Download Crisis Intervention - Summit Bible College

Healing Word International
AND
Summit Bible College
.
WARNING
THE FOLLOWING MATERIAL MAY INDUCE A
TRIGGERING OF PAST POST TRAUMATIC
MEMORIES IN THE PARTICIPANTS.
LET THE INSTRUCTOR KNOW IMMEDIATELY IF
THIS IS HAPPENING TO YOU SO THAT YOU CAN
RECEIVE IMMEDIATE ASSISTANCE.
THANK YOU.
DR. KERRY L. BULLS
FOUNDER & PRESIDENT
This new model of C.I. S. M. is
called:
“THE CHAPAINCY MODEL.”
It incorporates all of the skills
involved in CISM as presented in
the other models [of which there
are several]-with the spiritual
dynamics of intervention used by
Chaplains world-wide.
IS DESIGNED TO USE
WITH:
THESE TECHNIQUES
ARE EXCLUSIVELY
USED BY CHAPLAINS
MODELS OF STRESS DEBRIEFING
1. CISD
2.CISM [Mitchell]
3. PD
4.Dyregrov
5.GCI
6.NOVA
7. MSD
8.ARC
9.CED
10.Stokes
11.HERD
12.Marshall / Shalov
And now we add # 13
THE CHAPLAINCY
MODEL
The certificate you receive from this
class is proof that you have been
trained in 12 classroom hours of CISM
for Individuals, with an emphasis in
Chaplaincy.
This training is approved by the
Bakersfield City Fire Department and is
acceptable in any setting involving
disaster response requiring Critical
Incident Stress Management.
•You are not a psychiatrist or psychologist.
•You are a Chaplain & a Crisis Interventionist
•Do Not try to play yourself off as a Shrink.
It is against the law.
•Shrinks cannot do your job.
•Shrinks try to “Fix” things, and the scene of
an emergency is not the place for that.
•Some Shrinks are cross trained in both.
•Be who you are and don’t entertain any
thoughts of inferiority about it.
•Being called of God is plenty important.
MAN WAS CREATED IN THE IMAGE OF THE
TRIUNE GOD. SHRINK METHODS ENGAGE
THE MIND. GOD ENGAGES THE SPIRIT.
THEN THE MIND COMES INTO AGREEMENT
WITH THE WORD AS IT IS FED TO THE BORN
AGAIN SPIRIT.
PROCESSING INFORMATION IS GOOD BUT
ALONE IT WILL NOT BRING THE VICTIM OF
POST TRAUMATIC STRESS TO WHOLENESS.
Gen 1:27
So God created
man in His own
image, in the
image of God he
created him; male
and female He
created them.
This is one of the reasons we
ordain
Chaplains to the Chaplaincy.
If you have problems with the
Co-Ed Chaplaincy, the sooner
you sort it out for yourself the
better.
The Women are here to stay.
Ti 1:7
For God has not
given us a spirit of
fear, but of power
and of love and of
a sound mind.
Rom 12:2
Do not be conformed to
this world, but be
transformed by the
renewal of your mind,
that by testing you may
discern what is the will
of God, what is good and
acceptable and perfect.
1Th 5:23
Now may the God of
peace himself sanctify you
completely, and may your
whole spirit and soul and
body be kept blameless at
the coming of our Lord
Jesus Christ.
THE HOLY
OF HOLIES
THE HOLY
THE
OUTER
COURT
COMPARE
THE
TABERNACLE
IN THE
WILDERNESS
TO THE
TRIUNE
HUMAN BEING
WHO IS
CREATED IN
THE IMAGE OF
THE FATHER,
SON & HOLY
SPIRIT
John 15:7
If you abide in me,
and my words abide
in you, ask
whatever you wish,
and it will be done
for you
SECTION ONE
KEY TERMS
AND
CONCEPTS
THE PROBLEM
•Over 80% Americans will be
exposed to a traumatic event
(Breslau) About 9% of those
exposed develop PTSD (40-70%
IN RAPE, TORTURE) (Surgeon
General, 1999)
•Disasters may create significant
impairment in 40-50% of those
exposed (Norris, 2001, SAMHSA)
•About 50% of disaster
workers likely to develop
significant distress (Myers &
Wee, 2005)
•Terrorism likely to adversely
impact majority of
population (IOM, 2003);
Ranges from =
40 - 90% (JHU, 2005)
•PTSD Prevalence: 8690% Iraq War Veterans
•As many as 45% of those
directly exposed to mass
disasters may develop
PTSD or depression
(North, et al., 1999, JAMA)
•PTSD Prevalence: 50-80% of Law
Enforcement Personnel
•PTSD Prevalence: 30 - 60% of
those in Fire Suppression
•PTSD Prevalence: 45-80%
Vietnam Veterans
4. From a Spiritual Perspective
The Chief Terrorist of the Universe is
Satan and his hordes assist him in
terrorizing nations and individuals.
Nothing can resist his attacks except for
the Blood of JESUS and the Word of
God.
Chaplaincy as it relates to terrorism is
that Chaplains who walk and work in
the HOLY SPIRIT terrorize him and
those evil spirits who assist him.
“Those who fail to learn from
history are doomed to repeat
it.”
Sir Winston Churchill
SOME SOCIOLOGISTS TELL
US THAT THE AVERAGE
PERSON WILL FORGET A
TRAGEDY IN 30 DAYS IF THEY
WEREN’T DIRECTLY
AFFECTED BY IT IN SOME
WAY
NOT FOR HATRED’S SAKE DO WE
REMEMBER 9/11, BUT RATHER TO
AVOID REPEATING THE MOST TERRIBLE
DISASTER FOR AMERICANS SINCE
PEARL HARBOR, DECEMBER 7TH, 1941
MORE DEFINITIONS
4. The psychological DISTRESS in
response to critical incidents
such as: emergencies,
disasters, traumatic events,
terrorism, or catastrophes is
called EXPERIENCING A CRISIS.
5. The event is not the crisis.
EXPERIENCING A CRISIS
5. CRISIS INTERVENTION
A
helping process.
Acute intervention designed to
mitigate the crisis the victim is
experiencing.
It is NOT psychotherapy.
CRISIS INTERVENTION
Goals: To PROMOTE
1. Stabilization of the victim
emotionally and mentally
2. Symptom mitigation
3. Return to normal functioning, or
4. Facilitation of access to the help
of a mental health professional
DON’T FORGET…..
•Crisis intervention targets the
RESPONSE, not the EVENT
Thus, crisis intervention and
disaster mental health
rventions must be applied after
of the need.
CRISIS INTERVENTION
Historical roots of current
crisis intervention practices
can be found in military
psychiatry, community mental
alth, and suicide
ention initiatives.
FOOLISHLY WE CALLED WW 1
“THE WAR TO END ALL
WARS.”
Physical treatment of acute war
Neurosis
Sargent, W. British Medical Journal, Nov
14, 1942, pp. 574-576: “Our
been the
mediate first
aid treatment of the acute
neurosis…” (p. 574)
SLA Marshall (Island Victory,
1944) described the manner and
value of group intervention via
historical event reconstruction
Military foundations for crisis
intervention have evolved
since 1919:
Simplicity- No Psycho-Babble
WHAT?????
JA…VELL, FIRST VE
HAF TO CALCULATE
ZA DEPTH OF ZA
FLIBBERDYGIBBIT AND
COMPARE IT TO ZA
CEREBRAL CORTEX OF
ZA MOTHER!!!!!!
RESISTANCE, RESILIENCE,
RECOVERY
Create Resistance, Enhance
Resiliency, Speed Recovery



You must utilize the tools:
Assessment
Intervention
Evaluation
AFTER EACH PHASE
Resistance, Resiliency &
Recovery Explained:
6. Resistance is the ability to
resist the symptoms of PTS
7. Resiliency is the ability to
bounce back from the
symptoms of PTS
8. Recovery is the
restoration of your
faculties to a
new normal
after your bout with PTS
CHAPLAIN’S CRISIS
MANAGEMENT- I
ELEMENTS OF C. I. S. M.
• Pre-incident Education and
PreparationAssessment
• Strategic Planning
• Large Group Crisis Intervention:
• Demobilizations
• (large groups of rescue
recovery)Respite / Rehab Sectors)
• Crisis Management Briefings
• (C. M. B. s)
CORE COMPETENCIES OF
Chaplain’s Crisis Management
CORE COMPETENCIES OF Chaplain’s
Crisis Management
Para-communications:
•Silence and Nonverbal Behavior
•“Mirror” Techniques
•Questions
•Action Directives
JESUS WAS A MASTER
COMMUNICATOR
•HE LISTENED
•HE ASKED QUESTIONS
•HE SAID STIMULATING THINGS
•HE REVEALED TRUTH
•HE SPOKE PLAINLY BUT NOT
WITH CRUELTY
•HE DIDN’T “CODDLE” PEOPLE
BUT LOVED THEM IN REAL WAYS
A CONVERSATION AT A WELL
•Jesus broke traditions of men
in order to speak to the
woman
•Jesus reached out to her and
engaged her in conversation
•He didn’t preach at her
•Chaplains should follow His
example
JESUS WAS MORE OF A CHAPLAIN
THAN HE WAS A PASTOR
•He met people where they were
•He went to them. He didn’t insist
the people come to him.
•He met them at the point of their
greatest need
•He touched them in their spirits,
souls and bodies
•He stepped into their lives and then
stepped out after helping them.
JESUS PRAYED FOR THE SICK
•He had compassion
•He was motivated
•He was equipped
•He was called of God
•He believed in the good will of
His Father to heal men and
women
•He operated in faith, hope & love
•Jesus attended synagogue
regularly but most of the time He
encountered opposition and even
violence.
•The modern day 0rganized, man
made church will not often receive
you if you are an “OUT OF THE
BOX” kind of Minister, i.e. A
CHAPLAIN
Excessive use of silence in
crisis situations can communicate
lack of interest, thus causing an
escalation
.
When a little firmness is
needed
If the victim blurts out that they are
going to go home and commit
suicide or that they are going to go
and murder someone you will need
to explain to them the long term
pain of that.
Explain to them the further damage
they will be creating for their loved
ones if they do so.
Always ask them for their plans.
MIRRORING
PARAPHRASING
SUMMARIZING
ALL WORK WELL
REFLECTING EMOTION
HELPS
“It must have been
horrible. You seem
really angry…..what
happened?
I. COGNITIVE
II. EMOTIONAL
III. BEHAVIORAL
IV. PHYSICAL
V. SPIRITUAL
COGNITIVE (Thinking)DISTRESS
1.
2.
3.
4.
5.
Distortion of the senses
Inability to Concentrate
Difficulty in Decision Making
Guilt (“If I’d only…..”)
Obsession with Event
(fixated)
6. Confusion
7. Inability to Understand
Consequences of Behavior
COGNITIVE (Thinking)
DISTRESS
•Thoughts of Murder and /
or Suicide
•Paranoia (overwhelming
fear)
•Persistent Diminished
Problem-solving
•Dissociation (withdrawal from
everyone)
•Disabling Guilt (Selfcondemnation
•Hallucinations
(Imagination gone wild)
•Delusions (lose touch
with reality)
•Continuing Hopelessness/
Helplessness
PTS VS PTSD
•Post-traumatic stress (PTS)
is a normal survival response;
•Post-traumatic Stress
Disorder (PTSD) is a
ABNORMAL variant of that
normal survival reaction
P. T. S. D.
Traumatic event
B. Intrusive memories
C. Avoidance, numbing, depression
D. Stress arousal
E. Symptoms last > 30 days
F. Impaired functioning
PTSD results from violation
of:
1. EXPECTATIONS
2. DEEPLY HELD BELIEFS
(Worldviews)
CORE BELIEFS
(Worldviews)
Severity of PTSD
•Dissociation=withdrawal from pe0ple
•Psychogenic amnesia=stress induced
•Persistent sleep disturbance
•Panic
•Severe exaggerated startle
•Response=i.e. diving to the ground
when a car backfires
•Evidence of seizures=psychosomatic
BEHAVIORAL DISTRESS
SEVERE BEHAVIORAL DYSFUNCTION
 Violence
 Antisocial Acts
 Abuse of Others
 Diminished Personal
Hygiene
 Immobility
 Self-medication
PHYSICAL DISTRESS
 Tachycardia or






Bradycardia
Headaches
Hyperventilation
Muscle Spasms
Psychogenic Sweating
Fatigue / Exhaustion
Indigestion, Nausea,
Vomiting
SEVERE PHYSICAL DYSFUNCTION
 Chest Pain
 Persistent Irregular
Heartbeats
 Recurrent
Dizziness
 Seizure
 Recurrent
Headaches
SEVERE PHYSICAL DYSFUNCTION
 Blood in vomit, urine,
stool, sputum
 Collapse / loss of
consciousness
 Numbness / paralysis
(especially of arm, leg,
face)
 Inability to speak /
understand speech
SPIRITUAL DISTRESS
 Anger at God
 Withdrawal from
Faith-based
Community
 Crisis of Faith
SEVERE SPIRITUAL DYSFUNCTION
 Cessation from
Practice of Faith
[ “BACKSLIDING”]
 Religious
Hallucinations
or Delusions
Screening Factors
1. Ask about nature & severity of exposure
2. Ask about EXCESSIVE traumatic
dissociation
3. Ask if person truly believed he / she was
going to die
4. Ask about appraisal of symptoms (are
they catastrophic?)
5. Physical injuries
6. Malignant sympathetic arousal –
panic, loss of bowel or bladder
control
7. Psychogenic amnesia
8. EXCESSIVE traumatic
depression, numbing
9. Self-destructive ideation
10.Evidence of psychotic process
11.Whenever in doubt!
PERSONALITY ALIGNMENT
PSYCHOLOGICAL
ALIGNMENT
•Don’t argue
•Don’t minimize problem
•Find something to agree
upon:
This is the most important
element in establishing
rapport!
A CHAPLAIN MUST HAVE A SERVANT’S HEART
4.
8.
11.
IF VICTIM MAKES RADICAL
OUTBURSTS RE: MURDER
OR SUICIDE, EXTRAPOLATE
FOR THEM THE OUTCOME
OF THAT
12. NEVER LET A VICTIM LEAVE
WHO HAS THREATENED
SUICIDE OR MURDER
…
1.
2
3.
THE CHAPLAINCY MODEL
FOR INTERVENTION
After the victim concludes their
sharing of what happened and you
have clarified the facts with the
victim, it is wise to simply ask:
“Are you a person of faith? If they
reply, “Yes” then ask them if they
would mind if you prayed for them.
They will most likely say “Not at all”
if they told you they were people of
faith.
Then pray for them a prayer of faith
and healing and for God’s mercy, love,
provision, favor and help come to
them immediately.
THE FOLLOWING EXERCISE IS NOT
GRADED HOWEVER IT IS SCORED FOR THE
PURPOSES OR MEASURING EACH
STUDENT’S GRASP OF THE SKILL SET
INVOLVED IN CHAPLAIN’S CISM.
HOWEVER THEY WILL BE TURNED IN TO
THE INSTRUCTOR FOR HIS REVIEW AND
THEN RETURNED TO THE STUDENT.
GROUP EXERCISE
1.
2.
3.
4.
BREAK INTO A GROUP
CHOOSE A SPOKESPERSON
CHOOSE A SCRIBE
USING THE SKILL SET FOR CHAPLAINCY CISM DO
THE FOLLOWING:
1. EACH PERSON IN THE GROUP
NEEDS TO PLAY A VICTIM AT A
DISASTER SCENE
2. EACH PERSON IN THE GROUP
NEEDS TO BE THE CHAPLAININTERVENTIONIST
5. YOU CAN USE YOUR NOTES IF
YOU WOULD LIKE.
6. MAKE SURE EACH PERSON PLAYS
BOTH ROLES
7. THE SCRIBE SHOULD MAKE
NOTES AS TO WHAT TRANSPIRES
DURING THE ROLE PLAY
8. THE SPOKES PERSON WILL
REPORT TO THE CLASS RE: THE
ROLE PLAY IN GENERAL ONLY
CISM Group Exercise Check List
1. CHAPLAIN INDICATED THAT THEY CHECKED IN WITH
THE IC UPON THEIR ARRIVAL ______ (worth 2 points)
2. CHAPLAIN INDICATED THAT THERE WERE 2 OF
THEM______
3. CHAPLAIN INTRODUCED SELF AND PRODUCED I D FOR
THE VICTIM AS WELL AS GIVING VIC THEIR BUSINESS
CARD______
4. CHAPLAIN ASKED VICTIM IF THEY HAD ANY FIRST AID
NEEDS THAT NEEDED THE ATTENTION OF THE
PARAMDICS______
5. CHAPLAIN ASKED THE VICTIM “WHAT HAPPENED”?
AND THEN LET THEM TALK______
6. CHAPLAIN USED THE FEEDBACK TECHNIIQUES OF
“MIRRORING,” “PARAPHRASING,” AND “SUMMARY” IN
THE COURSE OF THE CISM INTERVIEW______
7. CHAPLAIN BEGAN BY ASKING “CLOSE ENDED”
QUESTIONS THEN MOVED ON TO “OPEN ENDED”
QUESTONS______
8. CHAPLAIN ASKED VICTIM/S IF THEY WERE A
PERSON/PEOPLE OF FAITH_______
9. IF VICTIM ANSWERED IN THE AFFIRMATIVE THE
CHAPLAIN ASKED IF THEY WOULD LIKE PRAYER______
10. IF VICTIM ANSWERED THAT THEY WANTED PRAYER THE
CHAPLAIN PRAYED IN THE POSITIVE MANNER USING
SCRIPTURAL CONCEPTS AND IN AN ENCOURAGING
MANNER______
11. CHAPLAIN REASSURED THEM THAT IF THEY NEEDED
ANYTHING TO CONTACT HIM/HER USING THE NUMBER
ON THE BUSINESS CARD HE/SHE’D GIVEN THEM AT THE
BEGINNING OF THE CISM INTERVIEW______
CHAPLAIN TALKED TO CHILDREN BY SQUATTING DOWN
AND GIVING THEM A STUFFED ANIMAL______
13. CHAPLAIN REPORTED TO LAW ENFORCEMENT IF VICTIM
VOICED IDEATIONS OF SUICIDE OR MURDER______
14. CHAPLAIN ASKED VICTIM IF THEY NEEDED A RIDE TO THE
HOSPITAL TO SEE AN INJURED LOVED ONE______
15. CHAPLAIN VERIFIED CONTACT INFO FOR THE VICTIM SO
THEY COULD FOLLOW-UP WITH THEM THE FOLLOWING
DAY______
16. CHAPLAIN INDICATED THAT WHEN THEY FOLLOWED UP
WITH THE VICTIM THE NEXT DAY THAT THEY REFERRED
THEM TO A MENTAL HEALTH PRO FOR AN
ASSESSMENT______
17. CHAPLAIN INDICATED THAT THEY WOULD NOT PURSUE A
RELATIONSHIP WITH THE VIC AFTER 24 HOURS AND IF
CALLED BY THE VIC THAT THEY WOULD EXPLAIN THE
POLICY OF NOT BEING ALLOWED TO DO SO______
12.
18. OF PURSUING SUCH A RELATIONSHIP FOR THE VIC
AND FOR THEMSELVES AND CAN ARTICULATE IT______
19. CHAPLAIN UNDERSTANDS THAT THEY CANNOT
PROSELYTIZE WHILE RESPONDING TO AN EVENT AND
CAN ARTICULATE IT______
20. CHAPLAIN UNDERSTANDS THAT THEY CANNOT
PREACH OR USE SCRIPTURES AS A RULE WITH VICTIMS
AND CAN ARTICULATE IT______
21. CHAPLAIN UNDERSTANDS HOW CISM IS DIFFERENT
THAN PSYCHO-THERAPY AND CAN ARTICULATE
IT______
22. CHAPLAIN UNDERSTANDS THAT THEY CANNOT SHOW
THEIR EMOTIONS TO A VIC AND CAN ARTICULATE
WHY______
23. RESPONDING AGENCIES OF BEING “BIBLE THUMPERS
AND CAN ARTICULATE IT______
24. CHAPLAIN UNDERSTANDS THAT THEIR MINISTRY AS A
CHAPLAIN IS NOT ONLY TO VICTIMS BUT TO FIRST
RESPONDERS TOO AND CAN ARTICULATE IT______
NUMBER OF ITEMS ON THE SCORE SHEET:
24
MAXIMUM POSSIBLE SCORE:
25 (#1 worth 2 points)
LOWEST POSSIBLE SCORE:
17
A=24-25
B-22-23
C=19-21
 ALTHOUGH A “D” IS CONSIDERED “PASSING” IT IS AN
INDICATOR TO THE STUDENT THAT THEY DON’T HAVE A
GOOD HANDLE ON THE PERFORMANCE OF THE SKILLS.
D=17-18
F=Bel0w 17
THE SCRIBE WILL SCORE EACH PERSON’S SHEET AND
WILL NOT PARTICIPATE IN THE EXERCISE.
EACH PERSON WILL BE GIVEN THEIR SCORE SHEET AT
THE END OF THE EXERCISE.
THE SPOKESPERSON WILL REPORT ON THE GENERAL
PERFORMANCE OF THE GROUP RATHER THAN ON
EACH INDIVIDUAL’S SCORE.
WHEN YOU PRAY FOR A WILLING PERSON AT THE
SCENE OF A DISASTER THINK ABOUT PRAYING
ALONG THESE LINES:
EXAMPLE:
“Father God, I bring _______ and his/her family
before you now. I am asking you to intervene the
confusion, pain, and trauma affecting him/her now.
Send your Holy Spirit to release life to him
and
his/her family. Release supernatural he
them now wherever they
Bring your comfort and peace to him/her/them now
in Jesus’ Name. Carry them through the days ahead
and be their guide. And remind them that you love
them. In your Mighty Name.”
Last but never least some of
you will find that Disaster
Response Chaplaincy is your
“Cup o’ Tea…..
Whatever
you find
yourself
doing do it
heartily
unto the
Lord.