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UCLA School Mental Health Project
Center for Mental Health in Schools
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Continuing Education: Unit II
|Objectives for Section B|
|A Few Focusing Questions|
|Psychological First Aid: Responding to a Student in Crisis|
|Primary Prevention and Treatment|
|Mental Health Education|
|Psychosocial Guidance and Support|
|A Few Thoughts About Engaging Students in a Productive Dialogue|
|The Rescue Trap|
|Ongoing Case Monitoring|
|Form Used to Aid Follow-Up on Referral Follow-Through|
|Matters for a School to Consider|
|Test Questions, Unit II: Section B|
Move on to:
Unit II Section C
The many pieces of the helping puzzle.
How do we put them together?
After completing this section of Unit II, you should be able to:
explain the immediate objective of psychological first aid.
identify three phases of crisis intervention
identify seven activities related to providing psychosocial guidance and support
identify at least 5 specific things that can be done to facilitate student communication in a psychosocial counseling situation
David Schonfeld, Marsha Kline, and their colleagues at Yale University note:Schools are no longer the "islands of safety" that they once were believed to represent, as street crime, random violence, and large-scale accidents pervade schools in all parts of the country and affect children of all ages on a regular basis . . . . In a survey conducted in 1978 in two public high schools in Kansas City, Kansas, nearly 90% of the students reported having experienced the death of a grandparent, aunt, uncle, sibling, or someone else they cared about, 40% of the students reported the death of a close friend of their, own age, and approximately 20% had witnessed a death. In a 1990 survey involving urban high school students, half the students reported that they knew someone who had been murdered, 37% had witnessed a shooting, and 3l %, a stabbing (Pastore et al., 1991). In another survey of students attending 10 inner-city high schools, rates of direct gun-related victimization were alarmingly high; 20% of the students reported having been threatened with a gun and 12% had been the target of a shooting (Sheley et al., 1992). The exposure to community violence and violent deaths is not restricted to adolescents and adults .... In a 1992 study conducted in an. urban pediatric continuity clinic in Boston, 7% of the children had witnessed a shooting or stabbing before the age of 6 years . . . . As schools face an escalating number of crises, the probability that any child or group of children will experience violence or sudden death of a friend and/or loved one is increasing.
These events often require a response from the school in order to address the children's developmental needs during times of crisis and uncertainty. These crisis periods can disrupt learning, at a minimum, and also have the potential to retard children's emotional and psychological adjustment to the event and impair their subsequent development.
Despite the overwhelming need for a crisis prevention and response plan, many schools remain unprepared. . . . School systems, therefore, need to develop and institute a coordinated and systematic response plan before another crisis occurs. School systems, however, may be reluctant to consider the potential for crises to occur and may deny the need for crisis intervention services . . . . This organizational denial of the need for crisis intervention services may also be reflected in an organizational push to resolve a crisis prematurely -- "to get things back to normal as soon as possible." . . . . Schools increasingly need an effective crisis prevention and response plan in order to avert disasters where possible and to ameliorate their impact on children when the disasters cannot be avoided . . . .
Pynoos and Nader (1988) discuss psychological first aid for use during and in the immediate aftermath of a crisis (providing a detailed outline of steps according to age). Their work helps all of us think about some general points about responding to a student who is emotionally upset.
Psychological first aid for students/staff/parents can be as important as medical aid. The immediate objective is to help individuals deal with the troubling psychological reactions.
Managing the situation
A student who is upset can produce a form of emotional contagion.
To counter this, staff must
The student needs support and guidance.
Ways in which staff can help are to
try to engage the student in a problem-solving dialogue
Over the following days (sometimes longer), it is important to check on how things are progressing.
Another form of "first aid" involves helping needy students and families connect with emergency services. This includes connecting with agencies that can provide emergency food, clothing, housing, transportation, and so forth. Such basic needs constitute major crises for too many students and are fundamental barriers to learning and performing and even to getting to school.
Contents of Section B
A teacher brings you the following piece written by a student in class.
A Few General Principles Related to Responding to Crises
Immediate Response -- Focused on Restoring Equilibrium
Move the Student from Victim to Actor
Connect the Student with Immediate Social Support
Take Care of the Caretakers
Provide for Aftermath Interventions
Contents of Section B
REFLECTIONS ON CRISIS COUNSELING
When I first joined the crisis team, I thought we'd usually be dealing with emergencies that disrupted the whole school. But, most of the emergencies have involved individual students who seem suicidal or have taken a drug overdose, and most of the aftermath counseling has involved small groups of students and staff who are affected by the death of a student or staff member.
In times of crisis, I often have felt overwhelmed by the depth of despair and grief experienced by so many. In reaching out, I have had to learn how to draw in those among the quiet ones who will let some of it out only if I encourage turn-taking during an aftermath group session.
I also have learned how to avoid overwhelming those who are not ready, psychologically, to deal with what happened and those for whom the event itself is not important except as a trigger setting off strong emotions (e.g., pent up grief related to the death of others who were close to them and/or fears about their own mortality). At the same time, I've learned to avoid playing into the dynamics of those who just seem to get caught up in and want to maintain the supercharged atmosphere created by a crisis.
Early in my crisis team experience, I was surprised when one administrator seemed reluctant to have the team offer aftermath support. He wanted things to return to 'normal' as fast as possible and was convinced the team's activity would keep things stirred up. He also expressed concern that many students would be overwhelmed by the added pressures of reflecting on what had happened, listening to others' reactions, and expressing their own. He had concluded that the best strategy was to encourage everyone to put the event behind them and get on with things. We agreed that he was probably right with respect to most students. And, we finally convinced him that we could proceed in ways that would help to normalize the situation for the majority and still provide for those with special needs.
I have since learned that many people share a concern that crisis interveners don't appreciate how many individuals are ready to get on with things. So, I always try to assure everyone that I understand this, and then I clarify that helping those with special needs is an important part of getting things back to normal.
A specific aspect of normalization after the death of a student or staff member seems to be a wide-spread desire to gather funds to help the family if there is a need and/or to arrange a tribute. When this is the case, the concerned energy of most of the school population can be channeled in this direction after initial expressions of emotion are validated. Extended aftermath groups are necessary only for those seen as profoundly affected.
One of the hardest things about crisis counseling is establishing a relationship with students who don't know me at a time when they desperately need someone familiar whom they can trust. Therefore, I try, whenever possible, to enlist someone to work beside me who the students look up to. At the very least, I quickly identify someone in the group with whom I can ally myself.
Responding to crisis is exhausting. Thus, we have found it essential to have enough team members to spell each other whenever extended counseling is required on a given day. In responding to the needs of others, it is easy to ignore the impact on ourselves.
As a health professional, what drew me to crisis intervention is that I knew it was an essential element of any comprehensive approach to maintaining psychological well-being. What I didn't realize was what a powerful contribution an active school-based crisis team could make to a school's sense of community. At first, team meetings focused on improving crisis response plans and communicating them to the rest of the school. We found our efforts to take care of these matters were reassuring to others. Once these tasks were accomplished, we found ourselves addressing other school safety concerns and ways for students and staff to be more supportive of each other. In many ways, the crisis team has become a special forum for sharing concerns and a symbol of the school community's commitment to taking care of each other. And, I think that is pretty basic to maintaining our mental health!
Schonfeld, Kline, et al. (1994), School-based crisis intervention: An organizational model. Crisis Intervention, 1, 155-166;
Pynoos & Nader (1988), Psychological first aid and treatment approach to children exposed to community violence. Journal of Traumatic Stress, 1, 445-473.
Move on to: Return to
Next Page/ Unit II Section B Continued
Contents of Section B