The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Crisis Care Red Lake, Minnesota Dale Walker, MD Oregon Health and Science University 2/24/2019

For more information, contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit our website: www.oneskycenter.org 2/24/2019

Crisis Care Crisis Intervention: > Focus on immediate emotional support > The person’s resources for coping have failed > The design of your intervention is to assist in coping 2/24/2019

Crisis Care Critical Incident Stress: > Reactions to a “stressor” > Could be during > Could be after 2/24/2019

Crisis Care Defusing: > On-scene intervention > Help client to vent feelings > Begin the task of starting coping strategies > Begin the task of reducing stress 2/24/2019

Crisis Care Debriefing: > Organized approach by mental health professionals > Supportive of the disaster workers who had helped in the time of crisis > Usually done towards the end to bring closure to their experiences 2/24/2019

Loss, Grief, and Mourning Grief is both an ADAPTIVE and NORMAL process. NORMAL: Because it is a reaction that helps us confront the loss. ADAPTIVE: Because, while it is painful to go through, it can be productive in that we learn something through it. 2/24/2019

Stages of Grief DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE NOTE: People MAY go through these and they may go through them differently 2/24/2019

Stages of Grief Typical reactions: Drained of energy, purpose, and faith. Feel like they are “dead.” Mistake denial for recovery (too quick) Focus only on the LOSS, not their recovery Can’t focus on working through the grief, because of “all the other things” that must be done. Re-experience emotions at the “anniversary," and other tribal times 2/24/2019

Stages of Disaster The community response in grief. HEROIC: From impact to about one week out. HONEYMOON: Lasts several weeks and there is a sense of the community “pulling together.” DISILLUSIONMENT: One month to even a couple of years. Hype is gone and questions are unanswered. RECONSTRUCTION: Final stage with realization of what has been experienced and what they can do to restore the community. 2/24/2019

Symptoms of trauma Vary related to age, background, prior history of personal trauma. May apply to BOTH, victims and trauma workers. Many of these expressions are suggestive of the fact the trauma has not been handled well. 2/24/2019

Symptoms of trauma Phobias Exaggerated startle response Hyper-vigilance Encounter “reminders” Memory problems Anger, rage Nightmares Report stress Depression Anxiety Preoccupation with “death,” “injury,” and “separation.” Avoidance reactions 2/24/2019

Providing Support The 6 “T’s” Tears It’s Ok to cry Touch Hand or shoulder, supportive (Always ask first!) Talk With you, family, friends Trust Be non-judgmental Toil It will take work, but not to rush Time Recovery takes time, so you must take time to be with them 2/24/2019

Helping Children/Teenagers Children: Birth to 5 years old fear of being separated from parent crying screaming regressive behaviors clinging behaviors NOTE: How the parent reacts strongly influences how the child will react at this age. 2/24/2019

Helping Children/Teenagers Children: 6-12 years withdrawal and depression disruptive behaviors regressive behaviors irrational fears or guilt refusal to attend school anger and fighting bodily complaints and symptoms 2/24/2019

Helping Children/Teenagers Adolescents: 12-17 years old adult-like symptoms emotional numbing suicidal thoughts and depression confusion and memory problems feelings of “they could have stopped it” isolation avoidance and/or substance abuse 2/24/2019

Helping Children/Teenagers Create a sense of “safety.” Use multiple reassurances. Convey you understand what they are feeling. Convey it is “normal” to feel that way. Talking about the feelings and a return to normal. Keep families together as much as possible. Don’t criticize for “babyish” behaviors. Use the 6 T’s. 2/24/2019

Helping Children/Teenagers Encourage that they “take control.” Parents need to care for themselves, in order to care for the children. Don’t rush back to the routine, thinking it will “get their minds off of it.” Hold meetings with leaders in the community, schools, and churches to create awareness and networking. 2/24/2019

Post-Traumatic Stress Disorder Using the Diagnostic and Statistical Manual Witnessed, experienced, or confronted with trauma Intense fear, helplessness, or horror in their response Re-experiencing Avoidance Persistent symptoms (many already discussed) 2/24/2019

PTSD-continued Cognitive-Behavioral Therapies. Group Therapy can be used. Trauma/Grief-focused psychotherapy is being used, as well. 2/24/2019