Critical Incidents Flashcards
(20 cards)
What is a critical incident?
An incident charged with profound emotion which may involve serious injury or death
Incident generating a high level of immediate or delayed emotional reaction
Incident involving serious threat or extremely unusual circumstances
Incident attracting unusual attention from the community or media
Surpassing an individual, group or organisation’s normal coping mechanisms
(Cheshire County Council, 1995)
Post trauma stress symptoms and quotes
- Flashbacks and intrusive memories
- Headaches
- Difficulty concentrating
- Feeling guilty typically ‘it was my fault’
- Feeling detached from others
- “a normal reaction of normal people to events which, for them, are unusual or abnormal” (Parkinson, 1993)
- Becomes a problem when persistent or more than weeks and disrupts normal living (DSM IV APA 1993)
- ‘ The vast majority of people exposed to serious traumatic events do not develop PTSD’ (McNally, 2003)
- And some people ultimately learn and grow from their experience (Joseph, 2011). i.e. they experience some Post-Trauma Growth (PTG)
post trauma stress for children below 6
o Re-enacting events
o Emotional and/or behavioural difficulties
Theoretical frameworks underpinning support
Life-Belief Model (Janoff-Bulman)
Crisis Intervention Theory (Caplan, 1964)
Human Needs model (McCann & Pearlman, 1990)
Life-Belief Model
- Critical incidents challenge individuals fundamental beliefs about invulnerability and meaning in life
- This prompts them to search for meaning and growth
- i.e why me? Type questions
Human Needs model (McCann & Pearlman 1990)
- CIs disrupt persons core beliefs about safety, trust and self esteem requiring tailored interventions to rebuild these constructs
- Challenge peoples ability to protect or fulfil their needs
Crisis Intervention Theory (Caplan, 1964)
- CI causes an imbalance between cognitive and emotional states which leads to an ‘emotional crisis’
- Reaction across CI consisting of
o Impact
o Withdrawal and confusion
o Adjustment
o Reconstruction - They need to be supported or work through this process to not get stuck in it
Levels of support required (Hindmarch, 2002)
- Level 1
o Someone there
First hours - Level 2
o A listening ear
First days - Level 3
o Structured (group) support
First weeks - Level 4
o Specialist Therapy or Counselling
First months
Organisational and community support LEVEL 1 AND 2
- Pre incident preparedness
o EPs support schools in developing critical incident management plans, including training staff and conducting simulation exercises (Yule & Gold, 1989; Pousada, 2006)
o Plans should ensure a coordinated psychosocial response, integrating mental health support (NICE, 2005)
o Components of CI management plan
Pre-incident education and mental preparedness.
On scene crisis intervention support
Demobilization and Defusing.
Critical Incident Support/Psychoeducation
Support for Families and Children
Follow up and link to appropriate support services
(adapted from Mitchell & Everly, 2000)
Group level support level 3
Psychological First Aid
Critical Incident debriefing
Group Trauma focused - CBT
Psychological First Aid
- Aim to
o Create calm conditions
o Reduce initial distress
o Promote functioning and coping - Brymer et al. (2006): Described as a non-intrusive approach to stabilize individuals and promote coping.
- Dieltjens et al. (2014): Reviewed 44 studies, noting alignment with psychological theory but insufficient empirical validation.
- Fox et al. (2012): PFA’s adaptability to group needs makes it a practical response in schools.
- Aucott & Soni (2016): Classified PFA as “evidence-consistent” rather than “evidence-based,” despite its logical alignment with trauma theory.
- 8 core components
o 1. Contact and Engagement
o 2. Safety and Comfort
o 3. Stabilization (if needed)
o 4. Information Gathering: Current needs and concerns
o 5. Practical Assistance
o 6. Connection with Social Supports
o 7. Information on Coping
o 8. Linkage with Collaborative Services
Critical incident debriefing
- To create a shared narrative
- To help integrate cognitive and emotional memory
- To connect past, present & future
- To provide psycho-education
- To support normalisation
- (Mitchell and Everly, 1996; Dyregrov, 1998)
- Systematic Reviews of CISD suggest the evidence for its use is at best inconclusive, and some argue potentially harmful for individual primary victims (BPS, 2002, Cochrane Collaboration, 2004; Bisson et al 2009)
- It is therefore currently not recommended as a method of treating or preventing PTSD (NICE, 2018)
Group Trauma Focused - CBT
- Dorsey et al. (2017): Found emerging evidence supporting group TF-CBT for collective trauma experiences.
- Jaycox et al. (2010): Demonstrated its effectiveness in reducing PTSD symptoms among children exposed to violence.
Individual Level Interventions Level 4
Eye movement desensitisation and reprocessing (EMDR)
Trauma-focused CBT
Eye movement desensitisation and reprocessing (EMDR)
- Person recalls important aspect of traumatic event
- Whilst following repetitive side to side movements, sounds or taps as the traumatic image is remembered and focused on
- Watts et al. (2013): Found EMDR as effective as TF-CBT for adults, though evidence for children is limited.
- NICE Guidelines (2018): Acknowledge its potential for adults but highlight insufficient pediatric research.
Trauma-focused CBT
- Help confront traumatic memories
- Modify misinterpretations of threat
- Develop skills to cope with stress
- Wolpert et al. (2006): Identified as the intervention of choice for children aged 10+ to address trauma symptoms.
- Cary & McMillen (2012): Meta-analysis found TF-CBT significantly more effective than non-directive supportive therapies in reducing PTSD symptoms.
- NICE Guidelines (2018): Recommend TF-CBT as the first-line treatment for children aged 7-17 after trauma exposure.
Role of EPs
- Prevention: Training staff and simulating responses to prepare for potential incidents.
- Immediate Response: Coordinating psychological first aid and stabilizing affected groups.
- Medium- to Long-Term Support: Monitoring at-risk individuals and providing evidence-based interventions, such as TF-CBT.
Dorsey et al (2017) crit ev
Strengths:
Demonstrates potential for efficiently addressing collective trauma, which is critical in school settings.
Highlights peer support as a mechanism for reducing feelings of isolation.
Limitations:
Evidence base is still emerging, with few high-quality RCTs.
Risks of retraumatization in group settings, particularly for more vulnerable participants.
Conclusion: Promising for shared trauma but requires careful facilitation and further validation.
Brymer et al 2006 crit ev
Strengths:
Practical and scalable, making it well-suited for widespread incidents in schools.
Emphasizes reducing distress and promoting safety without forcing disclosure.
Limitations:
Described as “evidence-informed” rather than “evidence-based,” as high-quality RCTs supporting its long-term efficacy are lacking.
Outcomes are often measured through anecdotal reports and expert opinion, limiting generalizability.
Conclusion: A useful immediate intervention, but further empirical validation is necessary.
Cary & McMillen (2012) crit ev
Strengths:
High-quality meta-analysis, synthesizing data from multiple RCTs.
Strong evidence for TF-CBT’s efficacy in treating trauma-related symptoms.
Limitations:
Limited focus on younger children or those experiencing complex trauma.
Cultural representation within the analyzed studies was narrow, raising concerns about applicability to diverse populations.
Conclusion: Provides robust support for TF-CBT but highlights the need for expanded demographic representation.
