Group crisis counseling is one of the primary crisis intervention methods that seek to provide short-term and immediate help to individuals who experience events that produce mental, physical, emotional, and behavioral problems or distress. Such activities may include medical illnesses, sexual assault, mental illnesses, drastic changes or losses in relationships such as the death of a loved one, or such life-threatening events as earthquakes or tornados. Group crisis counseling is important for adolescents and children after experiencing a crisis since it helps in reducing the intensity of their mental, emotional, physical, and behavioral reactions to the crisis. Further, the intervention allows children and adolescents to return to their normal levels of functioning before the occurrence of the disaster and enhances their mental wellbeing.
The group crisis counseling approach is also helpful for the teachers, parents, and the community members who work with the children because it equips them with the relevant skills needed to help traumatized children to deal with the stressful events as well as assisting the children to adequately develop essential coping mechanisms. The intervention is particularly essential since based on the systems theory perspective, teachers, community members, and parents provide the crucial support system that children and adolescents require to overcome stressful events. Group crisis counseling is appropriate for children and adolescents, as well as the parents and other community members working with them since it equips them with the relevant skills for coping with stressful or traumatic events.
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Counseling Theory
The Trauma-Focused Cognitive Behavior Therapy (TF-CBT) is the counseling theory that will guide the crisis interventions. The crisis intervention pertains to helping parents and children of Middle Valley Consortium to effectively cope with the shock emanating from the death of two middle school students who died of a prescription drug overdose (Johnston et al., 2013). TF-CBT is a component-based approach that integrates trauma-sensitive interventions with family, cognitive-behavioral, and humanistic techniques and principles. The intervention is ideal for the selected crisis since it helps both children and parents to learn essential skills that assist in the processing of feelings and thoughts that relate to traumatic life events, promote growth, safety, family communications, and parenting skills, as well as managing and resolving distressing feelings, ideas, and behaviors that relate to traumatic events.
Moreover, the Association for Specialists in Group Work (2008) notes that TF-CBT has demonstrated high rates of success with adolescents and children who suffer significant emotional problems that emanate from traumatic life experiences. Children and adolescents who benefit from the intervention include children who have suffered multiple or single trauma, or those suffering from traumatic grief. Additionally, TF-CBT is appropriate since it can be applied to individuals residing in diverse settings. Particularly, TF-CBT has demonstrated effectiveness in managing depression, post-traumatic stress disorder, sexualized behaviors, anxiety, mistrust, feelings of shame, and externalizing behaviors ( Cohen, Mannarino, & Deblinger, 2006) . The parental component has shown great potential in increasing the positive effects for children by lowering the emotional distress and depression levels among parents, as well as improving the parenting support and practices in handling their distressed children. The primary goal that TF-CBT aims to achieve is addressing the biopsychosocial needs of children with problems that relate to traumatic events, including PTSD among others, as well as their primary caregivers or parents ( Association for Specialists in Group Work (2008) .
The TF-CBT intervention is best delivered through resourceful and creative therapists who have close therapeutic relationships with their clients. The design of the intervention allows TF-CBT to be provided in a developmentally appropriate and flexible manner, especially in the context of addressing the unique needs of each family and child. TF-CBT has been evaluated with African American and Caucasian children, as well as the Latino population (Cohen, Mannarino, & Deblinger, 2006). Currently, the intervention is being tailored for the Native American children as well as children in the diverse countries including Pakistan, Norway, Uganda, Zambia, South Africa, Germany, Cambodia, and the Netherlands (Cohen, Mannarino, & Deblinger, 2006). Moreover, the approach has been successfully adapted for deaf and hearing-impaired populations. Johnston et al. (2013) also note that the TF-CBT intervention works well with children who have different impairments, including ADHD and orthopedic impairments.
Skills Required in Diverse Groups
The key factors that influence the treatment experience of clinicians, clients, and other members of staff are the expectations and attitudes in the setting. Clinicians who come from significantly different cultural or socioeconomic backgrounds compared to those of their clients tend to project their reference frames onto the clients (Corey, Corey, & Corey, 2014). On the other hand, clients may feel like the clinicians are judging them negatively due to the differences. Hence, cultural competence is a crucial skill in the reduction and prevention of stigma. Cultural competence pertains to adapting TF-CBT for specific settings and populations as well as the broader set of attitudes that translate to the interpersonal skills and sensitivity.
Sample Group Outlines—Counseling Phase
Introductory Phase
The phase will include the following steps:
Gather the group members together for introduction and to explain their intention for joining the group.
Guide the members in clarifying their goals.
Explaining the term confidentiality in group counseling and the importance of all members maintaining confidentiality.
Setting rules on time and other factors, including relationships among members.
Fact Phase
At this point, the group focus shifts towards discussing the events that have occurred, mainly, the death of the two students.
All members are invited to participate, and each is expected to provide a comprehensive description of how the death of the students personally affected them after discovering the recent overdoses that led to the death of their peers.
Feeling Phase
Plan for the Group of Children
Members are encouraged to describe their initial reactions to the news of the deaths.
Members are then prompted to explore the stage of the grieving process that they are in by guiding them to provide their present experiences.
The adolescent groups will be guided and encouraged to explore their emotions, including anger, confusion, denial, and shock, as well as their feelings of loss. The phase will also involve exploring the ideas of individual choice and peer pressure with the adolescent group.
Plan for the Parents and Community Members
Members are encouraged to describe their initial reactions to the news of the deaths.
Members are then prompted to explain their concerns about their children’s emotional wellbeing
The parent group will be engaged in discussions on their anxieties and fears concerning the safety of their children as well as their concerns on the measures being taken to address the issue of the drug overdose at the community level and in school.
Client ’s Current Symptoms Phase
The phase involves assessing the symptoms of the clients by asking them to describe how the event is affecting them including whether they are experiencing non-specific body pain, upset stomach, or headaches as well as how the event is affecting their concentration levels, grades, and health.
Conversely, for the concerned community members and parents, the counselor will assess the effect of the recent events on them, but the key focus will be on their concerns and fears regarding the cases of death as a result of drug overdoses. The assessment will focus on such aspects as their level of anxiety when children leave the house, efforts to connect with the parents of their children’s friends, monitoring their children’s social circles and peer groups, as well as how the event is affecting their health.
Teaching Phase
Middle School Group
The teaching phase for the middle school group will comprise of an analysis of the human responses to a crisis as well as responding to and preventing addictions in children. Some of the most common emotional reactions include irritability or anger, denial or shock, fear and anxiety, depression, feelings of hopelessness, grief, guilt, numbness, and mood changes (Henderson & Thompson, 2011). Some of the most observable behavioral responses to traumatic experiences include insomnia or sleep disturbance, appetite changes, pacing or agitation restlessness, increased use of drugs, isolation or social withdrawal, and inability to relax. On the other hand, the most common physical responses to trauma include weakness, sweating, rapid heartbeat, trembling, muscle tension, vomiting, nausea, loss of energy, distress, and headache or back pain. Finally, the typical cognitive responses include confusion, self-doubt, difficulties in concentrating and making decisions, nightmares, dreams, or flashbacks of the event, and forgetfulness. Children who experience these signs and symptoms should immediately seek for help by consulting with the adults, particularly parents and teachers.
Parents and Community Members Group
Parents and members of the community should maintain close relationships with children, especially after losing their classmates or other traumatic experiences so that they can notice changes in their behavior to ensure that they get the necessary help early enough. Some of the key factors that indicate the need for counseling in children include:
Children who experience a loss of a classmate, parent, or other close people
Children who had a close relationship with a deceased peer but continue to pretend that nothing happened for a long time.
Learners who report poor grades or develop a phobia of attending school
Children who are continuously preoccupied with death
Children who exhibit a drastic behavior change that can be observed for a long period (Cohen, Mannarino, & Deblinger, 2006).
Moreover, in addition to monitoring children, parents should monitor themselves for signs of maladaptive coping. Parents or community members, who find it difficult to escape feelings of guilt, stress or depression or panic should contact a mental health professional immediately (Suffolk University, 2015).
Summary Phase
The summary phase will include providing the groups with an opportunity to present any of their concerns that has not been addressed in the previous phases. The counselor will work towards providing honest answers to all the clients’ concerns.
Summary of the Educational Component
It is crucial for individuals to be educated about the different responses to a crisis, and informed that their reactions are normal to the abnormal situation. Individuals should also be informed that the responses are not permanent but temporary ( Cohen, Mannarino, & Deblinger, 2006) . Although the recovery period is not defined, individuals can improve their recovery process by acquiring and engaging in healthy problem-solving and coping skills.
Other Aspects of Crisis Intervention
These aspects include helping the affected individuals to comprehend the crisis as well as their respective response to the crisis. Moreover, crisis intervention involves helping individuals to become aware of their feelings as well as their expression of such feelings as guilt and anger. A key focus of crisis intervention is on coping strategies, which may be enhanced or new skills developed. Some of the coping skills that individuals may employ include putting feelings and thoughts on paper rather than keeping them inside, exercises that reduce stress and body tension, and relaxation techniques such as yoga ( Henderson & Thompson, 2011) . Further, crisis intervention involves the provision of adequate social support, which can be obtained from people who can provide care and support. Problem solving is also a key area of focus in crisis intervention, and it involves gaining a comprehensive understanding of the problem, the desired changes, examining the available problem-solving alternatives, discussing the advantages and disadvantages of each of the available solution, selecting the most appropriate option, creating a plan to implement the solution, and evaluating the appropriateness of the solution.
Summary of the Final Phase of the Crisis Intervention
The final stage of the intervention involves the counselor reviewing the changes that the individual has made in a bid to establish whether the person is capable of coping with challenging life events. The counselor encourages the continued application of the effective coping strategies to minimize distress. The counselor also makes realistic future plans, especially in the context of helping individuals to cope with crises that may emerge in the future. Further, the professional discusses signs that may indicate that the client’s condition is worsening and provides information on the available resources for further help ( Henderson & Thompson, 2011) . Moreover, the counselor conducts period follow-up meetings to establish how the members are coping. The counselor may also recommend continued grief counseling for the children by the clergy, the school, or a community-based organization.
Assuring Cultural Appropriateness for Diverse Individuals
The members of the groups come from diverse ethnic and racial backgrounds, which illustrates that some of the norms of the group do not resonate with those of some members. However, ensuring the efficiency of the groups requires the counselor to incorporate all dimensions of the culturally diverse members, including abilities, gender, age, race, ethnicity, and religious affiliation ( Corey, Corey, & Corey, 2014) . To ensure cultural appropriateness for the diverse individuals, the counselor will ensure that he sensitizes himself about the cultures of the different members of the group by remaining attentive to the clues that members give regarding the aspects of culture that they consider to be affecting their group participation. Understanding the cultural aspects that members consider crucial will enable the counselor to create an ideal environment that adequately caters for the diversity of the group members.
Assuring Appropriateness for Individuals with Exceptionalities
The group comprises of members with exceptionalities, including hearing impairment, a motor neuron disease that has resulted to an orthopedic impairment that requires the child and his father to use a wheelchair, as well as two group members under medication for ADHD. Working with persons with disabilities requires the counselor to make some modifications in the environment to ensure that the individuals’ needs are taken care of as in accordance with such laws as the Americans with Disabilities Act (ADA) (Smart, 2011). Some of the modifications that the counselor will implement include using a sign language expert and developing a creative Powerpoint presentation that utilizes universal symbolic graphics and text to cater for the needs of the members with hearing impairments.
The counselor will also ensure that all members have equal access to the meeting facilities by making sure that the area is free from such external barriers as lack of elevators or narrow doors that can deny entry to individuals using wheelchairs. The counselor will ensure that the facility has wheelchair access ramps and adequate space to allow for easy movement of the wheelchairs. Similar to the group with hearing impairments, individuals being treated for ADHD will benefit from the creative Powerpoint presentation since it will help in breaking monotony during the counseling session, and therefore minimize the likelihood of the members losing attention and beginning to act out, which can also lead to the disruption of the entire group.
Conclusion
Most traumatized children demonstrate the need for other services apart from therapy for trauma. Hence, families and children who experience trauma require assistance with placement, transportation, safety planning, and housing. Moreover, most children experience problems with the legal or school system. Further, since families are often involved with multiple systems, therapists are often required to attend staff meetings, provide reports, or testify in legal proceedings.
References
Association for Specialists in Group Work. (2008). Best practice guidelines. Journal for Specialists in Group Work, 33(2), 111–117. Retrieved from: HTTP:// www.asgw.org/pdf/Best_Practices.pdf.
Cohen, J.A., Mannarino, A.P., & Deblinger, E. (2006). Treating Trauma and Traumatic Grief in Children and Adolescents. New York: The Guilford Press.
Corey, M. S., Corey, G., & Corey, C. (2014). Groups: Process and practice (9th ed.). Belmont, CA: Brooks/Cole.
Henderson, D. A., & Thompson, C. L. (2011). Counseling children (8th ed.). Belmont, CA: Brooks/Cole.
Johnston, L., D., O’ Malley, P., M., Bachman, J., G., and Schulenberg, J., E. (2013). Monitoring the Future National Results on Adolescent Drug Use: Overview of Key Findings . Bethesda, MD: National Institute on Drug Abuse.
Smart, J. (2011). Disability Across the Developmental Life Span : For the Rehabilitation Counselor . New York: Springer Publishing Company.
Suffolk University. (2015). Typical responses for crisis. Retrieved from: https://www.suffolk.edu/campuslife/4130.php.
