Crisis Response Soft Skills

The objectives of this course are:

• Understand the role of a First Responder in Crisis Incidents.
• Learn to assess and identify situations where immediate assistance is needed to respond to a distressed individual.
• Develop and enhance basic competencies to respond effectively and compassionately to an individual in a crisis incident.

Link to google doc version: https://docs.google.com/document/d/1wWGTES6Evnc26loKWHYULGZewJzZkXb23NLdzyvV8MU/edit#heading=h.qbl50c10gmbl

Lesson 1 – Introduction to Effective Crisis Response

Scenario description of someone with a varying state of crisis.

What is a Crisis?

• A state of imbalance
• A disruption and is upsetting
• Can be sudden and acute or chronic and ongoing
• Involves emotional health, physical well being, personal life, a loved one
• Can threaten the stability of an individual, a team, even an event

What is a Crisis Response?

A crisis response is an application of strategies designed to help deal with a sudden and significant negative event.

We practice crisis response soft skills because some individuals are overwhelmed after a crisis and are unable return to their norm using their existing coping mechanisms. The ultimate goal is stabilization and helping affected individuals return to their pre-crisis level of functioning or norm.

Levels of Crisis

Stress	Firefly Routine
Distress	Firefly Routine
Traumatic Events	Firefly Event
Critical Incidents	Firefly Incident
Mental Health and Medical Emergencies	Firefly Emergency

Knowing the nature of the incident and the level of crisis prevents us from either over or under responding situations.

Identifying the Severity of Crisis

				Emergency
			Incident
		Event
	Distress
Stress

As a First Responder responding appropriately to situations is important. This involves identifying the level of situation correctly. You will most likely be involved as it develops from Stress to Distress possibly through the Incident stages.

This training will focus on using specific strategies and techniques in applying enhanced support.

Remember: Medical and health emergencies represent the most severe form of crisis and require intervention of trained professional support. It is important to understand and recognize this level of crisis. Call in your Shift Lead at any time you think you recognize the signs of a medical or health emergency.

Role of a First Responder in Crisis Situations

The role of a First responder is to provide support and help return the participant to baseline functioning or normal.

Timeline for crisis resolution will be unique to each individual and each crisis.

Things to Keep In Mind

Confidentiality

Confidentiality is the cornerstone of trust, and trust is essential for your work as a Responder.

If you are not discrete and careful, individuals are not likely to open up and share their thoughts and feelings with you.

The information you receive during a crisis will often be highly confidential, such as personal or medical information.

What to do with confidentiality concerns?

• Do not try to handle the situation alone
• Reach out to your Shift Lead or other Core Volunteers who can safely and effectively intervene
• Only break confidentiality for medical or mental health emergencies
• Never talk about confidential matters over the radio including real using names

Boundaries

Crisis situations can be very emotional for both the individual and the crisis responder which can blur boundaries.

The Crisis Responder must:

• Maintain a proper and helpful relationship with those in need of support
• Demonstrate care and compassion while maintaining healthy boundaries and limits.
• Not be pulled into the participant's crisis

Important!!!

Remember to always:

• Respect the safety, dignity and rights of the individual
• Adapt your approach to take account of the person’s culture
• Be aware of other emergency response measures
• Look after yourself

Lesson 1 In Review-

• Crisis events are usually dangerous or distressing situations that create a degree of uncertainty.
• The four levels of crisis are stress, distress, critical incidents or traumatic events, and mental health or medical emergencies.
• Know the nature of the incident and the level of crisis to know how to intervene.
• Assess the situation to determine if additional immediate resources are needed
• The ultimate goal of crisis intervention is stabilization and helping the affected individual to return to their pre-crisis level of functioning or equilibrium
• The information received during a crisis is highly confidential. This confidentiality should be broken only in a very limited number of circumstances.
• A crisis responder should be aware of the boundaries and limitations of the type of assistance and take care not to become personally enmeshed with the individual in crisis.

Lesson 2 - Assessment of Crisis Level

Determining Crisis Levels

It is important for the First Responder to accurately identify the level of crisis involved in a situation in order to initiate appropriate assistance.

Under-reacting & Over-reacting can both escalate a situation.

Crisis Levels Examples:

Stress: The tarp it took you 2 hours to hang falls on top of your camp.

Distress: A friend is not acting right and you are not sure why.

Traumatic Event: News of a death in the family.

Critical Incident: Large art collapsing with injuries.

Emergency: A participant is talking about suicide.

Stress

Stress is the body’s natural reaction in response to a physical and or emotional challenge.

Stress may be caused by various sources of tensions at the individual, emotional, family or social levels.

Positive life events as well as negative ones can create a stress response to meet the challenges of a situation.

Causes of stress include:

In life:

• Work,
• Uncertainty of future,
• Public speaking,
• Busy schedule,
• Big move,
• Disagreement

At Firefly:

• Sleep deprivation,
• Not eating well,
• Not drinking enough water,
• Too much or little of any one thing

As stress levels change most people can successfully identify and adjust by using their typical coping mechanisms.

Everyone reacts differently to stress.

Physical symptoms include:

• Anxiety or nervous tension
• Faster and stronger heartbeat
• Muscle tension particularly around jaw, neck, or back
• Headache
• Upset stomach
• Shortness of breath
• Sweaty palms and dizziness

Emotional symptoms include:

• Anxiety
• Irritation
• A feeling of constant worry
• Depression

Most of the time dealing with a stressed individual will happen as a participant, campmate, friend or Ranger. Rangers are taught, first - do nothing. Stressed individuals can usually return to their norm on their own, using their own mechanisms and skills.

Distress

Distress is an elevation in stress levels or a prolonged period of stress that challenges and overwhelms a person’s usual coping ability.

Distress is more acute and uncomfortable, and individuals often struggle to resume control and a return to lower levels of stress.

Causes of Distress can include:

In life:

• Family discord
• Problems creating a sudden need to find new housing
• Financial difficulties
• Experiencing feelings from past trauma
• Loss of a job
• Divorce loss
• Ongoing illness
• Abuse of authority

At Firefly:

• Arguments with Campmates, neighbors, other participants
• Inability to return to your normal
• Medical issue
• Dehydration

Symptoms are similar to Stress but are heightened and can feel more urgent in nature.

• Anxiety or nervous tension
• Faster and stronger heartbeat
• Muscle tension particularly around jaw, neck, or back
• Headache
• Upset stomach
• Shortness of breath
• Sweaty palms and dizziness
• Irritation
• A feeling of constant worry
• Depression

Distressed individuals can be helped significantly by the assistance or intervention of a First Responder. The return to their norm can be faster or with greater success than on their own.

Traumatic Events & Critical Incidents

Are extreme events that have the potential to overwhelm a person’s usual coping mechanisms, resulting in significant psychological distress and impairment in normal, adaptive functioning.

Traumatic Events & Critical Incidents can include:

In life:

• Political crisis
• Natural disaster
• Terrorist attack
• Kidnapping
• Loss/damage of home
• Car accident
• Sudden death in the family

At Firefly:

• Medical emergency of a camp mate
• Escalation of inter camp disagreement

While enhanced support is not required to respond both to Stress and Distress almost all Traumatic Events and Critical Incidents require a First Responder for assistance or intervention.

Individuals who are experiencing a sudden increase in everyday stress may benefit from crisis support, those who are experiencing medical or mental health emergencies require professional assistance.

Emergencies

May be either medical or mental health-related, and sometimes even simultaneously both in nature.

Present a significant threat of harm to one or more person’s safety or survival.

Medical Emergency Examples:

• Chest pain
• Breathing difficulty
• Seizure or diabetic reaction
• Severe injury like a broken bone
• Unarousable

Mental Health Emergency Examples:

• Suicidal thoughts or acts
• Threats of violence or aggression toward others
• Being disoriented or experiencing the symptoms of psychosis, such as hallucinations (false sensory perceptions)
• Delusions (false, irrational thoughts or beliefs)

Both Medical and Mental Health Emergency situations are beyond the scope of the First Responder and require immediate assistance. Call your Supervisor, Khaki or IC.

IMPORTANT:  If you feel the situation warrants Emergency Services, Rangers have access to an emergency phone and resources to best get emergency personnel to the scene.

Supervisors, IC, Event Leads and Board also access to an emergency phone and important information and directions for Emergency Services to be able to find us in the event they are needed.

Although emergencies are beyond the scope of the first responder, the first responder’s ability to recognize an emergency and call in resources is vital.

Lesson 2 In Review-

• Crises range on a continuum from Stress, Distress, Traumatic Event, Critical Incidents to Emergencies.
• The First Responder’s skill set is primarily intended for situations for the center of the spectrum including Distress and Traumatic Events and Critical Incidents where enhanced support is needed.
• Individuals who are experiencing a sudden increase in everyday stress may benefit from Crisis Response, individuals who are experiencing Medical or Mental Health emergencies require other immediate assistance.
• In emergency situations call your Supervisor, Khaki or IC immediately.

Lesson 3- Crisis Reactions

How an individual reacts to a crisis depends on many factors.

Factors can include: Culture, age, beliefs, personality, past experiences, state of mind, social norms

Common Crisis Reactions

Both an individual’s brain and body react to a crisis.  A powerful survival response, “fight or flight” is triggered and a surge of neurochemicals flow through the body. As a result higher mental functions become less active and individuals may have decreased:

• Problem solving
• Decision making
• Judgement
• Logic
• Reasoning
• Impulse control
• Verbal processing

These reactions fall into four main categories. Remember that most people have some, all, or even none of these reactions while going through a crisis.

Cognitive: How we think and what we think about

Emotional: Describes feelings, rather than thoughts

Behavioral: What we do or don’t do

Physical: Bodily experience or response to a crisis

Cognitive: How we think and what we think about

Typical cognitive reactions include changes in thinking and concentration. Individuals often report feeling confused or disorganised, not knowing where to start first. They may have difficulty with short term memory, feel distracted.

Emotional: Describes feelings, rather than thoughts

Emotional reactions can vary greatly from person to person. An Individual may experience a wide range of different reactions. For example, it is not uncommon for those affected by a crisis to feel both sadness, shame and guilt, as well as anxiety. Although anxious and depressed feelings may seem to be opposites, it is possible for someone to experience both at  the same time. Other common emotional reactions include feelings of helplessness or hopelessness, shock, anger and grief.

Behavioral: What we do or don’t do

Behavioral reactions are experienced as changes in what an Individual does or does not do. For example, in the wake of a threatening event, some individuals may wish to stay close to their friends or family, while others may feel that they need more space and are uncomfortable being around others.

Physical: Bodily experience or response to a crisis

Physical reactions can include feeling jumpy or nervous. After a prolonged period of stress, many individuals report feeling fatigued, or having headaches and nausea. Bodily aches and pains are not uncommon, But these physical reactions, as well as other reactions to a crisis event typically resolve on their own over time. If the crisis event remains threatening or there are many reminders of the event, reactions may be more prolonged.

Extreme Crisis Reactions

Extreme physical or emotional reactions may represent medical or mental health emergencies.

Example of extreme crisis reactions:

• Severe physical reactions, such as chest pain or difficulty breathing
• Severe confusion
• Very aggressive behavior
• Total withdrawal from others
• Total lack of self-care
• Self harming acts
• Serious suicidal thoughts
• Psychotic symptoms

Call your Supervisor, Khaki or IC immediately if:

• The reaction to a crisis is outside the range of common reactions above
• The individual is so overwhelmed or upset that they cannot take care of themselves
• The participant states or hints the they may hurt themselves or others

Grief and Loss in Crisis

Both sudden and anticipated losses can trigger grief reactions that can feel very destabilizing. An individual who has experienced a sudden or traumatic loss may be most vulnerable.

Grief can create reactions that can range from shock and disbelief, to sorrow and even guilt. First Responders should look for reactions such as:

• Shock and Disbelief
• Anger and Rage
• Numbness and Avoidance
• Sadness and Sorrow
• Guilt

When responding to those who are grieving, it is important to validate feelings and show compassion, while gently redirecting the individual away from counterproductive reactions and towards more productive tasks.

Lesson 3 in Review

• Every individual’s reaction to a crisis depends on the circumstances and is unique.
• The human brain responds to crises differently when compared to the rest of the human body.
• Crisis reactions can range from shock and disbelief, to anger, sorrow and even guilt.
• Contact your Supervisor, Khaki or IC is any individual displays signs of extreme crisis reactions.

Lesson 4: Crisis Response

There is no ‘one size fits all’ or universal approach to crisis response.

Effective response must be tailored to the individual and the situation.

Stages of Crisis Response

Pre-crisis- Equilibrium is stable and status quo is maintained.

Crisis- A period of disorganization in which an individual feels overwhelmed and is not able to effectively cope using their coping skills or mechanisms.

Trial & Error-  A struggle to regain a sense of normalcy and a return to baseline.

Post-crisis-  A return to baseline through an increase in coping ability and/or a reduction in the severity of the crisis.

When an individual seems “stuck” and immobilized, unable to gain any traction in their Trial & Error attempt to return to baseline functioning, the situation may worsen and deteriorate further.

Role of a First Responder in Crisis Situations

Is to:

• Provide structure and support to the individual
• Assess the situation to determine the need for additional resources
• Help the individual regain a sense of control
• Offer resources and referrals

Is NOT to:

• Provide professional counseling or medical care
• Solve the individual’s problems
• Provide indefinite support or care
• Be capable of handling ALL crisis situations
• Manage emergency situations without assistance

It is important for the Responders to:

• Be clear in their understanding of their role
• Knowledgeable in crisis response skills
• Restore a sense of power and control to the distressed individual, not foster a sense of dependence
• Help the distressed individual understand that you support is brief and time limited
• Help the distressed individual think through the situation and possible next steps to regain control
• Communicate clearly as the individual in crisis typically react more to their perception of a problem, rather than the actual facts.

Crisis Response Strategies and Techniques

No one size fits all approach to Crisis Response. Many techniques are needed to adapt to each situation and individual. Below are four overlapping strategies and techniques every First Responder should have in their skill set.

Building Trust

Trust is a key element in crisis response. Individuals in crisis may feel more vulnerable and less trusting.

First Responders must demonstrate that they are trustworthy and invested in assisting the distressed  individual.

Take steps to quickly build trust by:

• Clearly verbalizing your concern and desire to help in the first 30 seconds.
• Demonstrate competence and confidence.
• Verbally and non-verbally communicate honesty, with sincerity and a commitment to help
• Repeat as many times as you need to that you care. Do not just assume that the individual in crisis understands.

As said before there is no “one size fits all” approach to crisis response. Below are several different but overlapping approaches to crisis intervention.

FLAME

F.L.A.M.E. is a meditation technique created by Black Rock Rangers and taught to all Black Rock and Regional Rangers.

FIND OUT about the situation.

LISTEN to all parties and sides.

ANALYZE the information using your understanding of the situation.

MEDIATE and help facilitate the parties reaching their own joint solution.

EXPLAIN the outcome to everyone.

FIND OUT.

Stand back and observe.

Take account of any safety issues. Call a Supervisor, Khaki or IC if you feel any safety hazards are present.

When you determine that it is safe find out the facts. What is the primary complaint? Who is involved? When did the conflict start/incident occur? Where did it happen?

There will always be at least three sides: the sides of the individuals involved directly in conflict (which may be two or more) and an impartial third perspective, when you can find it.

Add this to the perspective you bring to the situation, which encompasses your experience, the general opinion of all the participants, and the ideology of the Firefly Arts Collective.

LISTEN.

Listen to all parties: ensure that all stakeholders have had a chance to be heard and give their input.

Be aware that, at times, you may have to use your judgment as to who is really involved.

Concentrate on the parties who need your direct assistance and make time for everyone who has legitimate input.

Listening is a powerful tool, not only for getting information and de-escalating conflicts but also for establishing a general rapport and social capital with your fellow Fireflies.

ANALYZE.

Once you have gathered all the information that you can, analyze it with your partner.

Take all of the facts that you gathered during the F and L parts of the process and consider your understanding of the expectations of the Firefly community, the policies of your Core, and the ideology and policies of the Firefly Arts Collective.

Active deliberation and use of your best judgment is required at this stage in the process.

MEDIATE.

Your primary role when you mediate is to make suggestions as a neutral third party. Mediation allows the participants involved to arrive at the best way to resolve their situation.

Determine which participants involved may have room to budge and those whose interests are such that they cannot or will not give in. This is often not based on right and wrong.

Work with all parties involved until an outcome is reached that seems to function well. Whenever possible, facilitate the parties reaching their own joint solution. People are much more likely to stick to a solution when they feel ownership of the process and that the resolution came from them rather than from an authority figure telling them what to do.

EXPLAIN.

E is the explanation, and completes your “flaming” of the situation.

Explain the outcome of the mediation process to everyone involved, ensuring that all parties have come to a consensus that they can live with (...or at least live with for a week)..

4 L’s of Psychological First Aid

Psychological First Aid is an intervention that aims to help individuals gain skills to manage distress and cope with post-crisis stress and adversity.

It is designed to reduce initial distress and foster short-term and long-term adaptive functioning and intended to help individuals return to pre-incident norm as soon as possible. It is intended to be an “every person” skill set, not necessarily reserved for the mental health professional.

Can be effectively provided by anyone first able to assist the affected individual.

Psychological First Aid involves four key actions, referred to as the 4L’s.

LEARN about the situation

LOOK for signs of distress or possible emergency reactions

LISTEN calmly and patiently, to the distressed individual

LINK them with the appropriate resources and referrals

LEARN about:

The crisis event: What happened? When and where did it take place? Who are the people affected?

Available services and support: Where and how can people access the needed services? Who else can be of help?

LOOK for:

• Safety and security concerns: Is the area secure? Is there any immediate danger?
• People with obvious urgent basic needs: Does anyone need emergency medical help?
• People with serious distress reactions: Are there people who appear extremely upset, not able to move on their own, or not responding to others?

LISTEN:

Approach people who may need support:

• Approach people respectfully and according to their culture
• Introduce yourself by name and organization
• Ask if you can provide help
• If possible find a safe and quiet place to talk
• Help the other person feel comfortable (ex: offer water)
• Try to keep the person safe & remove from danger if safe to do so

Ask about people’s needs and concerns:

• Always ask what people need and what their concerns are
• Find out what is most important to them at this moment
• Help them determine what their priorities are

Listen to people and help them to feel calm:

• Stay close to the person
• Do not pressure the person to talk
• Listen in case they want to talk about what happened
• Try to make sure the person is not alone the they are very distressed
• Help them to feel calm

LINK:

Help people address basic needs and access services: Which services do they need to be linked to?

Help people figure out how to cope

• Encourage positive coping strategies (rest, talking to someone, exercise, eating)
• Help them identify people who may be able to help them
• Ask them how they have coped in the past

Give information about:

• The crisis event
• Loved ones or others impacted
• Their safety and rights
• How to access information
• Connect people with loved ones and support
• Help get into contact with their social support

Basic Principles of Psychological First Aid

The basic principles in providing Psychological First Aid including promoting:

Safety

Calmness

Connectedness

Self-efficacy

Hope

Safety

Help individuals meet basic needs and obtain medical or mental health attention if needed

Provide repeated, simple accurate information on how to obtain these

Calmness

Listen to individuals who wish to share their stories and emotions and remember there is no wrong or right way to feel

Be friendly and compassionate even if people are being difficult

Offer accurate information about the crisis event, and the assistance available.

Connectedness

Help individuals quickly connect with friends and/or loved ones following a crisis event

Keep families and friends together whenever possible.

Self-efficacy

Give practical suggestions that steer people towards helping themselves.

Engage people in meeting their own needs

Hope

Dealing with crisis can be overwhelming, scary, and discouraging.  It can be difficult for individuals to see any light at the end of the tunnel or feel life will ever be meaningful or satisfying again.

As a First Responder you should:

• Find out the types of help available to people and direct them to those services
• Remind people that more help and services are on the way when the express fear or worry
• Remind people that they are not alone
• Do not minimize the severity of the situation
• Promote hope and be a positive and optimistic presence

As a First Responder you should NOT:

• Force people to share their stories with you, especially very personal detail. This may decrease calmness in people who are not ready to share their experiences.
• Give simple reassurances like “everything will be OK” or “at least you survived”, statements like this can diminish calmness.
• Make promises that may not be kept or create a false sense of hope.
• Criticize relief efforts or services in front of people in need of these services; this can undermine hope and calmness.

The 5S Model of Crisis Response

Self-preparation

Safety

Structure

Support

Stabilization

Self-preparation: Assess the nature and severity of the crisis and determine who and what may be the most effective response.

Safety: The safety of all involved, including the individual or individuals in crisis and others who may be in the immediate area, as well as the safety of the First Responder.

Structure: An important goal in crisis intervention is providing structure to what may be a chaotic or overwhelming situation or when an individual has lost control.

Support: Support is related to emotional well-being and recovery following crises and difficult life events.

Stabilization: Stabilization in a crisis can mean both helping stabilize the situation by reducing stress or distress to help give the individual the time and space to better cope and bolstering the individual’s ability to cope.

Self-preparation

Self-preparation involves being ready and focused to deal with the crisis at hand. Preparing one’s self to assist in a crisis situation begins with the important question: “Is this a situation I can or should be helpful in?”

As the First Responder approaches the situation, consider the following:

• Am I the right person to become involved?
• Do I have prior training?
• Do I have knowledge of policies?
• Are medical, mental health or security professionals already involved?

Safety

Before engaging in a crisis response, First Responders need to identify and consider environmental, behavioral, and emotional hazards to ensure the safety and security of all involved.

• Plan your escape; keep it clear and don't get blocked in.
• Keep shoulders relaxed, turned to the side.
• Display a positive and helpful attitude
• Maintain normal eye contact (appropriate to culture)
• Use active listening skills and techniques
• Maintain a comfortable distance from the individual in crisis

Remain at the same level as the distressed individual when you can. If they can’t or won’t sit because they are too upset, you should also remain standing.

Stand Safely

When talking to a standing individual stand with one foot to the rear, perpendicular to, instead of parallel to the other, about shoulder width apart. This position will:

• Reduce a sense of challenge by not squaring off with an individual
• Respect personal space, by not encroaching and allowing a more open area
• Allow the First Responder to move quickly towards an exit

Sit Safely

If you can get an individual to sit down, the First Responder should determine if they would be better received sitting across or next to the individual.

If sitting across from the individual:

• Sit Squarely, facing the person, but not in a challenging manner
• Open Posture, without arms or legs crossed or closed
• Lean Forward, including your attention and putting you into a better position to move away quickly if the situation escalates further
• Eye Contact, that is direct but warm
• Relax, people have a tendency to synchronize their mood and tone with those around them. If you project a relaxed, calm and confident presence, it can be helpful in influencing the other person to be calm as well.

Angry or Agitated Individuals

It is unusual but not impossible for an individual in crisis to lose physical control and become aggressive or violent. As a First Responder, you should check for indicators of possible aggression in the behaviour and communication of the individual in crisis.

In the situation where there is threatening behavior

• React and respond to the individual in a calm but firm manner
• Encourage the person to sit down to discuss or think the situation through
• Use “de-escalation” techniques to calm the individual
• Help the person define their reaction, verbally define it: “I understand that you are upset” or “It sounds like you’re really angry about this.”
• Rehearse ahead of time what you would say or do in such situations
• Leave and call your Supervisor, Khaki or IC if the situation appears dangerous
• Angry or Agitated individuals become less responsive to verbal communication and more responsive to nonverbal communication. As a First Responder, you need to be mindful of both.

Structure

An objective of the First Responder is to de-escalate and calmly structure a productive interaction with the distressed individual. Providing structure may involve:

• Providing a safe quiet place to talk
• Helping an overwhelmed individual more logically think a situation through
• Setting ground rules or time frames around how a problem may be addressed.

There are a number of non-verbal de-escalation techniques that can be helpful in creating a structure that calms others and assists them in regaining control.

Nonverbal Communication

Body Language

Paraverbal Communication

Active Listening

Empathy

Nonverbal Communication

In crisis, stress situations, nonverbal communication plays a more critical role than verbal communications.

They include:

• Facial expressions
• Tone of voice
• Movements
• Appearance
• Eye contact

The more stressed and individual may be:

• the less able they are to process verbal information effectively
• the more reliant they become on non-verbal communication

Body Language

Important messages are conveyed nonverbally through body language, such as posture and gestures, and need to support the First Responder’s verbal messages. Conflicting messages can undermine confidence and cans seem insincere.

Typically an open and welcoming posture communicates warmth and a willingness to help. Make eye contact that is soft and positive which can be helpful in connecting us with others. Eye contact that is too intense or unbroken can feel like staring and may be perceived as challenging or judgemental.

How close or how far we stand from another, influences the message the receive from us. Invading another person’s personal space can raise anxiety and might escalate the situation at the same time you are trying to calm and comfort someone.

Widely accepted is an arm and a half length for Personal Space. However individual preference and other factors may influence what is appropriate at that time.

Paraverbal Communication

Paraverbal Communication is often defined as not what we say but how we say it. This is increasingly important when addressing a distressed or overwhelmed individual who is likely responding more to nonverbal messages than verbal messages. There are four primary elements of paraverbal communication:

Volume

It is not uncommon for an upset or overwhelmed individual to speak loudly and forcefully during a real or perceived crisis.  In order to help calm and focus a distressed individual, it may be helpful to speak a little more loudly than you usually do, and gradually and incrementally lower your volume.

Rate of speech

The same sort of approach can also be used to address rate of speech.  Individuals in crisis may speak quickly, adding to a sense of urgency and confusion. In order to help slow the distressed individual, the First Responder may begin by speaking a little more quickly than they usually do, and then gradually and incrementally slow themselves in order to influence the other to slow down as well.

Tone

In this context, the paraverbal element of tone refers to statements that may be mistakes as condescending or sarcastic.  While humour can sometimes be an effective tool to break the ice or lighten the mood, used in crisis situations, the affected individual may feel that others do not appreciate the seriousness of their situation or the degree of their emotional pain.

Therefore, it is usually best to avoid using humor in crisis situations.

Inflection

The paraverbal element of inflection refers to how we may inadvertently emphasize a word, phrase or even a syllable in a manner that seems to change the entire meaning of our statement.

As distressed individuals are more responsive to non-verbal communication than verbal communication, they may read into perceived change in your message and arrive at an entirely different meaning than you had intended.

Be careful with inflection that can alter your verbal messages and potentially escalate a crisis situation further.

It is important to understand and regulate each to ensure that your intended message is understood by the individual in crisis.

Active Listening

Active listening is an process to discern what a person is saying. It demonstrates your care and commitment. It means giving your undivided attention and being fully present to the individual in distress.

• Always remain non-judgemental and open-minded
• Never ignore the distressed individual or fake your attention
• Carefully listen to what the individual is really saying
• Use silence and restatement to clarify messages
• Use reflection to clarify and connect with the speaker

Empathy

Empathy is a powerful de-escalation technique that is an essential element for effective crisis communication. An individual in crisis:

• May not remember what the First Responder said
• But will remember how the First Responder made them feel

Support

Support is usually provided by the First Responder in the form of assisted coping and problem solving. The Responder is in a better position to think the situation through in a clear headed manner to provide direction, encouragement, and to link to resources. However, the Responder must remember that their role is not to “fix” the individual’s problem.

Support can take many forms. Including:

• Emotional support
• Social connection
• Feeling needed
• Reassurance of self-worth
• Advice and information
• Physical assistance
• Material assistance

A First Responder should hear from the individual in crisis what they think will be more helpful, or what types of support the may need more urgently. They should not assume to know what will be most helpful.

Crisis Support Do’s:

• Provide direction, encouragement and linkage to resources
• Listen and avoid faking attention
• Remain calm avoid overreaction
• Be aware of nonverbal cues
• Avoid jargon, it tends to confuse and frustrate

Crisis Support Don’ts:

• Don't “do for” an individual person, but “do with”
• Don't be alone, get assistance for yourself at the first indication of possible aggression
• Assume you understand how the person is feeling or what they are thinking
• Talk when you feel nervous/anxious
• Ignore the person’s painful feelings
• Take a judgemental attitude

Stabilization

Stabilization in a crisis can mean both helping stabilize the situation by reducing stress to help give the individual the time and space to better cope as well as bolstering the individual’s ability to cope.

To stabilize the situation, the First Responder takes actions to:

Manage the impact of the crisis event by asking about strategies that have worked for the individual in the past, guiding the individual to come up with new strategies and then following up and checking on the progress of the individual to see if there is a reduction in the level of discomfort and/or disruption.

Prevent a recurrence of the event and establish equilibrium by ensuring a connection to ongoing sources of support and encouraging ongoing attention to manage the situation to prevent a relapse

Lesson 4 In Review

Every crisis response is different and to be effective must be tailored to the individual and the situation.

The role of the First Responder with an individual in crisis is to help them regain a degree of control and manageability.

With an individual in crisis feelings and emotions can become the dominant force and thinking plays a much smaller role.

First Responders should focus on building trust with the person in crisis and prove they are invested in assisting the individual in crisis

F.L.A.M.E. can help you de-escalate a situation with the steps Find Out, Listen, Analyze, Mediate, Explain

Psychological First Aid (PFA) is a safe and effective “every person” skill set applied in the immediate wake of a crisis or traumatic event that involves the actions, Learn, Look, Listen, & Link.

The foundations of a crisis intervention are Self-preparation, Safety, Structure, Support and Stabilization- know as the 5 S model.

Lesson 5- Self Care for Crisis Responders

Secondary Trauma

Immersing oneself in the emotional pain and suffering of others can lead to secondary traumatization that is characterized by the same sort of emotional reactions experienced by those who were directly involved in critical incidents.

The secondary traumatic stress commonly experienced by First Responders include:

• Cumulative stress from hearing many difficult or emotional stories
• Not fully understanding how much listening and talking help the individual in crisis

Feeling overwhelmed by the depth of grief, anger or frustration expressed by those they help

• Over identification or enmeshment with individuals in crisis
• Unrealistic expectations of relieving other person's emotional pain

Together these stressors can lead to “compassion fatigue”, sometimes referred to as, “the cost of caring too much.”

Setting Limits

One of the effective means of managing stress is to set limits. It is important for the First Responders to know when to say “No”. Self-care isn’t an act of selfishness, it is a necessary part of being a Responder. Use a team approach whenever possible and let others help out in order to give you a rest.

Remember:

• If you are burned out and emotionally exhausted, you will not likely be an effective Responder to someone else’s problems.
• The effects of stress, if left unchecked, can add up and reduce your effectiveness and life satisfaction
• You are acting as a First Responder to be part of the solution; don’t allow yourself to become part of the problem.

Active Stress Management

Active Stress Management involves beginning purposeful stress management before feeling the effects of stress.

• Know yourself and be able to self-identify your early warning signs
• Acknowledge that First Responder work is difficult and important
• Understand your limitations
• Connect with others- support is the best preventative medicine
• Balance your life - physically, mentally, emotionally, spiritually
• Meditate and practice present moment awareness
• Exercise, be physically active, express yourself

Responders should initiate and continue these practices before, during and after their involvement in stressful or traumatic situation. Active Stress Management must be proactive and preemptive to be most effective.

Lesson 5 In Review

First Responders should initiate and continue active stress management practices before, during and after their involvement in stressful or traumatic situations.

Setting limits before reaching burnout is a very effective means in stress management.

Balance in life, having support and knowing yourself and your limitations helps with purposeful Active Stress Management.