Group Crisis Intervention

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5. th. Edition Slides. . Authored by Jeffrey T. Mitchell, . Ph.D.. 5. th. Edition Categories. Important Information . - Must know information. Critical Information . – Essential for CISM applications. ID: 683183 Download Presentation

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Group Crisis Intervention




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Presentations text content in Group Crisis Intervention

Slide1

Group Crisis Intervention

5

th

Edition Slides

Authored by Jeffrey T. Mitchell,

Ph.D.

Slide2

5

th Edition Categories

Important Information

- Must know information

Critical Information

– Essential for CISM applications

Enrichment Information

– Expands CISM knowledge base

Slide3

Objectives:

Define key crisis terms and concepts

Define key stress terms and concepts

Explain CISM

Understand Resistance, resilience and recoveryList elements of CISM strategic planning formula

List components of CISM system

Explain informational vs. interactive groups

Role-play practice

Explain risks if providers are not trained or if they violate standards of practice

Slide4

6

C

ore Elements of CISM

Surveillance, Assessment and Triage

Listening skills, SAFER-R, Individual Crisis intervention

Strategic assessment and planning

Informational group processes

Interactive group processes

Personal and Community resilience: resistance, resilience, and recovery- (

defined page 17

)

for further reading see appendix 1, page 133

Slide5

Section One

Pages 17-34

Key Terms and Concepts:

Crisis and Crisis Intervention

Slide6

Key Terms and Concepts of Crisis and Crisis Intervention

Critical Incidents

Powerful traumatic events that initiate the crisis response

Without

critical incidents

there would be no crisis

reactions

and no need

for crisis

intervention.

Slide7

The “Terrible Ten”

A sample of Critical Incidents

Line-of-duty death

Suicide of colleague

Serious line-of-duty injury

Disaster / multi-casualty incident

Killing or wounding an innocent person

Slide8

“The Terrible Ten”

Significant events involving children

Prolonged incidents especially with loss of life

Personally threatening situations

Events with excessive media interest

Any highly distressing event

Slide9

Simply stated….

Crisis is state of heightened

emotional

arousal

…a state of emotional turmoil

Slide10

Crisis

A crisis is an acute emotional reaction to some powerful stimulus or a demand

Slide11

PRE-CRISIS

CRISIS

THOUGHTS

FEELINGS

THOUGHTS

FEELINGS

Slide12

Types of Crises

Maturational Crises (plural of crisis) – Associated with changes in various stages of life: adulthood, midlife, aging, retirement.

Situational (associated with events such as accidents, deaths, disaster, violence, loss, illness, threats.)

Slide13

Characteristics of a Crisis

Disruption to a person’s state of psychological balance

Usual coping mechanisms fail

Distress, impairment, or dysfunction

(Gerald

Caplan

, MD, 1964)

Slide14

STAGES OF CRISIS

pre-crisis

crisis

post-crisis

Point of

impact

Trial and error

Angle of disorganization

2. stuck

1.function

3. improved

*

disorganization

Slide15

Crisis event

High anxiety

*

Denial

Anger

Remorse

Grief

Reconciliation

Slide16

Crisis and Stress

Crisis and stress are related. When a person has an emotional crisis, there is also a state of Mental and Physical arousal (stress) that goes along with the state of emotional turmoil

Slide17

Stress

Without Crisis

We live in stress throughout our existence (24 hours x’s 7days a week – always)

Balancing between eustress and distress

Stress is a state of arousal from mild to extreme. Helps us to stay healthyYou have stress even when you have no crisis.

But you can’t have a crisis without stress.

Slide18

Critical Incident Stress

An acute emotional, cognitive, and physical

reaction

that results from an exposure to a powerful, horrible, awful, terrifying, threatening or grotesque stimulus or to an overwhelming demand or circumstance

page 18

Slide19

Critical Incident Stress

A state of heightened cognitive, physical, emotional and behavioral arousal that accompanies the crisis

(more to be said in Section Two)

Slide20

Crisis Intervention

Crisis intervention is a

t

emporary,

active, and supportive

entry into the life situation of an individual or of a group during a period of extreme distress.

Slide21

Groups are

not

treated as individuals and individuals are

not

treated as groups!

Different intervention procedures are used for individuals than those that are used for groups.

Slide22

History of Crisis Intervention

…these milestones are amplified on pages 22-28

The beginnings of people helping others is lost in antiquity.

First organized approach to Crisis Intervention – Franco Prussian War (1870-1871)

Simple procedures: reduction of war stimuli, food, rest, fluids, opportunity to speak with medical personnel

Slide23

History of Crisis Intervention

World War I –First the French and then the Americans used a similar approach

Crisis intervention helped 65% of psychologically traumatized soldiers to return to front in 3-4 days.

Without crisis intervention, only 40% were able to return to combat and that took 3-4 weeks

. (Thomas Salmon, 1919)

Slide24

History of Crisis Intervention

Crisis Intervention has often been called “Psychological First Aid.” That term was first used about 1933. It certainly was applied in WWII.

Crisis Intervention formalized by the work of Gerald

Caplan

and Eric

Lindermann

in the Coconut Grove fire in 1942.

Slide25

History of Crisis Intervention

In the early 1970’s the foundations of CISM were set

In the 1980’s Dr. Jeffrey Mitchell developed the CISM program through his work at the University of Maryland Baltimore County.

2007 United Nations adopted CISM program for its employees world-wide.

Slide26

Providers of Crisis Intervention

Police

Firefighters

Medical staff

Pre-hospital EMSMilitaryFederal agenciesCommunications personnel

Community volunteers

School personnel

Disaster workers

Mental health professionals

Clergy / chaplains

others

Slide27

Goals of Crisis Intervention

Reduce emotional tension

Stabilize the person

Mobilize personal resources

Mitigate the impact of the traumatic event

Slide28

Goals of Crisis Intervention

Normalize reactions and facilitate normal recovery processes.

Restore individuals to adaptive functions

Enhance

u

nit cohesion and unit performance in homogeneous groups

Identify individuals who may need professional assistance and refer as necessary

Slide29

Principles of Crisis Intervention

Simplicity

Brevity

Innovative

PragmatismProximity

Immediacy

Expectancy

Slide30

Steps in Crisis Intervention

8

steps of CI, Albert Roberts, Ph.D

.

Introduction

Assess the situation and the impact on the people involved

Mentally list all the options

Choose the best option

Implement the option immediately

read more on pgs.

28 - 32

Slide31

Steps in Crisis Intervention

Reassess the people involved

Maintain, change, or abandon the option

Closure of the intervention

Note: if the person is suicidal, a referral to the next level of care is required.

(8 steps of CI, Albert Roberts, Ph.D.)

Slide32

Critical Incident

Stress Management

A

way to remember: Title and Description

C

-

Critical

I

-

Incident

S

-

Stress

M

-

Management

C

- Comprehensive

I - IntegrativeS - SystematicM – Multi-component

Pgs.33 & 34

Slide33

Critical Incident

Stress Management

An organized approach to Crisis intervention

A “package” of crisis intervention techniques

CISM is a subset of Crisis Intervention and shares directly in the history, theory, principles, practices, goals and techniques of Crisis Intervention

Pages 32 and 33

Slide34

Critical Incident Stress Debriefing

One tactic among many in the CISM system

Not the same as CISM

For homogeneous groups only

Interactive group crisis intervention

7 step model

Covered thoroughly in Section Seven

Slide35

Section Two

Stress: Psychological and Behavioral

Reactions to Stressors

pages 37-46

Slide36

Stressor

A stressor is a stimulus that causes or initiates the stress response

Slide37

Stressor vs.

Stress Response

there is

a difference

Stressor is the stimulus

Stress is

a

rousal in response to a stimulus. It is a

nonspecific response

of the body to any demand

Slide38

Stressor vs. Stress Response

there’s a difference

Stress consists of a combination of neurologic, neuroendocrine, and endocrine arousal response mechanisms that can alter every organ and function in the human body. Stress can accelerate the aging process. Stress equals arousal.

Slide39

General Adaptation Syndrome

Alarm equals arousal (cognitive, physical, emotional)

Resistance equals behaviors to cope with the arousal

Exhaustion equals the period when energy to maintain resistance is depleted

Concept developed by Dr. Hans Selye

Slide40

General Adaptation Syndrome

Stimulus

Resistance

Exhaustion

Recovery

Alarm

baseline

Slide41

Main Types of Stress

Eustress- positive

Distress- negative

Page 38

Slide42

Eustress vs. Distress

Stress Arousal

Health and performance

Maximum positive effect

Slide43

Stress is Usually Not Dangerous Unless…

It Prolonged or Intense

Slide44

Cumulative Stress

“Burnout” is an

o

ut-of-date term that is occasionally brought up

Cumulative stress is unmitigated stress arousal that builds over time

Cumulative stress: Three identifiable phases

a) Stress arousal

b) Energy conservation c) Exhaustion

Page 37

Slide45

Target Organ

The part of the body, or mind, that is a target of the stress and which develops signs and symptoms of over-arousal

Slide46

 

Stressor Stress Response

Target

Organ  Target Organ Identification

An Example…..

 

Traffic

jam

Increased Adrenalin

Increased Feelings

of

anxiety, Heart rate

increases,

and

blood

pressure rises,

etc.

Slide47

Trauma

A horrific event outside of the realm of usual human experience. The person experiencing it finds it markedly distressing and feels fear, helplessness and horror

Page 38

Slide48

Traumatic Stress

Most intense form of distress

A broad range of cognitive, physical, emotional, spiritual, or behavioral reactions

Page 39

Slide49

Post Traumatic Stress

Also known as

Critical Incident Stress

Normal response of normal, healthy, people to a terribly abnormal event.

Often overwhelms coping mechanisms

Slide50

Critical Incident Stress* is Normal After Trauma

It becomes dangerous to health when it is not resolved

*A

KA Post Traumatic Stress

Slide51

Post Traumatic Stress Disorder

If

Critical Incident Stress

is not managed properly and if it remains unresolved, it may turn into one or more psychological conditions that can interfere with normal life functions.

One of the worst conditions is Posttraumatic Stress Disorder (PTSD)

Page 39

Slide52

Overview of Criteria for PTSD

Exposure to actual

or

threatened death

,

serious injury or

sexual violence

B.

Symptoms of

intrusion

associated with the traumatic event

C.

Persistent

avoidance

of stimuli associated with the traumatic event

D.

Negative alterations

in thinking and mood Associated with the traumatic event

Slide53

Overview of Criteria for PTSD

E.

Marked alterations in

arousal

and

reactivity

associated with the traumatic event.

F

.

Duration of the disturbance(

B.C.D.E

) is at least 30 days

G

.

The disturbance causes clinically

significant distress or impairment

in social, occupational and other important areas of function.

Slide54

Overview of Criteria for PTSD

The

disturbance

is not attributable to physiologic effects of a substance (e.g. medication or alcohol) or other medical condition

.

Slide55

Other Conditions Resulting From Trauma

Substance abuse

Withdrawal

Depression

Brief

P

sychotic Reaction

Panic attacks

Panic disorder

Changes in personality

Loss of self confidence

Increased anxiety

Increased irritability

Slide56

Trauma Membrane

After trauma, people begin to form a membrane around themselves that insulates them from additional trauma. Over time it may block out appropriate help as well. Early intervention is highly recommended.

Slide57

Symptoms of Traumatic Stress

Cognitive

Physical

Emotional

BehavioralSpiritual

see, read and remember pages 41-43

Slide58

Psycho-traumatology

A study of psychological traumatization

Slide59

Section Three

Strategic Planning in Crisis Intervention

&

Critical Incident Stress ManagementPages 46-58

Slide60

Effective Staff Support Programs

Comprehensive

Not therapy, but support

Integrative

Systematic

Full support package

Multi-tactic

Slide61

Effective Staff Support Programs

Linkage to wide range of resources

Run and staffed by Peer Support Personnel

Contains the Six Core Elements

Slide62

Six Core Elements of CISM

Surveillance, Assessment of the event and the impact on the personnel

Strategic Planning

Listening, Individual support, and Crisis Intervention

Informational groups

Interactive groups

Follow-up and referral services

Slide63

Assessment

Circumstances

Nature and Magnitude of event

Impact on people exposed

Slide64

Characteristics of a Crisis Strategy

Full assessment

Development of goals and objectives

Select the right people to provide the services

Develop a strategic plan of action

Select the right crisis tactics

Slide65

Tactical Components of CISM

Pre-event preparation, education, training, planning and policy development

Assessment procedures (nature and magnitude of event, impact on people)

Strategic Planning procedures (5 T’s)

Individual crisis intervention support actions

Slide66

Tactical Components of CISM

On scene support services

Informational groups for operations personnel (RITS)

Informational groups for citizens (CMB)

Interactive groups: Defusing

Interactive groups: CISD

Slide67

Tactical Components of CISM

Significant other support services

Follow-up services

Referral services for those who need more than what CISM can provide

See pages 52-54 See chart on Pages 55-56

Slide68

Strategic Planning Formula

Theme

Target(s)

Types

TimingTeam

Slide69

Theme

W

hat are the issues, concerns, questions, threats, circumstances, and special situations that need to be considered?

Pages 50-51

Slide70

Targets

Who needs assistance and who does not need assistance?

Slide71

Types

What types of help will be most

beneficial?

Slide72

Timing

When will the assistance be most useful to those who need it?

Slide73

Team

Who is being sent in to provide the assistance and do they have the personality, background, and skills to provide the necessary support

See pages 50-52

Slide74

Introduction to Strategic Crisis Planning Exercise

Your instructor will conduct a brief Strategic crisis planning exercise at this time

.

Slide75

Section Four

Informational Group Crisis Interventions

Slide76

Informational Groups

1. Rest, Information, Transition Services (RITS)

2. Crisis Management Briefing (CMB)

Slide77

A change in terminology

RITS was formerly known as “Demobilization”

The name change brings about clarity of function and eliminates confusion with military communities. The need, function and process remains unchanged

Slide78

Rest Information Transition Services

Informational

session for staff,

not for use with populations outside of Emergency Services or the military.

Provided once at end of a unit’s first exposure to a major prolonged critical incident (disaster, military operation).

Some form of follow-up is usually required

.

Pages 59 -64

Slide79

R

est

I

nformation

Transition Services

Primary purpose: to provide support and information to operations personnel at large scale, complex and prolonged incidents.

Consists of two main segments

1) brief information presentation (10 minutes maximum)

2) rest, food, refreshments (20mins.)

Command then informs personnel of the next steps or tasks (reassignment, rest, etc.)

Slide80

Rest Information Transition Services

Only one provider necessary

No efforts to have a discussion

No one asked to speak

Provide information, instructions, guidance only

Have peers available for individual support

Slide81

Rest Information Transition

Services

Logistical Considerations

Assemble team

m

embers

Establish

a schedule for arriving

workers

Establish liaison with Incident Management

Establish location within reasonable proximity of the incident that has adequate space for crews

Goals-assessment, mitigate

i

mpact

Page 61

Slide82

Rest, Information, Transition Services

Exercise

Slide83

Crisis M

anagement

B

riefing

Versatile

informational

group process

Works well with heterogeneous groups

Works with any event that has an powerful impact on the community.

Has been used in schools, businesses, organizations, clubs, hospitals and government agencies.

Slide84

C

risis

M

anagement

Briefing

Can be repeated to accommodate huge numbers of people

Can be provided multiple times as long as new information is added each time.

May be done via television or radio if necessary

May be provided at regular intervals during a disaster

Slide85

C

risis

M

anagement

BriefingMay be applied to military and emergency services personnel

Generally 20 to 45 minutes

Primary purpose is information, instructions, and guidance only

Slide86

C

risis

M

anagement

Briefing

Goals

Provide Information

Rumor Control

Reduce Chaos

Share effective coping

Provide avenues for follow-up care / Referral information

Engender Community Morale / Enhance Morale

Restore to adaptive function

Slide87

C

risis

M

anagement

Briefing

Process

Step 1

Assemble participants (Team and Victims)

Step 2

Provide accurate information about the incident

Step 3

Anticipate, discuss and normalize current and potential stress reaction

Step 4

Teach stress management specific to the groups needs

Slide88

C

risis

M

anagement

BriefingExercise

Slide89

Section Five

Interactive Group Crisis Intervention

Defusing

Pages 69-83

Slide90

Yalom

s Eleven Most Therapeutic Factors for Effective Groups

Impart information

Instill hope

Altruism

Universal concepts

Corrective

recapitulation

Use socializing techniques

Initiate behaviors

Interpersonal learning

Group cohesiveness

Catharsis

Guidance, nurturing, support, assistance

Slide91

Homogeneous Groups

Best served by interactive group processes

The interactive group processes are 1. Defusing and 2. CISD

Understanding and resolving the traumatic experience can best be accomplished in a brief group discussion

Group members learn from each other

Slide92

Types of Groups

Primary groups – very homogeneous

Secondary Groups – some familiarity but most heterogeneous

Random groups – extremely heterogeneous

NOTE:

Defusing and CISD were designed only for

h

omogeneous groups never to be used for heterogeneous groups

Slide93

Therapeutic

F

actors in Group

Impart information

Instill hopeAltruistic

Universal concepts

Corrective recapitulation

Slide94

Therapeutic Factors in Groups

Use socializing techniques

Initiate behaviors

Interpersonal learning

Group cohesiveness

Catharsis (Irvin D.

Yalom

(2005)

Slide95

Defusing

An interactive group process

Same day (up to 8 hours after incident ends)

Has little effect or no effect after 12 hours

Group must be homogeneous

If opportunity is missed, provide one-on-one support followed later by CISD

Slide96

Defusing

Advantage in defusing is group members emotional guards are down and needs are high.

Groups in crisis are more open to right kind of help

Focus on unit cohesion and unit performance

Slide97

D

efusing

In a few cases a defusing may be all the group needs.

In other cases a CISD should follow

If reactions are intense or suppressed and if there appears to be unfinished business, then a CISD is indicated a few days later.

Slide98

Defusing

When a CISD is necessary, it is generally made stronger by having had the defusing first.

In a line of duty death situation a 5-phase CISD is provided instead of the defusing

5-phase CISD is taught in the advanced group course.

In a disaster, RITS is provided instead of a defusing

Slide99

Criteria for Homogeneous Group

Group members have a relationship with each other before the traumatic event

They have a shared history

They have spent considerable time together prior to the event

They have experienced the same traumatic event.

Slide100

Warning!

If the Group is Heterogeneous

Provide informational group services like the RITS (for staff in large scale events) or, more likely, the CMB

Slide101

Goals of Defusing

Stabilization of the traumatized group

Restore unit cohesion

Restore unit performance

Assessment tool to determine if group members need something else in addition to the defusing

Slide102

Defusing

Don’ts

go beyond 30 minutes

go into detail

try to turn the defusing into a therapy session.

have deep discussions of emotions

Slide103

Defusing

Do’s

Brief group discussion

Brief situation overview

Opportunity for a quick assessment of group needs

Run by two trained peers

Rarely a stand alone. It needs follow-up

Slide104

Defusing

All providers of defusing must be properly trained in CISM!

“…peer interactions tap into many therapeutic factors.”

(Paturel, 2012)

“groups provide social support, they improve social networks and they can reduce stigma, isolation and feelings of alienation among members.”

(Paturel, 2012)

Slide105

Defusing

“…hearing from peers may be more helpful than receiving guidance from a therapist since peers can identify with one another.”

(David

Yalom

, MD, 2005. Theory and Practice of Group Psychotherapy” as reported in Paturel, 2012)

Slide106

DEFUSING: 3 PHASES

INTRODUCTION – Introduce team; lay out the guidelines; lower anxiety about the process

EXPLORATION – Allows a brief discussion of the experience. A brief “story” of the event

INFORMATION – Provide information, normalize, teach, guidance, summarize key points

Slide107

Introduction Phase

Introduce team members

State purpose / describe process

Motivate participants

Set ground rules

Stress confidentiality

Not investigative

No one forced to speak

All viewpoints are important

Slide108

INTRODUCTORY EXERCISE

take a look at pages 86-81

Slide109

Exploration Phase

Ask for brief description of event

Ask clarifying questions

Group members share experiences of the event only as much as they wish

Look for themes / concerns

Assess need for more help

Reassure as necessary

Slide110

Information Phase

Acknowledge / summarize the exploration provided by the group members

Normalize experiences and / or reactions

Teach key stress survival skills

Emphasize taking care of self

Rest / family life / stress management

Offer additional help such as one-on-ones

Slide111

Section Six

Practice Exercises for Defusing

Slide112

Section Seven

INTERACTIVE

GROUP CRISIS INTERVENTION

CRITICAL INCIDENT STRESS DEBRIEFING

Pages 91-125

Slide113

Critical Incident Stress Debriefing

(CISD)

A structured GROUP discussion concerning a critical incident

First described by Mitchell (1983) for use with homogeneous groups of emergency services personnel

Historical roots in military psychiatry (see HERD, S.L.A. Marshall)

Requires a team approach

Slide114

CISD GOALS

Mitigate distress

Facilitate psychological normalization and psychological “closure” (reconstruction)

Set appropriate expectations for psychological / behavioral reactions

Serve as a forum for stress management education

Identification of external coping resources

Serve as a platform for psychological triage and referral

Slide115

CISD Team Resources

Minimum: Two CISM trained team members

At least one mental health clinician

Other team member(s) may be “peer support personnel,” spiritual leader, another mental health, or physical health professional

ALL TEAM MEMBERS MUST BE TRAINED IN the interactive group process - CISD

Slide116

PLANNING THE CISD

SIZE: group (2-20)

DURATION: 1-3 hours

TIMING: 1-10 days for most incidents (1-3 days for most acute public safety incidents; 3-4 weeks for disasters).

note: Implement when “psychological closure” possible, i.e., disengagement. Timing has more to do with

PSYCHOLOGICAL READINESS than the passage of time

LOCATION: Room with chairs placed in a circle or around a table, isolated away from incident site and distractions

Slide117

Convenient time

All involved operations personnel invited

Personnel relieved of duties

Ideal group size is 2 - 20

Homogeneous groups (homogenize with regard to traumatic exposure/ psychological toxicity)

Ideally, one team member for every 5 or 6 participants - minimum of 2

Follow up planning as necessary

CISD

Considerations

Slide118

Strict Confidentiality

No breaks

Timing is important

Location and physical environment

Closed circle format

Important CISD Considerations

Slide119

COMMON GROUND RULES

Participation voluntary

No notes, recording devices

Try to limit break until after group is finished

Not operational critique, not investigation

Not a “blame” session

Not therapy, nor substitute for treatment

Address issue of confidentiality vs. privilege

Slide120

MHP

Peer

PHYSICAL FORMAT

Door

Slide121

MHP

Peer

Peer

Door

Slide122

MHP

Peer

Peer

Peer

Door

Slide123

MHP

Peer

Peer

Peer

Door

Slide124

MHP!!!!

Door

Peer

Peer

Peer

Avoid tables

, distractions,

dispatch

speakers, equipment,

And CPR

training

dummies. Try

to avoid snacks till

after.

They

are

impediments to communications!

Slide125

CISD STRUCTURED 7 PHASES

INTRODUCTION

FACT PHASE

THOUGHT PHASE

REACTION PHASE

SYMPTOM

PHASE

TEACHING

PHASE

RE

- ENTRY PHASE

Slide126

Phase Progression of a CISD

COGNITIVE

AFFECTIVE

INTRODUCTION

FACT

REACTION

THOUGHT

SYMPTOM

TEACHING

RE-ENTRY

Slide127

Clarified Phase Progression of a CISD

COGNITIVE

AFFECTIVE

Introduction

Brief Situation Review

Aspect causing most personal distress

First Impressions of the Incident

Signals of Distress

Stress Management and

R

ecovery

P

rocess

Summary

Slide128

INTRODUCTION

I

ntroduces team members

Sets expectations

Describes “ground rules”

Ground rules anticipate potential problems and attempts to address them in advance

Addresses confidentiality

Participation in discussion is VOLUNTARY

Preview questions

Slide129

INTRODUCTORY EXERCISE

Take a look at Pages 110-113

Slide130

FACT PHASE*

Prompt

“Tell who you are and what happened from your perspective.”

*

May still be used when group exposed to multiple stressors, as in disaster out-processing, or culmination of a tour of duty. “Tell us about your experiences.”

Slide131

Used when larger than expected group shows up at

CISD

Used when the administrator places the CISD

team members under an arbitrary time restriction

Who arrived first; what happened

Who came in next; what happened, etc.

Alternative Fact Phase:

Slide132

THOUGHT PHASE

Prompt

“What was the first or most prominent thought that entered your mind regarding the incident?”

Any unusual or disquieting thoughts?

Slide133

REACTION PHASE

Prompts

“What was the worst part of this event for you?”

Any aspects of the event that have caused you the most pain or distress?

If you had the power to erase one single aspect what would you most want to eliminate from the total experience?

Slide134

SYMPTOM PHASE

Prompt

“What physical or behavioral changes have you experienced since the event?”

Or, “What has life been like for you since the event?”

Or, “What signals of distress have you noticed in yourself since this happened?”

Slide135

TEACHING PHASE

Team members normalize reactions, provide anticipatory guidance, teach stress management, describe external resources available.

Teach to what has been expressed

Encourage participants to continue the recovery process

The group should be used as a resource to identify coping techniques that have been useful in the past.

Slide136

RE-ENTRY PHASE

Prompts

Reiterate normalization

Q & A, if indicated

Summarize key points, “lessons learned”

Offer cognitive reframe if useful to facilitate closure, reconstruction

Foster group cohesion, if indicated

Slide137

Section Eight

CISD Practice Session

Slide138

End of Slide Program

Slide139


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