Crisis Intervention Using the NASP PREPaRE Model (2nd ed.)
Crisis Intervention Using the NASP PREPaRE Model (2nd ed.)
Crisis Intervention Using the NASP PREPaRE Model (2nd ed.)
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<strong>Crisis</strong> <strong>Intervention</strong> <strong>Using</strong> <strong>the</strong> <strong>NASP</strong><br />
<strong>PREPaRE</strong> <strong>Model</strong> (2 nd <strong>ed</strong>.)<br />
Present<strong>ed</strong> by: Stephen E. Brock, Ph.D., NCSP<br />
WS2 Author & <strong>PREPaRE</strong> Workgroup Co-Chair<br />
1
P<br />
R<br />
E<br />
P<br />
a<br />
R<br />
E<br />
Conceptual Framework of <strong>the</strong><br />
<strong>PREPaRE</strong> <strong>Model</strong><br />
Prevent and Prepare for psychological trauma<br />
Reaffirm physical health and perceptions of security and safety<br />
Evaluate psychological trauma risk<br />
Provide interventions<br />
and<br />
Respond to psychological ne<strong>ed</strong>s<br />
Examine <strong>the</strong> effectiveness of crisis prevention and intervention
Preface<br />
On <strong>the</strong> importance of being prepar<strong>ed</strong> to intervene<br />
with children:<br />
• “It is generally accept<strong>ed</strong> now that children represent a highly vulnerable<br />
population, for whom levels of symptoms may often be higher than for<br />
adults.”<br />
• “Recent literature also suggests that childhood trauma can have a lasting<br />
impact on child cognitive, moral, and personality development, and coping<br />
abilities.”<br />
Note. Barenbaum, Ruchkin, & Schwab-Stone (2004, p. 42).
Preface<br />
On <strong>the</strong> ne<strong>ed</strong> for a “school” crisis management<br />
model and<br />
training program.<br />
• “As outside providers enter <strong>the</strong> school setting specifically to provide mental<br />
health services, a clear understanding of <strong>the</strong> school structure and culture is<br />
warrant<strong>ed</strong>.”<br />
• “School-bas<strong>ed</strong> screening and treatments should be consider<strong>ed</strong> after<br />
community-level traumatic events because this is an efficient way of<br />
identifying and treating affect<strong>ed</strong> children.”<br />
Note. Brown & Bobrow (2004, p. 212); Cohen et al. (2010, p. 421).
Basic Assumptions<br />
<strong>Crisis</strong> Event Characteristics<br />
a. Perceiv<strong>ed</strong> as extremely negative<br />
b. Generate feelings of helplessness, powerlessness, and/or entrapment<br />
c. May occur suddenly, unexpect<strong>ed</strong>ly, and without warning<br />
Note. APA. (2000); Brock (2002a; 2006, July; 2006); Brock et al. (2009); Carlson (1997).
Basic Assumptions<br />
<strong>Crisis</strong> Event Characteristics<br />
1. <strong>Crisis</strong> classifications<br />
a. Acts of war and/or terrorism<br />
b. Violent and/or unexpect<strong>ed</strong> death<br />
c. Threaten<strong>ed</strong> death and/or injury<br />
d. Human-caus<strong>ed</strong> disasters<br />
e. Natural disasters<br />
f. Severe (nonfatal) illness or injury<br />
Note. Brock et al. (2001)
Basic Assumptions<br />
<strong>Crisis</strong> Event Characteristics<br />
2. Variables that affect an event’s traumatic potential<br />
a. Type of disaster<br />
i. Human caus<strong>ed</strong> vs. natural<br />
ii. Intentional vs. accidental<br />
Note. Charuvastra & Cloitre (2008).
Basic Assumptions<br />
<strong>Crisis</strong> Event Characteristics<br />
b.Event pr<strong>ed</strong>ictability, consequences, duration, and intensity –<br />
interaction with <strong>the</strong> crisis event (or disaster type)<br />
Note. Brock et al. (2009).<br />
Pr<strong>ed</strong>ictability Consequences<br />
<strong>Crisis</strong> Event<br />
Duration Intensity<br />
<strong>Crisis</strong> Event<br />
Devastation
Basic Assumptions<br />
Levels of School Mental Health <strong>Crisis</strong> Response<br />
1. Minimal response<br />
2. Building-level response<br />
3. District-level response<br />
4. Community- or regional-level response<br />
Note. Brock (2002b); Brock, Sandoval, & Lewis (1996, 2001).
The crisis state is<br />
Basic Assumptions<br />
“…a temporary state of upset and disorganization, characteriz<strong>ed</strong><br />
chiefly by an individual’s inability to cope with a particular situation<br />
using customary methods of problem solving, and by <strong>the</strong> potential<br />
for a radically positive or negative outcome.”<br />
O<strong>the</strong>r characteristics of <strong>the</strong> crisis state<br />
•More than simple stress<br />
•Not necessarily mental illness<br />
Note. Slaikeu (1990, p. 15).
Basic Assumptions<br />
© Yuri Arcurs | Dreamstime.com<br />
Note. Brock & Jimerson (2004); Cohen et al. (2010).<br />
Mental Illness<br />
• Anxiety disorders<br />
• Substance-relat<strong>ed</strong> disorders<br />
• Dissociative disorders<br />
• Mood disorders<br />
• Disorders of infancy, childhood, or<br />
adolescence<br />
• Sleep disorders<br />
• Adjustment disorders
Basic Assumptions<br />
The Consequences of Crises on School Functioning<br />
• School behavior problems (aggressive, delinquent, & criminal behavior)<br />
• School absenteeism<br />
• Academic decline<br />
• Exacerbation of preexisting <strong>ed</strong>ucational problems<br />
Note. Azarian & Skriptchenko-Gregorian (1998); Brock & Jimerson (2004); Cook-Cattone (2004); March et al. (1997); Monahon<br />
(1993); Nader & Muni (2002); Sharkey (2010); Silverman & La Greca (2002); Vogel & Vernberg (1993); Yule (1998).
© Monkey Business Images |Dreamstime.com<br />
Note. Moos & Billings (1984); Sandoval & Brock (2009).<br />
Basic Assumptions<br />
School <strong>Crisis</strong> <strong>Intervention</strong><br />
• Facilitate adaptive coping<br />
Restore basic problem-solving<br />
abilities<br />
Begin to return to pre-crisis<br />
levels of functioning
P<br />
R<br />
E<br />
P a<br />
R<br />
E<br />
Basic Assumptions<br />
Prevent and Prepare for psychological trauma<br />
Reaffirm physical health and perceptions of security and safety<br />
Evaluate psychological trauma risk<br />
Provide interventions<br />
and<br />
Respond to psychological ne<strong>ed</strong>s<br />
Examine <strong>the</strong> effectiveness of crisis prevention and intervention
Basic Assumptions<br />
The Incident Command System (ICS)<br />
1. Incident Command (<strong>the</strong> managers)<br />
2. Planning Section (<strong>the</strong> thinkers)<br />
3. Operations Section (<strong>the</strong> doers)<br />
a. Student Care Group<br />
i. Mental Health Response Strike Team<br />
4. Logistics Section (<strong>the</strong> getters)<br />
5. Finance Section (<strong>the</strong> payers)
Prevent & Prepare for Psychological Trauma<br />
© Elena Elisseeva | Dreamstime.com<br />
Note. Reeves, Nickerson, & Jimerson (2006).<br />
Prevent Crises<br />
1. Ensure physical safety<br />
a. Crime prevention through<br />
environmental design<br />
i. Natural surveillance<br />
ii. Natural access control<br />
iii.Territoriality<br />
b. Vulnerability assessment
Prevent & Prepare for Psychological Trauma<br />
Prevent Crises<br />
2. Ensure psychological safety<br />
a. School-wide positive behavioral supports<br />
b. Universal, target<strong>ed</strong>, and intensive academic and<br />
social–emotional interventions and supports<br />
c. Identification and monitoring of self- and o<strong>the</strong>rdirect<strong>ed</strong><br />
violence threats<br />
d. Student guidance services<br />
Note. Reeves et al. (2006).
Reaffirm Health & Safety<br />
“The first step following a disaster is to ensure <strong>the</strong><br />
safety, shelter, and sustenance of children and <strong>the</strong>ir<br />
caregivers. In our experience, mental health<br />
interventions are secondary. Once <strong>the</strong>se basic ne<strong>ed</strong>s<br />
are met, <strong>the</strong>re is a role for mental health<br />
professionals.”<br />
Note. Brown & Bobrow (2004, p. 212).
Reaffirm Health & Safety<br />
Psychological Health & Safety<br />
1. Recognizing <strong>the</strong> importance of adult reactions and<br />
behaviors<br />
2. Minimizing crisis exposure<br />
3. Reuniting/locating caregivers and significant o<strong>the</strong>rs
Reaffirm Health & Safety<br />
Psychological Health & Safety<br />
4. Providing facts and adaptive interpretations<br />
5. Returning students to a safe school environment<br />
6. Providing opportunities to take action
Reaffirm Health & Safety<br />
“Once traumatic events have stopp<strong>ed</strong> or been<br />
eliminat<strong>ed</strong>, <strong>the</strong> process of restoration begins. Nonpsychiatric<br />
interventions, such as provision of basic<br />
ne<strong>ed</strong>s, food, shelter and clothing, help provide <strong>the</strong><br />
stability requir<strong>ed</strong> to ascertain <strong>the</strong> numbers of youth<br />
ne<strong>ed</strong>ing specializ<strong>ed</strong> psychiatric care.”<br />
Note. Barenbaum, Ruchkin, & Schwab-Stone (2004, p. 49).
Evaluate Psychological Trauma<br />
Rationale for Assessing Psychological Trauma<br />
1. Unique consequences of crisis exposure.<br />
a. Not all individuals will be equally affect<strong>ed</strong>.<br />
b. Recovery is <strong>the</strong> norm.<br />
i. <strong>Crisis</strong> intervention should be offer<strong>ed</strong> in response<br />
to demonstrat<strong>ed</strong> ne<strong>ed</strong>.<br />
ii.“Not everyone expos<strong>ed</strong> to trauma ei<strong>the</strong>r ne<strong>ed</strong>s<br />
or wants professional help.” (McNally et al.,<br />
2003, p. 73)<br />
iii. Exception: students with preexisting<br />
psychopathology.<br />
Note. Brock et al. (2009); Cohen et al. (2010)
Evaluate Psychological Trauma<br />
Rationale for Assessing Psychological Trauma<br />
2. Unique consequences of crisis intervention<br />
a. <strong>Crisis</strong> intervention may cause harm if not truly ne<strong>ed</strong><strong>ed</strong>.<br />
i. It may increase crisis exposure.<br />
ii.It may r<strong>ed</strong>uce perceptions of independent<br />
problem solving.<br />
iii. It may generate self-fulfilling prophecies.<br />
Note. Berkowitz (2003); Everly (1999).
Note. Brock et al. (2009).<br />
Evaluate Psychological Trauma<br />
<strong>Crisis</strong><br />
Event<br />
Variables<br />
Risk<br />
Factors<br />
Pr<strong>ed</strong>ictability Consequences<br />
<strong>Crisis</strong> Event<br />
Duration Intensity<br />
Threat Perceptions<br />
Exposure Vulnerability<br />
Early Warning Signs<br />
(reactions display<strong>ed</strong> during<br />
impact and recoil phases)<br />
Enduring Warning Signs<br />
(reactions display<strong>ed</strong> during<br />
postimpact and<br />
recovery/reconstruction<br />
phases)<br />
Initial <strong>Crisis</strong><br />
Reactions<br />
Durable <strong>Crisis</strong><br />
Reactions<br />
Common<br />
Reactions<br />
Psychopathological<br />
Reactions
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 1: <strong>Crisis</strong> Exposure Risk Factors<br />
a. Physical proximity<br />
b. Emotional proximity<br />
*Risk factors increase <strong>the</strong> probability of psychological trauma and, as such, should result in increas<strong>ed</strong><br />
vigilance for symptoms of traumatic stress (or warning signs).<br />
Note. Brock (2002d).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 1a: <strong>Crisis</strong> Exposure Physical Proximity Risk Factor<br />
On Playground<br />
In School<br />
On Way Home<br />
In Neighborhood<br />
At Home<br />
Absent<br />
Out of Vicinity<br />
Note. Pynoos et al. (1987).<br />
PTSD Reaction Index × Exposure Level<br />
0 2 4 6 8 10 12 14<br />
Reaction Index Score (≥ 12 = Severe PTSD)
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 1b: <strong>Crisis</strong> Exposure Emotional Proximity Risk Factor<br />
Percentage with PTSD<br />
60%<br />
50%<br />
40%<br />
30%<br />
20%<br />
10%<br />
0%<br />
PTSD and Relationship to Victim×Outcome (i.e., injury or death)<br />
22%<br />
15%<br />
15%<br />
52%<br />
25%<br />
12%<br />
8%<br />
18%<br />
11%<br />
Person Injur<strong>ed</strong> Person Di<strong>ed</strong><br />
Outcome Category<br />
Parent/Sibling O<strong>the</strong>r Family Friend O<strong>the</strong>r Person No one<br />
Note. Appli<strong>ed</strong> Research and Consulting et al. (2002, p. 34).<br />
9%
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 2a: Internal Vulnerability Risk Factors<br />
i. Avoidance coping style<br />
ii. Pre-crisis psychiatric challenges<br />
iii. Poor ability to regulate emotions<br />
iv. Low developmental level and poor problem solving<br />
v. History of prior psychological trauma<br />
Note. Brock (2002d); Brock et al. (2009).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 2b: External Vulnerability Risk Factors<br />
i. Family resources<br />
1. Not living with a nuclear family member<br />
2. Family dysfunction (e.g., alcoholism, violence, child maltreatment,<br />
mental illness)<br />
3. Parental PTSD/maladaptive coping with <strong>the</strong> stressor<br />
4. Ineffective and uncaring parenting<br />
5. Poverty or financial stress<br />
ii. Extra-familial social resources<br />
1. Social isolation<br />
2. Lack of perceiv<strong>ed</strong> social support<br />
Note. Brock (2002d); Brock et al. (2009).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 3: Threat Perception Risk Factor*<br />
a. Subjective impressions can be more important than actual crisis<br />
exposure.<br />
b. Adult reactions are important influences on student threat<br />
perceptions.<br />
*Risk factors increase <strong>the</strong> probability of psychological trauma and, as such, should result<br />
in increas<strong>ed</strong> vigilance for symptoms of traumatic stress (or warning signs).<br />
Note. Brock (2002d); Brock et al. (2009).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4: <strong>Crisis</strong> Reaction Warning Signs*<br />
a. Early warning signs<br />
b. Enduring warning signs<br />
c. Developmental variations<br />
d. Cultural variations<br />
*Warning signs are symptoms of traumatic stress.<br />
Note. Brock (2002d); Brock et al. (2009).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4a: <strong>Crisis</strong> Reaction Early Warning Signs<br />
i. Most are common reactions to unusual circumstances.<br />
ii. Some are mental health referral indicators:<br />
1. Reactions that interfere with daily functioning.<br />
2. Acute reactions (panic, dissociation, extreme fright).<br />
3. Increas<strong>ed</strong> arousal (exaggerat<strong>ed</strong> startle, hypervigilance, and sleep<br />
disturbance).<br />
4. Maladaptive coping (suicidal or homicidal thoughts and behaviors).<br />
Note. Brock (2002d); Brock et al. (2009); Cohen et al. (2010)
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4b: <strong>Crisis</strong> Reaction Enduring Warning Signs<br />
i. Reactions do not remit or worsen after a week or more.<br />
ii. Acute stress disorder<br />
iii. Acute posttraumatic stress disorder<br />
Note. Brock (2002d); Brock et al. (2009); Nickerson et al. (2008).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4c: Developmental Variations<br />
i. Preschoolers<br />
1. Reactions not as clearly connect<strong>ed</strong> to <strong>the</strong> crisis event as those<br />
observ<strong>ed</strong> among older students.<br />
2. Reactions often express<strong>ed</strong> nonverbally.<br />
3. Given equal levels of distress and impairment, may not display as<br />
many PTSD symptoms as older children.<br />
4. May include a temporary loss of recently achiev<strong>ed</strong> developmental<br />
milestones.<br />
5. Trauma-relat<strong>ed</strong> play.<br />
Note. American Psychiatric Association (2000); Berkowitz (2003); Cook-Cottone (2004); Dulmus (2003);<br />
Joshi & Lewin (2004); Yorbik et al. (2004).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4c: Developmental Variations<br />
ii. School-age children<br />
1. Reactions tend to be more directly connect<strong>ed</strong> to crisis event.<br />
2. Event-specific fears may be display<strong>ed</strong>.<br />
3. Reactions are often express<strong>ed</strong> behaviorally.<br />
4. Feelings associat<strong>ed</strong> with <strong>the</strong> traumatic stress are often express<strong>ed</strong><br />
via physical symptoms.<br />
5. Trauma-relat<strong>ed</strong> play becomes more complex and elaborate.<br />
6. Repetitive verbal descriptions of <strong>the</strong> event.<br />
7. Problems paying attention.<br />
Note. American Psychiatric Association (2000); Berkowitz (2003); Cook-Cottone (2004); Dulmus (2003);<br />
Joshi & Lewin (2004); Yorbik et al. (2004).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4c: Developmental Variations<br />
iii. Preadolescents and adolescents<br />
1. More adult like reactions<br />
2. Sense of foreshorten<strong>ed</strong> future<br />
3. Oppositional and aggressive behaviors<br />
4. School avoidance<br />
5. Self-injurious behavior and thinking<br />
6. Revenge fantasies<br />
7. Substance abuse<br />
8. Learning problems<br />
Note. American Psychiatric Association (2000); Berkowitz (2003); Cook-Cottone (2004); Dulmus (2003);<br />
Joshi & Lewin (2004); Yorbik et al. (2004).
Evaluate Psychological Trauma<br />
Assessment Variables<br />
Variable 4d: Cultural Variations<br />
i. O<strong>the</strong>r important determinants of crisis reactions in general, and of<br />
grief in particular, are family and cultural and religious beliefs.<br />
ii. <strong>Crisis</strong> interveners should inform <strong>the</strong>mselves about cultural norms<br />
with <strong>the</strong> assistance of community cultural leaders who best<br />
understand local customs.<br />
Note. Sandoval & Lewis (2002).
Evaluate Psychological Trauma
Note. Brock et al. (2009).<br />
Conducting Psychological Triage<br />
Levels of Triage<br />
Level Timing Variables<br />
consider<strong>ed</strong><br />
Primary Before imm<strong>ed</strong>iate<br />
crisis intervention<br />
Secondary During <strong>the</strong><br />
provision of crisis<br />
intervention<br />
Tertiary As crisis<br />
intervention<br />
concludes<br />
Select<strong>ed</strong> risk<br />
factors and<br />
early warning<br />
signs<br />
Risk factors<br />
and warning<br />
signs<br />
Risk factors<br />
and warning<br />
signs<br />
Goals<br />
1. Establish initial intervention<br />
priorities<br />
2. Make initial decisions about<br />
intervention ne<strong>ed</strong>s<br />
1. Refine intervention priorities<br />
2. Match interventions to<br />
individual ne<strong>ed</strong>s<br />
3. Begin to consider mental<br />
health referrals<br />
1. Identify individuals who<br />
ne<strong>ed</strong> mental health referrals<br />
2. Make appropriate referrals
Conducting Psychological Triage<br />
Levels of Triage<br />
aImm<strong>ed</strong>iate mental health referrals should be made for students who, during any crisis phase, manifest grossly maladaptive coping<br />
(e.g., suicidal or homicidal ideation).<br />
Note. Adapt<strong>ed</strong> from Conolly-Wilson (2008).
1. Reaffirm physical health.<br />
2. Ensure perceptions of safety.<br />
3. Evaluate psychological trauma.<br />
4. Make initial crisis intervention<br />
treatment decisions.<br />
5. Reevaluate degree of<br />
psychological injury and make<br />
more inform<strong>ed</strong> crisis intervention<br />
treatment decisions.
Levels of School <strong>Crisis</strong> interventions
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Reestablish Social Support Systems<br />
Social Support Defin<strong>ed</strong><br />
“. . . an individual’s perception that he or she is lov<strong>ed</strong> or car<strong>ed</strong> for, esteem<strong>ed</strong>,<br />
and valu<strong>ed</strong> by people in his or her social network, which enhances personal<br />
functioning, assists in coping adequately with stressors, and may buffer him or<br />
her from adverse outcomes.”<br />
Note. Demaray et al. (2005, p. 691).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Reestablish Social Support Systems<br />
Strategies<br />
1. Reunite students with primary caregivers.<br />
2. Reunite students with peers and teachers.<br />
3. Return students to familiar environments and routines.<br />
4. Facilitate community connections.<br />
5. Empower caregivers with crisis recovery information.<br />
Note. Brock and Jimerson (2004).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
<strong>Crisis</strong> Psycho<strong>ed</strong>ucation Defin<strong>ed</strong><br />
The provision of direct instruction and/or <strong>the</strong><br />
dissemination of information that helps crisis<br />
survivors and <strong>the</strong>ir caregivers in understanding,<br />
preparing for, and responding to <strong>the</strong> crisis event, and<br />
<strong>the</strong> problems and reactions it generates (both in<br />
oneself and among o<strong>the</strong>rs).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psycho<strong>ed</strong>ucation Strategies<br />
1. Informational documents<br />
2. Caregiver trainings<br />
3. Classroom meetings<br />
4. Student psycho<strong>ed</strong>ucational groups<br />
Note. Brock et al. (2009); Reeves, Kanan, & Plog (2010).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Crisis</strong> <strong>Intervention</strong>s Defin<strong>ed</strong><br />
1. Active and direct attempts to facilitate adaptive<br />
coping and directly respond to symptoms of traumatic<br />
stress<br />
2. Aim at reestablishing imm<strong>ed</strong>iate coping (not<br />
necessarily crisis resolution)<br />
3. Design<strong>ed</strong> to help students cope with crisisgenerat<strong>ed</strong><br />
problems, and/or to allow <strong>the</strong>m to access<br />
more intensive psycho<strong>the</strong>rapeutic treatment
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategies<br />
1. Imm<strong>ed</strong>iate classroom-bas<strong>ed</strong> (or group) crisis intervention<br />
2. Imm<strong>ed</strong>iate individual crisis intervention<br />
3. Long-term psycho<strong>the</strong>rapeutic treatment interventions<br />
Primary Considerations<br />
1. How can <strong>the</strong>se interventions be counterproductive?<br />
2. When is parental permission requir<strong>ed</strong> or not requir<strong>ed</strong> for<br />
<strong>the</strong>se interventions?<br />
3. Are <strong>the</strong>re limits to what <strong>the</strong> school-bas<strong>ed</strong> mental health<br />
professional can and should do?
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong> (CCI)<br />
1. Explores individual experiences and reactions<br />
2. Helps students feel less alone and more connect<strong>ed</strong> to classmates,<br />
and normalizes experiences and reactions<br />
3. Recognizes <strong>the</strong> ne<strong>ed</strong> for and advantage of groups<br />
4. Is a psychological triage tool<br />
5. Is similar to “debriefing”
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong><br />
Indicat<strong>ed</strong><br />
1. For students who are secondary or vicarious crisis survivors<br />
2. When offer<strong>ed</strong> as a part of a comprehensive crisis intervention<br />
program<br />
3. When offer<strong>ed</strong> as a more involv<strong>ed</strong>, longer crisis intervention<br />
4. When us<strong>ed</strong> in a group setting with individuals similarly expos<strong>ed</strong> to a<br />
common crisis event<br />
Note. Brock et al. (2009).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong><br />
Not indicat<strong>ed</strong><br />
1. For physically injur<strong>ed</strong> or acute trauma victims<br />
2. As a stand-alone or brief crisis intervention<br />
3. As an individual crisis intervention<br />
4. With individuals expos<strong>ed</strong> to different crises<br />
5. With groups that are historically hurtful or nonsupportive<br />
6. When witness cr<strong>ed</strong>ibility is a concern<br />
Note. Brock et al. (2009).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong> Goals<br />
1. Imm<strong>ed</strong>iate coping improv<strong>ed</strong>.<br />
2. <strong>Crisis</strong> facts understood and rumors dispell<strong>ed</strong>.<br />
3. Experiences/reactions are understood and normaliz<strong>ed</strong>.<br />
a. Greater connection to peers comes from recognizing<br />
common experiences and reactions.<br />
4. Psychopathological reactions and maladaptive coping are<br />
identifi<strong>ed</strong> (secondary triage).<br />
5. Self-referral proc<strong>ed</strong>ures identifi<strong>ed</strong>.<br />
6. Strategies for managing stress and addressing crisis problems.<br />
Note. Brock et al. (2009).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong><br />
General Considerations<br />
1. Who should participate<br />
2. CCI group size<br />
3. Where to offer CCI<br />
4. When to offer CCI<br />
5. CCI providers<br />
6. Role of <strong>the</strong> teacher<br />
7. Follow-up<br />
8. Parental permission<br />
9. Limits of confidentiality<br />
Note. Brock & Jimerson (2004); Brock et al. (2009).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 1<br />
Classroom-Bas<strong>ed</strong> <strong>Crisis</strong> <strong>Intervention</strong> Elements<br />
1. Introduce session (10–15 min).<br />
2. Provide crisis facts and dispel rumors (30 min).<br />
3. Share crisis stories (30–60 min).<br />
4. Identify crisis reactions (30 min).<br />
5. Empower students (60 min).<br />
6. Close (30 min).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 2<br />
Individual <strong>Crisis</strong> <strong>Intervention</strong> (ICI)<br />
Preliminary Considerations<br />
1. Addresses <strong>the</strong> imm<strong>ed</strong>iate ne<strong>ed</strong>s<br />
2. Is not psycho<strong>the</strong>rapy<br />
3. Does not require crisis resolution<br />
a. Establishes momentum leading to crisis resolution<br />
4. Is a first-aid response<br />
Note. Brymer et al. (2006); Hobfoll et al. (2007); Ruzek et al. (2007).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 2<br />
Imm<strong>ed</strong>iate Individual <strong>Crisis</strong> <strong>Intervention</strong> Goals<br />
Reestablish imm<strong>ed</strong>iate coping<br />
1. Ensure safety, provide physical and emotional support.<br />
2. Contain distress.<br />
3. Identify crisis-generat<strong>ed</strong> problems.<br />
4. Support adaptive coping and begin problem solving.<br />
5. Assess trauma risk and link to helping resources.<br />
Note. Brymer et al. (2006); Litz et al. (2002); Phipps & Byrne (2003); Ruzek et al. (2007); Slaikeu (1990); Wilson et al. (2000).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 2<br />
Individual <strong>Crisis</strong> <strong>Intervention</strong><br />
General Considerations<br />
1. Participants<br />
2. Location<br />
3. Timing<br />
4. Providers<br />
5. Follow-up<br />
6. Parental permission<br />
Note. Brock et al. (2009).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 2<br />
Individual <strong>Crisis</strong> <strong>Intervention</strong> Elements<br />
1. Establish contact.<br />
2. Verify readiness.<br />
3. Identify and prioritize problems.<br />
4. Address crisis problems.<br />
5. Evaluate and conclude.<br />
4. Address<br />
<strong>Crisis</strong> Problems<br />
5. Evaluate &<br />
Conclude<br />
Not necessarily<br />
a linear process<br />
3. Identify &<br />
Prioritize <strong>Crisis</strong><br />
Problems<br />
1. Establish<br />
Psychological<br />
Contact<br />
2. Verify<br />
Readiness to<br />
Proce<strong>ed</strong>
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 3<br />
Psycho<strong>the</strong>rapeutic Treatments: Trauma-Focus<strong>ed</strong><br />
Therapies<br />
Trauma-focus<strong>ed</strong> psycho<strong>the</strong>rapies should be consider<strong>ed</strong> first-line<br />
treatments for children and adolescents with PTSD. These <strong>the</strong>rapies<br />
should<br />
1. Directly address children’s traumatic experiences<br />
2. Include parents in treatment in some manner as important agents<br />
of change<br />
3. Focus not only on symptoms improvement but also on enhancing<br />
functioning, resiliency, and/or developmental trajectory.<br />
Note. Cohen et al. (2010, pp. 421–422)
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 3<br />
Psycho<strong>the</strong>rapeutic Treatments: Cognitive–<br />
Behavioral Therapies<br />
1. Imaginal and in vivo exposure<br />
2. Eye-movement desensitization and reprocessing<br />
(EMDR)<br />
3. Anxiety management training<br />
4. Cognitive–behavioral intervention for trauma in<br />
schools (CBITS; group deliver<strong>ed</strong>)<br />
5. Parent training<br />
Note. Brock et al. (2009); Cohen et al. (2010).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 3<br />
Psycho<strong>the</strong>rapeutic Treatments:<br />
Psychopharmacological Treatments<br />
1. Us<strong>ed</strong> in combination with ongoing psycho<strong>the</strong>rapy<br />
2. Most appropriate for youth who do not respond to<br />
psychosocial interventions<br />
3. Tailor<strong>ed</strong> to <strong>the</strong> ne<strong>ed</strong>s and symptoms of <strong>the</strong> individual<br />
Note. Brock et al. (2009); Cohen et al. (2010).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 3<br />
Psycho<strong>the</strong>rapeutic Treatment <strong>Intervention</strong>s<br />
“Overall, <strong>the</strong>re is growing evidence that a variety of CBT programs are<br />
effective in treating youth with PTSD . . . Practically, this suggests that<br />
psychologists treating children with PTSD can use cognitive–behavioral<br />
interventions and be on solid ground in using <strong>the</strong>se approaches.”<br />
Note. Feeny et al. (2004, p. 473).
Provide <strong>Intervention</strong>s and Respond to Student Ne<strong>ed</strong>s<br />
Psychological <strong>Intervention</strong> Strategy 3<br />
Psycho<strong>the</strong>rapeutic Treatment <strong>Intervention</strong>s<br />
“In sum, cognitive behavioral approaches to <strong>the</strong> treatment of PTSD,<br />
anxiety, depression, and o<strong>the</strong>r trauma-relat<strong>ed</strong> symptoms have been<br />
quite efficacious with children expos<strong>ed</strong> to various forms of trauma.”<br />
Note. Brown & Bobrow (2004, p. 216).
Examining Effectiveness<br />
Strategies<br />
1. Ne<strong>ed</strong>s assessment<br />
2. Process analysis<br />
3. Outcome evaluation
Concluding Comments<br />
About <strong>the</strong> <strong>PREPaRE</strong> <strong>Model</strong> or Workgroup<br />
Melissa A. Reeves, PhD, NCSP, <strong>PREPaRE</strong> Chair<br />
– mereev@aol.com<br />
Stephen E. Brock, PhD, NCSP, <strong>PREPaRE</strong> Cochair<br />
– brock@csus.<strong>ed</strong>u<br />
Regarding <strong>PREPaRE</strong> Workshops<br />
• Workshop 1: <strong>Crisis</strong> Prevention & Prepar<strong>ed</strong>ness: The Comprehensive School<br />
<strong>Crisis</strong> Team<br />
Primary Contact:<br />
– Melissa A. Reeves, PhD, NCSP<br />
• mereev@aol.com<br />
• Workshop 2: <strong>Crisis</strong> <strong>Intervention</strong> & Recovery: The Roles of <strong>the</strong> School-Bas<strong>ed</strong><br />
Mental Health Professional<br />
Primary Contact:<br />
– Stephen E. Brock, PhD, NCSP<br />
• brock@csus.<strong>ed</strong>u
Questions and Comments<br />
• Imm<strong>ed</strong>iate <strong>Crisis</strong> <strong>Intervention</strong> Consultation<br />
<strong>NASP</strong> National Emergency Assistance Team (NEAT)<br />
– Susan Gorin, Executive Director <strong>NASP</strong>, or Kathy Cowan, Director of<br />
Communications – (301) 657-0270<br />
• Various handouts for information and dissemination<br />
http://www.nasponline.org/resources/crisis_safety/schoolsafety.aspx<br />
• To order <strong>the</strong> book School <strong>Crisis</strong> Prevention & <strong>Intervention</strong>: The <strong>PREPaRE</strong><br />
<strong>Model</strong><br />
http://www.nasponline.org/publications/booksproducts/prepare.aspx<br />
• To join <strong>the</strong> <strong>Crisis</strong> Management in <strong>the</strong> Schools Listserv<br />
Send an e-mail to <strong>NASP</strong>-IG-<strong>Crisis</strong>Manage-subscribe@yahoogroups.com<br />
Or go to http://groups.yahoo.com/group/<strong>NASP</strong>-IG-<strong>Crisis</strong>Manage/ and click<br />
on “Join This Group”<br />
• <strong>NASP</strong> Members can also join <strong>the</strong> <strong>Crisis</strong> Interest Group <strong>NASP</strong> Community<br />
Go to www.nasponline.org and click on “Communities” – follow instructions<br />
to join
Concluding Comments<br />
Acknowl<strong>ed</strong>gment<br />
Brock, S. E., Nickerson, A. B., Reeves, M. A., Jimerson, S. R.,<br />
Feinberg, T., & Lieberman, R. (2009). School crisis prevention and<br />
intervention: The <strong>PREPaRE</strong> model. Be<strong>the</strong>sda, MD: National<br />
Association of School Psychologists.<br />
$52 <strong>NASP</strong> Members<br />
$65 Regular Cost<br />
• brock@csus.<strong>ed</strong>u<br />
• http://www.csus.<strong>ed</strong>u/indiv/b/brocks/<br />
Available from: http://www.nasponline.org/publications/booksproducts/prepare.aspx