1. Crisis Care San Diego, California Dale Walker, MD Oregon Health and Science University The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services

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

3. 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

4. Critical Incident Stress: > Reactions to a “stressor” > Could be during > Could be after Crisis Care

5. Defusing: > On-scene intervention > Help client to vent feelings > Begin the task of starting coping strategies > Begin the task of reducing stress Crisis Care

6. 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 Crisis Care

7. Loss, Grief, and Mourning Grief is both an ADAPTIVE and a 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.

8. Stages of Grief DENIAL ANGER BARGAINING DEPRESSION ACCEPTANCE NOTE: People MAY go through these and they may go through them differently

9. 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

10. 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.

11. 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.

12. 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

13. Providing Support  The 6 “T’s”  TearsIt’s Ok to cry  TouchHand or shoulder, supportive (Always ask first!)  TalkWith you, family, friends  TrustBe non-judgmental  ToilIt will take work, but not to rush  TimeRecovery takes time, so you must take time to be with them

14. 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 will strongly influence how the child will react at this age.

15. 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

16. 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

17. 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.

18. 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.

19. Post-Traumatic Stress Disorder Using the Diagnostic and Statistical Manual 1. Witnessed, experienced, or confronted with trauma 2. Intense fear, helplessness, or horror in their response 3. Re-experiencing 4. Avoidance 5. Persistent symptoms (many already discussed)

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