Crisis Intervention and Working With Children in Times of Trauma

g-griffith-2011Crisis Intervention and
Working With Children
in Times of Trauma

By
Chaplain Gerry Griffith
Hamilton County Sheriff’s Chaplaincy

 

Many times Chaplains are called to support families in times of crisis and traumatic events. Too many times Chaplains are called to events not knowing what or whom they might encounter.  This might be to give a death notification, be present for an unattended death response, or assist at an accident scene.  There is always the possibility that children might be present and need to be included in the care given by the Chaplain.  Understanding the basic needs of children in times of crisis or trauma and having basic tools can impact the way a child might deal with the event for the rest of their life.  By having the basic understanding and tools, a Chaplain can give a child life long skills that will help them cope with the challenges of life and living. The child can learn to incorporate those life challenges into their life in a healthy, positive and life affirming manner.

Ethics of Working With Children – The first and most important issue when working with children is to remember that we have an ethical obligation to honor the faith or lack of a faith community when responding to a traumatic event. Our first goal is to ask about and respect their faith and worship rituals.  Our role is to provide comfort and support and a compassionate presence at the time of the crisis or traumatic event.  To challenge their faith or try to convert them away for the support system that is most familiar and accepted at this time would add more stress and confusion to an already difficult time in their life.

The Model:  The National Organization for Victim Assistance has developed a crisis response program that allows for those in the caregiving roles to provide crisis care in a way that supports healthy caregiving and a psychologically strong method for giving victims of crisis and trauma a way of processing the event.  Caregivers learn tools to give victims a language to express what they have experienced and to identify challenges that lie ahead of themselves and remember their support system.  The model is based on Maslow’s hierarchy of human needs as a guideline for the steps taken in the response.

What is Crisis: Each crisis and traumatic event might not be a crisis for everyone concerned.  A crisis is defined by an event that occurs when a person’s stressors outweigh their adaptive capacities.  When bad things happen, each child may be dealing with different life circumstances.  There might be an illness, divorce, financial challenges or some form of abuse that is present that might impact a child’s ability to cope.  It is important to remember that not all children will react or respond to a crisis in the same manner. This makes it even more important that each child is respected and cared for in a way that meets their individual need.

Adaptive Capacities: Some of the adaptive capacities in daily life that can impact our coping skills are our physical health, physical abilities, cognitive and emotional IQ, education or experience, community or family support, our spiritual connection and our individual personality.  Life challenging circumstances in each one of those areas can influence the way we deal with life on an everyday basis.  When a crisis or traumatic event occurs while we are being challenged in one or more of these areas it diminishes our ability to cope, think clearly or remember our strengths or support system.  The crisis event can add a traumatic memory that is connected to our five basic senses and can be triggered by any of those senses when we least expect or are least prepared to cope.

Crisis reactions can be even more challenging when issues such as addictions, past traumas, family discord or physical or mental illness are a part of the current life surroundings. This is why it is important for a Chaplain to listen to the child and those around them to be as sensitive as possible to the needs of the child or children we have been called to care for.

Goals of Crisis Response: The goals of crisis intervention are to respond to the concerns and issues that are heightened by the traumatic event.  Using the appropriate tools we can defuse the emotional memory so cognitive processing can take place.  We are there to assist individuals in the integration of traumatic events into their ‘life story’ and to reconnect them with their positive coping skills.  As Chaplains, our goal is always to reassure others and help restore and maintain a supportive and positive learning environment.  Whenever possible, our highest goal is to prevent long-term maladaptive stress reactions.

Not Psychotherapy: When responding to a crisis intervention it is important to remember that this is not psychotherapy.  Therapy in these situations is inappropriate because people have already been bombarded with overwhelming change.  People in crisis are highly stressed by events and conditions around them and out of touch with their coping skills.  People in crisis, many times do not feel safe.  Therapy depends on people feeling safe enough to explore the possibility of personal change.  This requires time and a working relationship.  Crisis interventions are short and event specific.  Our job when responding is to help the child find a way to express their reactions to a crisis or traumatic event.  A Chaplain is to be present for the situation at hand and to have a list of resources for those that might need a mental health referral. After those impacted by the trauma have dealt with the most immediate complications of the situation for six months or more with no improvement, or if they have an immediate need for care beyond the scope of a crisis response, they will need to have the referral information.

Needs of Children: There are specific needs that young people in crisis have.  Most of all they need to talk about what happened.  It is important to note that not all children have the developmental skills that will allow them to understand and process what has happened.  Children need to learn how to incorporate what has happened into their daily lives so they understand the changes that will come as their needs are being met in a new way.  It is important that they be able to explain to themselves what has happened so that they can acknowledge it and then reconnect with their positive coping skills.  It is also important to have a list of resources available for further help because many times the crisis responder is only present for a short period following the event.  Encouraging the children and families to attempt to continue with their usual routine is important because it is a positive step toward resuming their life as it was before the incident. 

Working with Younger Children: Younger children may not understand the permanence of death.  The crisis may cause them to regress to earlier developmental stages.  Their fear will be dominant, followed by anger.  Their confusion is due to their inability to understand the explanation of death, the change in their routine, caregivers, and favorite activities at home or in school.  They may have a sense of disorientation, abandonment and exclusion from activities.  Children postpone grief response due to external pressures.  The nature of their grief is sporadic because they cannot maintain a high level of emotionality for an extended period of time.  They may misinterpret the way adults respond to trauma and grief as they are often excluded from transitional plans and activities.  Children may postpone their own grief when faced with caring for other loved ones.

The impact of parental loss may be worse than the traumatic event itself. They will relate more to the sense of separation and abandonment and the fear of death of the surviving parent.  Grief may be exacerbated by a violent loss and the intensity of emotion may increase for the child.

Preadolescents and Adolescents: A crisis affects the whole person.  Their cognitive, physical, emotional, behavioral, and spiritual aspects will most times be changed by the crisis.  They recognize death as inevitable and realize that they will die some day.  Preadolescents may still have some level of magical thinking that tells them that death is punishment; they may blame themselves and fear that wishes can kill someone.  Adolescents understand that death is universal, inevitable, and irreversible.  With preadolescents and adolescents, they may experience sleep and  memory disturbances, appetite disturbances, irritability, rebellion, open rage, isolation of self and suppressed feelings.  They can also show physical symptoms, fear of things that had not frightened them before, and they may also express anger and anxiety. Wild mood swings may occur while denying that they are having any challenges with all that is happening around them.  The goals of providing a crisis intervention when trauma occurs are first and foremost, responding to the concerns and issues that are heightened by the traumatic event.  The Chaplain will strive to defuse the emotional memory so that cognitive processing can take place.  As we ask questions and listen we are assisting them in the integration of traumatic events into their own “life story.”  The Chaplain can support the children in reconnecting with their positive coping skills as they reassure the child, the parents and others involved. It is important to help them identify those that are there for them, to love, and support them as they process their reactions and memories from the event.

Common Coping Skills Among Children: Children cope by doing it in bursts.  They may cry hysterically for a period of time and then all of a sudden ask to go ride their bicycle.  They grieve spasmodically.  They seek and rely on help from others and can retreat into fantasy about what is going on around them.  Their spirituality may come into play as a coping skill in the same way playing may help them to cope.  Older children may have a sense of foreshortened future that will trigger risky behaviors such as using drugs, drinking alcohol, reckless driving, and having unprotected sex.

The Crisis Response: There are several key components to be aware of when responding to children that have been exposed to traumatic events.  It is important to be aware of cultural differences.  It is important to be aware of gender clusters as they are looking to feel safe with those whom they feel close.  It is important to have activities for younger children such as crayons, paper, small stuffed animals, and small toys.  They will use these as tools to develop a narrative or story.  It is important to let the children lead the discussion, which can be forwarded by asking open-ended questions.  It is helpful to explore what will happen next or in the future.

The Crisis Intervention: No matter which age group you are working with there are three components to a crisis response that need to be accomplished in their specific order.  The first step is to accomplish safety and security. To create safety in the response it is important that guidelines are clear and agreed upon by all those present.  Children need positive human physical contact.  They need rest and a plan for feeling safe.  They need physical symbols of nurturing such as stuffed animals.  The next step is ventilation and validation. This step allows the children to communicate about the event and their reactions.  It helps children understand the differences between life and death and reassures them that sadness is necessary.  During this time, it is important to talk with them about their observations of other people’s reactions.  Do not minimize their reactions.  The last stage is prediction and preparation. This is the time you will talk about what will happen next.  Giving them information about the coming days activities can help them be prepared for the future.  During this phase, it is good to encourage comforting routines and provide them with tangible comfort items such as stuffed animals, a picture or something they identify as important to them.  It is important to educate them about death and loss and help them develop reasons for living by talking about the things in the future they can look forward to.

Methods of Intervention: There are several methods to use during working with children in crisis.  Oral storytelling, play, creative writing, and art are positive ways to engage the children.  Music and pet interventions and for some children prayer can bring comfort.

Helpful Hints for Children:  There are some things to be aware of when working with children in crisis.  Young people may be distressed over the fears of what will happen to them if their parents die.  It is good to talk with them if they want to discuss this concern.  It is very important to give them as much factual information as possible, in a form that is age appropriate.  Allow them to ask questions and giving them correct information will help them to sort out their misunderstandings about what happened.  Give children short-term predictions:

  • Tell them what to expect in the next twenty-four hours and the next week
  • Help children to establish routines and home and at school
  • Reaffirm to children that they can have a full future and such a future can hold good things.
  • Identify older children or adolescents who have survived tragedy and have gone on to enjoy life.
  • Talk about people who have survived disasters and are still positive role models.

Caring for the Caregiver: Remaining healthy – physically, emotionally, spiritually – is of vital importance for those doing crisis care.  Self-care is being a good steward.  If as caregivers, we do not have proper self-care we can become secondary victims of the crisis and traumatic events we are called to respond to.

How to avoid becoming a secondary victim:

  • Get sufficient sleep. It is a great healer.
  • Attend formal and informal debriefing meetings. You need a place to talk through your ongoing experiences.
  • Get a ‘buddy’ you can visit with periodically who can give you the outlet you need for your frustrations and aggravations that always come in high-intensity situations.
  • Make time to resume hobbies or other avenues to detachment, even if it is less time than you normally spend.
  • Periodically slow down and note your breathing. Remember to observe your own Spirit.
  • Don’t fail to make time for prayer. Prayer and meditation are likely to keep you tuned to where God is at work in your life.
  • Refuse to isolate yourself from family, friends and colleagues. The tendency is to cut yourself off from your normal support systems. If you find that you have, this is one indication of over-stress.

Recognize Your Limits – And Realize You May Need To Set Limits On Others

How to Set Limits:

  • Recognize you can’t take away anyone’s pain, though you wish you could.
  • Tell people ‘no’ rather than reinforce their unrealistic expectations
  • Pace yourself. You are running a marathon, not sprinting in a dash. Back off when you need to.
  • Rest and play. Insist others do the same.
  • Take a day off and ‘go fishing’
  • Define your job with the Chaplaincy, and do that. Don’t try to take on too much or to be in charge of too many things.
  • Listen to those who know you well. They usually know when you are over-extending. Give your ‘buddy’ or spouse permission to be honest when they have concerns about you pushing your limits.

Summary: As with any call a Chaplain receives, being prepared lends to a positive experience for all concerned.  The quote that ‘people don’t care how much you know until they know how much you care’ can be the guiding force that encourages all of us to be open to learning as much as we can about the community we serve and each component of it.  Children are the most vulnerable and most forgotten many times when tragedy strikes.  Understanding the needs of children and how they react to crisis and trauma can support a Chaplain to bring comfort and understanding during one of the most difficult times in their life.  That compassion and empathy can give children the tools to cope with challenges for the rest of their life.   We must always remember that we cannot care for others to any higher degree than we care for ourselves.

Scriptures that guide us about working with Children.

2 Corinthians 1:3-42 Corinthians 1:3-4
English: World English Bible - WEB

3 Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort; 4 who comforts us in all our affliction, that we may be able to comfort those who are in any affliction, through the comfort with which we ourselves are comforted by God.

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            Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.

Luke 18:16Luke 18:16
English: World English Bible - WEB

16 Jesus summoned them, saying, “Allow the little children to come to me, and don’t hinder them, for the Kingdom of God belongs to such as these.

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& 17

16 But Jesus called for them, saying, “Permit the children to come to Me, and do not hinder them, for the kingdom of God belongs to such as these. 17“Truly I say to you, whoever does not receive the kingdom of God like a child will not enter it at all.”

Matthew 18:2-6Matthew 18:2-6
English: World English Bible - WEB

2 Jesus called a little child to himself, and set him in the midst of them, 3 and said, “Most assuredly I tell you, unless you turn, and become as little children, you will in no way enter into the Kingdom of Heaven. 4 Whoever therefore humbles himself as this little child, the same is the greatest in the Kingdom of Heaven. 5 Whoever receives one such little child in my name receives me, 6 but whoever causes one of these little ones who believe in me to stumble, it would be better for him that a huge millstone should be hung around his neck, and that he should be sunk in the depths of the sea.

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He called a little child and had him stand among them.  And he said: “I tell you the truth, unless you change and become like little children, you will never enter the kingdom of heaven.  Therefore, whoever humbles himself like this child is the greatest in the kingdom of heaven.  “And whoever welcomes a little child like this in my name welcomes me.  But if anyone causes one of these little ones who believe in me to sin, it would be better for him to have a large millstone hung around his neck and to be drowned in the depths of the sea.

Matthew 18:10Matthew 18:10
English: World English Bible - WEB

10 See that you don’t despise one of these little ones, for I tell you that in heaven their angels always see the face of my Father who is in heaven.

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“See that you do not look down on one of these little ones. For I tell you that their angels in heaven always see the face of my Father in heaven.

Mark 10:13-16Mark 10:13-16
English: World English Bible - WEB

13 They were bringing to him little children, that he should touch them, but the disciples rebuked those who were bringing them. 14 But when Jesus saw it, he was moved with indignation, and said to them, “Allow the little children to come to me! Don’t forbid them, for the Kingdom of God belongs to such as these. 15 Most assuredly I tell you, whoever will not receive the Kingdom of God like a little child, he will in no way enter into it.” 16 He took them in his arms, and blessed them, laying his hands on them.

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People were bringing little children to Jesus to have him touch them, but the disciples rebuked them.  When Jesus saw this, he was indignant. He said to them, “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.  I tell you the truth, anyone who will not receive the kingdom of God like a little child will never enter it.”  And he took the children in his arms, put his hands on them and blessed them.

Deuteronomy 6:5-7Deuteronomy 6:5-7
English: World English Bible - WEB

5 and you shall love Yahweh your God with all your heart, and with all your soul, and with all your might. 6 These words, which I command you this day, shall be on your heart; 7 and you shall teach them diligently to your children, and shall talk of them when you sit in your house, and when you walk by the way, and when you lie down, and when you rise up.

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5 Love the LORD your God with all your heart and with all your soul and with all your strength. 6 These commandments that I give you today are to be upon your hearts. 7 Impress them on your children. Talk about them when you sit at home and when you walk along the road, when you lie down and when you get up.

Mark 9:36-37Mark 9:36-37
English: World English Bible - WEB

36 He took a little child, and set him in the midst of them. Taking him in his arms, he said to them, 37 “Whoever receives one such little child in my name, receives me, and whoever receives me, doesn’t receive me, but him who sent me.”

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He took a little child and had him stand among them. Taking him in his arms, he said to them,  “Whoever welcomes one of these little children in my name welcomes me; and whoever welcomes me does not welcome me but the one who sent me.”

Scripture To Comfort Children

Psalm 46 The Message (MSG)

A Song of the Sons of Korah

46 1-3 God is a safe place to hide,     ready to help when we need him. We stand fearless at the cliff-edge of doom,     courageous in seastorm and earthquake, Before the rush and roar of oceans,     the tremors that shift mountains.

Jacob-wrestling God fights for us,     God-of-Angel-Armies protects us.

4-6 River fountains splash joy, cooling God’s city,     this sacred haunt of the Most High. God lives here, the streets are safe,     God at your service from crack of dawn. Godless nations rant and rave, kings and kingdoms threaten,     but Earth does anything he says.

7 Jacob-wrestling God fights for us,     God-of-Angel-Armies protects us.

8-10 Attention, all! See the marvels of God!     He plants flowers and trees all over the earth, Bans war from pole to pole,     breaks all the weapons across his knee. “Step out of the traffic! Take a long,     loving look at me, your High God,     above politics, above everything.”

11 Jacob-wrestling God fights for us,     God-of-Angel-Armies protects us.

 

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