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CRITICAL INCIDENT STRESS DEBRIEFING FOR SCHOOL EMPLOYEES

by

NANCY BLACKWELDER

May1995

Major Professor: Donald Orlosky, Ed. D.

Nancy L. Blackwelder 1995

All Rights Reserved




TABLE OF CONTENTS

(Page numbers in the Table of Contents reflect original document)

LIST OF TABLES vii

LIST OF ABBREVIATIONS AND ACRONYMS x

ABSTRACT xi

CHAPTER 1. INTRODUCTION


Problem and Its Significance 1

The Problem 1

Significance of the Problem 2

Purpose of the Study 3

Study Questions 4

Definition of Terms 4

Assumptions 6

Study Format 6

CHAPTER 2. REVIEW OF THE LITERATURE

School Violence 9

Changes in Crime Rate 9 Possible Causal Factors 12

School Responses 13

Summary 19

Crisis Intervention 21

Historical Perspective to Crisis Responses 21

Definitions of Crisis 23

Stages of Grief Response 25

Psychological Responses to Critical

Incident Stress 28

Physiological Responses to Critical

Incident Stress 29

Somatic Responses to Critical

Incident Stress 30

Susceptibility to Critical Incident Stress 32

Posttraumatic Stress Disorder 35

Coping Strategies 37

i

Historical Perspective of Short -Term


Crisis Intervention 38

Short -Term Intervention Strategies 42

Components of Crisis Intervention Strategies 44

Establishing School Crisis Intervention Teams 49

Training for Crisis Intervention Teams 51

Limitations of Crisis Intervention Teams 54

Summary 57

CHAPTER 3. METHODOLOGY


Introduction 59

Assumptions 61

Population 62

Study Design 62

Instrumentation 64

Procedures 69

Data Analysis 70

Limitations 70

CHAPTER 4. RESULTS

Introduction 72

Data Sources 72

Surveys Mailed and Received 72

Survey Response Rates 74

Interviews Conducted 75

Documents Examined 75

Staff Respondent Demographic Data 76

Crisis Team Respondent Demographic Data 77

Incidents and Interventions 84

District 1 Critique of the Incident 84

District 1 Interventions and Crisis plan 84

District 1 Staff Survey Results 88

District 1 Crisis Team Survey Results 92

District 1 Interview Summary 97

District 2 Interventions and Crisis Plan 99

District 2 Staff Survey Results 101

District 2 Crisis Team Survey Results 104

District 2 Interview Summary 107

District 3 Critique of the Incident 110

District 3 Interventions and Crisis Plan 111

District 3 Staff Survey Results 114

District 3 Crisis Team Survey Results 116

District 3 Interview Summary 118

Comparison Across Districts of Intervention

Delivered 120

Interventions Delivered and Received in Each

District 122

Comparison Across Districts of Crisis Team

and Staff Perceptions of Services Received

and Delivered 128

Crisis Team 128

Staff 129

Who Staff Chose to Consult About Reactions

to the Incident 131

District 1, 2, and 3 Staff Symptoms Summary 132

Proximity to the Incident 145

Comparison with EMS Agency Procedures 148

Perceived Effectiveness 151

Summary of the Strengths, Weaknesses, and Perceptions of CI Effectiveness From Staff

Respondents Across Districts 151

Summary of Strengths, Weaknesses, and Perceptions of Crisis Intervention Effectiveness

from Crisis Team Members Across Districts 155

CHAPTER 5. CONCLUSIONS AND RECOMMENDATIONS

Summary 159

The Problem 159

The Significance of the Problem 160

The Purpose of the Study 161

Study Questions 161

Assumptions 162

Results 162

Conclusion 163

Implications 167

Policy Recommendations 168

Pre-Incident Education 169

CISD Team for Employees 170

On-Scene Support Services 171

CISD Defusings 172

CISD Debriefings 173

Follow-up Services 177

Spouse Debriefings 179

Crisis Intervention Training for School

Employees 179

Community Outreach Programs 181

Other Considerations 183

Recommendations for Further Study 184

BIBLIOGRAPHY 186

APPENDICES 195

APPENDIX A. CISD OF FLORIDA STATE PROTOCOLS AND PROCEDURES MANUAL 196

APPENDIX B. CIS INFORMATION SHEET 214

APPENDIX C. INTERVIEW QUESTIONNAIRE 217

APPENDIX D. QUESTIONNAIRE FOR CRISIS TEAM MEMBERS 218

APPENDIX E. QUESTIONNAIRE FOR SCHOOL STAFF MEMBERS 222

APPENDIX F. LETTERS OF TRANSMITTAL 227

APPENDIX G. CRITIQUE OF DISTRICT 1 INCIDENT 231

DISTRICT 1 RECOVERY ACTIVITIES 237

APPENDIX H. CRITIQUE OF DISTRICT 3 INCIDENT 239

APPENDIX I. WRITTEN COMMENTS FROM STAFF SURVEYS 243

APPENDIX J. WRITTEN COMMENTS FROM CRISIS TEAM

SURVEYS 265

APPENDIX K. PERSONAL INTERVIEWS 280

APPENDIX L. DISTRICT 1 CRISIS PLAN 310

HANDLING CAMPUS EMERGENCIES 338

STRESS AND TRAUMA 347

VICTIM'S RIGHTS WITH THE MEDIA 352

SUGGESTED GUIDELINES FOR FIREARMS

ON CAMPUS 353

GUIDELINES FOR BUS DRIVERS--STUDENT FIGHTS AND WEAPONS 355

APPENDIX M. DISTRICT 2 CRISIS PLAN 359

APPENDIX N. DISTRICT 3 CRISIS PLAN 397

LIST OF TABLES

(Some graphs available in original document)

Table 1. Factors Possibly Associated With School Violence 12
Table 2. Attempted Solutions to School Violence and Vandalism 17
Table 3. Stages of Grief 26
Table 4. Short-Term Effects of Crisis 30
Table 5. Diagnostic Criteria for Posttraumatic Stress Disorder 36
Table 6. Determining Expected Degree of Trauma 48
Table 7. Essential Concepts in the Training of Crisis Workers 53
Table 8. Staff Surveys Sent and Returned 73
Table 9. Crisis Team Surveys Sent and Returned 73
Table 10. Percentage of Staff and Crisis Team Responses to the

Surveys for Districts 1, 2, 3, and the Pilot Study 74


Table 11. Percentage of Male and Female Staff Respondents 75
Table 12. Percentage of Staff Respondents' Occupations 76
Table 13. Percentage of Staff Respondents' Educational Level 77
Table 14. Percentage of Crisis Team Respondents' Occupations 78
Table 15. Percentage of Crisis Team Respondents' Educational Level 78
Table 16. Percentage of Crisis Team Respondents' Crisis Intervention Training 79
Table 17. Percentage of Crisis Team Respondents' Continuing

Education in Critical Incident Intervention Training 81

Table 18. Percentage of Crisis Team Respondents' On-the-Job

Experiences Performing Critical Incident Intervention 82

Table 19. Percentage of Crisis Team Respondents' Experience

Conducting a Formal Critical Incident Debriefing Session 83


Table 20. Percentage of Crisis Team Respondents who Delivered

One-on-One Counseling at Various Time Intervals 123


Table 21. Percentage of Staff Respondents who Received

One-on-One Counseling at Various Time Intervals 123


Table 22. Percentage of Crisis Team Respondents who Delivered

Small Group Counseling at Various Time Intervals 124


Table 23. Percentage of Staff Respondents who Received

Small Group Counseling at Various Time Intervals 125


Table 24. Percentage of Crisis Team Respondents who Delivered

Large Group Counseling at Various Time Intervals 125


Table 25. Percentage of Staff Respondents who Received

Large Group Counseling at Various Time Intervals 126


Table 26. Percentage of Crisis Team Respondents who Distributed

CIS Information, Mental Health Agency, or Other Handouts 129


Table 27. Percentage of Staff Respondents who Received CIS

Information, Mental Health Agency, or Other Handouts 130

Table 28. Percentage of Staff Respondents who Consulted with

Various Individuals About Reactions to the Incident 131

Table 29. Percentage of District 1 Staff Respondents Experiencing

Delayed Symptoms in Descending Order of Frequency 133


Table 30. Percentage of District 2 Staff Respondents Experiencing

Delayed Symptoms in Descending Order of Frequency 135


Table 31. Percentage of District 3 Staff Respondents Experiencing

Delayed Symptoms in Descending Order of Frequency 137

Table 32. Percentage of Staff Respondents Experiencing Zero, 1-3,

or 4 or more Symptoms in the During Phase 140


Table 33. Analysis of Variance on the Average Number of Symptoms

Experienced During Each Phase Ho: M1=M2=M3 141


Table 34. Percentage of Staff Respondents Experiencing Zero, 1-3,

or 4 or more Symptoms in the After Phase 143


Table 35. Percentage of Staff Respondents Experiencing Zero, 1-3,

or 4 or more Symptoms in the Delayed Phase 144


Table 36. Analysis of Variance Between Phases and Proximity

to the Incident Ho: M1=M2=M3=M4 147


Table 37. Comparison Between CISM model and District Interventions 148
Table 38. Percentage of Staff Respondents Answering "Yes" to

Questions 7-10 151

Table 39. Percentage of Staff Respondents Answering "Yes" to

Questions 12-14 and 16 153

Table 40. Percentage of Staff Respondents Answering "Yes" to

Questions 15 and 17 154


Table 41. Percentage of Staff Respondents Answering "Yes" to

Question 18 155


Table 42. Percentage of Crisis Team Respondents Answering "Yes"

to Questions 8-12 and 17 155


Table 43. Percentage of Crisis Team Respondents Answering "Yes"

to Questions 13-16 157


Table 44. Comparison Between Staff and Crisis Team Respondents 163

of Perceived Effectiveness


LIST OF ABBREVIATIONS AND ACRONYMS

CI Crisis Intervention


CIS Critical Incident Stress
CISD Critical Incident Stress Debriefing
CISM Critical Incident Stress Management
CIT Crisis Intervention Team
CT Crisis Team
EMS Emergency Medical Services
ERIC Education Resource Information Center
FDLE Florida Department of Law Enforcement
HMO Health Management Organization
PE Physical Education
PsycLit Psychology Literature
PTA Parent Teacher Association
PTSD Posttraumatic Stress Disorder
SAC School Advisory Committee
SRO School Resource Officer

Abstract

School employees can incur debilitating emotional damage from trauma associated with school violence. "The trauma to the victims of violent crime often invokes an emotional response in excess of grief and closely resembling Posttraumatic Stress Disorder (Bixler, 1985, p. 3)." The stress is exacerbated by the necessity of the victims to return to the scene of the crime each day and the tendency to deny themselves the natural human responses to stress in an effort to care for the children.

Emergency service professionals have incorporated Critical Incident Stress Management (CISM) programs and indicate worker burnout and workman's compensation claims decreased as a direct result.

The purpose of this investigation was to describe, compare, contrast, and evaluate crisis intervention procedures provided for employees of three school districts where a critical incident occurred.

A case study design included participant interviews, questionnaires and an analysis of public documents. Each district's crisis intervention plan is described, compared to emergency service CISM programs, and evaluated in terms of perceptions of the effectiveness of care provided.

This study addressed the following questions:

1. What was the nature of the crisis intervention for staff?

2. How did the provisions for employee crisis intervention compare and contrast with those provided by emergency service agencies?

3. What was the perceived effectiveness in caring for the emotional and psychological needs of the staff involved in the crisis and what component (s) of the plan contributed to that perception?

Results indicated that employees were greatly affected, exhibiting symptoms of critical incident stress and posttraumatic stress months and years post-incident. There was a significant difference in the average number of symptoms respondents experienced according to their proximity to the incident and there was a significant difference in the average number of symptoms experienced according to the nature of the incident. There were services provided to staff members that were perceived as effective and largely an absence of services that contributed to a perception of ineffectiveness.

It was recommended that school districts develop a Critical Incident Stress Management program for employees.

Abstract Approved:_________________________________________________

Major Professor: Donald Orlosky, Ed.D.

Department of Educational Leadership
Date Approved:________________________


CHAPTER 1.
INTRODUCTION
Problem and Its Significance

The Problem

Various types of crises have an impact on the function of the school; such as, social events and issues, economic changes, natural disasters, environmental crises, medical crises and deaths. Some crises or critical incidents are so traumatic they alter the consciousness of a school and community for many years.

The issue of school violence is not new, but the more recent phenomenon of firearms at school has increased confiscations, subsequent expulsions, serious injuries, and deaths. Relatively few homicides have occurred on campus in past history; however, statistics may change with the increased occurrence of violent crime in the community and subsequent increases in the schools.

When a major crisis occurs at school the staff is expected to take action immediately and to regain control of the situation. Children's needs are the primary concern as schools stand "en loco parentis". No matter how traumatic the situation, the children come first, a natural reaction for most due to the protective, nurturing nature of their profession. No matter how rattled, emotionally distraught, or frightened, educators are placed in the position to suppress and defer their natural responses in an effort to care for the children first. For days after a tragedy, they may be expected to console grieving, frightened children as they themselves grieve and inspect their own mortality. It is intense and exhausting. So who helps the helper?


Significance of the Problem
The premise of this study is that school employees can incur debilitating emotional damage from trauma associated with school violence. "Research on bereavement suggests that homicide bereavement is more severe than bereavement for suicide, natural death, or accidental death. The trauma to the victims of violent crime often invokes an emotional response in excess of grief and closely resembling Posttraumatic Stress Disorder (Bixler, 1985, p. 3)." The stress is exacerbated by the necessity of the victims to return to the scene of the crime every day and the tendency to deny or to steel themselves against the natural human responses to stress in an effort to care for the children. Since the teachers must be the primary care-giver for the children, it seems reasonable the school district should take responsibility for looking after the needs of its employees, in as proactive a fashion as it cares for the children.

Emergency service professionals have recognized the need for employee assistance and have incorporated effectively short-term crisis intervention strategies as a routinized protocol. The literature indicates that worker burnout and workman's compensation claims decrease as a direct result of this proactive initiative.

The crisis team members require extensive training and practical experience in defusing and debriefing strategies, as well as periodical continuing education sessions.

It is the contention of this researcher that schools can benefit from the research conducted in the emergency service field and can institute more aggressive employee assistance programs to deal with the ever increasing possibility of traumatic incidents in the schools.

A comprehensive crisis plan would need to address guidelines for handling weapons in school, plans to handle the inevitable media blitz, and victim assistance or crisis intervention plans for children, staff, and family during the incident, immediately after, and months post-incident, to facilitate the recovery of the school and community.

Purpose of the Study
The purpose of this study was to describe, compare, contrast, and evaluate crisis intervention procedures provided for school-based employees of three school districts in Florida, in which a critical incident occurred.

For the purpose of this study, a critical incident was defined as a line of duty death or serious injury, mass casualty or multiple serious injury, homicide or suicide. Crisis intervention refers to the methodology or procedural protocol implemented to restore normal job and personal functioning to individuals who have experienced a critical incident.

The researcher described each district's crisis intervention policy and procedural protocol, compared those policies and protocols to the crisis intervention of emergency service agencies and evaluated the perceived effectiveness of intervention provided.

Study Questions
This study addressed the following questions:
1. What was the nature of the crisis intervention procedures for staff members in the three school districts?
2. How did the provisions for employee crisis intervention compare and contrast with those provided by emergency service agencies which routinely face critical incidents?
3. What was the perceived effectiveness in caring for the emotional and psychological needs of the adults involved in the crisis and what component (s) of the policy or protocol contributed to that perception?

Definition of Terms
The following definitions are stipulative in nature and represent operational meanings for the purpose of this study.

1. Anxiety. a safety valve that helps us recognize and avoid danger. It increases our reflexive responses and sharpens our awareness of events around us. Excessive anxiety is a state of distress, trepidation, worry, apprehension or dread. Intense fear or dread lacking an unambiguous cause or a specific threat. (APA, 1988a, p. 1)

2. Critical incident. a line of duty death or serious injury, mass casualty or multiple serious injury, homicide or suicide. More generally it is any incident that causes personnel to experience unusually strong emotional reactions which have the potential to interfere with their ability to function. (Mitchell, 1988b, p. 47)
3. Critical Incident Stress Debriefing (CISD). an organized approach to the management of stress responses in or as a result of an emergency situation.
4. Critical Incident Stress Syndrome. a characteristic set of psychological and physiological symptoms related to experiencing a major disaster that causes people to experience unusually strong emotional reactions which have the potential to interfere with their ability to function either at the scene or later. (Mitchell, 1988a, p. 43)
5. Crisis Intervention. a methodology or procedural protocol implemented to restore normal job and personal functioning to individuals who have experienced a critical incident. (Mitchell, 1988b, p. 48)

6. Denial. a refusal to grant the truth of a situation. Difficulty accepting a suddenly changed reality that is too overwhelming to manage at the time. (Morris, 1970, p. 352)


7. Depression. a transient normal emotion of sadness or mood swings.

Serious depression. is an emotional problem characterized by persistent or severe feelings of worthlessness, hopelessness, sleeplessness, loss of self-esteem, loss of joy, social withdrawal, apathy, sudden outbursts of anger, loss of sexual desire and fatigue. Excessive sleep is commonly used as an escape mechanism as well as thoughts of suicide. (APA, 1988b, p. 1)

8. Hyperalertness. an exaggerated state of an alertness to one's environment or surroundings; excessive alertness and highly sharpened startle reaction. (Morris, 1970, p.31 & 647)

9. Hypervigilant. an exaggerated state of watchfulness which can result in sleeplessness. Ever watchful and alert. (Morris, 1970, p. 647 & 1429)
10. Intrusive Images. images and/or thoughts that plague ones consciousness.
11. Panic Attack. a category of anxiety that is unpredictable and creates a sudden, intense apprehension, fear or terror, and can cause heart palpitation, chest pain, choking or smothering sensations, dizziness, hot and cold flashes, trembling and faintness. (Upjohn, 1992,p. 2)
12. Posttraumatic Stress Disorder (PTSD). is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity, or witnessing an event that involves death, injury, or a threat to the physical integrity of another person: or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate. (APA, 1994, p. 424)
13. Psychic numbing or emotional anesthesia. a diminished responsiveness to the external world. (APA, 1988f, p. 1)
14. Somatic responses. a physical reaction to a physical or psychological stimulus affecting the body. Symptoms that show up as changes in bodily functions. (Everly, 1989, p. 153)
15. Stress. a physiological reaction, or response regardless of the source of the reaction. (Everly, 1989, p. 6)

16. Stressor. stimuli that alters the normal anatomical or physiological integrity of the individual to engender the stress response. (Everly, 1989, p. 7)

17. Stress response. the activation of psycholendocriological mechanisms. (Everly, 1989, p. 7)
18. Stress reactions. physical, cognitive, emotional or behavioral responses to stress. (see Appendix B for lists of reactions)
Assumptions
There are several assumptions the researcher has made in the design of this study:
1. Although people have been traumatized and a period of time has passed since the incident occurred, they will remember enough information about the incident to make the results valid.
2. The instruments developed will gather dependable data.
3. The Emergency Service Protocol and Procedures manual is a legitimate source of best practice in short-term intervention and is transferable to the school environment.
4. Although the researcher was a victim of violent crime at a school site, unbiased evaluation of data is possible.
5. People will respond honestly to the questionnaires.
Study Format
This dissertation was written in a five chapter format with the following organizational structure:

I. Chapter 1-- includes the problem and its significance, the purpose, the research questions, definition of terms, and the study format.

II. Chapter 2-- presents a review of the literature concerning issues related to school violence citing three strains of thought on the topic, to include changes in the rate of violent crime in schools, causal factors and school responses. A second section provides a review of the literature addressing critical incident stress, post-traumatic stress disorder, grief counseling and crisis intervention methods. It provides a model for critical incident stress debriefing, to include crisis team structure and training and a detailed description of a research based crisis intervention protocol

III. Chapter 3-- presents the methodology for the naturalistic investigation of this study. The data collection process includes the development of two questionnaires; one for the school employees and the other for the crisis intervention team; a set of interview questions for the personal and telephone interview process; and the examination of primary documents. Procedural safeguards for internal and external validity, reliability and objectivity are discussed, as well as, data analysis and limitations of the study.
IV. Chapter 4-- includes the results of the data collection.

V. Chapter 5-- includes the summary, conclusions, implications, policy recommendations, and recommendations for further study.

Appendices include, the Florida Critical Incident Stress Debriefing Protocol, stages of stress, critiques of the incidents, recovery activities, guidelines for firearms of campus, guidelines for violence/weapons on buses, CISD information sheet, victim's rights with the media, district policies and protocols, recommendations from study groups regarding the recovery process, staff questionnaire, crisis team questionnaire, personal interview questionnaire, letters of transmittal, applications for critical incident stress debriefing teams and other data tables.

In summary, the intent was to describe each district's crisis intervention policy and procedural protocol, to compare those policies and protocols to the crisis intervention of emergency service agencies and to evaluate the perceived effectiveness of intervention provided for school-based employees.

CHAPTER 2.



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