Responding to Traumatic Events

1. Responding to Traumatic Events 66thSOUTHEASTERN STATES PUPIL TRANSPORTATION CONFERENCE (SESPTC) Greg Akin Chief Operations Officer Volusia County Schools

2. Understanding Trauma • Definitions: • Trauma: Extraordinary events that overwhelm the human adaptations to life. • Traumatic events are not necessarily traumatizing to all who are exposed to the event. • Individual Trauma: Sudden blow to the psyche that forcefully breaks through defenses causing an ineffective response. • Collective Trauma: Blow to the tissues of social life that damages the bonds attaching people together.

3. Understanding Trauma cont’d. • Definitions: • Disaster: Sudden distressing event; catastrophe, tragedy, community crisis. • Community: A group of individuals who are interconnected through emotional, intellectual, or physical bonds. • Natural Communities: Bound together through time by common attributes. • Transitory Communities: Bound together at one point in time by a highly charged emotional event.

4. Your Day to Day Life • Individuals exist in a normal state of “equilibrium,” or balance. • That emotional balance involves everyday stress, both positive and negative. • Occasionally, stress will be severe enough to move an individual out of the state of equilibrium, and into a state of depression or anxiety, as examples. • But most people most of the time stay in a familiar range of equilibrium.

5. When Trauma Occurs • Trauma throws people so far out of their range of equilibrium that it is difficult for them to restore a sense of balance in life. • Trauma may be precipitated by stress: “acute" or “chronic.” 1. Acute stress is usually caused by a sudden, arbitrary, often random event. 2. Chronic stress is one that occurs over and over again- each time pushing the individual toward the edge of his state of equilibrium, or beyond

6. Pre-Trauma Equilibrium • Question the “equilibrium” of the community directly impacted by the event. • Equilibrium of individuals directly impacted • Equilibrium of other community groups • Assess the nature of coping strategies • Response should be trauma-specific • Exceptions: recent previous trauma or repeated trauma

7. The Trauma ResponseManifestations of Crisis Reactions • The Crisis Reaction: Physical Response 1. Physical shock, disorientation, numbness (frozen fright) 2. Fight or Flight • Adrenaline pumps through body • Body may relieve itself of excess materials • Heart rate increases • Body begins to hyperventilate or sweat • Body increases its attention to sensory perception (may focus on only one sense) 3. Exhaustion

8. The Trauma ResponseManifestations of Crisis Reaction • The Crisis Reaction: Emotional Response 1. Initial reaction of shock, denial and disbelief 2. Cataclysm of emotions • Fear and terror • Anger, fury, and outrage • Confusion and frustration • Guilt or self-blame • Shame or humiliation • Grief or sorrow 3. Reconstruction of equilibrium

9. Dimensions of Catastrophe • Duration of the event:(the longer any of the following periods last, the greater the intensity of the experience of crisis) • Duration of immediate life-threatening event; • Duration of on-going survival concerns; • Duration of sensorial involvement; • Duration of community preoccupation.

10. Proximity Effects on the Emotional Aftershocks of Disaster Eyewitnesses And rescuers The Victims: the dead, the injured, And their loved ones Converging rescuers Immediate neighbors Community-at-large and former Disaster victims

11. Role Dimensions • Role Classification • Primary victims • Secondary Victims • Tertiary Victims • Subjective Roles • Individual experience/trauma perception • Loss by Association

12. Role Dimensions • Primary Victims – directly exposed • Secondary Victims – close family and personal ties – The Parents! • Tertiary – Immediate Responders: • Teachers • Administrative Staff • School Receptionists • Guidance Counselors • School Social Workers and Psychologists • SRO’s • Paramedics and Ambulance Personnel • Transportation staff

13. Role Dimensions Continued • Law Enforcement • Firefighters • Hospital Personnel • Victim Service Professionals • Mental Health Professionals • Crisis Interveners • Community Witnesses • Survivors of other similar events • Bus Operator • Bus attendant • Dispatch

14. Hierarchy of Elements of Traumatic Experience High Exposure • Survival by freak accident • Threat to life • Risk of injury • Dissociation • Absence of control • Safe by chance: guilt • Seeing death • Actual injury • Witnessing injury • Actions during event • Duration of exposure • Awareness of destruction and loss Low Exposure

15. Issues to Consider • Crisis in a school or on a bus • Multiple impacted locations • Role Dimensions • School goes into lockdown or bus accident • Duration Issues • Where are the parents • Pre-trauma equilibrium • For school and entire community including school district • Future community impact

16. Elements of Intervention • Safety is an issue for victims who survive. Until it is addressed, other issues or concerns will seem unimportant. • Safety for victim-survivors involves: • Addressing physical safety or medical needs. • Addressing survival needs such as shelter, food, clothing or the need for warmth and sleep. • Providing information and a source of communication.

17. Elements of Intervention cont’d. • To promote security a caregiver needs to: • Help survivors find privacy for the expression of emotions. • Reassure survivors that their reactions are acceptable and not uncommon. • Help survivors begin to take control of the events going on around them. • Help the survivor feel they are being “cared for” – that sense of emotional safety.

18. Elements of Intervention cont’d. • Ventilation refers to the process of allowing the victims/survivors to “tell their story.” • Survivors often need to tell the story of the disaster over and over again. • Each time the story is told it may take a different form. • Occasionally the differences will be due to memory problems. • Sometimes the differences will reflect what is important to the survivors at a particular time in the aftermath. • Defusing – within hours of the incident • Debriefings – 24 to 72 hours after the incident • Crisis management Briefings – Groups need facts due to rumors or traumatized from other participants ventilation of gory details

19. Elements of Intervention cont’d. • Techniques: • Be a compassionate presence. • Monitor your speaking style. • Use effective words and questions. • Use effective listening skills.

20. Listening Skills: Ineffective Listening Styles • Assumptions • Boredom • [Lack of] Concentration • Disagreement • Ego-involvement • Failure to understand • Generalizations • Hearing only what you want to hear • Interruptions • Judgments • Kindness that kills • Listening to words only

21. Listening Skills – Effective Listening Styles • Ask questions only to facilitate flow • Believe what is stated is valid • Clarify confusions • Discern unspoken messages • Echo significant words or phrases • Find words and phrases for response • Give information • Help develop context and chronology • Instill quiet • Journey through narratives • Keep judgments to yourself • Listen for summaries and narratives

22. Elements of Intervention cont’d. • Hints for Helping • Open discussions with words such as “I am sorry this has happened” • Use the term “reactions” rather than “feelings” • Let survivors talk for as long as they want, but when there is a pause, validate what was talked about • Prepare for and predict the practical issues that will face survivors in the aftermath of the tragedy. One of the most important concerns of survivors is “what is going to happen next?”

23. Elements of Intervention cont’d. • In addition to preparing and predicting what might happen in the aftermath of a disaster, it is helpful for caregivers to assist survivors to prepare and plan for up-coming events. • Encourage survivors to talk or write about the event. • Suggest that survivors establish a daily routine that they can easily follow. • Help survivors plan time for memories and memorials. • Promoting healthy eating, sleeping and exercise habits can increase the ability to cope.

24. Services to Communities • Crisis Intervention to all impacted populations • Establish a Family Assistance Center • Counseling • Financial Support • Death Certificates • Process for incoming families • Media Center • Establish a hotline/emergency number/website • Memorial Services • Review community crisis plan • Outreach to additional response organizations

25. Coordinating the Event • Whether small scale or large scale: • Guidance Counselors, School Social Workers and Psychologists will be the “anchors” and act as coordination liaisons. • Follow school district protocol for accessing Regional or District School Crisis Response Teams. • Determine if additional resources may be needed. • Response may last one day or several weeks.

26. Closing Thoughts • Remember, not everyone exposed to a traumatic event is traumatized … BUT… everyone has a story! • Think outside the box when identifying high risk populations. • Everyone grieves in their own way and in their own time.

28. Questions????