disaster

may create stress and be difficult to solve, but the family or individual is capable of finding a solution. They do not require outside intervention

problem

is a sudden, pressing necessity, such as when a life is in danger. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to life-threatening events. If a situation can wait 24 to 72 hours for a response, without placing an individual or a family in jeopardy, it is a crisis

emergency

Realistic perception of the event, Adequate situational supports, Adequate coping mechanisms

successful crisis outcome

Created 7-stage model of interventions: assess, rapport, identify problems, explore feelings, generate alternatives (coping skills), restore functioning, follow up

roberts crisis intervention

New developmental stage is reached, Leads to increased tension and anxiety, Internal conflict that arises at each developmental stage due to interaction of physical, cognitive, instinctual, and sexual factors

maturational crisis

occurs when previously effective coping mechanisms are no longer helpful for current context

crisis

Arise from events that are: Extraordinary, External, Often unanticipated, Examples: Job loss or change, A death

situational crisis

is a community problem (crisis) rather than a personal problem (situational), ex: natural, human (shootings, mass casualties), accidental

adventitious crisis

phase of crisis: Serious stressor or problem results in increased anxiety, This stimulates the usual coping methods and defense mechanisms in an effort to address the problem and decrease anxiety

phase I

phase of crisis: Defense mechanisms fail, so Threat persists, Anxiety increases, producing Feelings of extreme discomfort, Functioning becomes disorganized, Trial-and-error attempts at problem-solving begin

phase II

phase of crisis: Trial-and-error attempts fail, Anxiety can escalate to severe or panic level, Automatic relief behaviors mobilized (i.e., withdrawal and flight), Some form of resolution may be devised (i.e., compromising needs or redefining situation)

phase III

phase of crisis: Problem is unsolved and coping skills are ineffective, anxiety overwhelms the person, can lead to personality disorganization, depression, confusion, violence, SI

phase IV

has a limited duration and usually resolves in 4-6 wks, once resolved people will emerge at different levels of functioning

crisis

A Tertiary Prevention Tool, Seven-phase group meeting: intro, fact, thought, reaction, symptom, teaching, reentry, Examples: debrief staff on an inpatient unit following a patient suicide, debrief schoolchildren and school personnel after a school shooting (CISD)

critical incident stress debriefing

meeting purpose is explained, overview given, confidentiality ensured, questions answered: phase of CISD

introductory

participants discuss the facts of the incident, participants introduce themselves, share their involvement in the incident, and describe the event from their perspective: phase of CISD

fact

participants discuss their first thoughts of the incident: phase of CISD

thought

participants talk about the worst things of the incident, what they want to forget, and what was most painful: phase of CISD

reaction

participants describe their cognitive, physical, emotional, or behavioral experiences at the incident scene and describe any symptoms they felt following the experience: phase of CISD

symptom

the normalcy of the expressed symptoms is acknowledged and affirmed, anticipatory guidance is given, stress techniques are enacted: phase of CISD

teaching

Proactively addressing a crisis situation before it occurs, stipulates wishes such as treatment choices, treatment facilities, providers, and designated support person for help, usually are used in end-of-life situations. In psychiatry these plans take the form of a document that is developed by the consumer to be used in crisis situations where the consumer is unable to make decisions

psychiatric advance directives

“crisis” lines for when someone isn’t in a crisis just yet

warm lines

FEMA’s Four-Phase Disaster Management Continuum:

mitigation, preparedness, response, recovery

reduce risk and impact before disaster, Strengthen mental health systems, Build resilience, Train staff, Stock meds, Reduce stigma - phase of disaster management continuum

mitigation

plan and get ready before disaster (when we know a disaster is coming), Develop disaster mental health plans, Conduct drills, Educate communities, Create support networks - phase of disaster management continuum

preparedness

Coordinates first responders, Incident command system training (ICS) (NIMS)

national incident management system

Coordinate United States responses to US disasters, Ultimate responsibility for US safety, Assure immediate availability of preparedness, response, and recovery protocols, Uses civilian first response professionals, Created National Incident Management System (NIMS) to coordinate efforts between responder agencies

DHS

Avoid making people attend —— to preserve some of their autonomy after a traumatic event 

psychological debriefing

is a supportive intervention for individuals affected by crisis, trauma, or disaster, Aims to reduce initial distress, promote adaptive coping, and support recovery, Address immediate biopsychosocial needs, Support recovery through practical, compassionate assistance, not a mental health treatment plan (PFA)

psychological first aid

must be taken to the survivors in a disaster. Most victims will not seek help, and many will not even accept offers of help when made available to them

mental health interventions

Prevent mental illness before it starts, Community education on coping and resilience, Psychological preparedness, Mental health literacy, Training for first responders in Psychological First Aid (PFA), Strengthening social support systems

primary prevention

Early detection and intervention, Rapid screening for distress or psychiatric symptoms, Immediate application of PFA, Crisis intervention, Referral systems and short-term counseling, Monitor high-risk individuals

secondary prevention

Reduce complications and promote recovery, Long-term psychiatric care (therapy/meds), Rehabilitation and social reintegration, Peer support and group therapy, Continuity of care, Family education and relapse prevention

tertiary prevention

Avoid harm from unnecessary treatment, Prevent overdiagnosis/overtreatment, Respect patient autonomy and rights, Use trauma-informed, culturally sensitive care, Monitor medication side effects, Support mental health of healthcare workers

quaternary prevention

s/s: intrusion, negative mood, dissociation, avoidance, arousal, 3 days-1 mo post trauma

acute stress disorder