Responding to critical incidents in schools evidence

Cheshire County Council, 1995

Critical Incident defined as:

- Emotionally charged events involving serious injury, death, or serious threat.

- Generates high emotional reactions, often surpassing normal coping abilities.

- Can attract unusual media or community attention.

APA, 1993

PTSD vs Normal Response

PTSD: If symptoms persist or worsen after ~6 weeks

DSM-IV: re-experiencing, avoidance, arousal

APA, 2013

PTSD vs Normal Response

Adds negative cognition/mood to symptom clusters

APA, 2013

- PTSD in Children

- Above age 6: Same criteria as adults

- Younger children: May show through repetitive play, emotional and behavioural changes, or re-enacting trauma

Joseph, 2011

Some individuals experience growth or positive psychological change after trauma

Janoff-Bulman, 1985

- Life-Belief Model

- CIs challenge core beliefs:

- That life is safe, meaningful

- That people are good

- Leads to existential questioning

McCann & Pearlman, 1990

- Human Needs Model

- CIs disrupt needs: safety, self-esteem, control, relationships

Caplan, 1964

- Crisis Intervention Theory

- Trauma disrupts cognitive-emotional balance

- Reaction progresses through 4 stages:

Impact

Withdrawal/Confusion

Adjustment

Reconstruction

- Need to be helped through these stages so they don’t get stuck

Hindmarch, 2002

- Grief/Bereavement Theory

- Trajectory: Denial (shock, disbelief) → Pain & Distress (anger, guilt) → Realisation (depression, apathy) → Resolution (readiness to engage in new activities and relationships)

Hindmarch, 2002

- Educational Psychologist’s Role in CI Response

Levels of Work:

Community: Preparedness planning, inter-agency liaison

Organisation: Staff training, response planning, media statements

Group: Debriefing, psychoeducation, peer support

Individual: Screening, short-term support, referrals

Mitchell & Everly, 2000

- Critical Incident Management Plan (Community)

- Pre-incident preparedness

- On-scene crisis support

- Defusing & demobilisation

- Critical incident support/psychoeducation

- Family/child support

- Link to longer-term services

Hindmarch, 2002

Organisational Effects of Trauma (organisation):

- Trauma can amplify both positive and negative dynamics:

Reveals the best and worst in people

Can strengthen or expose relationship tensions

- Common responses:

“In-group” vs “out-group” formation

Tension between returning to normal and processing the trauma

- However, shared experience can also lead to greater support-seeking and mutual care.

Hindmarch, 2002

Organisational Response Model to Trauma (organisation):

- A phased model showing how schools and organisations may move through stages in response to trauma:

Pre-trauma context – baseline status before the incident

Crisis – the event itself

Retribalization – emotional realignment; group bonding (or division)

Polarisation – “us vs. them” dynamics may emerge

Depression – emotional exhaustion, withdrawal

Mobilisation – efforts to regain control, plan actions

Breakthrough – new coping strategies, progress begins

Exhaustion or Elation – mixed emotions after coping efforts

Post-trauma context – establishment of a “new normal”

- This model helps understand group-level emotional shifts and organisational recovery trajectories.

Parkinson, 1997

Post-Incident Group Supports (group):

Debriefing

Brymer et al., 2006

Post-Incident Group Supports (group):

Psychological First Aid (PFA)

Dorsey et al., 2017

Post-Incident Group Supports (group):

Group-based Trauma-Focused CBT

Mitchell, 1983

Critical Incident Stress Debriefing (CISD)

Mitchell & Everly, 1996

Critical Incident Debriefing:

A structured group process: Introduction → Facts → Thoughts → Emotions → Symptoms → Teaching → Re-entry

Stallard & Law, 1993

- positive evidence for CISD

- reduces intrusive thoughts

Van Emmerick et al., 2002

- negative evidence for CISD

- Studies found it not effective for PTSD prevention

Bisson et al., 2009

- negative evidence for CISD

- approach doesn't differentiate responses for individuals

BPS, 2002; Cochrane Collaboration, 2004

- negative evidence for CISD

- systematic reviews say evidence is inconclusive and its potentially even harmful for primary victims

WHO, 2010

- Psychological First Aid (PFA) (group)

- “Non-intrusive, supportive, practical assistance”

Brymer et al., 2006

- Psychological First Aid (PFA) (group)

8 Core Components:

Contact & engagement

Safety & comfort

Stabilisation

Information gathering: current needs and concerns

Practical help

Connection with social support

Coping info

Link to services

Aucott & Soni, 2016

- evidence about PFA

- Considered "evidence-consistent", not fully evidence-based

Fox et al., 2012

- positive evidence for PFA

- considered an appropriate response to a CI

Dorsey et al., 2017

- negative evidence for PFA

- other approaches are needed to address PTSD, e.g TF-CBT

NICE, 2005

- Recommended Individual Interventions:

- Watchful waiting

- Psychological First Aid

- Eye Movement Desensitisation Reprocessing (EMDR):

Person recalls an important aspect of a traumatic event

Whilst following repetitive side to side movements, sounds or taps as the traumatic image is remembered and focused on

- Trauma-Focused CBT (TF-CBT):

Help confront traumatic memories

Modify misinterpretations of threat

Develop skills to cope with stress.

NICE, 2018

- Trauma-Focused CBT (TF-CBT):

Ages 7–17: individual or group, depending on shared experience

Meichenbaum, 1994

- Trauma-Focused CBT:

Build rapport, share story

Make sense of the story

Cognitive restructuring

Restore relationships and confidence

Develop strategies to prevent relapse