Posts tagged social work

Any information in the following article is either drawn from the Family Service League presentation on Crisis Intervention, which draws heavily upon methods and materials put forth by the International Critical Incident Stress Foundation, or relies on common psychological knowledge gleaned from psychology courses taken throughout my undergraduate career.

Broad Applications

I’m adding this note after the fact, because I realize that this piece addresses mostly events that affect groups, but use examples that are probably rare in many schools. Domestic terrorism, school shootings, and massive trauma are not generally something an educator expects in their day-to-day job. There are also traumatic stress-inducing circumstances, however, that could happen anywhere to anyone — the unexpected death of a student, teacher, or community member; a fire, flood, or tornado; an attempted suicide in the school.

If you work in an area beset by any kind of violence, whether in the school or the community, this is information that will become useful at one point or another. Students and staff are witnesses to what happens in their communities as well as in their schools, and bring these events with them to the classroom, especially if they are troubled and distracted by them.

Because of the nature of media coverage of catastrophic events, this information also becomes applicable to anyone working with students who are old enough to be exposed to the media on a regular basis (which, of course, means just about everyone). In the event of a disaster that is aggressively covered by media, the best advice you can give to parents and caregivers is to avoid this media coverage in the presence of their children, and in fact to avoid excessive exposure to this media coverage themselves.

First, what is a Critical Incident?

A Critical Incident is, essentially, any event in a person’s life resulting in distress so severe as to overwhelm an individual’s coping mechanisms to the point of personal crisis. These can include:

- sudden deaths
- suicides
- natural disasters
- multi-casualty incidents
- acts of violent crime
- serious on-the-job injuries
- events with excessive media coverage

As educators or counselors, these can take a variety of obvious forms, whether very public and affecting large groups (school shootings, student or teacher deaths of any kind, tornadoes) or private and effecting a student and their immediate contacts (domestic violence or sexual abuse, a sudden loss of job in the family, homelessness). They might also, however, be due to events that are removed but highly publicized. The most prevalent example of this is 9/11 — students who seemed too young to remember the event have been so affected by the reactions of those around them as well as by the constant and frequently unfiltered coverage growing up that mental health professionals are still seeing negative effects in youth and adults alike (especially with the coming anniversary). To some extent one could also see this in the rash of coverage of LGBT youth suicides.

All of us can name at least one example of a Critical Incident that might have occurred in the lives of students or staff. In fact, it might be good to choose something to keep in mind now, to refer back to later.

What makes Critial Incident stress different from other kinds of stress?

It probably won’t surprise you that there’s good stress and bad stress. Stress in itself is a very natural survival response, tapping into that fight-flight-or-freeze response. Dis>stress is the bad stress, obviously, and can be cumulative or traumatic.

Cumulative stress is what we might also call burnout. The Family Service League presentation given to our organization on Monday describes symptoms — a slow erosion of functioning, cynicism, incomplete work, lateness, impulsive need for change, and chronic physical illness — that many people in helping professions may have experienced themselves. This can be managed over time through the teaching of appropriate coping techniques.

The stress we’re concerned with here is the traumatic stress. Even if individuals have strong coping skills, traumatic stress resulting from a Critical Incident can override these coping skills and leave the victim unable to function at their normal.

There is little that we can do to prevent this kind of stress reaction when it occurs, as it is a normal reaction to an abnormal situation.

A Normal Reaction to an Abnormal Situation

This is an incredibly important phrase to keep in mind. Students and staff who experience a traumatic event could experience a variety of symptoms that seem abnormal — nightmares, recurring and intrusive thoughts about the incident, depression or anxiety, a general inability to function in daily life, physical fatigue or pain, avoidance of certain aspects of the event, just to name a few. For example, if a student witnesses a drive-by involving a blue sedan, the student may become unable to focus, jump at any sound resembling a gunshot, complain of being too tired to go to school, avoid a three block radius of the shooting, and panic at the sight of any blue sedan.

Not all individuals experience continuing symptoms of trauma, but many experience acute stress reactions immediately afterward.

Diffusing, Addressing, and Preventing the Trauma

There are any number of very specific interventions that would be of use to a social worker or other mental health professional, many of whose positions are meant specifically to deal with these situations. Chances are, however, that many if not most of the people reading this right now are educators, students, or individuals whose positions do not allow them to conduct formal interventions.

Because of this, I’m going to focus on some basics that anyone can facilitate. Consider it “emotional first aid.”

Please note that, when I use the word “victim,” I am referring to anyone directly exposed to a critical incident, but also to those who have been indirectly exposed through media, family, colleagues, and friends.

Normalize

In a crisis situation, people need stability.

Normalize the environment. The most immediate actions need to be taken at or near the site of the crisis — especially if the place of crisis is the school — in order to restore the site to a place of safety. “Immediate,” of course, is a sort of relative term here. Crisis management, in terms of emotional need, obviously needs to wait until the danger is removed. Emotional first aid can’t happen until shooting stops, winds die down, or a fire is put out. However, in order for the environment to regain its former feelings of safety, it is critical that at some point it be revisited in the least threatening context possible.

Normalize the process of coping. Make sure that students, staff, whoever was involved in the critical incident, understands that what they are feeling is (once again) a normal response to an abnormal incident. Explain that talking about the incident is okay, but do not force anyone to talk about it.

Do what you can to include familiar support structures. If the school building suffers a disaster that renders it unsafe to be used, and students must be displaced, find a way to keep them with the same teachers and peers they were learning with before. Don’t change the curriculum to focus only on the critical incident — discuss it as is appropriate, but be sure to maintain routines and continue previous lessons if possible. Don’t integrate them into other classrooms; don’t give them a new teacher if their current teacher is still able to perform their duty. This seems like it might be common sense, but I’ve seen this mishandled first-hand after my brothers’ elementary school burned down several years ago.

Communicate

Knowledge needs to be shared about the incident itself and what will be done in regards to the incident. This communication should be a two-way street, and should include both the facts and the victims’ emotional reactions.

Gather - ask people involved what happened. This can be done in an organized group conversation or on a one-on-one basis, depending on what will work best in the situation. Be sure to remember that this is not an interrogation. Victims should only recount as much information as they feel comfortable with, which may in the case of an especially traumatic incident, be none. Listen to victims’ accounts for recurring themes or concerns that have the potential to resurface later, or that are common across a group of victims and might be better addressed through future programming or assistance. Done well, gathering information from the people involved can even lend them some control by allowing them to recount the incident in a safe, controlled setting. If victims are highly emotional and needs to be calmed, try to ask specifically cognitive questions — who, what, where, when — that will allow them to shift their thinking away from the emotional response to a cognitive one, and reassure them as frequently as is needed.

Inform all involved — immediate victims as well as extended community as is appropriate — about the critical incident. Do so in a way that allows for questions and answers, and involves figures that will be able to supply the most information possible. Do not hold a Q&A session about an incident at a school without the principal. Do not send a letter home about an incident wracking the building without allowing for some kind of conversation between parents and school officials. If the incident affects a small group of students, a meeting among the students and their parents with teachers and administrators might suffice. If the incident affects a community at large — for example, a violent crime at a local business — press conferences and town hall meetings might be necessary.

Allow victims to share their emotional responses to the event. It’s incredibly important that victims are given the space to react. This also gives you an opportunity to assess their need for additional support.

Caution:
Key phrases to look for in victims’ discussions:
- “I don’t know how I can go on without them.”
- “There’s nothing left.”
- “I can’t survive.”

In adolescents, pay special attention after extended periods of depression following a critical incident to what seems like a sudden lift in mood. Inexplicable relief after severe depression, without the addition of any therapies, medications, or any change in conditions, may be a sign that the individual has decided to end their life. Other warning signs include unexplained donation of belongings to friends and relatives and sudden declarations of thanks for lasting friendships. (Consider a student that has been inconsolable after the death of a relative who comes in one day full of sunshine, texts twenty friends that they’ve been great, and gives away all of his or her video games and DVDs. This raises some alarm.)

Teach

Once victims have shared their feelings as well as their perceptions of events, and have been informed to their satisfaction or to the best of your ability, they should be further informed as to how to cope with the critical incident and their reactions to the critical incident.

Let them know that they may experience a variety of symptoms in response to the critical incident that may seem unrelated or extreme, including those they have expressed experiencing while sharing with you, and that they are (say it with me now) a normal reaction to an abnormal situation.

Discuss positive coping techniques. Stress that self-care is important, including but not limited to good nutrition, rest, and open communication about continuing reactions to the incident. Encourage victims to try to return to old routines and hobbies. Social workers and psychologists might conduct workshops for victims within a specific community or population about stress management.

Connect victims to external services. In a school setting, this could mean providing parents and students with hotline numbers, contact information for local mental health clinics and counseling centers, or setting up and publicizing an open-door policy with the school social worker or psychologist.

Keep in mind: we are not trying to make our victims better-functioning people than they were before the incident when we address trauma. This is first aid, not therapy. If a victim was a nail-biter before an incident, while we might not necessarily want them to resume nail-biting, we aren’t trying to make them quit either. What we want is for victims to return to a previous level of functioning. As educators, you have an advantage in this regard over crisis management professionals, in that you are already familiar with the victims enough that you can identify what symptoms were present before an incident, and which are a result of trauma.

For More Information or Assistance

If this is a topic that interests you, and you’d like to be more prepared to assist others in response to a Critical Incident, the International Critical Incident Stress Foundation offers workshops and certificate programs. These do not require professional affiliation, though they do have an application component, and many of their courses are geared specifically to the education field.

If a Critical Incident occurs in your school, place of work, or general community, you have resources to assist you. Many local mental health clinics, counseling centers, and community organizations offer crisis interventions, suicide pre- and postventions, and other trauma services to groups suffering immediate crises.

And remember that everyone can suffer from trauma. If you are experiencing symptoms of extreme distress, do not simply push it aside to help others — seek help for yourself as well. You can only do so much physical first aid when you’re bleeding out, and the same goes for emotional first aid.

Miss N was an intern at our program, but when her term was up, she didn’t want to leave.  Instead she signed on as a paid volunteer for the rest of the school year.

She and I had a long talk about her Master’s program.  Apparently what I’m looking for is Social Work.  For a long time, I thought Social Work was intrinsically linked to CPS, positions in which I admire people for working, because I think that many of those positions would honestly destroy me. 

Actually, whereas Mental Health Counseling certification is nowhere near as versatile as I thought it might be, a Social Work degree could allow me to be placed in a school or have a private practice, work with students or families or returning veterans.

City Year has some amazing “Give a Year” partnerships with a number of colleges and universities.  If you give a year to City Year they help you get something back in the way of furthering your education, through scholarships and special considerations from these partner schools.  One of these is Boston University.

As far as I knew previously, I was moving to MA.  I was just not considering Boston.  I know no one there.  I’m not particularly fond of the city.  Don’t get me wrong — it is a beautiful, diverse city full of history and culture.  But coming from New York, something about it is just…strange.  There’s a lot of sky.  It’s a little bit too clean.  Things are condensed but also oddly spread out.  I really don’t know how to explain it; I’ve just never felt quite at ease there.

But through City Year, if I go to Boston University specifically for Social Work, I get 100% tuition for up to two years.  And, and, Boston U has a Trauma Certificate Program, training their Social Workers additionally in working with individuals recovering from chronic violence, natural disasters, and war zones.  (They also have an amazing set of Dual Degree programs through the school of Social Work, one of which includes Social Work and Education.  Because it must focus either on Special Education or Administration and Leadership, it isn’t going to suit my needs, but it’s something for interested parties out there to consider.  Hence the bold.)

Now it’s just a matter of getting in.  I’m going to have to apply for Spring entry, which may mean I’m here for another semester, which may also mean I’ll have to talk to my supervisor about signing on as staff at my program for that semester. 

There’s also the matter of living.  Things like food and shelter.  I would like if at all possible to take my cat with me, because when I was gone recently for a week she became incredibly depressed and wouldn’t let anyone near her, hiding in a spare room.  Can’t do that on campus.  So if anyone has any advice about living in the Boston area — places to try, places to avoid, etc. — I would be incredibly grateful for it.

But no jumping the gun.  This means…this means I can apply.  I have something definitive to apply to.  I have direction again.  This, this is a very good feeling.