10 th world congress on stress, trauma & coping creating and maintaining a multi school based...

10th World Congress on

Stress, Trauma & Coping

Creating and Maintaining a Multi School Based CISM Team: Lessons and Tools

ICISF 10th World Congress on Stress, Trauma and Coping

February 26, 2009

Baltimore, Maryland

Presenters

• Katy Kramer Lee, LISW

• Leslee Sandberg, Ph.D.

Grant Wood Area Education Agency

Cedar Rapids, Iowa

Agenda for Today• Welcome and Introductions• Who We Are and Where We’re From• Learning Objectives for Today• Establishing The Need for a School

Based CISM Team• CISM School Based Toolkit• Student Funerals• Emergency Preparedness• Team Maintenance• Closing Activity

Who We Are

• An 90+ member ICISF trained team composed of school social workers, school psychologists, educational consultants, school counselors, nurses, administrators, clergy and pastoral care staff

Where We’re From

6th St Office6th St Office

Photo courtesy KCRG YouNewsTV (http://www.kcrg.com/younews)

By the end of our session today, participants will be able to:

1. Describe a process for establishing a multi-school based CISM Team including mission, vision and guiding principles.

2. Identify ways to grow, develop and maintain a multi-school based CISM Team guided by best practice.

3. Develop and access additional resources for use in their own school setting. What does a CISM Tool Kit contain?

4. Plan for special circumstances: funerals, memorials, the media.

5. Review the SAFER-R model as an intervention in the school setting.

6. Utilize the Critical Incident Stress Debriefing (CISD) in a school setting: children and adults.

7. List ways to be pro-active in school crisis planning

8. Describe the importance of strategic planning in responding to school crises

9. Understand how faith-based CISM members contribute to the school based CISM team.

10.Develop an action plan to guide next steps in participants own setting.

Establishing the Need for a School Based CISM Team

“There are two kinds of schools….those that have had a crisis and those that will.”

-Mary Schoenfeldt of Schoenfeldt and Associates

In the beginning……..

• Prior to 1999: informal response

• 1999 student death at track practice

• Met with hospital, Red Cross, Abbe Center for Community Mental Health

• Formed an Advisory Committee: first task was to define our need and develop guiding principles, mission, and vision.

Need Statement

• Grant Wood AEA is aware that difficult and critical situations occur in the lives of students and staff.

• Some effects of traumatic stress are: disruption of teaching and learning, deterioration of job performance, relationship problems, depression.

We chose the ICISF CISM intervention model.

Traumatic Stress

• Critical incidents are intense events that can rapidly overwhelm the coping skills of students and staff exposed to them.

• Critical incidents can set the stage for both critical incident stress and post-traumatic stress disorder.

Goals and Outcomes of Interventions

• Reduce stress.

• Stabilize.

• Facilitate returning to a more normal routine.

• Provide access to a more intensive or higher level of care, as indicated.

Critical Incident Stress Management

• Prevention of critical incident stress.• Mitigation of critical incident stress.• Intervention to assist in recovery from

critical incident stress.• Acceleration of recovery whenever

possible.• Restoration to function.• Maintenance of school personnel and

student health and welfare.

CISM Interventions• Pre-incident education, preparation

• Assessment

• Strategic Planning

• Large Group Crisis Intervention:– Demobilizations (large groups of rescue/ recovery)– Respite/Rehab Sectors– Crisis Management Briefings (CMB)

CISM Interventions (cont.)• Small Group Crisis Intervention:

– Defusings (small groups)– Small group CMB– “Debriefing”

• One-on-one crisis intervention, including individual PFA

• Family CISM

• Organizational/ Community intervention, consultation

• Pastoral crisis intervention

• Follow-up and referral for continued care

And then…….Community organizations funded our

first training: School Crisis Response (Barb Ertl)

• Grant Wood AEA CISM Team formed

• Guiding Principles

• Mission

• Vision

Grant Wood AEA CISM Guiding Principles

All schools in Grant Wood AEA deserve access, in a timely manner, to critical incident support.

In coping with traumatic events, greater positive impact can best be achieved through equal partnerships between school and local community resources.

Asking for community support is a healthy and productive response to crisis.

Involving the broader community is an effective way to address issues of cultural diversity.

A written intervention plan and prior practice can assist in easing chaos.

Response plans tailored to each school district or building best meet the needs of the staff and students.

Consistent training and preparation of local community-wide teams provides the most effective crisis response.

Since students relate best to people they know, it is preferable that local school staff are trained in crisis intervention to facilitate the initial response and provide long – term support.

Providing post-vention support for crisis response teams is a critical part of a traumatic event response plan.

The social / emotional development and learning that occurs when coping with a traumatic event are important elements in the education of our students.

Providing proactive crisis prevention is a critical part of a traumatic event response plan.

• Why is it important to identify guiding principles?

The Team’s Mission

Defines the scope of the work

And

How it will be done

Mission Statement

• To support schools within the Grant Wood Area Education Agency in coping with traumatic events by providing trained, local community response teams.

Mission Fulfillment

• Create & facilitate effective community partnerships.

• Promote safety & security in schools by linking with other crisis prevention & management efforts.

• Provide training & follow-up for the local community response teams.

• Provide schools access to crisis intervention response teams that use the ICISF model.

After that……

Developed GWAEA CISM Operations Manual with team membership application

• Became a registered ICISF team

• Individual members took additional ICISF training

Spreading the Word!

• Created a brochure

• Spoke to School Superintendents

• Informational “ How to Contact the Team” flyers sent to all schools

• Internal communications within our agency

• Word of mouth from schools receiving our services

Vision

the preferred future of the team

Vision Statement

• Schools within Grant Wood AEA will have an effective, integrated community-wide response to a school crisis, based on a plan that provides access to local resources.

• There will be a systematic, consistent approach utilized by response teams.

• Community resources will be organized and easily accessed by school personnel.

What is Your Team’s Mission?

A mission statement defines the scope of your work and how it will be done:

The mission of____________ is to

_________________ by________.

Team Organization

Coordinating Agency

• Grant Wood AEA serves as the coordinating agency for the Grant Wood AEA CISM team.

• Grant Wood AEA CISM team serves schools and districts in the Grant Wood AEA service area.

Comprehensive CISM Team

• Voluntary partnership between area schools and GWAEA, with linkages to local team and community groups.

• Comprised of trained individuals – peer support – mental health professional as defined by

the ICISF model.• Additional support provided by community

spiritual caregivers trained in the CISM model.

Team Membership

• Team Coordinator

• Clinical Consultant

• Mental Health Team Member

• Peer Support Team Member

Team Coordinator

• General management of the team• Receipt of service request• Assessment of the need and type of service to be

offered• Notification of all involved personnel• Representation at community meetings• Assistance with continuing education opportunities for

team members• Assistance with development of policies and

procedures• Facilitation of periodic team meetings, co-leading

meetings with clinical consultant

Clinical Consultant

• Provides clinical expertise and consultation to the CISM Team

• Strategic planning with team coordinator• Monitors services provided, offers

suggestions for improvements and the need for follow-up services

• Facilitates continuing education for team members

• Completes periodic reviews of team records and services

• Chairs membership committee

Mental Health Team Members

• Assistance with education of the team• Psychological leadership during the debriefing• Assistance with follow-up and referral services

after any intervention• Clinical consultation with peer support team

members who have intervened in traumatic events

Peer Support Team Members

• On-scene support services to individuals who are showing signs of distress during an incident

• Assist with assessment of the need for defusings, debriefings, individual consults, family support services, referrals, etc.

• Provide full range of CISM services under the guidance of mental health team members

• Report interventions and observations to mental health team members

Peer Support Members from the Faith Based Community

• How did you become interested in being a member of the CISM team?

• What are the roles of peer support members from the faith based community?

• What are the benefits of including faith based team members on school CISM teams?

On-Site Team Leader

• Coordinates the activities of the team at the incident site

• Collaborates with school administration, emergency providers and other personnel responding to the incident

• Maintains contact with team coordinator and clinical consultant regarding the on-site team intervention and the need for additional resources

CISM Website Resource

Handout:

GWAEA CISM Response Checklist

Initiating GWAEA CISM Team Intervention

• Telephone contact is made to Team Coordinator at GWAEA.

• Team Coordinator designates On-site Team Leader to manage interventions.

• Team Coordinator consults with On-site Team Leader, as needed, about intervention plan.

Initiating Intervention (Continued)

• On-site Team Leader, with other CISM team members, are deployed and intervention is implemented.

• End of day review of interventions conducted and future planning by on-site CISM Team members with school personnel.

Strategies and Tips on working with the media

• Who meets with the media?

• Preparing a statement

• Holding a press briefing off campus

• What have your experiences been?

Summary

• Critical situations occur in the lives of students and staff.

• The mission of the GWAEA CISM Team is to provide support to schools in coping with traumatic events by providing trained, local community response teams.

Summary Continued

• There will be a systematic, consistent approach utilized by response teams that is easily accessed by school personnel.

• The GWAEA CISM Team is a voluntary partnership between area schools and GWAEA, with linkages to local team and community groups.

And when the call comes in……

Our experience with a critical incident involving a murder, attempted murder and attempted suicide.

The Intake Process

• Description of the Sunday evening phone call….

• Using the intake form in your packet what additional information would you want?

Tools

• Availability Template

• Coverage Template

Availability Template

Monday Tuesday Wed. Thursday Friday

Morning

7:30-12

Sally

Karin

Sally

Karin

Beth

Karin

Afternoon

12-5:00

Sally

Karin

Sally

Karin

Kris

Evening Cheryl

Teresa

Bob

Teresa

Cheryl Cheryl

The Interventions

• Setting up the school response

• Strategic planning with administrators

Using the CISM Response Checklist, What would you anticipate as possible needs?

Overview of Interventions

• Individual interventions/SAFER-R model

• CMB-s (School and Day Care)

• Strategic Planning

• CISD (School Personnel)

• PASS (CISM Team members)

Accountability

• Student Contact Sheet– Individual tracking form– Keep in accordion file– May be used for other individual contacts as needed, such as

staff

• Student Follow Up Sheet– Complete at the end of each day– Lists all individuals seen – Date seen, by whom, outcome, need for follow up– Highlight individuals as they no longer need follow up

Example Student Contact Sheet

Student: Curt Kay Date: 2/22/09

Seen by: K. Lee

Outcome: Curt weepy, hesitant to talk, identified several supportive adults, not sure how he will be able to talk with friend when he returns to school, recommend follow up

Example Student Follow Up Sheet

Student Date by whom Follow up? Date by whom Follow up?

Curt Kay 2.22.09 KLee Yes

Sam Jay 2.22.09 KLee No

Sara Pai 2.22.09 Klee No

Lisa Day 2.22.09 Klee Yes

Tim Olay 2.22.09 SSmith Yes 2.23.09 Klee yes

Jim Pay 2.22.09 SSmith Yes 2.23.09 SSmith No

Parent Meetings/CMB-s

• District spokesperson

• Expert

• Handouts/Resources

Strategic planning

• Student transition back to school.

• Intervention with day care and elementary school.

• Utilizing child mental health expert.

• Media management.

Overview of PASS

• Please refer to your handout

– Review

– Response

– Remind

• Staff CISD

• GWAEA team PASS



Taking care of your team members

Maintaining and honing skills, building resistance to burn out

Team Maintenance

• Table top exercises

• Lessons learned

• Writing grants

• Register a team

• Annual updates

• SWOT analysis

• PASS



CISM Quarterly Meetings

Four high school boys all juniors and seniors were driving to a basketball game in a neighboring town for a big play-off game. On the way the driver swerved to avoid a bale of hay, lost control of his car and landed in the ditch. Two boys in the back seat were not wearing seatbelts and were thrown from the vehicle. One boy died instantly, the other boy was in critical condition, the driver and the front seat passenger survived.

The high school science teacher and his wife were the first on the scene of the accident. The teacher recognized all the victims and used his cell phone to dial 9-1-1. The critically injured boy was airlifted to the hospital.

One of the first responders that assisted at the accident was the school custodian and neighbor of the critically injured boy.

The driver of the car was on his cell phone talking with his girlfriend when the accident occurred. She heard him scream and the crash before they were disconnected. The girlfriend was a cheerleader who was already at the game and she immediately called her boyfriend’s parents.

Barriers Exercise

• Barriers to Responding to CISM Events

• What is in place now that enables members to respond to CISM events?

• What are some things that we can do to ensure people are available to respond?

Barriers to Responding to CISM Events

What is in place now that enables members to respond to CISM events?

What are some things that we can do to ensure people are available to respond?

Distance Districts are supportive of CISM members leaving

Identification of role when incident happens

Lack of confidence experience

GWAEA voicemail and e-mail

Awareness of number of people trained in each region

People don’t check email/vm regularly

Ability to schedule n for half day if unable to do more

Someone from GWAEA would call or e-mail directly – make it a request

SWOT

• Strengths

• Weaknesses

• Opportunities

• Threats

Strengths• Member skills, training, background,

experience• Number of responses we’ve done• Diversity and size of team• E-mail notices• Working relationship• Our protocols• Same language• Affiliation with ICISF• Understand school culture• Local school support

Weaknesses / Stretches• Follow up after we’ve left• Don’t always know on site team leader (blue

button)• Command center• Additional on line resources??• Pre-incident training for districts• Communicating with so many schools• Location of schools (directions/maps for team)• More systematic way to train new members:

observe, mentor• Not all districts are on board yet

Opportunities

• To learn from experienced people• To learn from our experience• We serve a broader community (i.e.Boy Scouts)• Standardized procedure• Could tap more school staff to be our allies• To increase our knowledge of grief resources• To do more strategic planning• More grants?

Threats• Emotional wear & tear• Negative opinions or research on the model:

does it work?• Continuity in team coordination• Large scale disasters• Liability?• Managing a large team

Our next steps based on our SWOT

• Consider regional and/or school district based teams

• Clear identification of on-site team leader

• Formal mentoring for new team members

• Continue skill building through quarterly meetings

Team Maintenance:The SAFE-R Model

• Stabilize• Acknowledge

– The crisis– Help is available

• Facilitate– Discussion, problem solving, plan

• Encourage– Acceptance/use of resources

• Recovery/Referral



SAFE-R ModelRole Play



Critical Incidence Stress Debriefing

Video taped role play of a school based CISD

GWAEA CISM School-based Toolkit

Incident Organization, Consents andStudent Tracking Tools

-Consent for debriefing-Debriefing Process Map-Incident Report Template-School Feedback Survey-Sample letters and announcements

Counseling Resources-Guiding Elementary Students through Stress/Trauma

Student Funerals in Schools

• How did it come about in our schools?• What are some potential problems or

issues that might arise?• What do you need to consider before

making a decision to hold a funeral in the school?

• When might holding a funeral in the school be contraindicated?

Visitations and Funerals

Teachable moments

Suggested guidelines for memorial service at school

• Hold after school hours• Voluntary attendance• Students involved in planning• Music, student performance, soothing music to set

tone• Preview student planned readings, service• Time limited (30 minutes for secondary students)• Several speakers, include student tributes• Symbols of life and hope• Provide quiet, supervised place for those not

attending or allow to go home with parents• Limit media coverage

Memorials

http://rems.ed.gov/views/documents/ERCMNewsletter_Memorials.pdf

“Paying Tribute to Deceased School Community Members”

The US Dept. of Education Readiness and Emergency Management for Schools

Permanent School Memorial Structures

• Consider the long term relevance/impact

• Contagion effect

• Re-traumatization

• Design

• Maintenance resources

• Benefits of a community vs school memorial



A memorial policy should be included as part of a school district’s Emergency Management Plan

Alternatives to Permanent Memorial Structures

• Scholarship fund• Gifts of library books, equipment• Planting a tree or shrub with plaque and funds

for upkeep/care• Cards, letters, memory books, blogs for family• Moment of silence• Temporary display• Fund to charity (i.e. Cancer Society, MADD,

Crisis Line)

Other considerations

• Cultural norms• Tributes should honor the person and

not the cause of death, especially in the case of suicide or death caused by risky behavior

• Spontaneous memorials, monitor messages, remove with careful consideration/input from students/staff

Emergency Preparedness

What potential emergencies might schools face in your area ?

Our Need for Emergency Preparedness

• Numerous highways and train tracks serve as routes for hazardous materials

• GWAEA is in the middle of “tornado alley”

• Methamphetamine labs• Commercial and general aviation

airports• Power plants and natural gas

pipelines• Research laboratories• Prison facilities• Farm chemical spills• Threats of flooding• Student traffic accidents• Student firearms • School bomb threats• Student suicides

PREP Grant/Project Purpose:

To assist all school buildings within GWAEA to strengthen and improve their Emergency Response/Crisis Management (ERCM) plans

PREP Project Goal:

All 176 schools within GWAEA are prepared to respond to and recover from crisis, including domestic or international acts of terror, technological, or natural disasters

4 measurable objectives:

1. Mitigation/Prevention-NIMS training, review of emergency/crisis plans

2. Preparedness-Incorporation of NIMS training in plans, request for safety

equipment/supplies

3. Response-table top drills

4. Recovery

-GWAEA CISM trained trainers in individual and group

interventions

NIMS

National Incident Management System

www.fema.gov/emergency/nims



Emergency Response Crisis Management Response Plan Review Matrix

Handout

Your Next Steps

Action Planning: Make a list of your next steps when you go home.

• What will you do?

• Who else will you involve?

• What is your timeline?

Thank You for Your Participation Today!

• Please provide us with your feedback on today’s session.

• Best wishes in creating, maintaining, growing your CISM team!

10 th world congress on stress, trauma & coping creating and maintaining a multi school based...

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