For instance, preschoolers may display cognitive confusion. They may not know that the danger is over when a emergency event ends and may need to be given repeated concrete clarifications for predicted confusions. Older, school-age students may display exact fears triggered by traumatic reminders. They may require help in identifying and articulating those reminders as well as related anxieties. They may advantage from being encouraged not to generalize, According to Saltzman. Adolescents, on the other hand, may begin to exhibit posttraumatic acting out behavior such as drug use, delinquency, or sexual activity. Saltzman postulates that helping adolescents understand the acting out behavior as an effort to numb their response to, or to voice their anger over, the event may be of benefit.
Importance is located on house and friendship. Maintaining and nurturing relationships is indispensable after a emergency event for students at every stage of development. Saltzman points out that sometimes emergency events cause corporal relocations that can at once interrupt usual daily sense with loved ones. When this happens, it is helpful to make the effort to keep relational ties regardless of corporal separation in order to be comforted by them.
Saltzman makes clear that it is always foremost to reintegrate students back into the school and classroom environment as soon as possible. Somatic complaints and exact fears related to school or loss of a loved one may make it difficult for a student to want to enter back into school. The house and the school need to work together to make sure students' fears are resolved and attendance in school is maintained.
Saltzman's model includes an introductory interview protocol that asks emergency survivors questions in seven stages. The first step is to accumulate factual facts about where the student was while the event, what they were exposed to and how they knew the habitancy involved. One foremost demand to ask at this stage is Whether or not the student has ever experienced any other kind of emergency or trauma, including subjection to violence, serious illness or sudden, unexpected loss. The next four stages of questions have to do with the students' responses to the crisis. What was their subjective response to the event? Are they exhibiting new behaviors or new concerns since the event? What type of grief responses are they displaying? Finally, in the sixth stage of the interview, students are asked about their coping mechanisms before the final stage of windup the interview is done.
Saltzman's arrival is useful. Awareness and notice of the separate expressions and needs of students at varying developmental levels is helpful. Caution should be made, however, that while times of crises, students may indeed and swiftly regress back to earlier stages of development so that even adolescents display the behaviors of pre-school children. Saltzman highlighted "anxious attachment" as a potential pre-school response that may involve clinging and not wanting to be away from the parent or worrying about when the parent is advent back. This can happen with teenagers. Like pre-school students, adolescents may also greatly advantage from being reassured about "consistent caretaking" of being picked up after school and always knowing where their caretakers are.
In a present of all of Saltzman's hypothesized responses of students at separate ages, it was easy to see that any one of these responses could come from a student at any developmental level. We do not want to make assumptions about how a student will act given their age. If we have expectations we may not see what we need to. Nonetheless, it is beneficial to be aware of the possibility of age and stage differences. Especially in teenagers should we expect to see such age-specific behaviors as "premature entrance into adulthood." indeed that is something exact to adolescence. However, behaviors attributed to adolescence in Saltzman's approach, such as "life threatening re-enactment, self-destructive or accident-prone behavior, abrupt shifts in interpersonal relationships, and desires and plans to take revenge," are facilely seen in some younger school age children after a emergency event.
Saltzman's approach, like most, is cognitive and emphasizes the use of verbal language and request questions. It is unclear how soon after a emergency event all of the questions from the introductory interview protocol are to be asked. Like other cognitive approaches, including the debriefing model, Saltzman asks emergency survivors to talk about their "most disturbing moment" and "worst fear." We need to learn from the examples we now have available to us that this kind of questioning may increase suffering.
Hass
Dr. Michael Hass has attempted to help schools build a emergency intervention model utilizing the ideas of solution Focused Brief Counseling (Hass, 2002). His emphasis, like most others, is on interviewing the emergency survivor. The stages of emergency interviewing in his arrival comprise role clarification, a description of the problem, an exploration of current coping efforts, "scaling" of coping progress, formulation of the "next step," and closure. The focus of this arrival is on the preparation of helpful coping skills. Questions while the interview are intended to facilitate coping in order to empower students to take action on their own behalf.
Examples of coping questions include: What are you doing to take care of yourself in this situation? Who do you think would be most helpful to you at this time? What about that man would be most helpful? Have you been straight through a frightening situation before? How did you get straight through it then? Developing resources for the student to draw upon while difficult times is key. "Scaling" questions are also related to coping. They help students rate how much good or worse they think they are doing and give a gauge to emergency counselors of how much enlarge has been made. Together, the counselors and students problem-solve to arrive at solutions for enchanting the scale in the desired direction.
During Hass' presentation, he highlighted the point of telling the story of what happened while the crisis. He stated that researchers have found that putting a traumatic incident into language is a indispensable highlight of the healing process. The idea being that language helps the images and feelings we have about a frightening event become more organized, understood and resolved.
The studies that Hass was referring to were led by Dr. Edna Foa, a professor of science of mind at the University of Pennsylvania who, twenty years ago, began studying rape victims. She found that most rape victims artlessly recovered without the need for formal intervention, but that fifteen per cent developed symptoms of posttraumatic stress (Groopman, 2004). Foa devised a technique of storytelling to restore resilience in those who continued to suffer. The women were asked to tell their story into a tape recorder and listen to it, then re-tell it and listen to it, and so on. Within almost twenty sessions, Foa found that twenty-nine of the thirty participants experienced a marked correction in their symptoms and ability to function. She attributed their correction to the changing of the story over time. It became more organized, with a beginning, a middle, and an end. It was hypothesized that because they were able to give such a well-developed catalogue of the incident, they were more likely to build perspective on the event, create a sense of length from it, feel a sense of closure about it, and feel more hopeful about the future.
Hass' extensive focus on strengthening and empowering students to cope after a traumatic event is very helpful. It is foremost to create a balance in the nervous ideas in the middle of the alarm response triggered by the event and whatever will be soothing to that sense of alarm. However, it is risky to recommend a technique to professionals who work with school-aged children, when the few studies that sustain such an arrival have been done with adult women who experienced sexual assault. The appropriateness of using such an arrival with students may be suspect, especially when other eminent professionals in the field have seen that telling the story can re-traumatize the victim (van der Kolk, 2002). It is true that when trauma survivors can tell their story in an organized, fluid way without becoming overwhelmed by it, this can be a sign that they are recovering from the experience. Telling the story at some point in a trauma survivors' medicine may be relevant. However, we are not talking about adults receiving therapy. We are talking about emergency intervention for school-aged students. Now that so many responsible scientists and practitioners are warning us that telling the story can cause hysteria and re-traumatization, it is best not to endorse such an arrival to schools.
Brock
Dr. Stephen Brock developed a model of emergency intervention for schools that takes into catalogue the separate stages of the event (Brock & Jimerson, 2002). The first stage is the impact, or when the emergency occurs. The next stage is the first phase of the school's response to the event, which he calls "recoil." Immediately after the event, the students complicated receive "psychological first aid" and, in some cases, healing intervention. sustain systems need to be enlisted while this phase, ensuring that loved ones are located and reunited. Psycho-education groups, caregiver training, and informational flyers are also foremost at this time, as is risk screening and referral for students who may require more intense intervention.
The "postimpact" phase occurs in the days and weeks after the event. This is the time that Brock suggests that group emergency debriefings occur, as well as ongoing psychological first aid, psychotherapy, and emergency prevention/preparedness for the future. Rituals and memorials may be helpful at this time, as well as in the next phase of "recovery/reconstruction."
Recovery/reconstruction, the final stage of the approach, involves anniversary preparedness. Anniversary reactions have been found to be as intense as introductory ones (Gabriel, 1992).
Brock recommends that, before the school responds in the recoil phase, all pertinent staff members meet as a team, interpret their roles, and conclude who will do what. There will be a separate part to play for school psychologists, nurses, counselors, and administrators.
The psychological first aid arrival developed by Brock specifically for schools is called Group emergency Intervention (Gci). It is designed to work with large groups of students who experienced a common crisis. Such large groups are typically classrooms. The arrival is not intended for use with severely traumatized students, whose emergency reactions are understanding to interfere with Gci (Brock, 2002). Like in Mitchell's model, these students are removed from the group and referred to reasoning health professionals. It is recommend that Gci occur at the start of the first full school day following resolution of the event to ensure that participants are psychologically ready to talk about the emergency (Brock, 2002).
The six-step model includes an introduction, provision of facts and dispelling of rumors, sharing stories, sharing reactions, empowerment, and closing. Gci is ideally completed in one session persisting one to three hours, depending on the developmental level of the classroom of students. Similar to other approaches, group facilitators introduce themselves and define their roles. Opportunities are in case,granted for students to share their stories, their reactions, and become "empowered" straight through a focus on coping and stress management.
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