illinois emsc1 psychobehavioral objectives upon completion of this lecture, you will be better able...
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Illinois EMSC 1
Psychobehavioral Objectives
Upon completion of this lecture, you will be better able to:
Describe appropriate interventions for a psychobehavioral emergency
Perform a mental status examination to assess a behavioral emergency
Demonstrate techniques for communicating effectively with a violent or suicidal student
Identify community resources that can help you deal with violent, mentally ill or suicidal students
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Illinois EMSC 2
PSYCHOBEHAVIORAL EMERGENCIES
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Illinois EMSC 3
PSYCHOBEHAVIORAL EMERGENCIES
2000 Surgeon General Report found that 11% of youth aged 9 – 17 years (approx 4 million) have a “major mental illness that results in significant impairment at home, at school and with peers.”
National Institute of Mental Health found that only a fifth of these children and adolescents actually receive mental health care
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Illinois EMSC 4
COMMON PEDIATRIC MENTAL ILLNESSES
Depression Schizophrenia Anxiety disorders Eating disorders
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Illinois EMSC 5
PSYCHOBEHAVIORAL EMERGENCIES
Knowledge of normal childhood and adolescent growth & development is imperative in order to appropriately differentiate normal from abnormal behavior.
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Illinois EMSC 6
ASSESSMENT Mental Status Examination
(MSE) Previous history of violence Physical cues of escalation Substance abuse or use
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Illinois EMSC 7
PSYCHOBEHAVIORAL ILLNESS
Use MSE for baseline data on behavior Understand normal emotional development Awareness of family member’s history Knowledge of common mental disorders
Depression Schizophrenia Anxiety disorders Conduct disorders Eating disorders Threat to self/others
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Illinois EMSC 8
Signs of Distress
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Illinois EMSC 9
MENTAL STATUS EXAM
APPEARANCE Grooming, posture, cleanliness
MOOD Relaxed, irritable,frightened
SPEECH Tone of voice, slurred, fast,
loud BEHAVIOR
Pacing, eye contact, slouched
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Illinois EMSC 10
MENTAL STATUS EXAM
MEMORY Instant recall, recent
activities, current problem
REALITY ORIENTATION Day, time, place,
situation THOUGHT PROCESS
How the student thinks, are there hallucinations?
THOUGHT CONTENT What he/she says,
hopeless, suicidal?
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Illinois EMSC 11
MENTAL STATUS EXAM
INSIGHT Ability to analyze, blaming others or lack of
responsibility for own behavior/situation JUDGMENT
Ability to make decisions, impulsive or superficial
PERCEPTION Awareness of self and thoughts, guilt or
indecisive
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Illinois EMSC 12
EATING DISORDERS
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Illinois EMSC 13
ANOREXIA AND BULIMIA
SYMPTOMS: Discolored teeth Poor nutritional status Pale skin Brittle hair Abrasions on knuckles Wearing inappropriate clothing, e.g. a bulky
sweatshirt in summer Making inappropriate body image comments,
e.g. stating she is “fat” when this is clearly not the case
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Illinois EMSC 14
IMAGES
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Illinois EMSC 15
Conduct Disorders
Conduct disorders include a wide range of antisocial acts, such as:
Bullying Lying Stealing Truancy Cruelty
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Illinois EMSC 16
BULLYING
MYTHS ABOUT BULLYING “ I was bullied at school and it
did me no harm.”
“Tell him to hit back - harder.”
“It’s character building.”
“That’s not bullying! It’s just kids teasing.”
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Illinois EMSC 17
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Illinois EMSC 18
BULLYINGPOSSIBLE SIGNS OF BULLYING Children may:
Be frightened of walking to or from school
Not wanting to go to school Start doing poorly in school Become withdrawn Become anxious Attempt or threatened suicide Become aggressive and unreasonable
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Illinois EMSC 19
HOW TO HANDLE A BULLY Take the bullying seriously Investigate all incidents Interview the bully and victim
separately Interview all witnesses Follow-up Document all incidents and
action taken
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Illinois EMSC 20
VIOLENCE VIOLENCE IS AN ABUSE OF POWER! Youth learn to protect themselves
by use of weapons or joining gangs Behavior is learned, modeled or
justified as a survival coping mechanism
Rarely are adolescents violent just to be violent
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Illinois EMSC 21
PLAN AND INTERVENTION
Policies and procedures for violent behavior are well thought out, clear and consistently enforced
Staff and students understand that a safe environment as top priority
Scene safety is part of primary assessment
Administrative support is readily available to the school nurse
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Illinois EMSC 22
INTERVENTIONS REQUIRING PHYSICAL RESTRAINT
Never approach student alone, and be sure there are no weapons before approaching
Call for assistance, (staff experienced with such interventions)
Keep a distance and avoid standing directly in front of person. NEVER BLOCK AN EXIT!
Be concrete in directions to student but show concern about his/her situation
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Illinois EMSC 23
INTERVENTIONS WHEN AGITATED BUT NOT VIOLENT
Talk in low, measured tones Verbalize empathy and that you will
assist the student to control his/her behavior
Walk while you talk - difficult to sit still if agitated
Restate what the student says: You are feeling angry What do you need to do?
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Illinois EMSC 24
TRIAGE AND TRANSPORT
EMERGENT Student with a weapon Student “high” on drugs requiring restraint
URGENT Student exhibiting abnormal behavior
requiring referral and evaluation NON-URGENT
Student calmed by verbal intervention, able to return to class
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Illinois EMSC 25
PREVENTION School aware that violence is reality Policy and procedures for early
intervention Campaign for school as “no
violence” zone Support groups for students Faculty inservice Peer counseling and mentor program
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Illinois EMSC 26
ASSESSMENT OF SUICIDE
MSE DETERMINE SUICIDAL LETHALITY
Do you have a plan? How will you carry it out? Do you have access to completing the plan?
DETERMINE OTHER RELATED RISK FACTORS A family history of suicide The student lost a friend from suicide The student had a recent loss or perceived loss
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Illinois EMSC 27
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Illinois EMSC 28
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Illinois EMSC 29
PLAN AND INTERVENTION
Based on assessment and lethality Relationship of warmth, genuineness,
and empathy Calm and affirmative Listen and reflect but non-judgmental Acknowledge that suicide is a CHOICE Explore feelings and discuss
alternatives
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Illinois EMSC 30
TRIAGE EMERGENT
Suicide attempt or student has a plan and lethality is high.
Assure that student is never left alone. EMS transport, maintain ABCs.
URGENT Suicide ideation with or without a plan. Parent/guardian called in. Assure that student is never left alone. Immediate referral.
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Illinois EMSC 31
EVALUATION AND FOLLOW-UP
De-briefing for involved school personnel
Validate school policy and procedures Revise procedures that did not work Continue or re-establish therapeutic
relationship with students returning to school
Educate students/staff about mental illness
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Illinois EMSC 32
PREVENTION In-service education for school personnel on youth
stress including signs and symptoms of depression, substance abuse, and physical and sexual abuse
Implement a crisis intervention team in the school
Incorporate stress management, decision making skills, and interpersonal skills into the health curriculum
Develop a peer support program
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Illinois EMSC 33
SUMMARYPsychobehavioral emergencies are inevitable,
but with planning and preventive measures, you may be able to avert some tragedies
Emergencies of this type demand specialized knowledge and skills, including excellent therapeutic communication techniques understanding of normal growth and development comprehensive network of mental health
professionals and resources in the community
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Illinois EMSC 34
ANY QUESTIONS??