The  School  Nurse  and  Multi-­‐Hazard  Emergency  Planning  for  Schools  Sherry  Todd,  PhD,  LPC,  ATR-­‐BC,  CTS  Regent  University  

Overview  0 Crisis  Concepts  0 What  Can  Go  Wrong  (Types  of  Incidents)  0 Role  of  the  School  Nurse  in  Critical  Incidents  0 Critical  Incident  Planning  in  Schools  –  PPD-­‐8  0 Crisis  Intervention  Tasks  0 Prevention,  Protection,  Mitigation  (Before)  0 Crisis  Intervention  (During)  0 Recovery  or  Postvention  (After)  

0   Resources  0 References  

Crisis  Concepts  0 Crisis  is  a  commonly  misunderstood  concept  0 CRISIS  is  the  REACTION  to  an  EVENT,  NOT  THE  EVENT  0 Event  can  be  a  critical  incident,  traumatic  experience,  or  a  disaster  

0 How  we  react  to  that  event  can  be  a  crisis  0 Perception  of  the  event  determines  crisis  or  not  0 You  and  I  can  have  same  experience  but  perceive  it  differently  

What  Can  Go  Wrong    (Types  of  Incidents)  

0 Natural  Disasters  0 Community/School/Family  Violence  0 Suicide  /  Homicide  0 Sexual  Assault/Abuse  0 Death  of  Teachers,  Staff,  Students  0 Substance  Abuse,  Intoxication,  Overdose  0 Pandemic,  MSRA,  Flu  of  the  year  0 Medical  Emergencies  (allergies,  cardiac,  seizures,  etc)  0 Zombies,  Creepy  Clowns,  and  other  unknowns  

Role  of  the  School  Nurse  in  Critical  Incidents  

0 Of  the  events  or  critical  incidents  on  the  previous  slide  how  many  have  the  potential  to  need  medical  intervention?  

0 How  could  school  nurses  and  health  personnel  assist  Xirst  responders  during  an  incident?    

0 After  an  incident,  what  responsibilities  do  school  nurses  and  health  personnel  have?    

0 Does  the  School  Nurse  have  a  seat  on  the  Crisis  Team?  

Critical  Incident  Planning  in  Schools  –  PPD-­‐8  

0 PPD-­‐8  de(ines  preparedness  around  (ive  areas  0 Prevention  –  the  action  taken  to  prevent  a  threatened  or  actual  incident  from  taking  place  

0 Protection  –  focus  on  ongoing  activity  to  protect  anyone  in  the  school  from  threat  or  hazard  

0 Mitigation  –  reducing  likelihood  event  will  happen  0 Response  –  capability  to  stabilize  if  event  occurs  0 Recovery  –  capability  to  restore  learning  environment  

Before  

During  

After  

Crisis  Intervention  Tasks  0   Prevention,  Protection,  Mitigation  (Before)  0 Bulletin  Boards  0 Campaigns    

0   Response  or  Crisis  Intervention  (During)  0 LUV  0  SAFER  

0   Recovery  or  Postvention  (After)  0 Mandalas  (sometimes  during  a  crisis)  0  Journaling  

 Prevention,  Protection,  Mitigation  (Before)  

0 Bulletin  Boards  0 Hot  Topics  in  Health  and  Well-­‐Being  

0 Campaigns    0 SADD  Students  Against  Drunk  Driving  0 Blood  Drives  0 Lion’s  Club  

0 Develop  Partnerships  with  Local  EMS,  PCP,  Hospitals  0 Collaborating  with  area  hospitals,  medical  clinics,  and  physicians  can  help  schools  gain  access  to  equipment,  education,  and  training.      

Crisis  Intervention  (During)  

TWO  MODELS  0 LUV  0 Disaster  Behavioral  Health  

0 SAFER  0 International  Critical  Incident  Stress  Foundation  

LUV  The LUV Triangle – Reach Out with LUV 0 Listen 0 More Important that Talking

0 Understand 0 Paraphrase and Summarize 0 Clarify (to convey understanding)

0 Validate 0 Find Strengths in the Story

SAFER-­‐Revised  Model    Stabilize  the  Situa,on  

 Acknowledge  the  Crisis  

 Facilitate  Understanding  /  Normalize  

 Encourage  Effec,ve  Coping  Techniques  

 Recovery  or  Referral  

Putting it all Together 0 Stabilize 0 Acknowledge

0  Opened Ended Q’s

0 Facilitate Understanding 0 Encourage Coping 0 Resources OR 0 Refer to next level of care

Find survivor

Close Ended Questions

Close Ended Questions

Listen

Understand

Validate Summarize / Paraphrase

Recovery  or  Postvention  (After)  

0 Mandalas  –  (sometimes  during  a  crisis)  0 Any  art  created  with  in  a  circle  0  Used  by  other  cultures  since  beginning  of  time  0  Use  as  healing  tool  credited  to  Carl  Jung  0  “Calming  effect  while  facilitating  psychic  integrating”,  (Henson  et  al.,  p.148)  

0  Can  be  done  over  and  over;  each  is  unique  0  Say  “you  can  do  whatever  you  want  inside  the  circle”  

0  Encourage  use  of  color,  symbols,  shapes  to  represent  current  state  or  reaction  .  .  .  Move  toward  how  you  want  to  be  (healthier)  

0  Single  best  tool  for  crisis  intervention  with  kids  (3+)  

Recovery  or  Postvention  (After)  

Journaling  0  After  a  critical  incident,  people  need  to  tell  their  story  or  

narrative,  journaling  can  do  this  0  Visual  or  Creative  Journaling  may  help  a  young  person  

who  does  not  have  words  0  Lucia  Capacchoine  offers  prompts  to  start  the  process  of  

visual  journaling  Lucia.com  0 A  Special  Place  –  we  suggest  a  ‘Safe  Place’  0 A  Family  Portrait  0 A  Helping  Hand  0 My  Hero  or  Heroine  0 My  Dream  House  0 Draw  a  Dream  

Resources  Potential  Assistance  Providers  0 Regent  University’s  Center  for  Trauma  Studies  http://www.regent.edu/acad/schcou/trauma/  0  Offer  training  to  School  Districts  and  Crisis  Teams  

0 Green  Cross  Academy  of  Traumatology  http://greencross.org/  0  International,  humanitarian  assistance,  non-­‐proXit  org  0  Has  trained  and  certiXied  Field  Traumatologist  that  can  deploy  to  an  incident  and  provide  disaster  mental  health  services  

0 Local  or  Regional  CISM  Teams  0  Search  CISM  and  your  region  

Resources  0 Presidential  Directive  http://rems.ed.gov/K12IntroAndPurpose.aspx  0 Responding  to  Crisis  at  School  http://smhp.psych.ucla.edu/pdfdocs/crisis/crisis.pdf  0 Psychological  First  Aid  for  Schools  http://www.nctsn.org/content/psychological-­‐Xirst-­‐aid-­‐schoolspf  

Resources  0 Homeland  Security:  Dakota  County  Pandemic  InXluenza  Exercise  https://training.fema.gov/programs/emischool/el361toolkit/assets/pandemicinXluenzatabletop.pdf  

0 Planning  for  the  Needs  of  Children  in  Disasters  https://training.fema.gov/is/courseoverview.aspx?code=IS-­‐366.a  

0 SAMHSA  Publications  (substances,  disasters,  issues  and  conditions,  suicide,  ect)http://store.samhsa.gov/facet/Issues-­‐Conditions-­‐Disorders  

Resources  National  Association  of  School  Nurses  (www.nasn.org)  0  Search  for  the  following  documents:    0  School  Nurse  Role  in  Bioterrorism  Emergency  Preparedness  and  Response  

0  Disaster  Preparedness:    School  Nurse  Role    The  National  Association  of  State  School  Nurses,  Inc.  (www.nassnc.org)  0  Search  for  the  following  articles:    0 What  is  the  School  Nurse’s  Role  in  Disaster  Preparedness?  0 What  is  the  role  of  the  school  nurse  in  disaster?    Pediatrics:    The  Of(icial  Journal  of  American  Academy  of  Pediatrics  (www.pediatrics.org)    0  Search  for  the  following  article:    0  The  Preparedness  of  Schools  to  Respond  to  Emergencies  in  Children:  A  National  Survey  of  School  Nurses  

References  0 Federal  Emergency  Management  Agency  FEMA.gov        Multi-­‐Hazard  Emergency  Planning  for  Schools  0 International  Critical  Incident  Foundation  ICISF.org        School  Crisis  Courses  0 Substance  Abuse  and  Mental  Health  Services  Administration  SAMHSA.gov  

     Disaster  Behavioral  Health    

Thanks  for  ALL  you  do!  

Sherry  Todd,  PhD,  LPC,  ATR-­‐BC  stodd@regent.edu