1. Time in a Bottle: Supporting Families in Crisis Linda McKellar, RN., BSW September 19, 2008

2. It is important for us to remember: We are involved in the lives of these individuals and families for only a brief moment in the bigger picture of their lives

3. For many, perhaps most, this experience will be the first, and most devastating in their lives

4. For others, this experience may be one among many

5. What is a Crisis? An internal experience of emotional change and distress. A crisis can be precipitated by a perceived life problem or pose an obstacle to an important goal resulting in internal discord because the individual’s typical coping strategies are inadequate.. The Social Work Dictionary (1996)

6. The outcome of the crisis can be positive if the individual eventually finds new coping mechanisms to deal with the unfamiliar event, thus adding to the repertoire of effective adaptive responses. The Social Work Dictionary (1996)

7. What does a person in a “crisis” look like? Crying Angry Laughing Withdrawn Agitated Demanding Silent Absent “Normal”

8. In other words, just like many of us!

9. Possible Underlying Needs and Interests Evident in Individuals and Families Experiencing a Crisis Resource needs not met : inadequate time, staff, space, information, supplies, equipment, money

10. Psychological needs not met : control, respect, authority, recognition as an expert, power, safety, inclusion, sense of belonging, feel wanted, feel needed, success, sense of achievement, need to compete, need to be seen

11. Emotional needs not met : fear, shame, remorse, guilt, anger, frustration, sadness, loss, disappointment, love, support

12. Paying attention to unexpressed needs How might these present?  Perceived to be overly solicitous  Repeated questioning  Checking with more than one person  Withdrawal  Silence  Talkativeness  Anger  ?

13. Common roles we play in crisis situations Advocate (negotiator) Facilitator (mediator) Go-between Information provider (expert) Interpreter – clarifier – reality tester Observer (witness, audience) Referee Resource Broker Supporter Listener

14. We must be mindful of cultural and individual differences. Some cultures foster open and public expressions of emotions, others tend to be more private or controlled. Particularly in North American/British cultural groups, we often acknowledge that anger and outrage are tolerable, however, it seems that we are often embarrassed by sadness. Is this because we are afraid to be seen as fragile and vulnerable in a world that champions control?

15. Important skills for us to keep in mind: Active listening for ‘understanding’ Importance of acknowledgment of loss: hopes, dreams, plans Future orientation Reframing Clarifying/validating Identifying unexpressed interests and needs

16. Ask: –How have they managed to get through other difficult times in their lives? –If babe is ill, ask about the infant’s name – had they thought of a name? was there any special significance to the name? –Are there other children, how old, what do they know? –Perhaps ask about funeral/memorial service plans

17. –If it is a mom, (or a woman of any age), who is ill, ask about memories, what about special times, legacies (journals, audio/video tapes, etc.) –What are her wishes about where she will die, funeral plans, fears, unfinished business –Who are the supports (formal and informal) for the family –What do the children know –Who will provide care for the children

18. Possible Indicators for Escalation Be aware of: Changes in number of visitors and time spent with the infant or mom Symptoms of depression Increased vigilance Evidence of alcohol or drug use

19. Be aware of the words you use when talking with families. “I think the selection of words these people use is so critically important”. Phrases such as: “I’m so sorry, this is so sad” can be very supportive Communicate what you need to “without using words that open the wound” (brouvard & Gladu: 1998)

20. There may also be other factors we are not aware of that are causing the family increased distress. Some of these might be: Marital conflict; medical, physical, or emotional concerns with other children or family members; financial issues; pressure from extended family or friends; guilt; …

21. People will need to tell their stories over and over. If we are able to listen in an accepting, non-judgmental, respectful manner we will have assisted them them to find and use the tools to begin their recovery process.

22. Tangible Ways to Provide Support Listen, Listen, Listen Have Kleenex handy Listen with your ears, eyes, and your heart!