 This broadcast is brought to you in partnership between the Federal Emergency Management Agency and the International Critical Incident Stress Foundation. In safe school planning, policymakers and staff must consider all four phases of emergency management – mitigation, preparedness, response and recovery. Unfortunately, one of the least emphasized phrases frequently is the last. On today's program, we're going to continue our look at a system that schools can use to improve returning and growing from a disaster incident. It's called critical incident stress management. Joining us will be three members of the team at the International Critical Incident Stress Foundation, as well as participants in the emergency management course for teachers on earthquake preparedness and a number of special guests. Now on this program, we're going to look at school crisis management strategies, building and maintaining staff support in school crises and the efficacy of these programs in coping with disasters. Today we're going to start the program with Dr. Ken Johnson, a classroom teacher for 25 years and the author of several books. Ken, let's open and start looking at those strategies. Thanks very much, Ken. The last 10 years have seen the development of a new entity on the school scene, the crisis response team. Crisis response teams respond to school crisis under the direction of the school administration. The school administration is in the overall control of school crisis management and towards that end may utilize the services of a crisis response team. Now a team can be a school based team or it can be a community based team or it can be a combination of the two. Training community crisis responders to work on campus requires some adjustment in their goals and their objectives. They're compatible with school crisis management, goals and objectives. However, the fit works, the skills are the same, the application needs to be adapted. So the question we're asking right now is what sort of strategies can crisis response teams bring to the school crisis management context? And those three general strategies are consultation, intervention and facilitating the access of resources. In terms of consultation, there's several elements that consultation can utilize and the three target areas are the administration, the staff and parents. Administrators are in charge of the crisis. But anyone in charge of a crisis knows that sometimes it's difficult to think clearly and comprehensively when under fire. A crisis response team can provide assistance through consultation and thinking through the steps of crisis management. It's absolutely critical to have a crisis plan, an idea of where we're going and what we're going to do and who we're going to use to get there. However, each crisis is different. Schools don't ordinarily operate under crisis context. And so when crisis comes as an unwelcome visitor, it creates shock on the side of the administrator as well as anyone else. Administrative consultation helps the administrator think, okay, what is the wide variety, the wide range of things that need to be considered from an overall global perspective within the school addressing the crisis needs. The team can provide some of those skills and some of the resources to do that. But the administrator has to make the connection between what's needed and what's available in terms of resources. It often helps in an administrative consultation that a checklist be used by the consultant who's coming and talking to the person. This should not be new information though. Significant preparation should have taken place so that when the consultant sits before the administrator and says, have we considered these things, the administrator is familiar with what the things are and what the normal expectations would be. This is about preparation. Preparation and pre-planning is critical for this. Administrators should know the strategies in relationship to the goals and objectives. Staff should know techniques that can be used in conjunction with outside resources to do what the administrator sees fit to do. The staff is critical to this process. Staff provide the eyes and ears for the administration. Staff provide the immediate contact with students. Staff can interface with students in a constructive way. Staff can interface with parents in a constructive way. And staff can also fail miserably at this task if they themselves are overwhelmingly battered by the incident. Because we have to remember the closer we get to the students, the more we have personal attachment and personal relationships. And dealing with children who are suffering is very, very difficult. And so the stress is on the staff person. Supporting staff is a subject we'll deal with in just a minute, even some depth. But we have to realize that the staff people have to be up and running. And if they are up and running, they can serve the school crisis management goals objectives and they can carry out team functionings. Consultation with staff can take place in a number of forms. From a basic introduction to what the situation is at the very outset. To sizing up the staff and how they're functioning and what they need on a personal level. To providing direction and goals and strategies to use with their students throughout the day. Days following the incident. To follow up with after school consultation about how they're reacting to the situation. Finding what they need. Doing crisis intervention if it appears that the person is in crisis. Doing group interventions of a various sort. Following up with family discussions with the involved staffs family. All these are aspects of staff consultation. By providing these services we're empowering the people who are in the position to use their power the best. In order to stabilize the crisis situation and restore the school to functioning. Parents often are hard hit by crisis in the student in the in the lives of students. Their own children are involved first of all. Each parent if a parent has a child in a school in all probability they know a cluster of other students. And if something happens to any one of those students directly it directly affects a parent. It affects a child in the home and the child's changes and alterations and concerns and fears and worries all affect the parent. And the parents have to cope with this. Parents provide stability for students. But I don't know when you had your babies if anybody issued you the how to parent book that made any sense. But they didn't when I came home from the hospital with my kids. I didn't know what to do. I didn't even know what to do with the second one after the first one. And I sure didn't know what to do when they bring home wounds from school. And they come and say something happened. Josie was missing today. And I don't know what it was. And all of a sudden as a parent I realized OK I am now the immediate first responder in my own child's emergency. I don't know the first thing to do. And we can say you know a lot of the crisis intervention skills are really basic human skills. But when it's your own child it becomes even harder. And so parents can tend to overreact or underreact or be shocky or be over responsive. And some guidance helps a lot. And so one of the strategies that crisis response teams utilize in service of school crisis management is to provide a flow of information from the school to the home. And part of the flow of information is the official narrative of what occurred. And what to expect. Part of it also has to do with parenting. And can say OK folks here's what your kids may have experienced. Here's the reactions they may be having. And if you see the following things you might want to take the following actions. It gives some guidance and some stability. It gives phone numbers and resources. And parents then are empowered. Similarly parent meetings following a crisis can be very very useful. How they're run is very critical to the success. And crisis response teams can be knowledgeable about how to construct meetings for parents in the crisis mode. It's one thing to have a meeting with parents under normal conditions. But if everyone is concerned worried having reactions to an incident orchestrating the meeting differently may be very valuable. And so that puts the school administrator or people who are conducting the meetings in the position of being forewarned and forearmed. That's in the basic consultation mode. There's two other ways we can deal as crisis response teams on a campus in crisis. One of those ways is intervention. Not only can we talk to other people about what to do. But crisis response teams are able to reach out and do those things that the school personnel feel that they themselves can't crisis response people who serve on the schools don't normally do but can be redirected to do. We can bring some technology to a human dilemma. There's various ways we intervene. As I mentioned before this can be on an individual basis or on a group basis. It can be at the immediate onset or immediate aftermath of a crisis or it could be later when the aftermath of the crisis rolls through the weeks of recovery period. There are a variety of strategies and techniques a crisis response team can bring to your school. As I mentioned before staff often have serious needs. It's very important when dealing with school staff that you know their world before you try and intervene in it. If you know their world you can be effective. If you don't know their world it's good to find out first. So part of crisis team training with resources from in the community would involve familiarizing them with aspects of the teaching world, the school world, the world of dealing with children that they might not be otherwise familiar with. Not just in the sense of developmental adaptations to the strategies but also sensitizing them to political realities, to organizational realities, to vulnerabilities and confused lines of authority that permeate the school system. I remember a debriefing that I sat through in my school. We had had a difficult situation in which there was gang involvement there seemed to have been a drive-by. It wasn't clear. People claimed that there was a gun sticking out a window and when a car drove by and the students did scatter and they came, a group of them who looked like they were not the people to run from a crisis were heading for the phone. It was a pay phone on campus. And so I felt that chances are they were not calling home to mom to share their pain but rather were calling for reinforcements and I felt that it was very important to circumvent that call. And so with the brashness of youth, I stepped between them and the phone something I probably wouldn't even think about doing anymore. I'd get my car and go home. But no, I stepped in front of it and a shoving match ensued and things were getting ugly before I got some reinforcement. But following that, I received a death threat and so did several other people who had broken up the struggle. We got actual death threats. Well, it's hard not to take a death threat personally. It's hard to go home and say, well, how was your day, honey? Well, somebody wants to kill me. Other than that, it went well. So there was some stress and a debriefing was called and they brought a debriefer in who wasn't well trained. This person didn't know how to do debriefings, first of all, and had no sense of what school environments were about. A lot of bad press that comes from people who experienced debriefings gone bad comes usually from having somebody that doesn't know what they're doing attempt to do it. Anybody who does school intervention has to be trained in crisis intervention strategies and in school intervention strategies. This person wasn't. He sits down and after listening to us all share what was rumbling about inside, he sort of draws himself up and is concluding comments and says, well, you knew it was a dangerous line of work when you signed up. We have to be very, very careful that if we're going to put crisis people with children and with staff that they know what they're doing. It's very, very critical. Students have needs that are accentuated and exacerbated by crisis and a sensitivity to developmental levels is absolutely critical. The way in any intervention, be it a single crisis intervention or a group intervention of some sort is carried out must be modified to take into account the conceptual abilities of children, their developmental needs and the nature of the group with which it's being conducted. These are very critical concerns. Again, we have to have people who are trained well to do this. In classrooms, however, we can do things that can last for weeks and months after the event if necessary. It's very important to realize that the crisis doesn't go away in the few hours afterwards or the few days afterwards that there can be residual effects impacting learning, impacting classroom behavior and impacting our students' personal lives that last for months and sometimes years. There's a wide range of classroom activities that can be modified to help the process of assimilating crisis experiences. These classroom activities can be designed to blend into the ongoing curriculum or blend into the ongoing style of activities in the classroom so they, while not seamless, are going to flow from one another and have a not doing therapy effect but a effect that is therapeutic. Writing activities can be used, art activities can be used. Some kinds of enactment activities can be used. It's important that if crisis people are going to be recommending that teachers use these or are going to be participating in the use of them, it's important that they know the people that they're doing it with. They need to be able to have a sense of the dynamics of a particular class, the needs of the class, work out with the people who are already there just how this particular exercise will be perceived. Don't want to do some things in some classes because of polarized feelings or affiliations or conflict in the class. With other classes, you can do a great deal. Again, this is a matter of training. The training is there. Resources are there. It calls for a commitment for us to put the two together. We've spoken of families and the extensive family intervention that can be done. Consultation, intervention, and then there's a third. That has facilitating the access to resources that students and family would not have. In our next slide, we can see how identifying those resources, facilitating the access of those and providing outside access to staff members can be activities that a crisis response team can help the administration by doing for them or with them in ways that, once again, a small action here can have a tremendous effect over there. The community is rich with resources, many of which the school is not aware of. Many resources in the community would like to extend services but aren't able to. How we marry the two is absolutely critical. Starting with the teams themselves, how we provide the language, the information about procedures and context, how we provide the incentive to bring outside resources to bear on school crisis is critical in determining the success of the way in which the school can carry out its crisis management strategies. Remember, crisis teams assist a principal in restoring health of the system, health of the students. A critical area has to do with staff, as I've mentioned, and Barb is going to discuss ways in which staff can be supported in carrying out the activities of their schools. Thank you, Ken. A very good friend of mine is an elementary school teacher, probably one of the most dynamic and effective teachers that I've ever met. She once explained to me that her philosophy in dealing with kids is that she begins every year with the same kind of mission. Her mission is to get across to her students that she cares about them because people need to know that you care about them before they care about what you know. And that's true with teachers and faculty members after a crisis. They need to know that the administration cares about them, cares about how they're reacting to it, cares about how they're going to carry on their job of dealing with students. In fact, one of the most commonly asked questions that I heard when I responded to the shooting in Edinburgh as I talked to a variety of teachers throughout the first couple weeks was, how can I best take care of my kids? That was their focus. And my reaction to them was, how are you doing first? And then I'll talk to you about how you can take care of your kids. It's critical that we deal with the faculty members first after a crisis. Now, this can be short-term crisis or it could be long-term crisis. And the way you deal with faculty members and staff, difference depending on the nature of the event. But you do need to deal with them. And one of the ways that you deal with faculty, one of the ways that you support faculty is by giving them information. Ken talked earlier about how we all have a need to know the story. We need to get across to the faculty, to the students and to the parents. What were the actual facts in this situation? What actually occurred? Because what is our natural reaction if we're not told what happened? What do we do? We fill in the empty spots. It's like a puzzle. Nobody wants to look at a puzzle that has pieces missing. Well, we don't want to deal with the puzzle with pieces missing, so we fill in the answers. We fill in those spots. So the first thing that we can do is we can make sure that our faculty and staff is well-informed about what is going on. What are the facts of the incident and what are the facts of our response to the incident? What are the expectations on the various faculty members? That's important. Clear expectation, clear information. Another thing that we can do is empower them. We need to remind them that, you know, not only is it that we're sending them back into the classroom, but you're the absolute best person to be in that classroom. You know your kids. They know you. You know, one of the things that frequently comes up when I do a response in a school is, well, what happens if I have a teacher that breaks down in front of her class? And lots of administrators are real nervous about that, about having a teacher cry in front of their class. My response to that, again, is what is the mission of the school? The mission of the school is to educate. Educate on appropriate reactions to these kinds of events. Is the death of a person sad? Sure. Is it an appropriate reaction to cry when you're sad? Sure. And then what do you do after that? The students need to see that. So we need to empower our faculty members to have normal reactions to these horrible events. It's all right. Now, that doesn't mean that you leave a teacher who is obviously distressed to the point of being dysfunctional alone to kind of flounder in front of her class. You don't do that. But you first give them the opportunity to show how they react. So you empower them. Empower them, too, in recognizing that in knowing their students, they're doing them a service. Because it is in observing them. It is in talking to them that they play a very important role in assessment. As Ken referred to earlier, what is the baseline behavior for this student? If you have a child that's fidgety and hard to keep focused and they suddenly become very passive, is that something you need to be aware of? Sure. What about conversely, the child that's usually the good student that's suddenly now somewhat hyperactive? Another red marker that only teachers are going to know because they deal with children on an everyday basis. So they have a very important role in school crisis. Another thing is we need to remind them sometimes that they do have good coping skills. That they have skills that they've utilized in previous experiences in their lives on how to deal with things that are stressful or things that are sad or grief, that they've gone through those kinds of incidents where maybe a younger student hasn't. And so you kind of remind them of what worked for you in the past. Things like convening a social network. Who do you talk to when you go home at night and things weren't, you know, just fine in school today? Who do you talk to? Diet, exercise, those kinds of things that are basic stress management. We give those teachers the ability to convey that information to their students. We protect them from the media. Again, getting back to the situation where I responded to the shooting, I drove up and there were 75 news cameras in the parking lot. Well, if I drove up and they were there, when the faculty drove up, they were being assaulted by these people, okay? Can we give faculty and support staff something to say other than no comment? No comment doesn't serve a whole lot of purpose except it gets you out of the immediate situation. So can we, in some way, give faculty members a way to respond to the press? Maybe a referral to our public relations person instead of no comment because then they'll get the information they need and it'll take the pressure off of the people that need to get into the school to do their job. Next way of dealing with, of supporting staff is to partner with them. As members of Crisis Team, can you help them to do their job? Can you help them to deal with students and to deal with each other? Things like you are not alone. If you get jammed up, I'm right here or you send this student here, giving him that information again. Now, one of the worst things to be when everything is out of control is to feel alone, to feel that, hey, it's all in my hands and I can either muck it up or I can make things better. And so being able to say to a faculty member, you're not alone and I am going to be with you in a very concrete sense is so important. And that might be using some of these strategies that Ken talked about, doing classroom debriefings together where you don't need to worry about the process because maybe the trained crisis responder does, but you do the other part. You facilitate the discussion. You observe your kids. You give us feedback about what looks normal and what doesn't. Okay? Give them breaks. You've been affected too. It is so important that we acknowledge that, that you are something beyond being a teacher, that you are a person first and that things that you are exposed to, incidents that are brought into your school do have an effect on you. Being able to say that it's off some of the stress of having to be this mighty, mighty person in control all the time. Okay? Sometimes it's a matter of saying, hey, you know, come down to the lunch room and if you need to talk, I'll be there. Sometimes it's a matter of building in, especially when you have a long-term response, a long-term incident, building in a way to give people a physical break from the routine of facing students one class after the next. You know, can you meet somebody in the hall and have a break? Can I teach the first 10 minutes of your class, give you a break to go down and kind of just do what you need to do and take a deep breath and come back in? It's a reality. It's something that we all need. Recognize the bigger picture. And I think that this is one thing that we historically did not pay a lot of attention to. The bigger picture is that for six, seven, eight hours a day, yes, you're a school teacher or a school administrator or the cafeteria worker or the bus driver. But at the end of those eight days, you go home and you're something different. You're a parent. You're a spouse. You're a best friend. And that what you experienced in the classroom as a result of your job may in fact impact upon all of those things. We need to recognize that as a crisis response team. And we need to give faculty and staff ways in which they can mitigate or minimize the effect that what happened at school is carried on in their home life. And sometimes ways to do that is sending home with the faculty member a list of things that their spouses need to know. They may come home grumpy today because or if you notice that Steve isn't sleeping for the next four days, maybe you need to think about these things. So you need to look at this bigger picture where school is one component of our lives. We need to provide formal supports. I can think of many stories and I guess that's my confusion right now is to which one to tell you. After a major incident, after any major incident for that, for that matter, there are a certain number of people that by virtue of their life circumstances, life circumstances meaning maybe they're going through a divorce, maybe they've just lost a parent, maybe they're in the middle of moving, all kinds of things that go on in our lives. A particular person or a group of people may be more vulnerable to the long-term effects of an incident than other people. And one of the things that we need to be aware of as a crisis response team, as Ken was mentioning earlier, are follow-up services. Some things are not within the province of the school to provide, but may need to be referred to. In looking at follow-up services, one of the things that you need to look at is are you aware of the resources in your community? Are there people specifically trained in post-traumatic stress disorder? What kinds of credentials do they have? Are the people that are trained in post-traumatic stress disorder necessarily people that have a familiarity with the school culture? After the shooting, now imagine, and I hate to keep referring to this, but it is such a good example of all of these things. After the shooting of teacher John Gillette, we had a whole school that was in shock. We had many, many teachers that had worked with him for a number of years. This was a man that was soon to retire, was very well liked, was very well respected. For the first week after the shooting, lots of things happened, and lots of good things happened in terms of teachers rising to the occasion to take care of students. They did a tremendous job. My hats go off to each and every one of them. They were there for the kids, they were there for the family. One of the things that happens in the long term or an incident like that is that there's a fatigue factor that sets in. It can only be up for other people for so long. And what we saw is after the first week, they were very, very tired. And so the formal supports, the folks on the crisis team that had to be brought into the school were then spending a lot of time reinforcing the staff. We needed to look at certain people that obviously were having a very bad time. And we needed to make referrals to outside resources. Now I'm from a relatively small town and so that was of great concern to me as to who we would refer these folks to. And if I didn't believe in a God before this happened, I believed in it that particular week because we had an organization step up that had a great deal of experience with post-traumatic stress disorder and offered free, long-term services to anybody that was impacted by this incident. We had the Veterans Administration Hospital step up. Now without them, in my little town, would we have had people that had enough training and enough time slots to respond to these people? Probably not. So not only when you look at follow-up services, do you look at things like, are people trained to respond to this particular need, but you need to look at things as access to them? Will they accept your insurance? Will they accept a number of people from your organization? And will you feel comfortable as a staff member accessing that? Because there is a tone. There is a culture within schools, in many buildings, in many school districts that say, hey, you know, you're falling apart, maybe you need to kind of, you know, take this, take a leave or something else and let someone that's not falling apart take over your class. After a crisis like this, it is very, very important that the administration support those staff members. Very important. Another true aspect of that particular incident, I learned a lesson, something that I never knew. As I said, teacher John Gillette was a very well-respected, well-liked individual. One of the things we needed to deal with was the funeral, his funeral. And of course, every teacher in that school building, every teacher in that district wanted to go. Well, I didn't know that in the state of Pennsylvania in order to close a school, even for something as well publicized as that, you had to get permission from the Department of Education. And you did. I mean, I didn't know that. And so the superintendent called in and said, hey, you know, we had this teacher get murdered and all of my staff, all of my faculty want to go to the funeral. It'll be necessary to close the schools. Well, Harrisburg's about 200 miles away from my hometown and they didn't know John Gillette. And so there was some himming and humming around whether or not you can close the school. My question to you is, in your district, in your buildings, if a decision were to be made that says you cannot close your building or your schools, even in light of all of this, what would you do? And what would the message be that you would give to your faculty and your staff if the answer had to be you need to be at work? Okay? Support for staff members comes in all different manners, but it comes back to that saying that my friend uses. They have to know that you care before they care anything about what you know. Thank you, Barbara. We now have a lot of questions in our audience because we've had a lot of information here today. And Sarah, would you like to start and ask the first question? Yes. My question is for Ken Johnson. I'd like to know, after there is an incident in a school, should every classroom have crisis activities or interventions going on in them? No. Those classes which need it should have it. Something probably will be done in each class in a very general way of providing information regarding the situation. And yet that doesn't have to be on a crisis intervention context. We can triage classrooms. Those classes which had direct exposure to an incident ought to have some sort of more formal intervention on a classroom level. However, individual students within a particular classroom may need direct intervention while others don't need it and like cases should be treated alike and different differently. We don't need to run everyone through a full crisis intervention protocol if they were tangential to the situation. But those who were directly affected or who seemed to be showing signs of distress, whether they were affected or not, ought to be handled separately, either in a small group or individually. Let me add to that. One of the things that we often recommend is a simple concept of using a bullseye where you have an inner circle, an outer circle and another circle out. And you've got to ask yourself who is most seriously impacted like this and then hit them first as your primary targets. By the time you get out here on a bullseye, the less impacted group information will be useful for them, not much more. The other thing I would always recommend and since it has been alluded to is homogeneity of group, classroom by classroom, homeroom by homeroom. If you've got to do groups, don't be mixing and matching. It's not a good idea. Okay, good points. Sally. My question has to do with liability. Are there any liability issues involved in providing these services in our schools? Okay. I'll take this answer first off. Your greatest liability today is not in not... The greatest liability is not that you're providing the services. The greatest liability is not providing the services. Okay? In fact, it is becoming quickly a standard of care and systems that put their head in the sand and decide we don't need to do anything about this are more prone to get sued because there are tactics now that we know work, there's evidence that they work, there's empirical evidence that they work, and not to provide them puts you more into the state of being vulnerable to lawsuit. Now, what we always have to caution is that those who are providing the services have appropriate training and that they provide the services exactly according to procedures and protocols and not vary from that. I think that's real important. Okay. But I think you've answered my two other concerns which had to do with community-based organizations and also what the liability would be if the school district did not provide the services. Yeah, I think that's the much more risky of the task is you're less likely to make mistakes, more likely to get sued if you're not providing anything. Thank you. Dave? Good. Could you elaborate a little bit more, some of you, on the issue of balancing the school's need to aggressively pursue their curriculum goals and get on with the school program and how you balance that against the needs of your community and your student body to recover from a crisis? Absolutely. This is an issue which is an apparent problem more than a real problem. In other words, if people are negatively and adversely affected by crisis so that it affects their learning needs, you can pursue the most tightly engineered curricular programs you want to until you're blue in the face. It's not going to sink in. The amount of time that's actually spent in direct student intervention and direct alteration of normal classroom activities is really minimal during crisis management response. It's very minimal compared to the amount of setback in educational programming that's experienced both on the individual and the school-wide level for not doing anything at all. Okay. Next question. Steve? This is to the panel as a whole. I've jotted down some things that I've heard being a teacher at a school as far as I know does not have a crisis team. Things that staff should be doing would be making referrals outside services, providing follow-up services and facilitating access to intervention. So my question is basically, how could we as a school, and specifically myself as a teacher, what would be some ways that I could help parents? How could I share where I used with parents that they could help their children? They're going to need to build trust with me, but what would be some ways that I could share with them? Could I start with that one? Sure. One of the things that I think it's very important to do is to not start there, but rather start by articulating a plan that your school is on board with and have that plan, that disaster or crisis response plan, have that plan approved by the Board of Education and have all of these central administrators be bobbing their heads up and down when it goes by them because if you're going to get in trouble, you'll minimize that if you were directed by your superiors to do it. That's the first step. The second step is training is available and you can get that training and bring your staff, people, up to speed. Exactly. Ken talked about the first step being awareness and certainly I think we opened your eyes today to all kinds of issues and maybe it's a matter of bringing that same amount of awareness or kind of awareness to your administrators because they really do need to buy in and it's by the group efforts to provide services that we allay the fears of parents and so by doing both, by addressing the school's need, we're also addressing parents' needs. We had a quick example I'll give you. You had a child who was getting off a school bus and all the lights are on and the gates are up and all the proper things are being done and an inpatient driver spun around the end of that bus and rammed up the side and struck the child and killed it. All the children on the left hand side of the bus had an eyeball on this. The children were on the bus on their way home from school. The paramedics arrived and said, this is not good to send these kids home like this. They diverted to another school, got cooperation in the school to connect with every parent and they brought the parents there and the school said we're not trained to do this and the paramedics said well Jeff Mitchell trained us in the crisis stuff so we're going to do the best we can and here it is and they gave simple advice. Your child saw this, may experience these symptoms if these continue, get help. Here's what you might want to do. The child might need to sleep in your room. They might disrupt their normal behaviors, be aware of those things. If it gets out of control call help and then they turn it back over to the school the next day and the parents will come in and do much the same thing with a little bit more elaborate. A lot of times keeping it simple is a good way to go rather than try to go to elaborate. What Jeff just suggested is completely compatible with all forms of education. This is not psychotherapy. Parents typically welcome this. Carol, next question. Barb. After a crisis what can we as educators expect a way of absenteeism with students or staff? Depends on really what the incident is, what the nature of the incident is and the grade level that's been affected. For instance we know that developmentally that middle school students and high school students turn to their peers much more than they turn to their families or their parents as their major link in support. And so after certain tragedies you see kids that kind of come to school as their zone of comfort. With little children you may see just the opposite because parents are tentative, are anxious about how their kids are going to return to school and so they keep them home. It really depends on the nature of the incident and the developmental level. And the good news is if you do the right things you will decrease absenteeism. If you don't do the right things you'll probably have pretty high absenteeism. Yeah the absenteeism rate will climb later. With staff we're on a dilemma because more staff will come when they shouldn't. In other words they'll be walking wounded and be sometimes only marginally able to fulfill their functions in the class but they're there out of a sense of duty, they're there out of a sense of love for their kids when they really shouldn't be and they need to be supported when they're there. On the other side of the coin is there usually won't be enough substitutes to replace them anyway so you're stuck. You need to support them in the line of duty. Okay question from Marilyn. Earlier it was mentioned that being in a routine and keeping that routine was important. Shouldn't we though following a crisis situation just do crisis intervention type things? No we really shouldn't. As I said before the amount of time that's actually spent in crisis intervention activities does not have to be an enormous amount of time. The crisis intervention activities can be woven with elements of routine in such a way as to not distress the child with further disruptions in their daily activities. Okay question from Brent. In anticipation of an incident what can we do as teachers who have been trained in a limited sense and do have management teams in place to involve the parents and the community as well? That's a really good question because I think if you start there it'll be easy road. My suggestion is that you have permission forms developed in advance that says in the course of a normal school year it is possible to have a child who is injured, a child who dies to have a tragedy. If you would like your permission in advance to be able to bring in these teams to provide support please remember this is not psychotherapy so you explain that to them in advance. Then when something happens they say oh yeah I remember that form came home from school and I kind of signed it and you have it in the files there. You may have a parent who says no way I don't want that done and in that case that child has to be separated out from the rest of the group if the parents truly object to it and explain it's not psychotherapy nor a substitute for it nor is it trying to replace parental authority but it's there as a crisis intervention during a particularly bad stressful event I think that the parents generally cooperate with that most parents I know will cooperate if they're well informed and they understand what you're attempting to do and they see it as a benefit to their children. Okay Tom. This is for Jeff or Barb I've been involved for a number of years in the critical incident stress debriefing process. Today's program has focused on critical incident stress management are the two terms interchangeable and if they are not can you share with us the differences. Critical incident stress management is a big umbrella and underneath that there are lots and lots and lots of things that are done. We talked earlier about individual support we talked about family support we talked about organizational support that's all part of critical incident stress management but there is a specific group tactic called critical incident stress debriefing which is done for small groups of people who've been through trauma so right off the bat it's a group tactic it's not used for individuals it's used for groups and in addition to that it's only one tactic within a whole field within a whole umbrella of this so if you're looking at a pie it's one slice out of the pie but it's a slice that's used specifically for group interventions. Okay Grace has a question How do we go about obtaining CISM training for school personnel? The International Critical Incident Stress Foundation has a specialized course in school crisis management the course is put on in various places throughout the United States and in fact in other parts of the world including overseas it's going to eventually move over there and start getting invites on it you can contact the foundation look at the calendar on the website which is www.icisf.org you can connect with them look at the calendar see where it's being offered sign up for it any place there if it's not coming to your neighborhood connect with them we can get one of the instructors who normally teach it to go out into your area and do it there so there are ways to connect with that I think that when you get that training one of the things it really promotes is not only the techniques but the planning and the thinking and all the processing before it so that's the way to do that and we'll go back over that address a little bit later on. Okay we have a question from Ron Well Dr. Mitchell you alluded to crisis affecting short term memory and retention I wonder how this might play out in say math and assessment reading assessments over time I'll say a few words and Ken Johnson will say a few basically what we see is that when is a high level of emotional distress one of the first things to go is the mathematical abilities so on standardized testing that usually is depressed and later if the distress continues on abated what you start seeing is verbal functions will deteriorate substantially over time so we move from the abstract very complex kind of mental processes such as calculations then we start going into the things that are more vital to our life and our survival which is how you communicate with people and that starts to fall off so both on the verbal and on the mathematical scores you'll start seeing deterioration and test performance. Ken you want to add to that? That was really good That's absolutely true and it's compounded by the fact that remember we have an interaction between these secondary reactions to trauma and the world in which the child lives so the child starts suffering in these classes and we kick off a process by which the child gets labeled as being a not a good learner and a behavior problem and these sorts of things which are symptom based assessments with characterological labels and so the kid gets labeled as being a failure and that compounds the effect on the kid by increasing the stress and further diminishing the child's ability to focus, concentrate, attend and do those higher cognitive operations So in other words it's going to have an impact somewhere? Absolutely Okay, well we had some Go ahead Jeff. Can I add one quick thing? We see kids who get traumatized elsewhere outside of school come to school with outside trauma and one of the things that you can see is acting out behavior, behavior change you can see deterioration in school performance we've had FBI agents involved in a shooting and their children were the ones who showed the impact so I just want to also bring that piece out as well Good point, good point Well we've had some really good questions today but obviously in a program of this length we can't answer all the questions so you need to go to a place where you can get more answers This is the International Critical Incident Stress Foundation They are 10176 Baltimore National Pike in Unit 201 Ellicott City, Maryland The zip is 21042 Now the phone number is 410-750-9600 and you can reach them on the web at www I-C-I-S-F .org Well Jeff it's been an exciting day but I think we need to bring this a conclusion here and wrap up some of these key issues Sunday morning just a few days ago I happened to stop off at a little bagel shop my wife and I were sitting down with our baby and we were eating breakfast and somebody who had been here before had left the newspaper behind and it was an unusual newspaper because it was listed as the high school view or something like that and so I happened to pick it up and there on the front page he reads, principal denies access of critical incident stress team and so immediately got interested and I read the article and what am I reading? a principal who says in my experience those crisis teams never work okay and I said clearly this person is not well versed in what he's talking about so he's spouting out a pontification without knowledge okay it's funny that where I see them working where I put them in so I was a little surprised by that and it kind of reminded me of the old head in the sand kind of approach to life okay about a dozen years ago I received a phone call in my office saying one of one of our students parents knows you and recommended that we call you because you're an expert in the field of stress and I said well thank you that's a nice compliment and so the principal of the school said we had a terrible tragedy and he said we had a young man who is about to graduate about two months from now who committed suicide what do you think we ought to do and I said well if it were my school what I would be doing is I would have first of all a crisis team come in talk to your administration help them the sortest thing out some steps next thing I would do is I would have a general assembly for the especially the upper grades who knew this kid I would make sure that you clearly spell out to them that suicide is a bad option and that it hurts everybody they love and everybody who loves them ends up devastated by it so you got to take it away from being like a good idea you got to kind of really downplay that good idea I would also have some well trained mental health professionals the individual kids who start popping additional symptoms you use the group meeting to identify them in the classes where he was from I would do critical incident stress debriefings and if you don't have the skills and the abilities to do that we got teams that can do that for you and they chose to do exactly 0.0 because their figuring was if you just ignore these things they will go away the only thing in my life that I have ever seen that disappears when you ignore them is your teeth but traumatic stress does not go away by ignoring it it is about the worst possible choice you could make is to ignore something like this to make believe it did not happen okay in the article that I was reading on Sunday they had a teacher, a favorite teacher who was fired kids were ordered not to speak about it and the kids tried to organize a little protest and they said to the reporter that they were grabbed by their arms dragged away from the door where they were doing the protest and thrown into their homerooms that is bad crisis management that will get you sued for a number of different reasons but what I am saying is we got a better plan we got a better way there are things that can be done that work better there are things that can be done that can make a huge difference a success story because I don't want you to go away thinking that it has all been negative okay we had a school that was running a summer program it was a private school it was running a summer program they had a pool there somebody came in to clean the deck of the pool and they added some chemicals together that eventually created chlorine gas big cloud of green chlorine gas gets out the kids evacuate there was probably one child who got a whiff of it slight response to that they were under arrest were not even impacted but it got them scared and the school immediately said this is out of our ordinary and under ordinary circumstances ordinary rules of engagement no longer apply so we need to get some help in here and they brought in a crisis team that said first step this is what you do second step this is what you do and you make sure you do all these things and I'll tell you who said thank you thank you for the information thank you for not being over reactive or under reactive to this thank you for informing us immediately thank you for doing so we got a lot of thanks but it wasn't one school saying oh we're going to handle this by ourselves they really realize right up front this thing is big and it has the potential to spill over because who's coming down the street the media spill outside your boundaries in a hurry so it's a success story but not a success story done in isolation it's a success story that's done with people combining their efforts and their resources and it was combined it was the fire department it was the EMS agency it was the school system it was the transportation system that gets the kids home it was all these agencies working together and also the parents and that's a school where they had sent out like we might have a crisis and this is what we're going to do and we're going to inform you in advance of it this is our procedures and parents signed off that they at least have been aware of that that's a success story and we can see a lot more of those things now there's a couple of things that I want to tell you about efficacy in this field because people say gee I read somewhere this doesn't work or that doesn't work well let me tell you in the world that has empirical evidence that shows it works there is no other besides what we're doing now that has been studied and it has been studied to this point so we have the empirical evidence let me take it even back to crisis intervention 1960s the earliest studies were done in crisis intervention and it was shown to be effective and that was just the beginning 1979 it was a study done by two people Bordeaux and Pruitt and what they found was that one intervention tactic worked better than nothing isn't that something and then the second thing they found was that more than one intervention tactic combined together as a systematic approach had a far greater impact than one tactic now this is not a study that you have to be Einstein to figure out folks it's kind of pretty plain something is better than nothing a systematic approach is better than one thing Dr. Ray Flannery has done some wonderful studies his was done within hospital staffs and they had staffs who were being assaulted in hospitals he was given three hospitals to do something about them he put a program, a systematic approach comprehensive multi part approach into this hospital they had significant reduction in sick time utilization of staff they had significant reduction in cost of taking care of stressed staff who were being attacked by violent patients and to the point of it was in excess of $600,000 in one year savings the other two hospitals did not have a program put in they were used as a control group okay so success story they put the program into the second hospital decrease in staff turnover in the cost of recovery and guess what they found in both of those two hospitals that they now had a program in lowered violence in the hospital against staff how do they think that happened not sure but what they think happened the theory is that when you take care of your staff they feel more supported they feel that somebody is behind them somebody is backing them up and they are less provocative towards the patients so they draw less fire when they went they put it into the third hospital so nothing happened in the third hospital until they actually moved to that point when they put it into the third hospital significant reduction in symptoms significant reduction in turnover significant reduction in cost so what you are seeing here is a study done in a hospital setting and you know you got violence in the schools you can probably apply the same thing staff that feels unsupported wants to get out of town okay staff that feels supported will hang around for a while but we have seen that happen in hospitals there is another study done in banks shows 60% reduction in sick time utilization after a staff support program was put in place and 68% cost reduction alright and I can show you the whole pile of these studies if you want otherwise I can bore you to tears going through the numbers two years ago a gentleman by the name of Richards in the United Kingdom does an interesting study he wanted to compare and it was good for your question here CISD in comparison to a whole systems approach and although I invented CISD I can tell you that CISM as you might predict worked better than CISD by itself alright so we have the evidence and has also been a number of meta-analyses very complex statistical procedures done recently four different studies showing a critical incident stress management services are effective and not only effective that they are cost reduction and that they lower symptoms they accelerate recovery they get healthy people back to function again in a healthy manner and we can do the same for kids in schools I have used critical incident stress management services right down to the age six bracket if you go below age six they do not have the verbal skills to really do it very well so they don't work with you very well they do better things with manipulations of toys or drawings I'll also tell you this if you're going to do drawings with kids don't just leave it like draw the tragedy go to the next step with that and say how have you grown from that how have you changed in a positive manner so that you come out with something stronger at the end so I mean with kids below age six you're really going to have trouble getting this kind of information to them because they don't deal with it the same way we've had to modify the procedures slightly for children in a six to twelve year old bracket because we don't usually ask them what their thoughts were what their symptoms were we more stick to a little bit more of the kind of cognitive stuff and when we do ask about emotions we ask it directly were you angry were you sad it's okay to be sad okay and you have to work that a little bit with changes that are made but with minor adaptations to the model it can be very nicely applied within school ages right down to age six and with high school we sort of go back to the standard model again the only thing with teenagers you have to be pretty astute and not let them get away with just sitting there silently so I have to say where were you when that happened and what happened to you so you have to really engage them a little bit more and of course with teenagers you always have to say the word cool that's one or else it doesn't work now there are some big mistakes that I want to caution you about and one of those is over-response and I'm going to tell you in disaster management today the most dangerous thing that we can do is have over-response of well-meaning but on-trained mental health professionals who show up at your site that is worse than having no help at all and school systems as I've seen them work through crises have made some extremes of errors they either shut the doors and don't let anybody in at all which is like a really fatal error okay it's like hey we're out here to help no way we don't trust you you're not going to get any help so they really slam the doors on one site the other side of that is y'all come now here and you get everybody and you get everybody who knows nothing about this stuff let me tell you flat out you do not need 145 mental health professionals wandering through your school if you have a tragedy unless you conclude that every child in the school has been equally damaged by the event which I can tell you in the worst of events you can never conclude that each child is equally damaged it just doesn't work that way so be very cautious not to go to extremes of closing the door shut to appropriate help or to opening it up and the problem is with opening it up I've read about a school one time so therefore I want to come and help you and they say do you have any training the question you have to ask is what training do you have where did you get it are you certified there are now programs that certify school crisis interventionist through the American Academy of Experts in Traumatic Stress through the Association of Traumatic Stress Specialists through the Florida State University through the University of Maryland through our foundation there are programs that are putting people into these places where they actually have appropriate training Black Welder in Massachusetts did an interesting study looking at people on critical instance stress teams and what she found is when a school said well I know you don't have any training in it but we really need you to be on the team so why don't you just sign on the dotted line and join up you two George you get in there too if you're not trained have far less effect than trained teams so you need training in this if you're going to do it well another couple of things that I might say to you is that we know that there's a system we've talked about that system today it's a programmatic approach please don't think one size fits all schools that say okay well all we're going to do is I like that debriefing thing so we're going to put that in you've made a terrible mistake if you do that don't go with just a single tactic you must have multiple tactic approach alright you cannot have one size fits all and it's ludicrous to think that every person in every crisis will receive equal benefit from the same intervention it is simply not going to happen you have to really be thinking beyond that the other thing that I can say is look folks the wave is rolling and you got a choice here in the school systems because the military is on board business is on board fire rescue and police is on board and it's time for you to get on board and you can be on the wave or you can be in front of the wave and get crushed by it or you can follow five to ten years from now behind the wave when everybody else is starting to wonder why you're so slow picking up on the game and then you're going to get sued so that's the best place to get sued is behind the wave so my suggestion to you is let's be surfers and get on the wave folks don't be in front of the wave because it's going to roll right over you if you're standing there to block it no we're not going to let this wave go by sorry it's already rolling you might as well just get on it because I hate to see school systems lagging behind when they have a huge opportunity at this point to make a real serious difference a difference in the lives of the children a difference in the lives of the staff a difference in their communities a difference for this country and this country needs a big difference now so I want to thank you for your attention thanks for being with us we hope the comments have been helpful to you Jeff, thank you very much, great job there is a saying that when there is a major incident in a community involving schools or otherwise that it will probably stay on the front page of the local paper for about three months and then it will disappear the implication is that after three months everybody must be okay because it's out of the paper well in 1991 there was a fire in a small community in North Carolina the imperial foods chicken processing plant some of you may remember it 25 people were killed, 52 people were injured, more importantly over 200 children were directly impacted by the injuries and deaths that occurred at that plant a plant incidentally where the owner eventually went to jail for having exits locked and having insufficient plants did that impact the schools in that community? absolutely, did it impact the people? it certainly did, did it last three months? oh absolutely not because there was an article in the paper just a few months ago that profiled a counselor who has been going to that community since 1991 to work with people over 700 trips now who's on the ground floor of all this? the people here in our audience today because that's the message we have to take away that if we're going to recover we all have a role to play but teachers just like these and educators are the ones who are going to be connected with our children and bring our schools back on mission it's not going to happen overnight and it won't happen if you don't plan for it that's what CISM does, it allows you to anticipate and prepare we certainly wouldn't go into our classrooms unprepared we wouldn't start a school year unprepared let's not be unprepared in case we have a tragedy in our community on behalf of all of our partners today and on the ENETS for the ENETS staff right here in our studios, thanks for watching we hope you get some information and that you'll consider implementing CISM in your community critical incident stress debriefing is a group tactic it is used for small groups who have been through the same event so we're looking at what we call a homogeneous group a group that's been exposed to the same kind of experience they roughly have about the same experience of the event and it is a kind of a guided storytelling time, it's a group discussion of the experience so it is a group process, that's its primary function critical incident stress debriefing is designed to basically lessen or mitigate the impact of the event it's designed to help personnel recover from it as fast as possible it's designed ultimately to point them in one of two directions either they're going down a road to its recovery or they're going down a road to its referral at the end of the crisis intervention what we should see is either recovery of people or if they're not reaching that then at least it should be a referral mechanism to the next level of care so this is a group process and just as a firefighter would never use ventilation alone to fight a fire and a police officer would never use surveillance alone to arrest a suspect you cannot use this group crisis intervention format for all kinds of things under all circumstances you got to use it for the tool that it is to be used for which is a group intervention now this goes back to the golf analogy this is like one club right you wouldn't use just a putter to play an entire round of golf although in the right circumstance that putter would be very effective spring board off what Jeff is saying in terms of the CISD being a small group crisis intervention and a very powerful and effective one it is but one part of the puzzle there are other interventions so what may happen in some sort of significant critical incident you may have a crisis management briefing as an initial foray into the into the situation where you bring 100 or 200 300 people together it is kind of like a town meeting to discuss the critical incident and then you are going to have perhaps after that a small group intervention not every one of that 300 not every individual in that group of 300 individuals will need anything more but some will so you offer them perhaps the opportunity to do a critical instance briefing after that and you may find that a few individuals even after the debriefing requires some one-on-one follow up so just in that example alone we have a crisis management briefing followed by a critical incident stress debriefing followed by one-on-one so part of the effective I think crisis intervention is knowing how not only to use the techniques but how to combine them so I think it is important again that we understand that CISD is one part of the CISM puzzle and I guess the thing we really haven't talked about yet is a very important one and that's how do we know this stuff works the research and that's one of the again one of the issues that we hear a lot about that's a very fair question the research on crisis intervention goes back to about the 1960s and it was found even then that crisis intervention for the right people under the right circumstances could be as effective if not more so than traditional psychotherapy there was a study done in the 70s where they took a look at one aspect of crisis intervention basically a one-on-one contact followed by a group intervention and follow up and found that the more complicated or complex intervention was more powerful than just the one intervention alone one of the debates that's been going on is revolves around that issue of critical incident stress debriefing that Jeff brought up and it was well how do we even know that group crisis interventions work and there have been a number of studies now that show when you do a group crisis intervention critical incident stress debriefing when you follow the protocols as described in the standardized manuals the techniques tend to be more effective than not effective and there have been a number of even what are called meta-analytic studies where a number of studies are put together and analyzed to see just how powerful they really are and the results are very very positive and they point to the notion this group crisis intervention technique called CISD does work but that almost begs the issue because this is about CISM it's not about any one given technique so the real research question for us was when we put a comprehensive crisis intervention program together does it work and is it even more effective than a singular technique and there have been about seven studies now that show critical incident stress management as an intervention system is effective and we've all even gone so far as to combine those studies in a meta-analytic format and once again we find it to be a very powerful technique but one thing I think we would both be remiss if we didn't mention similar to psychotherapy and the outcome studies based there the issue is not so much does any given intervention always work or never work the issue is what technique do you use for what population at what time and what training do you need to be effective and I think those are the really the salient issues and that's where I wanted to go with this because as we have been talking it's obvious that there are many components that can be put together in very creative ways depending on the situation the needs and the outcomes that you're looking for so how do you get trained to do this obviously you don't just read a book and then go out and do it what kind of training does someone need because this sounds like a system that needs to be applied here one of the things that the International Critical Incident Stress Foundation does is we do a lot of training we're training about 30,000 people a year worldwide to actually be on critical incident stress management teams my dead emotional first aid to put people on the road to recovery and with those 30,000 trainings a year I can tell you that we see both a core level of courses and electives if you're thinking of it in terms of a college program the core courses would be the basic group crisis intervention techniques basic critical incident stress management the next one would be the advanced group crisis intervention techniques and group work is difficult then there's a program called assisting individuals in crisis which is how do you help one-on-one in fact just a little side note doing a one-on-one is the most common of all of the interventions we do we probably do a thousand one-on-ones for every single debriefing that is done it's just that you know most people come up with a single review of the thing so we look at those three courses basic advanced group crisis intervention procedures and then assisting the individual in crisis as the core course we have 19 other courses that are taught and these courses have been recognized widely as far as the United Nations our organizations recognized by them we've been recognized by the association traumatic stress specialist in the American Academy of Experts in Traumatic Stress by San Diego State University by the University of Maryland by at least Florida State University by at least three other universities so there is recognition and people saying this is important and every time we look at places where they have done inadequate training we find that the procedures are not well managed and they're not well provided and therefore the results are a lot more mixed but when you have people who have been trained well they keep abreast of the developments in the field they keep up on it they do provide quality services to their communities to their organizations we're seeing the effects in school systems in businesses, industries commercial adventures with fire rescue and police units and very strongly now in the military so all of those parts of society are using critical instance stress management procedures and I think making a huge difference and making a contribution George you talked about there are protocols there are steps to follow and standards of practice and it sounds like this is not limited by national boundaries either oh no, no crisis is an international phenomenon and we talk about things as distasteful as international terrorism in this country we've certainly had a small taste of that there is now under way a training program to prepare 125 metropolitan centers in the United States for weapons of mass destruction terrorism but this is not just an American problem it's a problem worldwide you have natural disasters you have terrorism you have man-made disasters inadvertent accidents but disaster no less we have done trainings now on every continent in the world with the exception of Antarctica and when the penguins have a problem we'll probably get a call there too but this is something that there is a need for but this is something that you don't approach catch-as-catch-can I think there is a standard of practice there is a standard of care that is admittedly emerging but we are dealing with human beings we are dealing with human welfare training and research are important elements to this whole process