Conflict Management Final Review
Watch out! This stuff isn’t exactly the nicest of formattings!
Crises of Loss (death, dying, AIDS, death notification)
Crises of Loss
Death and Dying… Kubler-Ross’ 5 Stages : Denial & Isolation, Anger, Bargaining, Depression, Acceptance
Definitions of terms: Bereavement (state of loss), Grief (feelings of sorrow, anger, guilt), Mourning (expression of grief)
Tasks of Mourning (accepting the reality of loss; experiencing the pain of grief; adjusting to the environment; withdrawing emotional energy & reinvesting in another relationship)
Manifestations / Determinants of grief
What is an approriate way to “intervene” with loss issues? Do’s and Don’ts. How best can a police officer handle death notification? Guidelines provided by MADD and others. What is important to consider when the loss is a child?
Information of AIDS : facts vs. fiction; misconceptions and reality; application to policing
Elizabeth Kubler-Ross spoke and wrote extensively on the subject of death and dying (1969 was her first publication). Her view was that as the world modernized, we became further removed from the natural aspects of death and as North Americans, we grew more fearful and uncomfortable with death, itself. Today, she might add that we fear not only death but aging, too! Kubler-Ross noted patterns in her terminally-ill patients (she worked mainly with cancer patients) and presented to the world her “5 stages of dying”. She recognized that not all patients go through all 5 stages, nor in that order. However, many do. And so do the survivors (often the loving family members of the dying patient). Perhaps you have heard of the 5 stages, even if you haven’t heard her name before. It is generally accepted today, that many of us go through these 5 stages in our lifetime, over many kinds of loss, not just loss experienced through death (ie. loss of major job, loss of a major relationship). Have you experienced these stages? Or witnessed these stages in others?
Research in the field illustrates that one usually goes through developmental stages in the mourning process. To lose someone we love is extremely difficult and often we need to first accept that the loss is real (attending the funeral helps one with this part of the process). We need to allow ourselves to experience the pain of this loss (publicly and/or privately). Usually, we need some time to adjust to the physical environment where the deceased is gone. This might take a long time. Imagine a couple married 50 years, and the difficulties adapting to the absence of the other, on a daily basis. Finally, the fourth “task” requires recognizing that one can withdraw some of the emotional energy for the deceased and begin to slowly reinvest that energy into other relationships… with other surviving children, other friends, perhaps another partner.
In class, we reviewed the 27 do’s and don’ts of death notification as compiled by MADD. Some of these are:
- Always notify in person, don’t call. Do not take any possessions of the victim to the notification. If there is absolutely no alternative to a phonecall, then you must first arrange for a professional, neighbour, or a friend to be with the next of kin when the call comes.
- Take someone with you.
- Talk about your reactions to the death with your partner before the notification to enable you to better focus on the family when you arrive.
- Present your credentials and ask to come in. Sit down and ask them to sit down. Be sure you have the nearest next of kin (do not notify siblings before notifying parents or spouse). Never notify a child. Never use a child as a translator.
- Use the victim’s name… “Are you the parents of ___________?”
- Inform simply and directly with warmth and compassion.
- Don’t use words like “expired” or “passed away” or “we’ve lost ___”.
- Sample script: “I’m afraid I have some very bad news for you. Name has been involved in __________ and he/she has died”. (Pause briefly to allow them to digest this). “I am so sorry.” Adding your condolence is very important because it expresses feelings rather than just the facts, and invites them to express their own.
- Continue to use the words dead or died through ongoing conversation. Continue to use the victim’s name, not “body” or “the deceased”.
- Don’t blame the victim regardless of what you may know. It’s not the place nor time.
- Don’t discount feelings. Intense reactions are normal: fight, flight, freezing.
- Answer all questions honestly. Do not give more details than asked for.
- When a child is killed and one parent is home, notify that parent, then offer to take them to notify the other parent.
- Don’t speak to the media without the family’s permission.
- Don’t leave a survivor alone. Be prepared to wait for someone else to arrive to support them before you leave.
- Call or visit again the next day. They will probably have more questions the second day than they did initially.
- Let the survivors know you care. Attend the funeral if you can. The best first responders are those who are willing to share the pain of the loss.
- Debrief your personal reactions with qualified disaster mental health personnel on a frequent and regular basis. Don’t try to carry the emotional pain by yourself, and don’t let your emotions and the stress you naturally experience in empathizing with the bereaved build into a problem for you.
We also explored some common misconceptions regarding AIDS and it’s impact upon policing. AIDS is a virus that invades the body, disrupting the immune system so that it can’t protect itself, especially against deadly infections. It is life-threatening, and most die within 6 months to 2 years after the AIDS diagnosis (not the HIV diagnosis).
AIDS is not primarily a homosexual issue… in fact, homosexual transmissions of AIDS are down, and heterosexual, mum-to-infant, and IV-drug user transmissions are all up. In Africa, it is the 25-40 year old group of heterosexuals that are the most severely affected with AIDS. There is a 100% chance of spreading AIDS with needle sharing. BUT, AIDS is NOT spread by kissing, touching, sharing utensils or water bottles. The concentration in saliva is too small to be spread this way. It is not spread through the air like flu viruses. AIDS is spread solely through exchange of bodily fluids, primarily semen and blood.
Substance Abuse (drug abuse crises, models of addiction, dynamics of alcoholics & those involved with alcoholics, other drugs)
The Crisis of Addiction and the impact in policing
Defining substance abuse (a maladaptive pattern of use, impairment, distress, and demonstration of 3+ of the following over 12 months: tolerance, withdrawl, larger amounts/longer time period, desire to cut down, time spent in using, obtaining, & recovering; social, occupational activities given up, continued use despite knowledge of damage).
4 main types of drug abuse crises: Medical, Legal, Psychological, Spiritual
The key models of addiction (from the behaviour learning model to the sociocultural model)
The dynamics of the alcoholic: issues, common emotions, defense mechanisms, impact upon self and family members.
The “co-dependent”; ACOA (adult children of alcoholics), the roles kids of alcoholics adopt
Other drug/substance abuse: Cocaine, crack, speed (the amphetamines); LSD; Heroin: Marijuana
Gambling Addictions/Problems… research; Canadian statistics.
PTSD (what it is, causes, symptoms, officer vulnerability)
POST-TRAUMATIC STRESS DISORDER is experienced by someone who witnessed or was involved in a severely traumatic event (war, rape, fire, car accident) and is currently (months, even years later) not functioning well due to “lack of integrating the trauma and laying it to rest”.
- often described as “psychic trauma revisited”
-1st diagnosed with Vietnam war vets; then rape trauma victims
- definition (criteria for DSM-1V diagnosis) and common symptoms: numbing (of emotions), repressed memory, recurrant or intrusive thoughts, dreams and feelings of the trauma, efforts to avoid “triggers”, insomnia, irritability, hypervigilance, increased startle response, sense of foreshortened future, feelings of detachment from others.
- police officers at high risk of developing PTSD due to likelihoond of traumatic events/ critical incidents
examples include: losing a partner in line of duty, having to take a life in line of duty, being violently assaulted, attending occurences where children have been killed, intervening/witnessing a suicide, attending car crashes with severe injury/death.
If an officer is overwhelmed with the stress of the critical incident and does not seek help, ptsd will develop. Serious condition that may lead to personality changes, illness, or even suicide
- severity required to induce PTSD varies from person to person
- PTSD does not always manifest itself immediately
- contributing factors: proximity of the person to the event; close involvement; person’s mental, emotional and physical state; event has special significance; stress management skills; help received after the trauma
- What is in practice today to reduce the likelihood of a police officer experiencing PTSD? CISD (Critical Incidence Stress Debriefing)
CHILD ABUSE
- common signs of PHYSICAL abuse in children (behavioural & physical signs)
How might a child behave if he/she is being physically abused? Some behavioural indicators:
unable to recall how injuries suggestive of abuse occurred
very aggressive/extremely withdrawn
vacant stare
indiscriminately seeks affection
compliant/eager to please
caters to parents needs
models negative behaviour when playing
dresses inappropriately in an attempt to hide injuries
runs away/is afraid to go home
describes incidents of abuser
behaves in a way that provokes punishment
flinches or pulls away if touched unexpectedly
Some physical signs of physical abuse: bruises, welts or lacerations that are unexplained; injuries to parts of body that are not typically injured in play or sports (suspicious locations for injuries are mouth, other parts of face, the backs of legs, the buttocks, soft tissue area like the abdomen). Abusive injuries may also take the shape or pattern of imprints of objects such as belts, cords, etc. Numerous bruises of various colour (indicating different time frame for multiple bruises) might indicate abuse. Unexplained burns: small, circular burns from cigarettes, immersion burns from hot water, rope burns on neck, arms, or legs.
- common signs of SEXUAL abuse in children (behavioural & physical signs)
BEHAVIOURAL signs include: age-inappropriate sexual play with toys; child touches himself sexually at inappropriate times; age-inappropriate sexually explicit drawings; evidence of sexual knowledge beyond that of children of same age; refusal to go home for no apparent reason; fear of being in particular area of house; hints at being sexually abused.
In teens: depression, self-destructive behaviour such as alcohol or drug abuse, aggressive or sexually suggestive behaviour; promiscuity or prostitution; reoccurring references to sexual abuse in school essays; sexually transmitted diseases or pregnancy.
PHYSICAL signs of sexual abuse might include: STD’s, unusual itching or pain in the genital or anal area; blood in urine or stools; bruises, lacerations, redness or swelling in the genital or anal area; torn or bloodied underclothing; pregnancy.
Note that sexual abuse does not always involve physical contact. Many other forms of sexual abuse can be perpetuated on the child. These include: exposing the child to adults engaged in sexual activity, having the child view pornography, having the child undress in front of the abuser, take pictures of the child in various poses, watch the child using the bathroom, having the child touch his/herself sexually. The abuser can be charged with Corruption of a Minor, Criminal Cod, Section 172.
SIGNS OF NEGLECT
- child inappropriately dressed for season; child is extremely dirty; child suffers from very poor dental or medical care; child left with inappropriate caregivers or left unattended for long periods of time excessive to the child’s age; child lacks shelter; child is malnourished; child suffers extreme diaper rash due to lack of proper hygiene.
- behavioural signs might include: slowness in development of speech and motor skills; lack of attachment to parents; overly attached to other adults; exessive demands for affection and attention; poor school performance; illegal use of alcohol and drugs.
Please note that it is much more likely an officer lays charges of physical or sexual abuse than neglect. Charges of neglect are rare. Usually the neglect has to be extreme in order for a conviction.
Spousal Assault (cycle of violence; characteristics; appropriate police intervention)
SPOUSAL ASSAULT
- statistics & myths
- types of abuse
- the cycle of violence ( occurence, reconciliation, honeymoon, tension building)
- characteristics of the abusive spouse
- characteristics of the abused spouse?
- Police Intervention in Spousal Assault … responding officer procedure, do’s and don’ts
- Victim assistance
- Officer Safety
Sexual Assault ( myths and facts; dynamics / characteristics; rape trauma syndrome)
SEXUAL ASSAULT
Rape is about desire –> Rape is about Power
the girl is asking for it
Only bad women are raped/rape is uncommon
fundamental assumptions:
rape is not sex
rape is an uninvited act
rape can happen to anyone
rapists come from every segment of society
incidence of sexual assault is under-reported
almost all perpetrators are men, most survivors are women and children
recovery of survivors is enhanced by the empathic help and understanding of persons close to them
dynamics of rape
personal & psychological factors
the male offender (Williams and Holmes, 1991)
-acts in hostile, aggressive, condescending, domineering manner, even though he may feel weak, inadaquate, dependent
-lacks the skills to make his point in society
-power: control, proves self
-anger: violence more likely
-sadism: extra violence, mutilates or tortures
the female who is assaulted
fears for her life
may respond by exhibiting no emotions
feels humiliated and demeaned
might blame self
may feel hatred towards rapist
immediate and long-term trauma is very possible
may fear police and/or crisis centre
will never be the same (although she may learn how to cope and/or recover)
rape trauma syndrome
stage 1: acute/crisis reaction. 2-6 weeks. emotional pain, physical pain. sleep disturbances are common, sense of vulnerability at night. eating disturbances, nausea, hysteria, fear . anxiety, humiliation, guilt, anger, acute sense of vulnerability. previous coping styles will influence response
stage 2: reorganisation. begins to realise she’ll get through it, may tell herself she needs to get back to the real world, may lead to minimalisation or denial of the rape; if there is no professional help, she may stay stuck here. is functioning, but at lower levels. mood swings, depression, psychosomatic illnesses, substance abuse, phobias, failed relationships, sexual dysfunctions, suicide attempts, revictimisations
stage 3: reintergration. moves from being a victim to a survivor. intergrates what has happened to her. may emerge stronger, more assertive,, more aware of her self-worth and increased self-esteem.
Elder Abuse (types, signs, reasons, appropriate police intervention)
Elder Abuse
Violence or mistreatment by someone on whom the elderly person is dependent, e.g.:
Isolation
Beatings
Stealing monies
Usually not reported by victims
Types:
Physical abuse – assault, sexual assault, confinement
Financial abuse- theft or misuse of money, extortion of money or property
Neglect – withholding necessitates of life (food, shelter, clothing, health care)
Mental abuse – humiliation, insults, threats, etc (only threats are criminal offence
Signs of elder abuse
Signs of depression, fear, anxiety, passivity
Unexplained physical injuries
Dehydration or malnutrition
Poor hygiene (possibly bedsores)
Effects of overmedication
Missing property
Missed medical or social appointments
Note: many of these signs may not be abuse. Also, possibility of self-neglect
Reasons for elder abuse
Elder abuse can be inflicted by family, professional caregivers, institutions, etc.
Stress is often a cause, complicated by financial dependence, mental impairment
May feel sandwiched
Cycle of violence continuation
Vulnerability of elderly makes them an easy target for those who are stressed, emotionally disturbed, greedy, controlling, addicted, etc
Police intervention
Meet needs of victim yet investigate thoroughly
Victim may be reluctant to provide info
Officer must not be influenced by ‘alternate care as only solution’; abuse must be stopped
Obtain detailed statement from victim, neighbours, clergy, etc
Possibly consult health records (with victim’s permission)
Note: eyesight/hearing problems, etc
Empathy and kindness critcal to obtain trust, information
Mentail health mayu be impaired by depression, dementia, alzheimers, etc
Suicide risk may be assessed
CISD ( what it is, 7 stages, purpose, why it works)
Ptsd
Severe disabling variation of occupational stress
Estimated 9% of young adult population (U.,S0
No agreement upon treatment of choice
CISD
Developed by Jeffrey Mitchell to prevent ptsd in high risk populations
Method for mitigating harmful effects of work related trauma
Over 400 cisd response teams
Designed for firefighters, police, paramedics
Adopted by military, clergy, business, eap
Cisd tems
Partnership of mental health professionals and emergency workers to prefvent, mitigate, the negative impact of acute stress on selves and others
Mental health oprofessionals with masters degree
Peer support personnel from occuaton
Cisd defined
Process of group meetings./discussions about the traumatic event
Based in crisis intervention theory
Mitigate the psychological impact of trauma, and to prevent ptsd
Early warnings of possible ptsd
Stages of CISD
Introduction
Objectives:
-introduce team, explain process, set expectations
Fact
-describe traumatic event from each participant’s perspective (cognitive level)
Thought
Participants describe cognitive reasons and transition to emotional reactions
Reaction
Identify the most traumatic aspect of the event; emotional reactions
Symptom
Identify personal symptoms of distress and transition back to cognitive level
Teaching
Educate as to normal reactions; adaptive coping mechanisms; provide cognitive anchor
Reentry
Clarify ambiguities and prepare for termination
Debriefing is educational/psychological, but is not psychotherapy
Structured group meeting to discuss thoughts and emotions about distressing event in a controlled environment
Defusing is into, explanation, information, no more than an hour, much more flexible
Why does CISD work?
1) early intervention
before memories concretise or distort
2) Opportunity allows for catharsis
ventilate emotions
reduce stress, improve immune functioning
3) Opportunity to verbalise trauma
verbally reconstruct – fears, regrets, etc
4) Structure
very definite beginning and end, superimposed over chaos
5) Group support
group education/healing
exchange ideas, normalise, modelling
help self by helping others
hope generated
6) Peer support
value of peers as support models (especially when group views itself as ‘unique’)
7) Allows for follow-up
identify individuals who need/seek more help
Test structure
Death and dying; AIDS
2t/f
5m/c
0sa
Kubler-Ross 5 stages of dying
Addictions
1 t/f
6 m/c
1sa
PTSD
1t/f
1m/c
0sa
Spousal assault
7t/f
4m/c
1sa
Sexual assault
4t/f
7m/c
1sa
Child abuse
3t/f
0m/c
1sa
Elder abuse
1t/f
0m/c
1sa
CISD
1t/f
2m/c
2sa
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