Campus and Community Campus and Community CrisesCrises

Chris Flynn, Ph.D.Karen Settle, Ph.D.Sherry Benton, Ph.D.

Field shaping crisesField shaping crises

UT Austin 1966 Tower shootingsUT Austin 1966 Tower shootingsKent State 1970 4 students killed by National GuardKent State 1970 4 students killed by National GuardPan Am Flight 103, 1988 25 Syracuse U students killedPan Am Flight 103, 1988 25 Syracuse U students killedUniv. of Florida 1990 Serial murdererUniv. of Florida 1990 Serial murdererU. Of Illinois, 1991-1992 Menningitis outbreakU. Of Illinois, 1991-1992 Menningitis outbreakCal State Northridge, 1994 EarthquakeCal State Northridge, 1994 EarthquakeUniv. of Wyoming, 1998 Matthew ShepardUniv. of Wyoming, 1998 Matthew ShepardTexas A& M, 1999 BonfireTexas A& M, 1999 Bonfire9/11 Pace University, New York U and others9/11 Pace University, New York U and othersHurricane Katrina, 2005Hurricane Katrina, 2005VTU, 2007 campus shootingsVTU, 2007 campus shootings

Population Exposure ModelPopulation Exposure Model

B. Community victims killed and seriously injured Bereaved family members, loved ones, close friends

• Community victims exposed to the incident and disaster scene, but not injured.

• Bereaved extended family members and friends Residents in disaster zone whose homes were destroyed, First responders, rescue and recovery workers Medical examiner’s office staff Service providers immediately involved with bereaved families, obtaining information for body identification and death notification

• Mental health and crime victims assistance providers Clergy, chaplains Emergency health care providers Government officials Members of the media

• Groups that identify with the target-victim group Business with financial impact Community–at-large

A B C D E

Reclaiming ReclaimingLifeLife

Anxiety AnxietyIntrus ionsIntrus ions

Is olation Is olation Lonelines s Lonelines s

Depres s ionDepres s ionSadnes sSadnes s Des pair Des pair

GuiltGuilt

Shock Denial Shock DenialDis orientationDis orientation

Model of Responses to Model of Responses to Trauma & BereavementTrauma & Bereavement

Dis be lie fDis be lie f Outcry Outcry

HeroismHeroism

RageRageAngerAngerBlameBlame

Recons tructing Recons tructing A New Life A New Life

Event

0 7 2 5 to Days TIME toYears

Coming to Coming to Terms with Terms with

New NewRealitiesRealities

Numbing

Numbing

Avoidance

Avoidance

Hypervigilance

Hypervigilance

Search

ingfor

Search

ingfor

Mean

ing

Mean

ing

Mental Health Roles in CrisisMental Health Roles in CrisisResponseResponse

Mental health consultationMental health consultation Liaison with key agenciesLiaison with key agencies Psych-education through mediaPsych-education through media Mental health services with survivors, Mental health services with survivors,

familiesfamilies Mental health services with Mental health services with

respondersresponders Stress management supportStress management support

Beware! Common PitfallsBeware! Common PitfallsAnd RisksAnd Risks

Over-involvement, doing too muchOver-involvement, doing too much Confusing friend and counselor rolesConfusing friend and counselor roles Becoming lax about confidentialityBecoming lax about confidentiality Providing services beyond Providing services beyond

competencycompetency ““I’m the only one who can…” I’m the only one who can…”

syndromesyndrome Disengaging from family and own lifeDisengaging from family and own life

Cultural CompetenceCultural Competence

Recognize the importance of culture and respect diversityRecognize the importance of culture and respect diversity Maintain a current profile of the cultural composition of the Maintain a current profile of the cultural composition of the

communitycommunity Recruit disaster workers who are representative of the Recruit disaster workers who are representative of the

community or service areacommunity or service area Provide ongoing cultural competence training to disaster Provide ongoing cultural competence training to disaster

mental health staffmental health staff Ensure that services are accessible, appropriate, and Ensure that services are accessible, appropriate, and

equitableequitable Recognize the role of help-seeking behaviors, customs and Recognize the role of help-seeking behaviors, customs and

traditions, and natural support networkstraditions, and natural support networks Involve as “cultural brokers’ community leaders and Involve as “cultural brokers’ community leaders and

organizations representing diverse cultural groupsorganizations representing diverse cultural groups Ensure that services and information are culturally and Ensure that services and information are culturally and

linguistically competentlinguistically competent Assess and evaluate the program’s level of cultural Assess and evaluate the program’s level of cultural

competencecompetence

(CMHS, 2003)

Emergent Professional IssuesEmergent Professional Issues

1. The role and responsibility of the 1. The role and responsibility of the university counseling center in dealing university counseling center in dealing with the seriously mentally ill.with the seriously mentally ill.

2. Student privacy and the critical role of 2. Student privacy and the critical role of consultation.consultation.

3. The emergence of the threat 3. The emergence of the threat assessment team.assessment team.

4. Advocacy for the emotionally 4. Advocacy for the emotionally challenged.challenged.

Emergent issues cont’dEmergent issues cont’d

5. Beware the “business” of violence 5. Beware the “business” of violence preventionprevention

6. The impending collision between 6. The impending collision between privacy/confidentiality and crisis privacy/confidentiality and crisis prevention/management.prevention/management.

7. The need for comprehensive data and 7. The need for comprehensive data and trend analysis on college student mental trend analysis on college student mental health.health.

8. Restoring peace, harmony, and a sense 8. Restoring peace, harmony, and a sense of safety on our campuses.of safety on our campuses.

After the Storm: Katrina’s Impact on Psychological Practice in New OrleansAfter the Storm: Katrina’s Impact on Psychological Practice in New OrleansFaust, D.S., Black, F.W., Abrahams, J.P., Warner, M.W. & Bellando, B.J.Faust, D.S., Black, F.W., Abrahams, J.P., Warner, M.W. & Bellando, B.J.

Professional Psychology: Research and PracticeProfessional Psychology: Research and Practice, 2008, , 2008, 3939, 1-6., 1-6.

Long-Term PlanningLong-Term Planning

Develop a disaster plan.Develop a disaster plan.

Coordinate the organization of a disaster plan with fellow Coordinate the organization of a disaster plan with fellow professionals.professionals.

Establish a decision tree for evacuation planning.Establish a decision tree for evacuation planning.

Bank documents through the Association of State and Bank documents through the Association of State and Provincial Psychology Boards or establish multistate Provincial Psychology Boards or establish multistate licensure.licensure.

Make provision for portability of financial issues, Make provision for portability of financial issues, including billing, personal and business accounts, and including billing, personal and business accounts, and employee information. Consider one out-of-city accountemployee information. Consider one out-of-city account

Routinely back up patient records electronically and Routinely back up patient records electronically and store off-sitestore off-site

Immediately Prior to Anticipated DisasterImmediately Prior to Anticipated Disaster

Arrange for contact person remote from anticipated site of impact.Arrange for contact person remote from anticipated site of impact.

Contact patients to cancel appointments.Contact patients to cancel appointments.

Make provision for later follow-up.Make provision for later follow-up.

When necessary, make provision for referral of patients.When necessary, make provision for referral of patients.

Ensure electronic back up of current records, staff and patient Ensure electronic back up of current records, staff and patient contact information, referral contact information, billing files, email contact information, referral contact information, billing files, email addresses, and phone numbers.addresses, and phone numbers.

Place all office equipment, tests, recording forms in location least Place all office equipment, tests, recording forms in location least likely to sustain damage.likely to sustain damage.

Secure insurance and other documentation.Secure insurance and other documentation.

Bring laptop and cell phones with extra batteries and chargers.Bring laptop and cell phones with extra batteries and chargers.

2007 Gallagher National Survey2007 Gallagher National SurveyCounseling Counseling

Greatest concern:Greatest concern:

Finding referrals for long-term help 62%Finding referrals for long-term help 62%

Administrative issues re serious path 61%Administrative issues re serious path 61%

Growing demand for services w/oGrowing demand for services w/o

increase in resources 59%increase in resources 59%

Students on MedicationStudents on Medication

23% of center clients are on psychiatric 23% of center clients are on psychiatric medication—up from 17% in 2000 and 9% medication—up from 17% in 2000 and 9% in 1994in 1994

87.5% of directors see increase in # of 87.5% of directors see increase in # of students coming to campus on medicationstudents coming to campus on medication

63% of schools offer psychiatric services63% of schools offer psychiatric services

Severe Psychological ProblemsSevere Psychological Problems

91.5% of directors see a continuing trend 91.5% of directors see a continuing trend of greater number of students with severe of greater number of students with severe psychological problemspsychological problems

49% of counseling center clients have 49% of counseling center clients have severe psychological problemssevere psychological problems

87% of campuses hospitalized a student 87% of campuses hospitalized a student last year for psychological reasonslast year for psychological reasons

What centers are doingWhat centers are doing

Increase campus training for how to Increase campus training for how to respond to students in trouble and respond to students in trouble and make appropriate referralsmake appropriate referrals 67% 67%

Increase staff training re: difficultIncrease staff training re: difficult

casescases 58% 58%

Psycho-education info. on website 55%Psycho-education info. on website 55%

Expanding external referral network 48%Expanding external referral network 48%

Student asked to give EM contact 54%Student asked to give EM contact 54%

How VT impacted other centersHow VT impacted other centers

Increase in calls from faculty, etc.Increase in calls from faculty, etc. 66% 66%

Increased interest in crisis mgt. team Increased interest in crisis mgt. team or redesigning current one 61%or redesigning current one 61%

Requests by higher ups for reports 50%Requests by higher ups for reports 50%

Greater interest from student leaders 46%Greater interest from student leaders 46%

Policies being revised for communicatingPolicies being revised for communicating

with parents of students in crisis with parents of students in crisis 31%31%

VT aftermath, continuedVT aftermath, continued

Pressure to share more information Pressure to share more information

with administration about “difficult” with administration about “difficult”

cases is increasingcases is increasing 30% 30%

Calls from parents re: counseling Calls from parents re: counseling

services have increasedservices have increased 23% 23%

Directors spending more time Directors spending more time

discussing limits of confidentialitydiscussing limits of confidentiality

with their bosseswith their bosses 26% 26%

Non survey suggestionsNon survey suggestions

Smith, R. & Fleming, D. (2007). Student Smith, R. & Fleming, D. (2007). Student Suicide and Colleges’ Liability. Suicide and Colleges’ Liability. The The Chronicle of Higher Education, The Chronicle of Higher Education, The Chronicle Review, 53Chronicle Review, 53, 24-26, 24-26..

Better define Ferpa’s emergency Better define Ferpa’s emergency exception to permit disclosures to exception to permit disclosures to administrators and others administrators and others

Smith and Fleming article con’tSmith and Fleming article con’t

Take a holistic view of students’ well being Take a holistic view of students’ well being and use Screening Programs to help at-and use Screening Programs to help at-risk studentsrisk students

Require students to report mental illness Require students to report mental illness during application to help the university during application to help the university anticipate needs and development long-anticipate needs and development long-term treatment plans where appropriate.term treatment plans where appropriate.

New Eng. J. of MedicineNew Eng. J. of Medicine

Shuchman, M. (2007). Falling through the Shuchman, M. (2007). Falling through the cracks-Virginia Tech and the Restructuring cracks-Virginia Tech and the Restructuring of College Mental Health Services, of College Mental Health Services, The The New England Journal of Medicine, 357, New England Journal of Medicine, 357, 105-110105-110..

OutreachOutreach

Univ. of Illinois suicide evaluation policyUniv. of Illinois suicide evaluation policy

Improve triaging methods for wait listsImprove triaging methods for wait lists

New Eng. J of Medicine, cont.New Eng. J of Medicine, cont.

Improve communication between Improve communication between physicians in health center who refer a physicians in health center who refer a client to the counseling centerclient to the counseling center

<65% of college counseling centers have <65% of college counseling centers have no relationship with the college health ctr.no relationship with the college health ctr.

SMU CAPS consent, SMU CAPS consent, “I understand that “I understand that CAPS may share my records with SMU’s CAPS may share my records with SMU’s Health Center physicians if beneficial for Health Center physicians if beneficial for continuation of care.”continuation of care.”

Viewing crises in contextViewing crises in context

Most violence in our society is perpetrated by Most violence in our society is perpetrated by those who do not have a psychological disorderthose who do not have a psychological disorder

Most of those who have psychological disorders Most of those who have psychological disorders will never become violentwill never become violent

Vehicle driving, accidents, alcohol poisoning, Vehicle driving, accidents, alcohol poisoning, and suicide are far more likely to lead to and suicide are far more likely to lead to untimely death of students than campus untimely death of students than campus shootersshooters

Most campuses have dealt with students who Most campuses have dealt with students who may be a danger to themselves and others may be a danger to themselves and others every year for many years.every year for many years.

Level of CrisisLevel of Crisis

Critical incidentCritical incident

student or faculty suicide, accidental student or faculty suicide, accidental deathsdeaths

Campus EmergencyCampus Emergency

suicide pact, public suicide, power outage, suicide pact, public suicide, power outage, 1993 flood1993 flood

DisasterDisaster

Community wide– Earthquake, VTCommunity wide– Earthquake, VT

Campuses have on-going planningCampuses have on-going planning

90% of college campuses have a Crisis 90% of college campuses have a Crisis Management teamManagement team

80% of college counseling centers have 80% of college counseling centers have after hours coverageafter hours coverage

Crisis ManagementCrisis Management

Who is on the team?Who is on the team?

Who is in charge?Who is in charge?

Who provides coordination and Who provides coordination and communication?communication?

How is communication maintainedHow is communication maintained

How is team training provided and How is team training provided and maintained?maintained?

Crisis Management planCrisis Management plan

Who makes it?Who makes it?

How is it disseminated?How is it disseminated?

How is it updated?How is it updated?

How are roles and responsibilities How are roles and responsibilities defined?defined?

Psychological First AidPsychological First Aid

First Goal– Timely restoration of physical safety First Goal– Timely restoration of physical safety and emotional securityand emotional security2) Help anyone effected cope and adapt2) Help anyone effected cope and adapt3) Respond effectively to everyone in the larger 3) Respond effectively to everyone in the larger community in relation to the incident.community in relation to the incident.

Remember most people have natural coping Remember most people have natural coping ability and participation in crisis debriefing.ability and participation in crisis debriefing.

Response should be on-going, a one shot Response should be on-going, a one shot approach can do as much harm as goodapproach can do as much harm as good

Crisis Management CycleCrisis Management Cycle

Learning Planning

Prevention

Response

Recovery

Zdziarski, E.L., Dunkel, N.W., & Rollo, J.M. (2007). Campus Crisis Management: A comprehensive Guide to Planning, Prevention, Response, and Recovery. Josey-Bass, San Francisco, CA.