Effects of three different approaches to crisis intervention training with pre-service teachers

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Effects of three different approaches to crisis intervention training with pre-service teachers
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by Kara Elizabeth Alker.
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EFFECT OF THREE DIFFERENT APPROACHES TO
CRISIS-INTERVENTION TRAINING WITH PRE-SERVICE TEACHERS













By

KARA ELIZABETH ALKER


A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE
UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE DEGREE OF























To my parents, Richard and Nancy Alker,
with all my love and admiration














ACKNOWLDGEMENTS

I would like to thank my dissertation chair, Dr. Nancy Waldron, for allowing me


to pursue a topic of personal interest.


I would like to thank my whole committee


(including Dr.


Waldron, Dr.


Wayne Griffin, Dr. Marshall Knudson, Dr. David Miller, and


Dr. Tina Smith-Bonahue) for their guidance, support, and patience through this process.

I owe a great debt of gratitude to the staff and volunteers of the Alachua County Crisis

Center for the inspiration, training, and participation necessary to find and study my

passion.

I give my parents, Richard and Nancy Alker, my most heartfelt thanks for


believing I could accomplish anything I desired.


them for encouragement.


I have never had to look further than


I also thank my sister, Leah Adams, and my brother, Richard


Alker.


All my fears and anxieties have been weaker than their support.


There is nothing


greater than family.

For the encouragement, the wine, and the cheers I thank the most extraordinary

circle of friends: Shelly and Jonathan Cardi, Christie Vamadoe, Patty Xirau-Probert, Jim


Probert, Susie Farnsworth, Andrea Kramer, Crista Shivers, and Jessica Hoida.


They


taught me what it means to stick with something regardless of the hurdles.

Finally, my loving and devoted husband, Randy Penfield; and my sweet son,










TABLE OF CONTENTS

page

ACKNOWLEDGMENTS..... ... .. .. ...... .................................................... .. aiii

TABLE OF CONTENTS........................ ............c..............b....a....... ........... ...iv


LIST OF TABLES.. ....... ............ .. .. ...... c........... ............... ........... ..... v.ii



CHABSTRACT.........................................................................................v
CHAPTER


INTRODUCTION AND RATIONALE FOR STUDY ..........e...... .................1


LITERATURE REVIEW


... .. . .. .. .. .. ...* ... 9 ... .. ........ ... ... ... ... ........4


The Work of Eric Lindeman .... ....... ... ...... ................................................7
The Work of Gerald Caplan ....................................................................9
Crisis Intervention in the Schools.................. ................................ ........... 12
Theory and Concepts ......................... ........................... ....... ...........13
Recommended Processes ... .. ..... ..... ..... ................. ...................... ..... 15
Program Evaluation........................................................................ 18
The Role of Teachers ...... ..... . ....................... ...... ....... ....................22
Crisis Intervention Training in the Schools ..... ...................................26
Measuring Effectiveness of Crisis Responders.......................... .... ...............30
A ttitude........ ....... ... a... ........................ ...... ..... .......................... ...31
Em pathy .....................................................................................31
Transfer of Knowledge and Skills....... ................................................31
Research Question and Hypotheses..........................................................32
TJranjsfaer of KQniovwledge and Sk ills . . . * . . . . . . . . 3 1
1Rese atchQ Iu estion anid IHIypotheses . . . a a a . . . . . . . * 9.3 2


METHODOLOGY


. .. .. . . . .. ... ... .. .. .. ... .c. .. .t. .. .*3 5


.. ........... ......35


Participants .... ......... ...... ..... ......
Procedure ........ .......... .... ..........
Training Program . . . . ....
Crisis Intervention Theory........
Personalizing Crisis.................
Paraphrasing vs. Other Modes of


Response


Naming Taboo Subjects.......................


*** **~*~** c a C Sacetecb ~ .35
S . . . c. ...... . .. .** . *.. .38
a . a .... c ..a .a.. 39
..... ........... ........ ....................39
.. ......a...................................39
....................................... ......40
. ......... ...................... ............40


- a At









A nalysis............. ................ ... ...... .............. ............... ........................54


Research Question 1
Research Question 2
Research Question 3


... .. .. .C* .. C. .. .. ... ... .. .. .. .. .. .... .. ... .... .. ... 57

.. ... .. .. . ,.... .. ,. .. .....,....... ...........o ... 0.. ... .59


Summary and Conclusions


Connections to Existing Literature
Conclusions........C........ ..........


Limitations of the Study


....61


CC CCSCaCSC*CCC C CCC C S.69


Future Research..


...C .. C........... 0... .. ......... ... .. ........... 7 1


APPENDIX

A TRAINING MATERIALS-READING GROUP.. .... ...... .... .........................75

B TRAINING MATERIALS-LECTURE GROUP......................................... CC90

C TRAINING MATERIALS-INTERACTIVE GROUP.... ......... ....................1 03
D PARTICIPANT CONSENT FORM ....................................................... 116


E TEACHERS' PERCEIVED SELF-EFFICACY RELATED TO
ADOLESCENT SUICIDE QUESTIONNAIRE, ADAPTED ..................... 118

F ITEM TOTAL CORRELATIONS FOR PILOT DATA-MEASURING
ATTITUDE USING TEACHERS' PERCEIVED SELF-EFFICACY
RELATED TO ADOLESCENT SUICIDE QUESTIONNAIRE, ADAPTED...120

G ITEM TOTAL CORRELATIONS FOR FINAL DATA-MEASURING
ATTITUDE USING TEACHERS' PERCEIVED SELF-EFFICACY
RELATED TO ADOLESCENT SUICIDE QUESTIONNAIRE, ADAPTED... 121


REALTIONSHIP INVENTORY


... ... ............. ...... ..................... .............122


ITEM TOTAL CORRELATIONS FOR PILOT DATA-MEASURING
EMPATHY USING RELATIONSHIP INVENVORY...................... ............ 124


DISCUS SION ................... ................... ........~~ .................








L ITEM TOTAL CORRELTATIONS FOR PILOT 1-MEASURING
TRANSFER OF KNOWLEDGE AND SKILLS USING THE APPLIED
KNOWLEDGE OF CRISIS SKILLS SCALE . . . . . . . . . 1 30

M ITEM TOTAL CORRELATIONS FOR PILOT 2-MEASURING
TRANSFER OF KNOWELDGE AND SKILLS USING THE APPLIED
KNOWLEDGE OF CRISIS SKILLS SCALE...................... ..... ............ 131

N ITEM TOTAL CORRELATIONS FOR FINAL DATA-MEASUREING
TRANSFER OF KNOWELDGE AND SKILLS USING THE APPLIED
KNOWLEDGE OF CRISIS SKILLS SCALE . . . . . . . . . 132

O DEMOGRAPHIC QUESTIONNAIRE....................................................133

RE FERE N CES ................................. ........................... .......... ..... ......... 134


BIOGRAPHICAL SKETCH


.......................... ...................... ...........139















LIST OF TABLES


Table


page


Description of the Three Treatment Groups Used in the Study

Comparison of Attitude as Defined for the Present Study and


..................37


Self-Efficacy as Defined by Bandura


Changes Made to the TPSE from the Original to Adapted Form

Descriptive Statistics Attitude Scale (TPSE-A) .................


Descriptive Statistics

Descriptive Statistics


- Empathy Scale (RI)


Transfer of Knowledge and Skill (AKCS)


................45


a..... too *m*


Pairwise Comparisons


Transfer of Knowledge and Skill Scale (AKCS) ......61


Item Total Correlations for Pilot Data


- Measuring Attitude Using Teachers'


Perceived Self-Efficacy Related to Adolescent Suicide Questionnaire,


Adapted ............................

Item Total Correlations for Final Data


- Measuring Attitude Using Teachers'


Perceived Self-Efficacy Related to Adolescent Suicide Questionnaire,


Adapted ...... .....


............121


Item Total Correlations for Pilot Data


Inventory ..........


Item Total Correlations for Final Data


Inventory


Item Total Correlations for Pilot Data


- Measuring Empathy Using Relationship
..... ............... ...... a ... ................ 124


- Measuring Empathy Using Relationship
................ .. ............ .............*.m.a...... 125


- Measuring Transfer of Knowledge and


Skills Using Applied Knowledge of Crisis Skills........


..130


..............60


..59


.43














Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy

EFFECTS OF THREE DIFFERENT APPROACHES TO
CRISIS INTERVENTION TRAINING WITH PRE-SERVICE TEACHERS

By

Kara Elizabeth Alker


August 2004

Chair: Nancy Waldron
Major Department: Educational Psychology

In recent history, schools have acquired the responsibility for providing emotional


support to students in crisis.


Teachers are in a prefect position to provide this support,


because they have established relationships and constant contact with their students.

However, they require training to develop the necessary knowledge, skills, and

self-confidence to support students and identify those in need of further intervention.

Our study considered three different educational formats to guide pre-service

teacher training in providing emotional support to students in crisis: individual reading,


lecture-based presentation, and interactive workshop.


The researcher prepared 10


counselors from the Alachua County Crisis Center to provide the training.


We divided


78 students (preparing to teach kindergarten through 12th grade) into three groups based


. ( ar* V i A U t ,


-








attitude toward the provision of emotional support to students in crisis); the Relationship

Inventory (measuring empathy); and Applied Knowledge of Crisis Skills (measuring the

transfer of knowledge and skills).

Three separate one-way analysis of variance (ANOVA) tests were conducted to

determine the effects of the three training programs on attitude, empathy, and transfer of

knowledge and skills. The null hypothesis associated with each one-way ANOVA was


assessed using a Type I error rate of 0.05.


omega squared.

three groups. A

and skills. Bec;


Estimates of effect size were computed using


Group differences in attitude or empathy were not found among the


significant difference was found in participants' transfer of knowledge


cause a difference was found, three independent-samples t-tests were


conducted to test for between-group differences.


Group differences were found in level


of knowledge and skill between the lecture and interactive groups, but not between the


reading and lecture or reading and interactive groups.


These differences must be


interpreted with caution due to low reliability of the knowledge and skill instrument.

Results of our study do not support using the crisis intervention-training program in the

forms used in our study to increase the attitude, empathy, or transfer of knowledge and

skill in pre-service teachers.













CHAPTER 1
INTRODUCTION AND RATIONALE FOR STUDY

In the early 1970s, in Chowchilla, California, a busload of school children was


kidnapped and buried for 27 hours before they escaped (Terr 1983).


A West Paducah,


Kentucky youth shot into his high school's prayer group, killing three fellow students and


injuring four, in 1997


The deadliest school shooting in American history happened in


Littleton, Colorado, in 1999, when two high school students killed 12 classmates and one


teacher, and took their own lives (Poland & McCormick 1999).


On September 11, 2001


terrorists killed more than 3,000 people in New York City and Washington, D.C., when

airplanes were flown into both towers of the World Trade Center and the United States

Pentagon (Berson & Berson 2002).

These are only a few tragic examples of the many crises witnessed directly (in

their own schools) or indirectly (through television news media coverage) by American

children during my lifetime, and yet the magnitude of this violence sounds like a World


War radiobroadcast.


As a result of these and other horrific events, most schools


developed some form of crisis-intervention program by the early 1990s.


Crisis theory


and research strongly supports providing immediate intervention services, which requires

significant training and development, before the crisis event (Brock et al. 2001, Pitcher &

Poland 1992, Slaikeu 1990).








momentum quickly wanes as the incident fades into memory.


In the event of a future


crisis, a school will retrieve the plan from a file, call rusty team members into action, and


likely become overwhelmed by the situation due to lack of practice.


For this reason,


more effective initial and ongoing training programs must be developed to maximize a


school's


limited time and resources.


School crisis response teams usually include representatives from various areas:

teachers, administrators, community mental health providers, and law enforcement.

Team members usually receive respectable amounts of crisis-intervention training while


remaining school staff members may not be included in the process.


Plans provide clear


roles, establish resources, and map out procedures to be followed in the event of a crisis.

Those school personnel who have received training report feeling prepared to respond to


large-scale crises.


The perceived value of crisis response plans is represented in


countless qualitative accounts written by educators who have experienced crisis


in their


schools (Hanna 1998,


Neuhaus 1990, Paine 1999, Poland et al.


1999).


The next step requires clearly defining the role of teachers before, during, and


after a crisis (Feinberg & Jacob 2002).


Teachers are in the best position to recognize


students in crisis because they have the most direct and consistent contact with the


children (Brock et al.


2001


, Pitcher & Poland 1992, Slaikeu 1990).


This is especially true


after a crisis when the other professionals return to their regular duties.


Poland &


McCormick (1999) suggest teachers should be able to provide necessary crisis-

intervention services for 95% of their students.





3


goal entails determining the most effective approach for training teachers (Brock et al.


2001, Slaikeu 1990).


Our purpose was to investigate the most effective ways to prepare


pre-service teachers to respond and provide emotional support to students in crisis.


study considered three different educational formats to guide pre-service teacher training

in crisis-intervention: individual reading, lecture-based presentation, and interactive

workshop.













CHAPTER


LITERATURE REVIEW

After a nightclub fire that killed 493 people, Eric Lindemann (1944) published an

article documenting his experiences and observations while providing crisis-intervention


services to the survivors and family members of the victims.


Lindemann's


article became


the seminal work in crisis-intervention theory and response in all fields relating to


providing mental health services.


Although the study and practice developed


significantly in the next decades, it wasn't until the 1970s that crisis-intervention began


crossing over into the field of education.


After the kidnapping of a busload of children in


Chowchilla, CA, a school system found itself without the knowledge and skills necessary


to provide support services to the victims.


After


7 hours, all children escaped and were


returned to their families without any form of emotional support in response to their


experiences.


Research conducted 5 years after the incident indicated long-term


psychological effects in all survivors of the kidnapping (Brock et al.


Pitcher &


Poland 1992).

Since the incident in Chowchilla, various factors have motivated school systems

to develop some form of crisis response plan: (a) an increase in violence in the schools,


(b) children's


exposure to large-scale national tragedies, (c) an increase in services that


schools are legally obliged to provide to students, (d) a change in the role that school
I 1. A A** 6 1 a I t' r*4 1








Specifically, our nation's


children were exposed to 61,700 incidents of serious violence


within their school environment (Department of Education 2003).


School shootings,


kidnapping, suicide of teachers and peers, sexual assault, and natural disasters are only a

few examples of the magnitude of trauma that children in our nation have experienced at


school (Brock et al.


2001


, Slaikeu 1990).


Beyond direct personal experience, children in


recent history have been exposed to large-scale national disasters such as the Oklahoma

City bombing on April 19, 1995; and the terrorist attacks in New York City and


Washington, D.C.,


on September 11


2001


These acts of violence threatened the sense


of safety and security of children across the nation and the world (Berson & Berson

2002).

Although the courts have generally supported the good-faith efforts of schools to

provide a safe learning environment for their students, numerous court cases have been


brought against school systems after crises (Feinberg & Jacob 2002).


Schools are not


likely to be held liable as long as they provide substantive intervention services.


ensure protection from violence and legal action, schools are encouraged to implement


crisis prevention and response procedures.


For example, the intervention component of a


safe school plan should include written procedures to be followed in case of suspected

violence, job descriptions of school personnel should include possible roles in crisis-

intervention, those who are expected to play significant roles in the intervention process

should be provided with verifiable training, and crisis response plans should be

coordinated with local law enforcement (Feinberg & Jacob 2002).








because they have the most consistent and direct contact with students.


Although not


explicitly trained to provide emotional support, teachers must interact with students


before the arrival and after the departure of mental health professionals.


After the


terrorist attacks of September 11


2001


, teachers were encouraged to support students'


emotional reactions, respond to questions regarding a great breadth of issues (e.g.,


safety,


terrorism, racial differences), and alter their lessons to address student concerns while

continuing to teach required curriculum (Berson & Berson 2002).

As media technology becomes more sophisticated, our society is exposed to

greater detail, and more realistic images, related to all topics covered in the news.

Improvements in the level of media coverage have presented benefits as well as


disadvantages.


For example, images historically available only in written (e.g.,


newsprint) or spoken (e.g.,


radio broadcast) form are now vividly projected into our


homes (e.g.,


live footage of the World Trade Center terrorist attacks).


These images can


be particularly harmful because visual images have a greater impact on children than


other forms of information.


It is difficult to filter out all such images from our children's


view; therefore they are forced to deal with the reality of extreme pain experienced by


strangers thousands of miles away (Thornburg 2002,


Maeroff 2000).


Presently, there is a critical need for crisis prevention and intervention programs

in our schools. As programs continue to develop, school personnel must be prepared to


provide these services to students.


The progression of the theory and practice of crisis-


intervention today can be traced back to the early 1940s and the foundational work of two





7


intervention programs present in community agencies and schools today requires

comprehension of this seminal body of work.

A review of the development of school crisis-intervention programs over the last

30 years also is relevant to understanding the role educators are expected to play in


response to crises.


Efforts must be made to prepare teachers to willingly and effectively


support children's emotional needs.


Fortunately, several training methods have been


developed to prepare people to provide emotional support.


Some approaches simply


distribute crisis-response documents, and present lectures on crisis-intervention.


Others


use a more interactive training format, including short lectures, activities, and crisis

response simulations.

This chapter reviews the earliest work in crisis-intervention relevant to preparing

teachers to respond to crisis, discuss the development of crisis-intervention programs in

the schools, and discussed of different approaches to crisis-intervention training.

The Work of Eric Lindemann


In the early 1940s, a fire at the Coconut Grove nightclub killed 493 people,


leaving survivors, family, and friends in various states and stages of crisis.


Lindemann


(1944) provided psychological assistance to those left to grieve, and noted the common

characteristics and stages in the recovery process. He documented his observations, and

summarized findings on human reaction to loss, which became the "fundamentals of

'crisis theory' as a conceptual framework for preventive psychiatry" (Caplan, 1964, p.


10). He noted five main characteristics of grief: (a) somatic distress (e.g., disruption of





8

Lindemann (1944, page 143) said people commonly avoid the intense pain caused

by the loss of a loved one, and most people who effectively grieve do so with much

effort:


The duration of a grief reaction seems to depend upon the success with
which a person does the grief work, namely, emancipation from the
bondage to the deceased, readjustment to the environment in which the


deceased is missing, and the formation of new relationships.


One of the


big obstacles to this work seems to be the fact that many patients try to
avoid the intense distress connected with the grief experience and to avoid
the expression of emotion necessary for it. (p. 143)

Lindemann (1944) acknowledged the role and value of religion in an individual's


grieving process.


Many grieving people find comfort in their relationship with a church.


Although the belief that the loss has served a divine purpose, and that the survivor and

the deceased will have the opportunity to resolve any conflict when they meet again is


helpful, spiritual comfort will not itself suffice.


To return to a state similar to a pre-crisis


state, grieving clients must actively participate in all of the stages of grieving while in


therapy.


Grieving persons must (a) accept the pain of bereavement; (b) review the


relationship shared with the deceased; (c) consider the future as it will be without the

deceased; (d) work through intense emotions that may feel abnormal or insane;

(e) express the intense sorrow related to the loss in various ways, one of which must be

verbal; (f) reformulate the relationship with the deceased; and (g) rely on those around

them (i.e., significant others) for help in acquiring new patterns of conduct for their lives

(Lindemann 1944).

During therapy sessions, the grieving client may direct anger toward the therapist.






9


social worker, minister, family member) to help out in this situation by encouraging the


client to continue with therapy.


He found that when clients became willing to face their


grief, although admittedly a difficult task, they experienced "rapid relief from stress."


therapy progressed, clients became more animated in their discussion of the deceased and


were able to begin facing the changes necessary in the future.


Contrary to common


observations by psychiatrists, Lindemann found that in response to most grief situations

that were not somehow distorted, clients progressed to a more settled state within 4 to 6
4


weeks of therapy.


Lindemann's


(1944) work in personal crisis led him to establish the


Wellesley Human Relations Center where he began working with another psychologist,

Gerald Caplan (Pitcher & Poland 1992).

The Work of Gerald Caolan


Straying from Lindemann'


view of crisis as a personal, unpredictable situation,


Gerald Caplan viewed crisis from a developmental perspective.


crisis on Erikson's


Basing his theory of


theories of lifespan development, Caplan believed crises were


predictable developmental "tasks"


that occurred at certain stages in life (Pitcher & Poland


1992).

In his book, Principles of Preventive Psychiatry, Caplan (1964) theorized that

personal crises result when an individual has difficulty moving from one stage of life to


the next.


A crisis occurs when an individual's


difficulty dealing with a problem is


compounded by the level of importance assigned to the problem.


in this state, an individual's


Caplan explained that,


normal approaches to problem solving no longer work.





10


Tension during this phase will rise to either one single peak or rise and fall in


several smaller peaks.


situation.


Effects of tension depend on the duration and intensity of a


Caplan (1964) identified four phases in the rise of tension:


Phase 1 during the initial rise in tension an individual will attempt to use normal
approaches to problem solving.

Phase 2 when unsuccessful at solving problems, tension will rise to a level that
causes a loss of usual functioning.


Phase 3


- a further rise in tension causes an individual to use extra energy, external


resources, and try less common or novel approaches to problem solving.


If the


problem is solved at this point, an individual may feel stronger and capable of
readapting to life.


Phase 4


- if the problem is unsolvable or unavoidable, the tension will increase to a


point of significant dysfunction.


High levels of dysfunction, according to Caplan, can lead to mental illness.


His theory


redirected the field of mental health toward a preventive rather than reactive approach to

crisis-intervention (Caplan 1964).

Caplan's belief (that crises are developmental in nature) suggests that the stages


of crises are predictable.


Therefore, clinicians should prepare individuals for the


upcoming crisis and, it is hoped, avoid mental illness (Caplan 1964).


For this reason,


primary prevention is a significant part of Caplan's theory (Pitcher & Poland 1992).

preventive crisis-intervention, mental health professionals work with community

members from related fields to identify, assist, and refer those who are faced with an


approaching crisis (and potential mental illness).


Caplan (1964) called on the


participation of community professionals such as school counselors, teachers, nurses, and








This was the beginning of community psychology, and the foundation for what has

become the school psychologist's role in crisis-intervention (Pitcher & Poland 1992).


Mental Health Consultation involves a three-part approach.


Primary care, or


prevention, focuses on reducing the incidence of crises. Secondary care (or intervention)

involves providing assistance to individuals while in crisis. The purpose of tertiary care


(sometimes called postvention) is to reduce the long-term effects of the crisis on the


individual and significant others, such as family members and friends.


Primary


prevention involves identifying individuals who may be in danger of crisis (and thus


mental illness).


Community and mental health professionals also work to determine


groups at risk for specific crises, based on such characteristics as gender, race, religion,


and socio-economic status (Caplan 1964).


Programs then are developed to prevent the


crises from occurring, by having the prevention message delivered by a community

member (e.g., a male role-model from the inner-city encouraging avoidance of gang


membership).


illness.


Secondary prevention focuses on reducing the number of cases of mental


Early identification would be made possible by an effective referral process, and


by reducing the barriers between public and mental health professionals.


Another key


point in secondary prevention is the use of effective treatment intervention through


setting and striving for attainable goals.


Tertiary prevention aims to reduce negative


effects of the mental disorder once an individual has recovered from the crisis.


Attention


is placed on an individual return to a social and professional state of functioning more

similar to the pre-crisis state.








rely on or adapt his major concepts" (Hoff 1998, p. 11).


weakness does exist as viewed by the field today


However, one significant


Caplan approached crisis-intervention


theory from a medical model, and considered an individual suffering from acute crisis as


mentally ill.


Today, the tendency is to focus on the individual, the environment, and the


specifics of the situation; and to consider the crisis a phase of life, requiring help from


others.


Examination of how school-based crisis-intervention programs are developed


illustrates this point.


Crisis-intervention in the Schools


While crisis-intervention programs were originally developed in community-

based settings such as mental health centers, the need to extend services to school settings


has been evident for the past 30 years.


It was both a logical and necessary decision to


begin viewing schools as critical settings for crisis prevention and intervention programs.


In fact, Peterson and Straub (as cited in Poland 1994) stated that schools


have a legal


obligation to develop plans to prevent and manage crises.

In the early 1970s, the city of Chowchilla, California was faced with one of the


first school crises to gain national attention.


A review of the incident and the response of


the school system was compiled by Terr (as cited in Brock et al. 2001


Pitcher & Poland


1992).


A busload of school children was kidnapped and buried for 27 hours.


After their


escape from the kidnappers, the children were not offered any form of crisis-intervention


from the school or the community.


Five years after the incident, 100% of the children


involved in the kidnapping had clinical symptoms of depression, fear, or anxiety.








intervention programs needed to become part of the school itself.


Then, instead of being


dependent on mental health professionals who are unknown to the students, school

personnel could provide critical support.

Theory and Concents


Recently, mental health professionals have begun specializing in crisis-


intervention.


Their knowledge has sparked the development of school-based


crisis-intervention programs.


Educators have taken the fundamental points of crisis


theory (Lindemann 1944, Caplan 1964) and adapted them to work effectively in the


school setting.


For example, today crisis-interventionists from the fields of mental health


and education agree that the term "crisis" is relative.


varies by model,


The term is difficult to define, as it


but three points seem consistent (Pitcher & Poland 1992): (a) the


perception of the individual defines a crisis; (b) the individual in crisis has a very difficult

time negotiating life while in this crisis state; and (c) the crisis state is not seen, in itself,


as psychopathology (nor is it chronic).


Gerald Caplan's


One point that has held constant over 35 years is


(1964) explanation that emotional crisis is a state of "psychological


disequilibrium" where the situation is not resolvable through usual methods.

Crises can come in many forms (including but not limited to suicide, death of a

student or teacher by natural causes, murder, sexual assault, auto accidents, natural

disasters, gang warfare, kidnapping, terrorist attacks in and outside the school, and


national emergencies).


Other forms of crisis that are not as apparent, but equally as real


to the individual, are divorce of parents, moving away from friends or family, separation





14


Whether a crisis is as apparent as a school shooting, or as personal as the divorce

of parents, one model of crisis-intervention has been embraced by many prominent

school crisis-interventionists (Brock et al. 2001, Sandoval 2001, Pitcher & Poland 1994).

Slaikeu (1990) describes crisis-intervention as a two-step process: psychological first aid


and short-term crisis therapy.


According to Slaikeu, psychological first aid is the


immediate response to a person in crisis, provided by those closest to the event.

support is relatively short-term, lasting between a few minutes and a few hours.


This

Five


steps are designated in psychological first aid: (a) make psychological contact,

(b) examine dimensions of the problem, (c) explore possible solutions, (d) assist in taking

concrete action, and (e) follow-up.

Support beyond psychological first aid is not necessary, for many who experience


a crisis.


Those requiring more significant support should be given short-term crisis


therapy by a mental health professional.


Crisis-intervention is intended to last no longer


than 4 weeks (Everly & Lating 2004, Litz & Gray 2002, National Institute of Mental


Health 2002).


Because of their proximity to the students, school personnel will most


often be in the position to provide psychological first aid and identify those in need of


short-term crisis therapy (Slaikeu 1990).


When a crisis occurs in the school setting,


involving school personnel in these steps is appropriate and necessary to the effectiveness


of the intervention (Brock et al. 2001).


Development of crisis response procedures is an


essential part of preparing schools to provide the best support to their students during a

crisis (Brock et al. 2001, Pitcher & Poland 1994, Slaikeu 1990).








schools to provide the best possible support during a crisis.


By 1990, most schools had


developed crisis response procedures to be followed by school staff (Pitcher & Poland


1992).


Although plans vary, crisis-interventionists in the schools have accepted some


concepts as fundamental (many of which are common to the field of crisis-intervention in

general( (Pitcher & Poland 1992, pp. 28-29).

* Feelings of anxiety and helplessness in response to crisis are considered normal, not
pathological.

* The focus of intervention is on quickly returning an individual to the "pre-crisis"
state.

* Crisis-intervention should be short-term.

* The individual in crisis is discouraged from relying on the crisis-interventionist, as
the goal is to help re-establish autonomy.

* By definition, the problem solving skills of an individual in crisis have been


exhausted.


For this reason, people in crisis are more likely to accept outside help.


Recommended Processes


According to Dunne-Maxim & Underwood (1991), crisis-intervention theory and

practice has evolved into a multidisciplinary approach for providing mental health


services to people in crisis.


Team approaches to crisis-intervention call for a member of


the school administration to serve in the leadership position and orchestrate the processes


of preparation and response (e.g., school psychologists, school counselors).


Other


members of the school crisis response team may include internal members (e.g., teachers,

counselors, administrators) and external members (e.g., clergy, law enforcement, local


mental health professionals).


Today, school leaders use Caplan's


Mental Health





16

Poland 1992). All crisis team members should be familiar with Caplan's model of

mental health consultation (Poland et al. 1999).


Caplan's


(1964) theoretical model of crisis-intervention as primary, secondary,


and tertiary intervention has endured as the foundation for crisis-intervention. Poland et

al. (1999) relied on Caplan's theories as a starting point for their theoretical model of

school crisis-intervention, and they recommend that this model be used in developing


crisis-intervention programs for individual schools.


The primary and secondary


components of intervention enable school systems to take a more proactive approach by

working toward decreasing crises yet to occur (Poland et al. 1999).

Primary prevention programs encourage participation on the part of school

personnel and students, by establishing a zero level of tolerance for preventable crises,


such as violence.


These programs encourage students to report concern regarding violent


acts they hear about from peers.


School personnel must commit to students that, unless it


is a matter of critical importance (e.g., in reporting plans for committing violence), their


identity will be kept confidential.


Schools need to create an environment where students


feel more secure and empowered to make a difference (Poland et al. 1999).

It is important for school staff to do a needs assessment before developing a

crisis-intervention plan, and also on a continual-improvement basis (Brock et al. 2001).

This needs assessment has definite roots in earlier theoretical works, such as those


discussed earlier (Caplan 1964).


According to Pitcher & Poland (1992), a school should


consider the following questions in assessing their prevention programs:








What systems of communication are available within and outside of school?

What special training/skills do school staff members have (e.g., first aid, anger
management, restraint training)?

Are there school personnel experienced in communicating with media?

What parental and community resources are available, and how should they be
mobilized in a crisis situation?

When considering a secondary approach to crisis-intervention, a timely response


reduces the long-lasting effects on individuals involved.


Slaikeu (1990) suggests that


teachers offer psychological first aid to all students, and determine students needing crisis


therapy for possible referral to mental health providers within the schools.


Schools


should develop and practice response plans for location-specific crises (e.g., hurricane

response in Florida, earthquake response in California), as well as crises common to

schools in general (e.g., medical emergencies, possession of a gun by a student).

Additional steps are necessary when providing intervention to schools directly

impacted by large-scale crises (e.g., natural disasters, violent attacks on school buildings).

Recommended procedures for crisis-intervention should be followed only after the safety


and security of survivors is established.


Intervention service providers are encouraged to


follow a three-step process: protect, direct, and connect.


Of primary concern in a disaster


situation is protecting survivors from further harm and exposure to traumatic stimuli.

Victims need to be moved to a safe shelter (separated from stimuli they can see, hear,


smell, and taste).


and rest).


Basic needs must be met (including medical attention, food, clothing,


Finally, media and other curious onlookers must be denied access to trauma








control over their environment.


Following the lead of a person who is calm and in


control can be a great relief to a survivor who may be stunned or in shock.


Finally, it is


time for responders to connect with the victims by establishing rapport through the use of


verbal and nonverbal communication skills.


This connection serves to establish a


relationship between people, and may reduce some fears and anxiety of the trauma

victims (Myers 1994, as cited in Young et al. 1999).

During tertiary intervention, schools are encouraged to offer students many


opportunities to express their feelings.


Sandall (as cited in Pitcher & Poland 1992)


suggests that children encouraged to verbalize feelings and concerns regarding an


incident recover more quickly and effectively from a crisis.


For example, giving students


an opportunity to speak with counselors or psychologists, or write letters to deceased

individuals; or participating in art therapy, or bibliotherapy might encourage students to


express themselves.


Developing and implementing school crisis-intervention programs


requires significant support in the form of time and money.


Program evaluation is an


important step in the attempt to ensure long-term commitment from supporters.

Program Evaluation


Crisis-intervention programs are a relatively new addition to the responsibilities


assumed by school systems in the United States.


Despite the pressing need for such


programs at this point, quantitative support for the long-term effects of crisis-intervention


programs is not available (Bates et al. 2002).


This may be a legitimate result of a lack of


school resources to collect data during such demanding times as the aftermath of a crisis.






19


intervention resources will be provided in exchange for the ability to collect data during

and after the process) (Brock et al. 2001).

The literature contains numerous qualitative accounts (i.e., case studies) of school

personnel who (after having the unfortunate opportunity to use a crisis-intervention

program to respond to an actual school crisis) attest to the value of having programs in

place (Lamden et al. 2002, Hanna 1998). Journals in the 1990s published many

crisis-intervention case studies, most falling into one of two categories: (a) articles

describing a crisis experienced in a school; and (b) articles teaching schools about


planning for and responding to crises.


Unfortunately, none of these systematically


evaluated the effectiveness of particular programs, or drew causal relationships between

intervention programs and intervention outcomes (Bates et al. 2002).

Until more systematic research results are available, qualitative accounts provide

insight into children's reaction to crisis, valuable components of existing programs, areas

for improvement based on recommendations appearing in the literature, and possible


structure for future quantitative research (Bates et al. 2002).


For example, the Lower


Camden County Regional School District, in New Jersey, describes the value of their

crisis-intervention model by telling the story of bomb threats in a local high school


(Hanna 1998). Their plan allowed the appropriate people to take on responsibilities,

without confusion. Because of successful communication among students, teachers,


administrators, and law enforcement, the eight students responsible for the threats were


quickly caught, tried, and reprimanded.


Hanna (1998) suggests that this prompt and





20


Paine (1999) recounts the day two students were killed and 22 injured by a


student at Thurston High School in Springfield, Oregon.

student had shot and killed his parents in their home. TI


Earlier that morning, the same


xe school crisis team, school


psychologists and counselors, volunteer counselors, and district and city personnel

provided intervention services according to the Springfield Public Schools


crisis-intervention plan.


Adhering to the building level crisis response plan, students and


teachers supplied immediate medical support until emergency personnel arrived.

Remaining students and staff were in classrooms following lock-down procedures


awaiting the signal designating it was safe to move around the building.


personnel set up "command central"


public and media.


District and city


and responded to questions and concerns from the


Based on an annual contract among neighboring districts,


psychologists and counselors from various public school districts and private mental


health centers provided intervention and counseling support services.


Prior to the return


to school, students and parents were invited to visit the campus together, supported by


counselors, district and school level administrators, and "comfort dogs.


On the first day


back to school, students attended class for half a day before attending a memorial service

for their deceased classmates.

Because the murders were committed three weeks before the end of school,


special steps also were taken when students and staff returned to school in the fall.


example, the cafeteria was painted and brightened to try to minimize reminders of the

trauma, counseling services were provided to all who requested or were referred to them,





21


identified greatly with this statement by Crisis Specialist Marleen Wong of the Los


Angeles Unified School District.


Before May 21


1998, Thurston High School was a


member of the former group, but now will forever pledge a haunting allegiance with the

latter (Paine 1999).

In response to the suicide of a student in a small rural school district, Neuhaus


(1990) was selected as one member of a 15-person crisis-intervention team.


was forced to develop a crisis

not have one in place. Upon c


The team


response plan from ground level because the district did


completion of this initial preparation, a student was injured


in a serious car accident.


The improvement in the district's


response (compared to the


aforementioned suicide) was apparent to teachers, administrators, and parents.


author stated this experience alone justified the time and money that must be committed


to developing a crisis-intervention model for our country'


schools (Neuhaus 1990).


Most agree the addition of intervention programs to the culture of American


schools is a valuable and necessary step.


Although agencies that assume responsibility


for providing crisis-intervention in a community and roles of particular players have

changed, much of the core of early crisis-intervention theory seems to remain untouched.

Researchers and theorists taking an active role in crisis-intervention today (e.g., Brock et


al. 2001


, Sandoval 2002, Slaikeu 1990) continue to build upon the earliest works in


crisis-intervention (Brock et al.


2001).


In fact, the foundation of crisis-intervention in the


schools today is made up of the theory and practice of Lindemann (1944) and Caplan

(1964) and the requirements and limitations set out by the American education system.








nature.


For example, Lindemann (1944) described the importance of giving an individual


in crisis the opportunity to express the intense sorrow related to their loss in various


ways.


Teachers now are encouraged to provide children in crisis with a variety of


opportunities for creative expression including: bibliotherapy, art therapy, and in class

discussion (Pitcher & Poland 1992).

The Role of Teachers


Although the provision of emotional support to students in crisis may not be an

explicit job responsibility for teachers, it has become implicit in American schools.


Teachers play a role in every crisis experienced by their students.


Whether the crisis is


on a large or small scale, our schools assume the responsibility of caring for students'


emotional and safety needs on a daily basis.


Teachers establish relationships with


students; understand a student's normal personality, behavior, and performance; and in

many cases, second only to parents, have the most consistent contact with students.

Development of successful crisis-intervention models relies on the consistent


involvement of teachers (Lamden et al. 2001).


The essential nature of a teacher's role in


crisis-intervention in schools becomes apparent when considering crisis theory as set out


by Lindemann (1944) and Caplan (1964).


According to Lindemann (1944), crisis-


intervention involved providing four to six weeks of crisis therapy in which the victim


was actively involved in facing intense levels of pain.


Today, it is recommended that


crisis-intervention and therapy occur within four weeks of the crisis (Everly & Lating


2004, National Institute of Mental Health 2002).


Unfortunately, most professionals








continuous contact with the students.


However, teachers continue to have contact with


students throughout the school year and, when prepared, may play a more critical role in

providing emotional support and eventually returning students to pre-crisis states.


Secondary intervention is provided during a crisis situation.


In a school system,


teachers, administrators, school counselors, and school psychologists familiar with the


students often provide immediate care.


than a week.


This period of intervention usually lasts no longer


Students are allowed to express their feelings, participate in memorial


services, and take an active role in putting the pieces back together. Teachers are

encouraged to openly discuss their own reactions with their students. It is important that


teachers give students permission to express a wide range of emotions (e.g., nervous

laughter, indifference, anger) in reaction to a crisis (Poland & McCormick 1999).

In the event of a crisis, teachers are with students before mental health


professionals arrive and after they leave.


Teachers are in the best situation to provide


emotional support because they often have the most direct contact with students during


all stages of crisis response.


Poland and McCormick (1999) estimate teachers will be


able to help 95% of their students after a crisis.


Therefore, the responsibility for


providing emotional support and identifying those at risk for experiencing long-term

negative effects of the crisis (the remaining 5%) is often placed on individual teachers.

By understanding the theory of crisis-intervention and developing crisis-intervention

skills, teachers can feel more confident in the role they assume before, during, and after a

crisis event (Brock et al. 2001, Slaikeu 1990).





24


subject (e.g., suicide, sexual assault, divorce) as soon as it becomes apparent, and

remaining nonjudgmental (Alachua County Crisis Center Training Manual 2001).


Providing psychological first aid can decrease an individual's

rapport between the teacher and student (Slaikeu 1990). Teac


consistent, direct contact with students.


anxiety level and develop


:hers have the most


This provides teachers a great opportunity to


provide emotional support by observing signs of crisis (i.e., changes in behavior, mood,

school performance), using pre-established rapport to speak with the student about their

problems, and naming taboo subjects.


Following the terrorist attacks on the United Stated on September 11,


2001,


teachers in classrooms across the nation were required to provide emotional support to


their students.


Berson and Berson (2002) encouraged teachers to take an active role in


supporting students following large-scale crises by: (a) identifying and talking about


feelings, (b) addressing fears, and (c) developing positive coping skills.


Teachers are in


an ideal position to incorporate these activities into group discussions and lessons (e.g.,


writing, social studies, art).


Several lesson plan programs have been developed to assist


teachers in weaving crisis experiences into their required curriculum (e.g.,


helping young people deal with terrorism and other tragic events).


Facing Fear:


According to Berson


and Berson (2002), teachers must be emotionally available to their students, respond to

student questions, be accepting of the range of emotions, and identify children at risk for


long-term psychological trauma.


Only through training will teachers develop the skills


necessary to facilitate this level of emotional support for their students while managing





25


Taylor et al. (1991a) studied the effects of crisis-intervention training on

elementary and secondary school teachers taking graduate-level education courses.

Training content included identifying life events likely to cause psychological distress in


children and the use of a five-step intervention process.


The five steps included in this


training were (a) establishing rapport, (b) exploring the problem, (c) assisting in the

development of possible solutions, (d) providing guidance for taking action to resolve the


problem, and (e) follow-up with the individual in crisis.


Ten months after the completion


of training a questionnaire was distributed to the treatment group and a control group of


teachers who had not participated in the training.


Questions explored self-perceptions of


ability to identify the need for crisis-intervention services and provide appropriate


intervention support.


Teachers who participated in training reported significantly higher


rates of self-efficacy in both areas when compared to teachers who had not participated.

Unfortunately, all teachers do not receive formal crisis training during pre-service


education.


Nims & Wilson (1998) surveyed 350 administrators from colleges and


universities regarding violence prevention and crisis response training in teacher


preparation programs.


Surveys queried whether their formal (i.e., college and university


curriculum) training programs included these specific topics: conflict resolution, peer

mediation training, crisis response, gang awareness, classroom strategies for disruptive

behaviors, violence de-escalation, and knowledge of search and seizure procedures.


Results indicate little preparation is provided during formal teacher training.


Only 44%


of respondents reported having courses that discuss these topics within their curriculum.





26

Taylor et al. (1991b) examined the extent and type of training provided for


teachers in crisis-intervention and response.


Forty-five percent of teachers ih the study


reported having no crisis-intervention training, while those that received training report it


was not part of their formal education.


In contrast to the limited crisis-intervention


training teachers receive, the majority (71%) reported they are required to recognize


students in need of intervention services.


Beyond recognition, most teachers state it is


their responsibility to report children to the appropriate professional (e.g., school

counselors, school psychologists), while some are required to deliver the crisis-


intervention services themselves.


Teachers who received training reported significantly


higher self-perceptions of ability to recognize and deliver crisis-intervention services than


teachers who had not received training.


Results of this study indicate the need for


training teachers to both recognize students in crisis and deliver intervention services.

Crisis-intervention training in the Schools


Although helpful, years of professional training in topics such as

psychopathology, learning theory, and personality dynamics are not necessary to provide

crisis-intervention services (Brock 2001, Joint Commission on Mental Illness and Health


1961, Pitcher & Poland 1992, Slaikeu 1990).


Leaders and developers of intervention


teams often attend training workshops lasting for several days or weeks (i.e., American


Association of Suicidology, National Organization of Victim Assistance).


These


individuals return to their schools or school districts and distribute information to

intervention team members during meetings or workshops (Brock et al. 2001, Poland &






27


Based on information accumulated in workshops and numerous books written to

assist schools in developing crisis response teams, procedures often are distributed to


school staff members.


Individual documents are assembled for each role in a school


setting (i.e., teachers, principals, counselors) specifying their responsibilities in the event


of crisis.


Further training, if offered to educators who are not part of the school's


crisis


team, may be presented during in-service training.

Individuals in crisis require immediate emotional support (i.e., psychological first


In schools, all personnel (i.e., teachers, administrators, counselors, bus drivers) may


find themselves in a position to provide this support to students, as immediate availability

of mental health professionals cannot be assumed (Brock et al. 2001, Slaikeu 1990).


Because this,


...home-spun emotional first aid is typically delivered without training...


school personnel would benefit from basic training in the emotional support of children

and adolescents in crisis (Pitcher & Poland 1992, p. 5).

The time to train school staff to respond to crisis is not during the crisis, but


during a state of equilibrium.


All educators need to be prepared ahead of time to cope


with their own emotions, emotions of students, and emotions of other staff (Brock et al.

2001).


The more individuals are educated regarding what reactions to expect and what


reactions are normal, and


... what... is expected of them, the more effective


they are likely to be in overriding their own emotional reaction and maintain a
focus on constructive methods to cope. (Pitcher & Poland, 1992, p. 157)

Unfortunately the need for training in crisis-intervention can place added strain on


1 ft I I I I I I


rF .1 111. ~~_f~.. L- .~..~ --..L It-





28


Slaikeu (1990) developed a psychological first aid training program that can be


easily adapted to apply directly to teacher training.


He recommends the 20-hour course


be presented during an all-weekend retreat, a three-day in-service, or in 10 sessions of


Course content is presented through lectures and interactive small-group


activities and divided into two main sections. Module

hours, depending on the group's previous knowledge

emotional support and crisis-intervention. Small grou

symptoms related to a personal experience with crisis.


:one lasts between one and three


and experience in the field of

ps are asked to discuss the range of

Returning to the large group, the


facilitator compiles a list of all symptoms and behaviors on the board. Finally, the group

determines whether the symptoms are affective, behavioral, or somatic. This exercise is


followed by a short lecture presenting the basic history of crisis theory and intervention.


Module two consists of 17 hours, primarily in small-group exercises.


The content is


divided into three main parts: (a) knowledge of the stages of psychological first aid; (b)


development of basic psychological first aid skills (i.e.,


appropriate statements and


questions); (c) and using psychological first aid skills to provide support, reduce lethality


and mobilize resources.


Small-group exercises used to develop knowledge and skills in


module two consist primarily of role-plays created to apply to the trainees'


setting.


specific work


Slaikeu (1990) recommends questions and further training needs be addressed


through supervision, peer conversations, and independent reading.


Brock (in Brock et al.


2001) developed an intensive two-day crisis-intervention


in-service training program for school personnel.


The course is to be presented in two,


hours each.





29


combining lectures and small-group activities and is divided into four main sections (i.e.,


sections one and two are lecture, sections three and four are interactive).

presented for the importance of training all school staff members. Facili


First, a case is


itators discuss the


prevalence of crisis in school settings as well as why people are motivated to participate


in training.


The second section presents relevant information regarding crisis-


intervention theory and practice.


Included in this section is a discussion of factors that


make certain individuals at greater risk for severe emotional reaction to a crisis (e.g.,


personal history, recent loss).


The final two sections focus on development of individual


and group crisis-intervention skills.


Following training, Brock (in Bro

evaluation to determine the level ofpartic

own skills and those of their colleagues.


1. 2001) recommends participant

' knowledge and attitude toward their


The measure of attitude can indicate how well


prepared an individual and group is to provide services for which they have been trained.


Brock recommends use of a questionnaire to survey participants'


attitude.


level of knowledge and


Changes in knowledge and attitude should be determined using either a pre-


test/post-test design with all participants or a post-test only design with participant and


control groups.


Sample questionnaire and evaluation design suggestions were provided


absent of any quantitative or qualitative data supporting the success of this program.

Brock et al. (2001) suggest that on-going training should be provided to as many


members of a school's


staff as possible.


Training should be offered annually to prepare


new staff members, while improving upon the skills of school veterans.


Pairing new and






30


upon significantly by helping to guide someone through an initial training and

development process.

Similar to school systems, training programs for crisis centers in the United States


must present large amounts of information in the most effective ways possible.


Many


crisis centers rely on volunteers to provide crisis-phone counseling services; therefore

time dedicated to adequate training competes with the need for phone support. Centers


often use an approach similar to Slaikeu (1990) and Brock'


(in Brock et al.


2001) to


prepare counselors, which incorporates a combination of short lectures, small group

exercises, and role-plays.


Measuring Effectiveness of Crisis


Resoonders


Even with implementation of school crisis


prevention programs, history has


repeatedly indicated we cannot protect our children from exposure to all crisis situations


(Brock 2001).


Therefore, it is necessary that school staff members be prepared to provide


psychological first aid to students.


Teachers are in a prefect position to provide this


support because they have established relationships and constant contact with their


students.


However they require training to develop the necessary knowledge, skills, and


self-confidence to support students and identify those in need of crisis therapy.


Current


demands placed on teachers in and outside the classroom limit the amount of time


available for training and development.


Programs must be developed to ensure proper


levels of training are provided in the shortest possible amount of time.


As with many


crisis-intervention programs, measuring the effectiveness of training is often reliant on





31

County Crisis Center 2001), and the transfer of knowledge and skills from the learning

environment to real-life situations (e.g., Alachua County Crisis Center 2001, Brock

2001).

Attitude


In the field of psychology, attitude is defined as the perceptual orientation and

response readiness of a person or a group of people in relation to something or someone.

Furthermore, an attitude is a relatively fixed perspective that endures over time, but


which can be altered with experience.


Finally, attitudes are beliefs that are evaluative or


affective in nature (Eysenck et al 1982).

Empathy

In the last one hundred years, empathy has been identified as a significant


component of what makes therapy and counseling work.


The term empathy, originally


coined by Titchner (1909) has assumed various definitions ranging from a personality

trait (Danish & Kagan 1971) on one end of the spectrum to a situation specific cognitive-


affective state (e.g., Barrett-Lennard 1962) on the other.


More recently, research related


to the construct of empathy has begun to decrease, largely due to the fact that researchers

and theorists have not, as a group, agreed to a single definition of empathy (Duan & Hill

1996).

Transfer of Knowledge and Skill


By definition, knowledge is familiarity with the facts related to a particular topic.

Skill is defined as a person's ability to execute a desired task or string of tasks (Webster's








be measured.


Countless theorists, researchers, and practitioners in the fields of education


and cognitive psychology have worked toward effectively defining and assessing our

ability to prepare students to transfer what they have learned in an educational setting to


his or her future as a member of society.


These theories consider whether a person can


effectively apply knowledge and skills accumulated in a learning environment to novel

situations or settings (Bransford & Schwartz 1999).

Research Ouestion and Hvootheses


In the last 30 years, schools have become increasingly aware of the need to


prepare their staff to respond effectively in the event of crisis.


Within their own school


setting children have been directly exposed to crises such as kidnapping (e.g.,

Chowchilla, CA) and numerous school shootings (e.g., Jonesville, AR, Columbine, CO).

The past ten years also have provided unfortunate examples of national disasters that


have caused crisis reactions from students across the country (i.e.,


Oklahoma City


Bombing, the terrorist attacks of September 11


the war in Iraq).


It is impossible to


predict most crises, whether they are on a large (i.e.,


school shooting, suicide of a


student) or small scale (i.e.,


sexual assault, loss of a loved one).


What we can forecast is


the intense emotional reaction exposure to crisis will cause.


Primary (i.e.,


prevention),


secondary (i.e., intervention), and tertiary (i.e.,


post-vention) programs have developed in


schools across the nation in response to the growing need to provide a safe and


supportive environment to students.


As the need for provision of emotional support to


students in crisis becomes more frequent, school personnel must assume a greater





33

Current crisis-intervention programs have grown from the seminal works of


Lindemann (1944) and Caplan (1964).


Schools are encouraged to develop a team to lead


the response in the event of a school crisis including internal (e.g., administrators,

counselors, psychologists, teachers) and external (e.g., law enforcement, clergy, private


mental health providers) members.


The team prepares by reading current literature,


attending conferences and workshops, and participating in crisis-intervention drills


(Brock et al. 2001, Pitcher & Poland 1992).

students before the team arrives and after the


When crises occur, teachers are with their

y leave. Effective intervention requires


immediate psychological first aid for the majority who experience a crisis and referral for


individuals who require more extensive support.


Because of the established relationships


with and proximity to their students, teachers serve a critical role in response (Slaikeu


1990).


Few teacher-training programs provide the necessary preparation to deliver the


required level of emotional support (Taylor et al. 1991 a).


Therefore, it is imperative that


effective programs be created to aid teachers in the development of necessary knowledge,

skills, and self-confidence.

Based on the need for teachers to be trained in providing emotional support,

finding the most effective approach to prepare teachers to provide this support to students


becomes relevant.


This study will investigate whether pre-service teachers report a


difference in attitude, empathy, and transfer of crisis-intervention knowledge and skills

related to the provision of emotional support to students in crisis as a result of different

forms of training: individual reading, lecture, or interactive format.





34

The following null hypotheses were investigated:

* Ho01: There will be no significant difference in attitude toward the provision of
emotional support to students in crisis of pre-service teachers between the groups
receiving training presented in an individual reading, lecture, or interactive format.

* Ho2: There will be no significant difference in level of empathy ofpre-service
teachers between the groups receiving training presented in an individual reading,
lecture, or interactive format.

* Ho3: There will be no significant difference in transfer of crisis-intervention
knowledge and skills of pre-service teachers between the groups receiving training
presented in an individual reading, lecture, or interactive format.














CHAPTER 3
METHODOLOGY

Participants


One hundred seventy-seven students, preparing to teach kindergarten through 12t


grade, participated in our study.


five-year (i.e.,


Each of the 177 participants was enrolled in the


undergraduate plus one year graduate training) pre-service teaching


program (PROTEACH) at the University of Florida.


Participants were recruited by class


enrollment in seven upper-level courses in the University of Florida's


program.


PROTEACH


Participation was voluntary and participant consent was obtained in writing


before the data collection began.


There was no compensation for participation in our


study.

The decision was made to use students from the pre-service training program,

rather than teachers presently working in the schools, to improve the external validity of


our study.


By using these participants, the researcher controlled for years of teaching


experience, prior experience with the provision of emotional support to students in crisis,

and prior participation on school-based crisis-intervention teams.

Procedure


The researcher prepared 10 counselors (i.e.,


crisis phone counselors) from the


Alachua County Crisis Center (ACCC) to provide crisis-intervention training in the seven








treatment groups used in our study.


Counselors also were presented with similarities to


and differences between their roles as crisis phone counselors and the participant's


roles as classroom teachers.


future


Each counselor previously completed the 60-hour ACCC


phone counselor training program and had at least six months experience as a crisis

phone counselor at the ACCC.

Approximately one week after the training session, the trained counselors


conducted the designated crisis-intervention training course in the seven classes.


Within


each selected class, two or more prepared ACCC counselors facilitated a crisis-

intervention training program depending on class size and the specifics of the particular

training format.

Seven intact PROTEACH classes were randomly assigned to each of the three

treatment groups investigated in our study (a) training using an individual reading format,


(b) training using a lecture format, (c) training using an interactive format.


Average class


size was


students and the seven classes ranged in size from


6 to 55 students.


A total


of 63


,59, and


participants were assigned to each the reading, lecture, and interactive


groups, respectively (Table 3-1).

lead by a trained counselor. The


Each class participated in a designated training program


content of the program was consistent across all three


groups, with variations only in the format of presentation.


Content presented included


crisis-intervention theory, personalizing crisis, paraphrasing, and naming taboo subjects.

Participants in the reading group spent 45 minutes reading about crisis-

intervention including a discussion of crisis-intervention theory, personalizing crisis,








Table 3-1.


Description of the Three Treatment Groups Used in the Study


Group


Reading


Lecture


Interactive


Treatment


45 minute individual reading on
crisis-intervention min the schools


45 minute lecture on crisis-
intervention in the schools


45 minute interactive workshop on
crisis-intervention in the schools


Dependent
Variables


Posttest


Posttest


Posttest


Lecture group participants listened to a 45-minute lecture on crisis-intervention

including a discussion of crisis-intervention theory, personalizing crisis, paraphrasing,


and naming taboos (Appendix B).


The lecture involved the counselor speaking to the


group and asking simple questions. Any questions asked by the participants were

answered by the presenting counselor and documented by the assisting counselor.

Allowing questions was appropriate because in a lecture setting, asking questions is


common as listeners find the need for clarification on a topic.


At the end of the lecture,


all participants completed the three post-test instruments.

The interactive group participated in an interactive workshop that involved the


same topics as the reading and lecture groups (Appendix C).


The lead counselor briefly


introduced the training session and provided a 5-minute lecture on crisis-intervention


theory.


Participants then were assigned randomly to smaller groups of equal size not


exceeding 10 participants per group.


The division into smaller sub-groups created a more


interactive learning environment by allowing individuals to participate more frequently








activities were personalizing crisis, paraphrasing, and naming taboos.


concepts (i.e., empathy vs. sympathy


The remaining


paraphrasing vs. other modes of response, and


steps in crisis-intervention) and any questions asked by participants involved discussions


including all group members.


Allowing questions was appropriate because, similar to a


lecture setting, questions are a natural part of the learning process in interactive workshop


settings.


In fact, asking questions in a small, interactive learning environment is usually


less formal than in a lecture format as all participants are encouraged to play a role in the


process.


At the end of the interactive workshop, participants in the interactive group


completed the three post-test instruments.

All participants completed the same three instruments during the post-test phase

of the study Teachers Perceived Self-Efficacy Related to Adolescent Suicide

Questionnaire (TPSE), Relationship Inventory (RI), and Applied Knowledge of Crisis


Skills (AKCS).


The decision to use only post-test measures, rather than pre-test and


post-test measures, was based on the belief that a decrease in time required for


participation would lead to an increase in validity of participant responses.


Since three


treatment groups were involved, effects of training on attitude, empathy, and applied

knowledge of crisis skills was based on between-group differences in post-test responses

rather than within-group differences from pre-test to post-test.

Training Program


The content of the interventions was adapted from the ACCC 60-hour phone


counselor training program.


The four main topics included in the content of the three








reasons.


First, the topics are the foundation upon which the ACCC training is built and


all subsequent training and experience at the ACCC can be categorized under one of


these four major headings.


Second, as discussed in the literature review, these topics are


directly related to crisis-intervention in most settings (i.e


., crisis centers, counseling


centers, schools).

Crisis-intervention Theory


This section provides a detailed outline of the training program used in the study.

The specific content of the three training groups is provided in the appendices (Appendix

A, B, C).

The discussion of crisis-intervention theory can be found in the text of all three


interventions under the headings What is a Crisis,


The Role of Teachers in Crisis-


intervention, Steps in Crisis-intervention, and Empathy Versus Sympathy (Appendix A,


B, and C).


The first subtopic,


What is a Crisis, defines crisis as relative to an individual


and provides examples of large- (i.e.,


apparent) and small-scale (i.e.,


less apparent) crises.


Next, The Role of Teachers in Crisis-intervention, discusses a teacher's responsibilities to


students in school in the event of large- and small-scale crises.


When small-scale crises


occur (e.g., divorce of parents), teachers are often most qualified to identify the need for


emotional support.


The third sub-topic, Steps in Crisis-intervention, presents steps


followed in crisis counseling as they relate to a school's


legal responsibility to students.


Finally, Empathy Versus Sympathy defines the terms, and provides the importance of


using empathy to establish rapport in crisis


response (ACCC 2001).








Personalizing Crisis


The second main topic of the interventions, personalizing crisis, asks an


individual to identify a crisis that they have experienced in their lives.


This helps people


identify key points in crisis response through personal experience, rather than theory.

Members of our society desire to make people feel better, to remove them from their


crisis state.


However, without the opportunity to experience and express intense


emotions elicited during a crisis, an individual will be unable to move beyond the crisis

(ACCC 2001).

Paraphrasing vs. Other Modes of Response


Five main approaches to responding to other people are introduced in this section

(a) giving advice, (b) interpreting, (c) supporting, (d) probing, and (e) paraphrasing.

While the first four approaches are presented for comparison sake only, in-depth


discussion of paraphrasing is provided in the intervention.


In crisis response,


paraphrasing is the most effective at building rapport between two people while


determining whether the listener correctly understands what the speaker is saying.


Three


types of paraphrasing are presented including the paraphrasing of facts, feelings, and

emotional content.

Naming Taboo Subiects


Many crisis topics are not easily discussed in our culture.


Such subjects are


referred to in ACCC training as taboo subjects (e.g., incest, abuse, AIDS).


By identifying


an unnamed topic being alluded to between two people, the listener communicates that





41

effective way to acknowledge the taboo subject a student seems to be hinting at is

through paraphrasing (ACCC 2001).


Instrumentation


The effectiveness of the three intervention approaches (i.e., reading, lecture,

interactive) was assessed using three dependent variables (a) attitude toward provision of

emotional support during crisis, (b) empathy, and (c) transfer of crisis-intervention


knowledge and skills.


Attitude was measured using the Teacher's Perceived


Self-Efficacy Related to Adolescent Suicide Questionnaire (TPSE), and empathy was


measured using the Relationship Inventory (RI).


presented in subsequent sections.


A description of modifications is


Transfer of crisis-intervention knowledge and skills


was measured using the Applied Knowledge of Crisis Skills (AKCS).


The researcher


developed this instrument because a suitable measure was not found in the literature.

Measuring Attitude Usine the TPSE


For the purpose of our study, the definition of attitude will be restricted to the

perspectives ofpre-service teachers on their perceptual orientation and response readiness


in relation to providing emotional support to children in crisis.


Emotional support is


defined as giving permission and encouraging students to express a wide range of


emotions in reaction to crisis.


It is expected that pre-service teacher attitudes are


relatively fixed, but may be altered as a result of participation in training.


attitudes are expected to be evaluative or affective in nature.


study considered (a) pre-service teachers'


Finally,


To measure attitude our


self-perceived ability to provide emotional








could be worthwhile.


These three constructs align closely to Bandura's model of


self-efficacy (Table 3-2), derived from social cognitive theory.

According to Bandura (1977), self-efficacy determines whether a behavior will be

exhibited, how much effort the individual will place on the successful completion of the

behavior, and how long the individual will persist in an effort to complete the behavior.

There are three major components of self-efficacy according to Bandura efficacy


expectations, outcome expectations, and outcome values.


Efficacy expectations are the


beliefs that a person has related to his or her ability to successfully perform a given


behavior.


Stronger efficacy expectations indicate a person is more likely to persevere in


the face of difficulty to successfully perform the task. Outcome expectations are specific

outcomes an individual expects when a behavior is completed. Finally, outcome values


are the worth or significance an individual places on expected outcomes of a given

behavior (Bandura 1977).

King et al. (1999) developed the TPSE to assess teachers' level of self-efficacy


when working with suicidal adolescents (Appendix E).


The TPSE is a 45-item


questionnaire that asks teachers to respond to questions using a 7-point Likert-type scale


with response options ranging from 1 (strongly disagree) to 7 (strongly agree).


The 45


items comprise three subscales measuring (a) teachers' efficacy expectations, (b)

outcome expectations, and (c) outcome values as they relate to working with suicidal

adolescents.

Reliability and validity information for the instrument indicates that the TPSE is








and correlating the scores obtained from the two administrations.


correlation coefficients were 0.71


The obtained Pearson


, and 0.67 for the efficacy expectations subscale,


outcome expectations subscale, and outcome values subscale respectively.


(1999) also estimated reliability by computing Cronbach'


King et al.


alpha (Traub 1994, Crocker &


Algina 1986) for a sample of 186 individuals.


The obtained values of Cronbach's


alpha


were 0.84, 0.89, and 0.60 for the efficacy expectations subscale, outcome expectations

subscale, and outcome values subscale, respectively (King et al. 1999).


Table 3


Comparison of Attitude as Defined for the Present Study and Self-Efficacy as


Defined by Bandura


Definition of Attitude for
the purpose of our study


Self-Efficacy Component


Definition of Self Efficacy
(Bandura, 1977)


pre-service teachers' self-
perceived ability to provide
emotional support to
children in crisis


Efficacy Expectations


a person


's belief that a he or


she has the ability to
successfully perform a
given behavior


the results he or she expects
when emotional support is
provided to children in
crisis


whether he or she perceives
that providing emotional
support to children in crisis
could be worthwhile


Outcome Expectations


Outcome Values


the specific outcomes that
an individual expects when
a behavior is completed


the worth or significance
that an individual places on
the expected outcomes of a
given behavior


King et al.


validity.


(1999) provided information related to face, content, and construct


Face and content validity were determined by distributing the TPSE to six


national experts in the field of adolescent suicide and three national experts on

self-efficacy. Alterations to the original instrument were made based on the suggestions





44


internal structure of the 45-item scale matched the intended three-construct structure

specified by the three subscales.

In its original form, the TPSE was intended to measure teachers' self-efficacy


when working with suicidal students.


To obtain a measure of attitude toward working


with students in crisis, the TPSE was adapted (TPSE-A) by selecting 14 of the 45 items

contained on the original TPSE, and modifying the wording of items to make them more

relevant to provision of emotional support to students in crisis rather than for provision of


suicide intervention with adolescents (Table 3-3).

easily altered by changing the words, "...student


Twelve of the 14 selected items were


at risk of attempting suicide" to


...student in crisis." The remaining two selected items were changed into two and three


questions, respectively.


Each of these questions, in their original form, are intended to


query an individual's ability to


...effectively offer support...


" In the present study an


individual'


ability to offer support is defined as their ability to paraphrase and name


taboo subjects, as discussed in the intervention section of this chapter.


The resulting 12


items formed a scale used to measure attitude toward working with students in crisis.


This 17-item scale will be referred to as the TPSE-A hereafter.


Total possible scores on


the TPSE-A range from 17 to 119, with higher scores indicating a more positive attitude

toward the provision of emotional support to students in crisis.

The TPSE-A was piloted on a sample of 25 ACCC volunteers to determine

whether changes in the wording of questions would adversely impact the instrument's


reliability and validity.


Review of item and reliability analyses obtained from the pilot








Internal structure evidence of validity was obtained by computing the corrected


item-total correlations for each item, which ranged from 0.44 to 0.77 (Appendix F).

Because the sample size of the pilot administration was relatively small, estimates of

reliability and validity also were computed for the final sample of 177 participants used


in the study.


For the final sample, coefficient alpha equaled 0.93,


and the corrected item-


total correlations ranged from 0.24 to 0.58 (Appendix G).


Table 3-3.


Changes Made to the TPSE from the Original to Adapted Form


Original Question


- TPSE


Item


Adapted Question


TPSE-A


I believe I can recognize a student at
risk of attempting suicide.


I believe I can talk with teachers and
counselors at my school to help
determine whether or not a student is at
risk of attempting suicide.


I believe I can talk with the parents) of
a student to help determine whether or
not the student is at risk of attempting
suicide.


I believe I can ask a student at risk of
attempting suicide if he/she is suicidal.


I believe I can effectively offer support
to a student at risk of attempting
suicide.


I believe I can effectively offer support
to a student at risk of attempting
suicide.


I believe I can refer a student at risk of


c,, c, .l


I believe I can recognize a student in
crisis.

I believe I can talk with teachers,
counselors, and psychologists at my
school to help determine whether or
not a student is in crisis.

I believe I can talk with the parents) of
a student to help determine whether or
not the student is in crisis.


I believe I can ask a student in crisis
about the specific issues they are
dealing with.


I believe I can effectively offer support
to a student in crisis by paraphrasing
their emotions.

I believe I can take the risk to name a
taboo subject being referred to by a
student.

I believe I can refer a student in crisis
- .. -1- I 1








Table 3-3.


Continued


Original Question TPSE


I believe if I recognize
of attempting suicide it
change that the student
suicide.


a student at risk
will reduce the
will commit


Item

8.


Adapted Question TPSE-A

I believe if I recognize a student in
crisis it will reduce the long-term
negative effects of the situation.


I believe if I talk with teachers and
counselors at my school to help
determine whether or not a student i
risk of attempting it will reduce the
chance that the student will commit
suicide.


I believe if I talk with the parents) of a
student to help determine whether or
not the student is at risk of attempting
suicide it will reduce the chance that
the student will commit suicide.

I believe if I ask a student at risk of
attempting suicide if he/she is suicidal,
it will reduce the chance that the
student will commit suicide.


I believe if I effectively offer support
to a student at risk of attempting
suicide it will reduce the chance that
the student will commit suicide.

I believe if I effectively offer support
to a student at risk of attempting
suicide it will reduce the chance that
the student will commit suicide.

I believe if I effectively offer support
to a student at risk of attempting
suicide it will reduce the chance that
the student will commit suicide.


I believe if I talk with teachers,
counselors, and psychologists at my
school to help determine whether a
student is in crisis it will reduce the
long-term negative effects of the
situation.


I believe if I talk with the parents) of a
student to help determine whether the
student is in crisis it will reduce the
long-term negative effects of the
situation.

I believe if I ask a student in crisis
about the specific issues they are
dealing with, it will reduce the long-
term negative effects of the situation.


I believe if I paraphrase the emotions
of a student in crisis it will help reduce
the long-term negative effects of the
situation.

I believe if I take the risk to name the
taboo subject being referred to by the
student it will reduce the long-term
negative effects of the situation.

I believe if I effectively offer support
to a student in crisis, it will reduce the
long-term negative effects of the
situation.


12.""








Table 3-3.


Continued


Original Question


TPSE


Item


Adapted Question


TPSE-A


I believe if I refer a student at risk of
attempting suicide to a school
counselor or psychologist it will reduce
the chance that the student will commit


I believe if I refer a student in crisis to
a school counselor or psychologist it
will reduce the long-term negative
effects of the situation.


suicide.


I believe as a high school teacher, one
of the most important things I could
ever do is to prevent a suicidal student
from committing suicide.

I believe one of the most important
things a school system could ever do is
to establish a program to help
recognize and find treatment for
suicidal students.


I believe as a high school teacher, one
of the most important things I could
ever do is provide emotional support to
a student in crisis.

I believe one of the most important
things a school system could ever do is
to establish a program to help
recognize and support students in
crisis.


*Items 5 and 6 of the TPSE-A were derived from the same question on the TPSE.


**Items 12, 13,


and 14 of the TPSE-A were derived from the same question on the TPSE.


Measuring Empathv Using the RI


Crisis-intervention at the ACCC considers empathy as fundamental to the

rapport that must be established between a client and a counselor in a counseling


relationship.


Empathy, as it is defined at the ACCC,


is the objective and insightful


awareness of the feelings, emotions, and behavior of another person (ACCC 2001).


This


definition will be accepted and applied to our study, as it is based primarily on the ACCC

crisis phone counseling training program.


To measure a person's


level of empathy, researchers and practitioners have used


self-report measures, reports of others, and observer ratings (Duan & Hill 1996).


Self-








others ask clients to rate the level of empathy of their counselor.


valuable data regarding a counselor's


These reports provide


level of empathy as perceived by a client.


However, they require the existence of a real-life relationship between a client and


counselor, making them unsuitable for our study


. Observer ratings require a trained rater


to observe either a real-life interaction or videotape of an interaction between a client and


counselor.


The rater then codes the level of empathy present in the interaction of the


counselor to the client.


Observer ratings can provide more objective ratings of empathy


but require large monetary and time resources making them an unrealistic approach for


experimental research with large sample-sizes.


Self-report measures were determined to


be most appropriate for our study because of the relatively large sample-size being used,


restrictions on time due to the length of classes at UF


, and the importance of congruence


across post-test instruments.


The most widely used measure of empathy


developed by Barrett-Lennard in 1962 (Hill et al 199,


the Relationship Inventory (RI),

4). Hundreds of studies have used


the RI in its original form, the revised form, and versions adapted to more effectively suit

a particular research study (Barrett-Lennard 1986, Duan & Hilll996, Barz 2001).

Researchers have adapted the original form of the RI both in length and perspective of


the reporter.


For example, the RI has been used to measure teachers


' level of empathy


when working with troubled youth (Scheuer 1971), supervisors'


level of empathy when


interacting with employees (Schacht et al 1988), and crisis phone counselor's


empathy when speaking with crisis callers (Barz 2001).


level of


In the present study, a portion of





49

In its original form, the RI included 96 items that could be used in a self-report or


report of others format.


The instrument later was revised by Barrett-Lennard to remove


one scale and decrease length of time required for administration.


In its revised form, the


RI is a 64-item questionnaire comprised of four 16-item subscales measuring empathy


congruence, level of regard, and unconditionality of a counselor to a client.


Questions


are directed toward either a counselor or a client; counselors are asked to rate themselves


and clients to rate their counselor.


Responses are based on a six-point scale ranging from


+3 on the far left hand side of the scale, I strongly agree it feels true about me to -3 on


the far right hand side of the scale, I strongly disagree it is not true about me.


Items


querying each of the four subscales are interspersed throughout the 64-item instrument.


One half of the items are negatively worded.


Total subscale scores range from 48 to


Higher subscale scores indicate higher levels of empathy, congruence, level of


regard, and unconditionality.

Reliability and validity data for the RI have been reported by Barrett-Lennard

(1962, 1986) for the original and revised forms and by numerous researchers for their


adapted versions (Scheuer 1971,


Schacht et al. 1988).


In its revised form and in various


adapted versions, the RI has been found to have adequate reliability and validity (Barrett-


Lennard 1962, Gurman 1977, Barrett-Lennard 1986).


Gurman (1977) reviewed the


reliability estimates of the RI obtained across various applications of the revised and


adapted versions.

alpha methods. I


In total, 1


studies estimated reliability using split-half and coefficient


leans of the reliability estimates obtained across the 1


studies were








subscale, and congruence subscale, respectively.


In addition, 10 studies reported test-


retest estimates ranging between 0.61 and 0.95 for the four subscales.

Barrett-Lennard (1986) report assessing the content validity of the RI by

distributing the original instrument to five judges and asking them to rate each item as a


positive or negative statement of the variable it was intended to measure.


revision, three relevantly experienced individuals


Following the


were asked to provide suggestions to


improve the face and content validity of the instrument.

In the present study, the 16-question empathy subscale of the RI (Appendix H)

was used independent of the other subscales to measure pre-service teachers' level of


empathy after participating in training.


The response options were transposed from a


range of +3 on the far left of the instrument (yes, I strongly feel it is true) to


on the far


right of the instrument (no, I strongly feel it is not true) to a range of 1 on the left (no, I

strongly feel it is not true) to 6 on the right (yes, I strongly feel it is true) to provide


consistency in the response option values and anchors of the TPSE-A and the RI.


Using


the revised response option values, the total score for the RI ranged from 16 to 96, with

higher scores indicating a higher level of empathy.

The empathy subscale of the RI was administered previously as an independent


measure of empathy in a study with crisis phone counselors (Barz 2001).


Subject


responses resulted in a coefficient alpha of 0.78,


indicating adequate reliability.


Because


the training program used in our study was an adaptation of the training program used to

prepare subjects in the Barz (2001) study, the empathy subscale of the RI was expected to








Because changes were made to the response options of the empathy subscale for


use in the present study, the revised empathy subscale was piloted with sample of


ACCC volunteers. Reliability and item analyses were conducted on the data from the

pilot administration. The coefficient alpha obtained using the 25 subjects was 0.81 and


the corrected item-total correlations for 13 of the 16 items ranged from 0.26 to 0.72.

corrected item-total correlations for the remaining three items were below 0.20


(Appendix I).


These results provided strong evidence that the revised RI empathy


subscale would provide an effective measure of empathy for our study.

Estimates of reliability and validity were also computed for the final sample of


177 participants used in our study.


For the final sample, coefficient alpha equaled 0.79,


corrected item-total correlations ranged from 0.24 to 0.58,


with one item falling below


0.20 (Appendix J).

Measuring Transfer of Knowledge and Skills Using the AKCS


Ability is defined as the effective transfer of knowledge and skills from a learning


environment to real life situations.


In the field of crisis-intervention, as in many other


applied fields, assessment of individual ability level can be difficult to measure (Knudson


2001).


Historically, the measurement of knowledge and skills has been approached


separately and by varied methods of assessment (Bransford & Schwartz 1999).

Traditionally, knowledge has been assessed through the use of replication


assessment (Broudy 1977).

committed to memory. As:


These approaches ask the test taker to recall facts they have


sessment of knowledge can be completed quickly and at





52

In the mental health field, authentic assessment often is used to measure level of


skill.


For example, through review of video taped client sessions or participation in a


role-play where they are the mental health professional and someone else plays the part


of a client (Nelson-Stewart 2000).


In either case, a mentor or supervisor takes time to


review a student's


performance and provide feedback.


The assessment of skill using


authentic assessment requires a significant amount of time and resources to complete,

making it difficult for use in experimental research with large numbers of subjects.

To assess the transfer of knowledge, researchers have used various measurement

techniques including paper-and-pencil tests, structured interviews, and skill based


assessments (Bransford & Schwartz 1999).


person


In all cases, the test attempts to measure a


's knowledge or skills in one situation based on prior learning experiences.


example, a person who has learned to use a software package to analyze statistics may

learn to use a second statistical software package more quickly if knowledge and skills

from the original learning experience transfer effectively.


The Applied Knowledge of Crisis Skills


measure participants

environment (i.e., du


(AKCS) was developed for our study to


' ability to transfer the knowledge and skills learned in the training


ring reading, listening to a lecture, participating in an interactive


workshop) to a crisis scenario (Appendix K).


There are two sections of the AKCS


first assesses participant ability to transfer knowledge and skill learned during training.

This section consists of a written scenario depicting a student in crisis who could

potentially benefit from emotional support, and four related multiple-choice questions.








response to that part of the situation based on the principles of crisis counseling.


second section assesses the amount of information from the training an individual can


recall.


This section consists of 10 multiple-choice questions that require the participant to


recall significant facts presented during training.


Responses for all 14 items were scored


with a 0 for incorrect answers and 1 for correct answers, with a possible total score range


of 0 to 14.


Higher scores indicate a higher level of transfer.


To conduct an initial investigation of reliability and validity of the AKCS a pilot

test was conducted using a sample of 25 volunteers participating in the crisis-intervention


training at the ACCC.


Using data obtained from the pilot study, item quality was


assessed through consideration of (a) the proportion correctly responding to each item,

(b) the discrimination of the item as measured by the corrected item-total correlation

coefficient and (c) the reliability of the instrument as measured by coefficient alpha


(Crocker & Algina 1986).


In addition, respondents were asked to provide feedback


concerning the face validity of the instrument and indicate whether other changes should


be made to items or administration procedures prior to data collection.


Using the


obtained data, coefficient alpha equaled 0.46 and the corrected item-total correlations


ranged from -0.19 to 0.48 (Appendix L).


Based on the results of the analyses, significant


revisions were made to the wording of the items for which poor discrimination was


observed.


The organization and presentation of the questions also was changed to


improve face validity.

The revised AKCS was piloted with a small sample of 17 psychologists and social








of 17 was 0.48.


The corrected item-total correlations were negative in three items and


low (e.g., below 0.20) in four items (Appendix M).


After expert review, the decision was


made to reword items having a negative corrected item-total correlation.


The four items


with low corrected item-total correlations were not changed because review indicated the


low value might have been a result of the small


sample size and the homogeneity of the


sample.

Item and reliability analyses of the AKCS also were conducted using the sample


of 177 respondents obtained for the present study.


Coefficient alpha was 0.53 and the


corrected item-total correlations ranged from 0.11 to 0.30, with 7 of the 14 items falling


below 0.20 (Appendix N).


To establish whether the relatively low value of coefficient


alpha was a consequence of item heterogeneity,


a split-half reliability analysis was run.


An odd-even split was used to divide the items into two groups.


Coefficient alphas for


the two groups were 0.37 and 0.44, and the equal-length Spearman-Brown split-half


reliability was 0.43.


The relatively low split-half reliability estimate indicates the items


are measuring different constructs and caution should be used in the interpretation of the

results.


Analysis


Our study investigated the impact of the independent variable (i.e.,


crisis-


intervention training program) on three dependent variables (i.e., score on the TPSE-A,

score on the RI, and score on the AKCS) by conducting three separate one-way analysis


of variance (ANOVA) tests.


An estimate of effect size associated with each ANOVA








ANOVAs the scores of the dependent variables were visually examined to ensure that the

scores were normally distributed with equal variances.


The null hypothesis associated with each one-way ANOVA (M


assessed using a Type I error rate of 0.05.


=M2=M3) was


An acceptance of the null hypothesis led to the


conclusion that intervention training program had no impact on the mean value of the


dependent variable.


A rejection of the null hypothesis led to the conclusion that the


crisis-intervention training technique did impact the mean value of the dependent variable

and was followed by three post-hoc comparisons (reading vs. lecture, reading vs.

interactive, lecture vs. interactive) to determine between which of the three groups a


significant difference existed.


For each of the three post-hoc comparisons an independent


samples t-test was conducted to test for between-group differences in the dependent


variable.


To maintain a family-wise Type I error rate of 0.05,


a Bonferroni adjustment


was applied to each comparison.


The decision to use the Bonferroni correction was made


because it leads to an appropriate correction of the per-comparison Type I error rate when


three or fewer comparisons exist (Albert, Cluxton, & Miller 1997).


Because a total of


three post-hoc comparisons were conducted, the resulting Bonferoni-corrected Type I


error rate was .05/3


.0167.













CHAPTER 4
RESULTS


The purpose of our study was to answer the following three questions:


Research Ouestion 1


teachers'


Does the type of crisis-intervention training impact pre-service


attitude toward providing emotional support to students in crisis?


Research Ouestion


teachers'


Does the type of crisis-intervention training impact pre-service


level of empathy?


Research Question 3: Does the type of crisis-intervention training impact pre-service


teachers'


ability to transfer knowledge and skill?


To answer the research questions, 177 subjects participated in our study.


Consistent


with enrollment in college education programs, the majority of participants were female


(i.e.,


male


11.7%, female


= 82.7%).


Seventy percent of the participants were of


traditional college age, between 18 and


years old.


Of the remaining subjects, 20.7%


were between the ages of 23 and 29 while 3.3% were between 30 and 49 years old. A


slight majority of participants (i.e.,


48.0%) are in the final year of the five-year


PROTEACH program, 15.1% reported being in the 4th and 32.4% in the 3rd year.

Education majors at the University of Florida do not begin PROTEACH coursework until


completion of two years of college.


Only


.4% of students reported having a major other


than education (education majors


= 89.9%, omitted answers


= 4.7%).


Because the


significant majority of participants fit the traditional model of college education students









Subjects were randomly assigned by intact classes to one of three training groups:


reading, lecture, and interactive.


The groups consisted of 63,


59, and


participants


respectively

Teacher's


ly.


Immediately after training, participants completed three questionnaires:


Perceived Self-Efficacy Related to Adolescent Suicide Questionnaire-Altered


(TPSE-A), measuring attitude toward the provision of emotional support to students in

crisis; the Relationship Inventory (RI), measuring empathy; and the Applied Knowledge


of Crisis Skills (AKCS), measuring the transfer of knowledge and skills.


The scores


obtained on TPSE-A, RI, and AKCS served as the dependent variables for research


questions I


and 3, respectively.


The remainder of this chapter sequentially addresses


each of the three research questions.

Research Ouestion 1


Table 4-1 displays the mean and standard deviation for the Teacher's


Self-Efficacy Related to Adolescent Suicide Questionnaire


for each of the three treatment groups. II

similar across the three groups, equaling

interactive groups respectively. While t


Perceived


- Adapted (TPSE-A) scores


inspection of the group means reveals they were


, and 5.68 for the reading, lecture, and


he standard deviations did differ between the


three groups (SD


= 0.686, 0.749, 0.935), the Levene's


test of homogeneity of variance


indicated that the differences were not statistically significant, F (2,174)


= 0.877


= 0.418.


A one-way ANOVA assessing the between-group difference in the mean TPSE-A score


yielded, F (2,174)

was not significa


= 0.593, p = 0.554, indicating the difference between the group means

Lnt. In addition, an estimate of effect size was obtained by computing





58


size it can be concluded that there is little or no effect of the three training programs on

the attitude ofpre-service teachers toward providing emotional support to students in

crISIS.


Table 4-1


. Descriptive Statistics


- Attitude Scale


(TPSE-A)
Group N Mean Standard
deviation

Reading 63 5.765 0.686

Lecture 59 5.611 0.749

Interactive 55 5.668 0.935

Total 177 5.683 0.789


Research Ouestion


Table 4-2 displays the mean and standard deviation for the Relationship Inventory


(RI) scores for each of the three treatment groups.


Inspection of the group means reveals


they were similar across the three groups, equaling 4.169, 4.218,


reading, lecture, and interactive groups respectively.


and 3.986 for the


Standard deviations did not differ


between the three groups (SD


0.569, 0.543) and the Levene's


test of


homogeneity of variance indicated the differences were not statistically significant,


F (2,174)


=0.517


= 0.597


A one-way ANOVA assessing the between-group difference


in the mean RI score yielded, F (2,


= 2.861


= 0.060, indicating that the difference


between the group means was not significant.

obtained by computing omega squared. The


An estimate of effect size also was


computed value of omega squared equaled





59


concluded that there is little or no effect of the three training programs on participating

pre-service teachers' level of empathy.


Table 4-2.


Descriptive Statistics


- Empathy Scale


Group N Mean Standard
deviation

Reading 63 4.169 0.522

Lecture 59 4.218 0.569

Interactive 55 3.986 0.543

Total 177 4.129 0.550


Research Question 3


Table 4-3 displays the mean and standard deviation for the Applied

Knowledge of Crisis Skills (AKCS) scores for each of the three treatment groups.

Inspection of the group means reveals they were different across the three groups,


equaling 0.67


, and 0.70 for the reading, lecture, and interactive groups respectively.


The standard deviations differed between the three groups (SD


=0.1


,0.189, 0.130) and


the Levene'


test of homogeneity of variance indicated the differences were statistically


significant, F (2,174)


= 3.742, p


= 0.026.


A one-way ANOVA assessing the between-


group difference in the mean AKCS score yielded, F (2,174)


= 4.331


= 0.015


, indicating


that the difference between the group means was significant.


was obtained by computing omega squared.


An estimate of effect size


The computed value of omega squared


equaled .036, which can be interpreted in practice as a small-to-medium effect size.









three groups a significant difference existed.


For each of the three post-hoc comparisons


an independent samples t-test was conducted to test for between-group differences in the


dependent variable.


To maintain a family-wise Type I error rate of 0.05,


a Bonferroni


adjustment was applied to each comparison.


Because a total of three post-hoc


comparisons were conducted, the resulting Bonferoni-corrected Type I error rate was


.05/3


.0167.


Table 4-3.


Descriptive Statistics


Transfer of Knowledge and


Skill (AKCS)
Group N Mean Standard
Deviation

Reading 63 0.671 0.151

Lecture 59 0.616 0.189

Interactive 55 0.702 0.130

Total 177 0.662 0.162


Table 4-4 presents the between-group difference in mean AKCS score, the

observed t-value for the independent samples t-test and the significance level of the


independent samples t-test for each of the paired comparisons.


Results of the pairwise


comparison between the reading and lecture groups indicated the difference between the


mean AKCS scores was not significant, t (120)


= 1.778,p=.078.


The difference


between the mean AKCS score of the reading and interactive groups also was not


significant, t (11


=-1.201,p


= 0.232.


However, the difference between the mean


AKCS score of the lecture versus interactive groups was statistically significant, t (112) =








Table 4-4


Pairwise Comparisons


Transfer of Knowledge and Skill Scale


(AKCS)
Pair Mean t Significance
Difference

Reading vs. Lecture 0.055 1.778 0.078

Reading vs. Interactive -0.031 -1.201 0.232

Lecture vs. Interactive -0.086 -2.817 0.006


Summary and Conclusions


Based on the results of our study, several conclusions can be drawn.


Attitude


toward providing support to students in crisis and level of empathy was not impacted by


the format of training provided to the three treatment groups.


There was no difference in


the transfer of knowledge and skills between the reading and lecture groups or between


the reading and interactive groups.


However, participants in the interactive group were


able to transfer a greater amount of knowledge and skill than those in the lecture group.














CHAPTER 5
DISCUSSION


The recent, large-scale school crises in our society have created a need for


preparing teachers to provide emotional support to students.


Students also experience a


variety of crises that may be less apparent to school staff (e.g., divorce of parents, abuse,


neglect).


Next to parents, teachers are often in the best situation to provide immediate


emotional support to students in crisis and identify those needing more intensive support.

Whether the teacher's role is to provide brief emotional support to students or notify

mental health professionals of the need for more significant support, they require training

to do so comfortably and effectively (Brock 2001, Pitcher & Poland 1994, Sandoval

2002, Slaikeu 1990).

Providing immediate emotional support to individuals in crisis (i.e., psychological

first aid) does not require advanced education in mental health services (Brock 2001,

Joint Commission on Mental Illness and Health 1961, Pitcher & Poland 1992, Slaikeu


1990).


Several training programs have been developed to prepare non-mental health


professionals (e.g., teachers, clergy) to provide this support in the event of a crisis.


content of existing programs includes facts supporting the need for crisis-intervention

training in the school setting, an overview of crisis theory, and an introduction to and


a -


_A -C..... ........- A I .* fI .. 4l t 4 -





63

Although crisis-intervention training is important, requiring teachers to commit this


amount of time may be unrealistic within the scope of their existing responsibilities.


As a


result, development of an effective training program during pre-service teacher education

may prove beneficial.

Our study investigated whether participation in a 45-minute reading, lecture, or

interactive training program differentially impacted pre-service teachers' attitudes toward

providing emotional support to students in crisis, level of empathy, and transfer of


knowledge and skills.


Results indicated no difference between participation in a reading,


lecture, or interactive training program on pre-service teachers' attitudes toward


providing emotional support to students in crisis.


Participants were asked to respond to


questions querying their attitudes toward providing emotional support to students in crisis

using a seven-point Lykert-type scale ranging from 1 (strongly disagree) to 7 (strongly


agree).


Specifically, questions asked participants to rate their level of comfort in


providing emotional support to students in crisis, and ensuring that the proper services are

provided to students in need of further support (i.e., crisis therapy) (Appendix E).


Responses in this study yielded a group mean of 5.68 (SD


= 0.78), indicating a relatively


high level of attitude toward providing emotional support to students in crisis.


This may


have been influenced by the participants' separation from an actual teaching


environment.


Participants in our study (i.e., pre-service teachers) have not yet been in a


school setting in their aspired roles.


This may cause them to feel more confident in their


abilities than they will when faced with an actual crisis situation.








participants were exposed to the training material.


Impacting level of empathy may


require long-term intervention training rather than the amount of time available in our


study.


The Alachua County Crisis


Center (ACCC) training program consists of 60 hours


of training.


A 60-hour training program focusing on providing emotional support to


students is not realistic for practicing teachers because of demands in and outside the


classroom. Future research should explore the amount of time necessary to impact pre-

service teachers' level of empathy.


The ACCC training program also consists of a greater breadth and depth of

experiences for participants: role-plays, various lectures, observation shifts where


trainees listen to calls between callers and counselors.


Individuals going through ACCC


training may participate in 10


role-plays, based on real crisis


calls.


Qualitative


reports by ACCC counselors indicate role-plays simulate the emotion and intensity of


actual calls.


ACCC training lectures go far beyond those provided in our study, to


provide trainees with a greater understanding of crisis theory and the most common


issues causing people to reach a crisis state (e.g.,


ones, failure, chronic pain).


sexual assault, unexpected loss of loved


Finally, trainees are given the opportunity to observe crisis


phone counselors interacting with callers in real-life situations.


perspective on the callers'


This provides a genuine


presentation as well as the relationship between the caller and


the counselor.

Detection of differences in level of empathy also could be difficult because, as a


group, pre-service teachers may posses a high level of empathy naturally.


In our study,





65

strongly feel it is true). Participant responses in our study yielded a mean response of


4.12 (SD


= 0.55


), indicating a relatively high level of empathy as a group.


If participant


groups had been more heterogeneous, consisting of university students from different


areas (e.g., engineering, statistics, history),


more apparent.


variations in level of empathy may have been


Comparison between level of empathy in pre-service teachers and other


groups would need to be explored through future research.

A lengthy literature review provided no good options for a test to effectively

measure transfer of knowledge and skill related to the content presented in this training.


Therefore, an instrument was developed specifically for our study.


Following expert


review of the first draft of the AKCS, two separate pilot studies were run on small groups


of subjects similar to the final research participants.


The first pilot yielded a low


relationship between individual items and the instrument as a whole.


revisions were made prior to the second pilot study.


Significant


Results from the revised instrument


also yielded low reliability indices, which led to further revision before final data


collection began.


Unfortunately


results from the final data of the study again indicated


low reliability.

Group differences were found in level of knowledge and skill between the lecture

and interactive groups, but not between the reading and lecture or reading and interactive


groups.


These differences must be interpreted with caution due to low reliability of the


knowledge and skill instrument.


Pre-service teachers may learn more about providing


emotional support to students in crisis


when they participate in a small group (i.e.,


ten or





66

be determined whether this brief intervention had any effect on the level of knowledge

and skill of the participants.

Unfortunately, comparisons cannot be made between the results of the present


study and other training programs (i.e.,


ACCC 2001


Brock 2001


, Slaikeu 1990) because


of the lack of quantitative data in the literature.


Results of our study serve as a step


towards development of research-based crisis training and intervention response

programs.


Connections to Existing Literature


Crisis-intervention programs in the schools are a relatively new responsibility to


the field of education.


Support for the development of these programs has grown due to:


(a) recent events in history (Berson & Berson


002), (b) a school's


legal obligation to


provide substantive crisis-intervention services when necessary (Feinberg & Jacob 2002),

and (c) a change in the role school personnel play in supporting children (Brock et al.


2001


, Pitcher & Poland 1992).


Well-designed quantitative research studies are needed to


secure long-term financial support and administrative backing necessary to continue these


programs (Bates et al.


2002, Brock et al. 2001


, Pitcher & Poland 1992).


The field of


school crisis-intervention would benefit from pre-established relationships between

researchers and individual schools stating that, in the event of crisis, they will assist in

providing intervention resources in exchange for the ability to collect data during and

following the crisis (Bates et al. 2001).

In accordance with the recommendations set out in the current literature, this





67

program was adapted to provide the necessary training content in a time frame suitable to


university course instruction.


Programs developed by Slaikeu (1990), Brock (in Brock et


al. 2001) and the Alacuha County Crisis Center (2001) incorporate reading, lectures, and


small-group interactive exercises to train crisis-intervention providers.


Although these


programs require between 12 and 60 hours of class time, the literature does not provide


quantitative support for the significant time commitments.


Our study presented identical


content through three different training methods (i.e., reading, lecture, and interactive) in

45-minute sessions and determined that the levels of empathy, attitude, and knowledge

and skill did not differ significantly as the result of a single university class period.

Our study attempted to impact pre-service teachers' attitudes toward providing


emotional support to students in crisis.


Responses to the TPSE-A indicated no significant


difference between the reading, lecture, and interactive groups.


The absence of an effect


across the three treatment groups is consistent with a large base of research in the field of


teacher preparation.


Numerous studies indicate that effectively impacting the attitudes of


pre-service teachers, prior to their field-based placements, continues to be a concern for

teacher-educators (Bramald et al. 1995, Weiner 2000).

Conclusions


Results of our study have implications for the design and development of pre-

service teacher training programs related to providing emotional support to students in


crisis when only limited amounts of time are available.


No differences were found in


participants' levels of attitude or empathy as a result of participation in the 45-minute





68

skill of the interactive and lecture groups is questionable, due to the low reliability of the

knowledge and skill measure used in our study.

Because no trustworthy effects were found, the power of the treatment must be


questioned.


The content of the training used in our study is based on the 60-hour training


program at the ACCC.


Although no quantitative support is available for the ACCC


training, qualitative support is evident in the fact that counselors trained at the ACCC


have been respected members of the mental health community for over 30 years.


Also,


the ACCC training is similar in content and approach to other crisis-intervention training

programs used to prepare individuals to provide emotional support to people in crisis


(e.g., Brock, in Brock et al. 2001, Slaikeu 1990).


These points suggest the content used


in the present study are appropriate for the intended outcome of an increase in level of

attitude, empathy, and knowledge and skill.

Participants in the present study were exposed to the content in a reading, lecture,


or interactive format.


The training programs used by the ACCC, Slaikeu (1990), and


Brock (in Brock et al. 2001) present the content to all participants in multiple formats,


providing a greater breadth of learning experiences.


Positive effects resulting from


participation in those training programs suggest that the variety of approaches used to

teach the material may be required to have an impact on pre-service teachers' levels of

attitude toward providing emotional support to students in crisis, empathy, and transfer of

knowledge and skills.

The training in the present study also differed drastically from the others in length






69

unavailable, an assumption cannot be made about whether the lengths of time required


are sufficient to prepare people to provide emotional support to students in crisis.


Lack


of significant effects of the treatment in the present study suggest that 45 minutes of

training, in any format, is inadequate to impact levels of attitude, empathy, and transfer of


knowledge and skill.


Future research must consider the amount of time necessary to


create the desired effects.

Our study was designed to assist in development of a crisis-intervention program


for pre-service teachers.


Teachers are often the only adults besides parents who have


consistent contact with students, allowing them to support all students and identify those


in need of intervention beyond the relatively brief psychological first aid.


With the


proper pre-service training, teachers have the opportunity to make a significant impact on


a child's


life by supporting them in the event of a crisis.


Limitations of the Study


Our study considered the effects of crisis-intervention training on pre-service


teachers in a university classroom setting.


Participants may have had difficulty


identifying with the need to provide emotional support to students in crisis because they


currently lack emotional connection to a group of students.


Once in practice, these same


participants may have a different reaction because they will have students who are at risk


to experience crisis at any time.


Pre-service training must be developed that can create a


more realistic and urgent need to learn and effectively use the information presented


before teachers are faced with a student in crisis.


The ACCC training uses role-plays to





70


quantitative support is not available, numerous qualitative accounts attest to the

effectiveness of role-plays in preparing trainees to respond to real-life crisis situations.

The length of time required for participation in the three training approaches in


our study varied greatly from those currently in use.


Existing training programs require


between 12 and 60 hours of training, a significant addition to the university pre-service


teacher curriculum.


Results of our study indicate that participants require more than 45


minutes to impact attitude, empathy, and level of knowledge and skill.


This raises the


question of whether 45-minutes of pre-service training would be worth the time spent.

Researchers must determine how much time is required to have the desired impact on

pre-service teachers.

By definition, experimental research requires valid and reliable measures to


identify the impact of a treatment on a specific variable.


Our study attempted to


determine whether 45 minutes of crisis-intervention training presented in a reading,


lecture, or interactive format differentially impacted pre-service teachers'


empathy, and transfer of knowledge and skills.


attitudes,


Attitude and empathy were measured


using pre-established instruments supported by numerous published accounts of


acceptable levels of validity and reliability.


An extensive review of the literature did not


yield an instrument appropriate to measure the knowledge and skills presented in our


study.


Knowledge often is assessed through the use of replication assessment (e.g.,


multiple-choice tests), which requires little time and money to complete (Broudy 1977).

This is advantageous when conducting research with large numbers of people, but does








measure the development of counseling skills (Nelson-Stewart 2000).


Although


effective, this approach is not desirable when conducting research with many subjects, as


it requires substantial resources to complete effectively.


The AKCS was an attempt at


developing an instrument that quickly and effectively could measure a person's


of crisis-intervention knowledge and skills.


transfer


Unfortunately, the researcher was unable to


establish acceptable levels of reliability for the scores from this instrument.


The poor


measurement properties of the AKCS create speculation toward the significant

differences found between the interactive and lecture groups in transfer of knowledge and

skill.


Future Research


Given the prevalence of crises in the lives of young children and the current role


schools


have assumed, there is a definite need to prepare pre-service teachers to provide


emotional support to students in crisis.


Results of our study should be used as a catalyst


for future research on the topic of crisis response training for pre-service teachers. Our

study indicated a questionable increase in transfer of knowledge and skills when pre-

service teachers learn in an interactive setting including a group leader (i.e., counselor)


and no more than 10 adults.


Replication of our study is necessary before this increase in


knowledge and skill is relied upon in practice.


No differences were found in empathy or


attitude.

Accepting attitude toward the provision of emotional support to students in crisis

and level of empathy as important variables in the effectiveness of emotional support,








more robust approaches to crisis-intervention training.


While still in a pre-service


learning environment, training in areas such as crisis-intervention must provide vivid

examples of (a) how emotionally taxing it can be to watch a person experience a crisis,

(b) how uncomfortable it can be to engage in conversation with an individual in crisis,


and (c) how beneficial emotional support can be to an individual'


beyond a crisis state (ACCC 2001, Lindeman 1944).


ability to move


Incorporating experiential


components (like the role-plays used in the three training approaches discussed), may

create the necessary learning environment to impact pre-service teachers' attitudes

toward providing emotional support to students in crisis (ACCC 2001, Brock, in Brock et


al. 2001, Slaikeu 1990).


Future research should focus on how to most effectively impact


the attitudes of pre-service teachers related to providing emotional support to students in

crisis


Concerning the desire to increase pre-service teachers'


level of empathy toward


students in crisis, training programs may require a change in approach and amount of


time dedicated to training.


Training intended to alter level of empathy may need to be


more similar to the ACCC training program in time and intensity of experience.


study attempted to look at pre-service teachers' level of empathy after one 45-minute


training session embedded in a pre-existing university course.


To ensure this important


training is provided to as many pre-service teachers as possible, future research must

focus on the most efficient way to increase pre-service teachers' level of empathy.













APPENDIX A
TRAINING MATERIALS READING GROUP


Participants will be provided with training materials.


They will be asked to spend the


next 45-minutes reading the documents provided to them.


Thank you for agreeing to participate in our research study.


materials under your desk.

documents to yourself. Pl


Please place all other


For the next 45-minutes we ask that you read these


ease do not discuss the information with other students.


is important to this research project that you read as much of the information as you

can during the 45-minute period.

Completing the Questionnaires

At the end of the 45-minute training session, the facilitating trainer will ask the


participants to complete the forms being distributed.


It will be important to begin the


data collection phase on time so that the participants will be able to complete the


forms.


Participants should not put any identifying information (i.e., names, social


security numbers) on the questionnaires.

The other trainers should distribute the questionnaires and pencils to those who need


them while the facilitating trainer is explaining the data collection process.


Trainers


should wait by the doors to collect the questionnaires while the participants leave

class.





74


What Is a Crisis?


While crisis-intervention programs originally developed in community based

settings such as mental health centers, the need to expand services to school settings has


been evident for the past 30 years.


It was both a logical and necessary decision to begin


to view schools as critical settings for crisis prevention and intervention programs. In

fact, Peterson and Straub (as cited in Poland 1994) stated that "school administrators have

a clear legal obligation" to develop plans to prevent crises from happening and to manage

any crisis situation.

In the early 1970s the city of Chowchilla, California was faced with one of the


first school crises to gain national attention.


A review of the incident and the response of


the school system was compiled by Terr (as cited in Poland 1994).

children was kidnapped and buried underground for 27 hours. Aft


A busload of school


er their escape from


the kidnappers, the children were not offered any form of crisis-intervention from the


school or the community.


Five years after the incident, it was found that 100% of the


children involved in the kidnapping had clinical symptoms of depression, fear, or anxiety.

Incidents like the one in Chowchilla and changes in our society that have led

students and educators to feel less safe in our country's schools made it apparent that


crisis-intervention programs needed to become part of the school itself.


Then, instead of


being dependent on mental health professionals who are unknown to the students, school

personnel could provide critical support to students.

The development of school-based crisis-intervention programs has largely been








to work effectively in the school setting.


For example, today crisis-interventionists from


the fields of mental health and education agree that the term crisis is relative, determined


solely by the individual.


It is difficult to define crisi


s, as it varies by model, but three


points seem to be consistent (Pitcher & Poland 1992): (a) it is the perception of the

individual that defines a crisis, (b) the individual in crisis has a very difficult time

negotiating life while in this crisis state, and (c) the crisis state is not seen, in itself, as


psychopathology, nor is it chronic.


One point that has held constant, over 3


years, is


Gerald Caplan


's (1964) explanation that emotional crisis is a state of "psychological


disequilibrium" where the situation is not resolvable through usual methods.

Crises can come in many forms including but not limited to suicide, death of a

student or teacher by natural causes, murder, rape, auto accidents, natural disasters, gang

warfare, kidnapping, hostage situations in and outside the school, and national


emergencies.


Other forms of crisis that are not as apparent, but equally as real to the


individual are divorce of parents, moving away from friends or family, separation from


parents, unsuccessful relationships, lack of desired social acceptance, or low grades. T

severity of a crisis is relative to the individual who is experiencing it.

By 1990 some form of crisis-intervention program in the schools was the norm


(Pitcher & Poland 1992).


However, as crises are not necessarily a common occurrence,


the theory of crisis-intervention in the schools is still in the formative stages. Crisis-

interventionists in the schools have accepted some concepts as fundamental, many which

are common to the field of crisis-intervention in general.





76


The focus of intervention is on quickly returning an individual to the "pre-crisis"

state.

Crisis therapy and intervention should be short-term, usually lasting no more than 6

weeks.

The individual in crisis is discouraged from relying on the crisis-interventionist, as

the goal is to help re-establish autonomy.

By definition, the problem solving skills of an individual in crisis have been


exhausted


For this reason, people in crisis are more likely to accept outside help


(Pitcher & Poland, 1992, pp. 28-29).

According to Underwood & Dunne-Maxim (1997), crisis-intervention theory and

practice has evolved into a multidisciplinary approach to providing mental health services


to people in crisis.


Team approaches to crisis-intervention call for administrators from a


member of the school administration to serve in a leadership position and thus to


orchestrate the processes of preparation and response (e.g.,


counselors).


school psychologists, school


Other members of the school crisis response team may include internal


members (e.g., teachers, counselors, administrators) and external members (e.g., clergy,

law enforcement, local mental health professionals).

The Role of Teachers in Crisis-intervention


Although the provision of crisis-intervention services may not be an explicit job

responsibility for teachers in our society, it has become an implicit responsibility in


American schools.


Teachers will play a role in every crisis experienced by their students.





77

Teachers have the opportunity to establish relationships with their students; have an

understanding of the student's normal personality, behavior, and performance; and in

many cases, second only to parent's, have the most consistent contact with students.

The essential nature of a teacher's role in crisis-intervention in the schools

becomes apparent when considering crisis theory as set out by Lindemann (1944) and


Caplan (1964).


According to Lindemann (1944), crisis-intervention involved providing


four to six weeks of crisis therapy in which the victim was actively involved in facing


intense levels of pain.


The amount of time involved in crisis-intervention today remains


between four and six weeks.


Based on Caplan's


(1964) model of primary (i.e.,


prevention), secondary (i.e., intervention), and tertiary (i.e., post-vention) crisis care, the


four to six week period may be allocated differently.


Unfortunately, most professionals


trained in crisis-intervention (i.e., school counselors, school psychologists) are not able to


provide four to six weeks of crisis services.


However, teachers continue to have contact


with their students throughout the school year and, when prepared, may be able to play a

more critical role in returning students to pre-crisis states.


Secondary crisis-intervention is provided during a crisis situation.


In a school


system teachers, administrators, school counselors, and school psychologists who are


familiar with the students often provide immediate care.

intervention usually lasts no longer than a week. Studer


This period of crisis-


its are given the opportunity to


express their feelings, participate in memorial services, and take an active role in putting


the pieces back together. Teachers are encouraged to openly discuss their own reactions





78

express a wide range of emotions (i.e., nervous laughter, indifference, anger) in reaction

to a crisis (Poland & McCormick 1999).

In the event of a crisis, teachers are with students before mental health

professionals (i.e., school counselors, school psychologists) arrive and after they leave.

Therefore, teachers often have the most direct contact with students during all stages of


crisis response.


Poland and McCormick (1999) estimate that teachers will be able to help


95% of their students after a crisis.


Therefore, the responsibility for providing support to


those students and identifying the students who are at risk for experiencing long-term

negative effects of the crisis (the remaining 5%) is often placed on individual teachers.

By understanding the theory of crisis-intervention and developing crisis-intervention

skills, teachers can feel more confident in the role they are able to assume before, during,

and after a crisis event.

Today, crisis-intervention programs stress the need to listen actively, name the

taboo subject (e.g., suicide, rape, divorce) as soon as it becomes apparent, and remain


nonjudgmental.


By doing this, the student's (victim's) anxiety level decreases and


rapport begins to develop between the teacher (interventionist) and the student (Knudson,


2000).


Teachers have the most consistent, direct contact with the students in our schools.


This contact provides teachers a great opportunity to provide intervention by observing

signs of crisis in students (i.e., changes in behavior, mood, school performance), using

their pre-established rapport to speak with the student about their problems, and naming

the taboo subject.





79

need for crisis-intervention services and provide a response was measured before a crisis-


intervention training program and 10 months after the training.


The study found that


teachers who had participated in crisis-intervention training reported increased beliefs in

ability from pre- to post-test when compared to teachers who did not participate in

training.


Personalizing Crisis


We know that crises occur in everyone's life.


The details and magnitude of a


crisis may vary from person to person, but we have all reached a point in our lives when


our normal coping mechanisms no longer work.


When we don't know how to deal with


the emotions of a situation.


Think for a moment about a recent crisis in your life.


After you have identified


the crisis, consider the following questions as they relate to your experience.


When


answering the questions, try to think only of the feelings associated with the crisis, rather


than the details of the situation.


Details make the idea of crisis specific to you; we want


to consider the experience of crisis in general terms.

* What were your feelings during the crisis?


How did you behave during the crisis?


What were your actions?


What did you want from others during the crisis?

What helped and what hurt during the crisis?

Our goal in this training is to discuss ways that can make it easier for you to provide


emotional support to students in crisis.


It is only after you acknowledge that crisis is a





80


As discussed earlier, crisis-intervention in the schools is based largely on the


models used in mental health settings.

intervention also are the same. Follow


Therefore, the steps to providing crisis-


ving is a list of the steps that a school is encouraged


to take when providing emotional support to students in crisis.

1. Establish rapport and maintain contact with the student.


Establishment of rapport is the most critical stage in crisis-intervention; it is the


only way we can be trusted by another person.


In the case of schoolteachers, your


rapport presumably will have been established prior to the crisis.

While establishing rapport, do not promise to keep the things they tell you a


secret.


As a teacher you are a mandatory reporter and legally must tell their


parents if they are considering hurting themselves or if they are being abused.

You can tell them that you will not break their confidentiality unless you have to


and then you will let them know ahead of time. They ca

telling their parents in your presence) or as uninvolved (


in be as involved (i.e.,


.e., sitting in the next


room while you tell their parents) as they wish.


If a student's


crisis suggests imminent danger (i.e.,


suicide), you should not leave


them alone for any reason.


Only leave the child in the supervision of another


adult who is aware of the severity and specifics of the situation (i.e.,


another


school staff member or their parents).


Identify and clarify the student's


central problem.


Throughout this document, several ways to identify a crisis will be discussed








Evaluate danger.

* If a student is thinking of killing himself or herself, we need to determine whether

they have a plan, the means to carry out that plan, and know when they plan to


kill themselves.


You do not have to get all of this information, but if you can it


will be of great benefit to the counselor or psychologist who will be working with

them.


Assess the student's


strengths and weaknesses.


For example, is the student able to rely on any members) of their family for support,

are they good at talking about problems or do they prefer to write/draw/sing about

their feelings?


Mobilize the student'


resources.


If a student needs more support than you can offer, you have many resources to

help the student including parents, school counselors, school psychologists,


community mental healthcare workers, local clergy


Department of Children and


Families, Hospice, librarians (for books related to their crisis), art teachers (for

suggestions about art projects or to provide you with art supplies), etc.

Empathy vs. Sympathy


Empathy (em-, in + pathos, feeling) 1


the feelings, emotions, and behavior of another person.


An objective and insightful awareness of


To be distinguished from


sympathy which is nonobjective.


Empathy is the process of grasping and understanding the other person's


point of





82

as if they were you're own and communicating something of this awareness to the other


person.


You are accurately empathic when you can, (1) discriminate; get inside the


person, look at the world through the perspective or frame of reference of the other


person, and get a feeling for what the other's


world is like; and (2) communicate to the


other this understanding in a way that shows the other that you have picked up both their

feelings and the behavior and experience underlying these feelings.

It is important to maintain the "as if' quality, to sense the confusion, timidity or

anger as if it were your own, yet without your own uncertainty or far or anger getting

bound up in the understanding.

Empathy is not to be confused with sympathy (which implies agreement or


feeling the same way).


It is not necessary to like the other person's point of view, only to


understand it and accept the feelings that are involved.


This kind of understanding is rare.


We seldom receive or offer it.


Instead, we


offer a very different kind of understanding, such as,


"I understand what is wrong with


" or, "I understand what makes you act that way." These are evaluative


understandings form the outside. Thi

world only in our terms, not in theirs.


not truly understand it.


s type of understanding views the other person's

We analyze and evaluate their world, but we do


However, if someone understands what it feels like to be me,


without wanting to analyze or judge me, then a climate of openness ad freedom is

produced in which I can relax my defenses, explore, learn to cope with my feelings, and

grow.








There are several different ways that we respond to people.


Different modes of


response are more or less effective in differing situations.

* Giving advice indicates that the listener is intending to make a judgement on the


relative goodness, appropriateness, or rightness of the statement.


To make a


judgement when someone is self-disclosing some personal information is a sure way


to stop (or modify) the communication. It ind

what the speaker should, or might do. An eva

the responder in a position above the speaker.


licates that the responder wants to imply

iluative or advice-giving response puts

The responder judges the situation


presented by the speaker and relies on his or her own experience to offer what the

responder considers to be the most appropriate course of action.


"You shouldn't let him get away with that.


If I were you, I'd make him


apologize."

Interpreting conveys to the speaker that you know what the problem really means.


tells the speaker that (s) he should think how the listener thinks.


The interpreting


response indicates to the speaker that the listener knows the cause of the problem.

When an interpretive response is used it offers the speaker information and


explanations the listener feels will help clarify the problem.

answer the questions; "Why does the speaker feel this way?


his/her feelings


This response tries to

What is the cause of


The listener, having answered these kinds of questions for


himself/herself will then explain his/her conclusions to the speaker.


It suggests that


the listener knows the problem and the solution, without considering the speaker's








"You feel that way because it'


so hot outside and you've got so much work to


Supporting intends to reassure the other person and minimizes the feelings by

indication that the speaker is not alone and that others have felt that way before.


supportive response tries to pacify or reduce the intensity of the speaker's


feeling


with some kind of soothing remark.


The speaker's


feeling is minimized when the


listener indicates that the feeling is not unique and is not particularly special.


listener tries to comfort the speaker with an underlying message of, "It'


not all that


When someone is having a rough time,; it really doesn't help him or her to


know that other people have also had a rough time.


It almost makes them feel like


they shouldn't be so distressed by it, and that certainly doesn't help the situation, to


tell someone,


sn't all that bad,


ok. After all, everybody feels


en they feel it is, is disturbing.

that way sometimes."


Probing seeks further information along a certain line.


This response tells the speaker


which point to discuss further. The probing indicates that the listener wants to know

more about the situation, to clarify areas that were confusing for the listener, or to


find out something that hadn't been said.


Probing responses can be used to better


understand a feeling that was unclear; they can also be used to narrow the content of


the speaker'


sharing or to change the subject and focus on something other than the


feeling that was being discussed.


A probing response is usually a question, but not all


questions are probing responses.





85


Paraphrasing intends to check out whether the listener correctly understands what the


speaker said.


a statement that demonstrates,


"Here's


what I understand, is that


correct?'


It lets the other person know what feelings you are hearing from them and it


lets them feel understood.


expressing.


It often helps the speaker to see more clearly what (s) he is


The paraphrasing response shows that the listener tuned in, heard and


understood the feelings.

* "You sound really excited about this weekend, even though you are worried about

meeting his parents."

We choose paraphrasing as a way to respond to others so that they will know they


have been heard and understood.


Sometimes you may feel like you are doing little,


because you are simply restating what they have said rather than helping them solve


their problems.


Interestingly enough, when person finally feels


like somebody has


heard what is going on in his or her life they will be more likely to work towards a


resolution to their crisis.


Also, just because you think you have understood what


another person has said doesn't mean you have.

your assumptions and perceptions. How can yo


Paraphrasing is a way to check out


>u know for sure without checking?


What is a Paraphrase?


Paraphrase is a restatement of the speaker's

understanding of that communication. It is a staten


communication in order to test your


nent, in your own words, indicating


what the speaker's


remark conveyed to you.


A paraphrase gives the speaker a chance to


determine whether their message got through to you.








feelings you heard to see if you understood those feelings.


And the third level is


paraphrasing the emotional content of normal conversation when others may be

attempting to cover up their feelings (or they may be unaware of them).

Three Typvoes of Paraohrasing


Paraphrasing facts


Statement: "My address is


Response: "That was 923 SW 3rd Avenue.

Paraphrasing feelings


923 SW 3rd Avenue.


Statement:


"WOW? This


really exciting


I don't expect everything to go so well the


first time around."


Response:


"You are delighted with the way things are going so far."


Paraphrasing the emotional content in normal conversation


Statement:


"boy, I've had it.


What a day


I had to work late and then the phone's


been ringing ever since I got in the door.


I'm exhausted.


Sure wish I could just curl


up in the comer with a good book instead of going to that meeting tonight."


Response: "Sounds like you're edgy tonight.


I bet you'd like some time just to relax


by yourself."

Why paraphrase?


Each person perceives us in a unique way and responds to us in terms of their


"image"


of us and their perception of him or herself.


Our behavior may not always


reflect our intentions.


Our own self-image is built from the reactions others have to us.








misunderstandings and the listener to try again.


We send many messages verbally and


nonverbally.


We even send some messages without knowing it.


We have no way of


knowing which messages the listener is "hearing"


unless we are told.


What happens when we paraphrase?


When a listener first begins to contribute to a conversation through paraphrasing,


they often feel that they "aren't doing anything.


response isn't helpful because it'


The feeling is that the paraphrase


just a repetition of what the sharer has said.


Those of us who are anxious to contribute our share of ideas to the conversation

(and thus, demonstrate that we are brilliant) realized immediately that the paraphrase


response allows little room for indicating our brilliance.

relinquishes the leadership role and "follows" the other


When paraphrasing, the listener


through the conversation.


Namine Taboo Subiects


As teachers, you will be expected to handle intense crises dealing with a range of


human emotion and experiences.


Many crises that your students will experience will deal


with topics that are not easily discussed in our culture.


Such subjects, often called taboo


subjects, may include issues such as abuse, incest, rape, and AIDS.


Saying something out loud that you are ashamed of or that feels awful,


called naming the taboo subject, can be frightening to anyone.


often


As a teacher you may be


working with students who are afraid to tell anyone what is going on in their lives, their

vocabulary may not be sophisticated enough to tell you exactly what is going on, or they


may be ashamed to tell you.


However, a student may hint around to you about what is








Naming a taboo subject requires you to take a risk and trust your gut.


You most


likely know what another person is referring to, but taking the chance to name that taboo

subject can be difficult. Most often you will be right and the person you are talking to


will be relieved to have the pressure taken away from them.


Now they will feel free to


openly discuss how they feel, especially if you sound nonjudgmental when you name the


taboo.


If you take a chance and make a mistake, the worst thing that will happen is that


the student will correct you... people rarely get mad when you are genuinely trying to

help them.

Following are some examples of statements that students could make to you where


you identify a taboo subject that they are too afraid to mention.

statements and try to identify the taboo subject being hinted at.


Read the following

At the bottom of the list


of statements you will find the taboo subjects the speaker may be hinting at.

1. "Something awful and gross happened when my babysitter took care of me last

night." (rape)


"My dad doesn't treat my mom right sometimes.


She has to stay away from her


friends for a while after it happens." (spouse abuse)


"My mom got so angry at me the other night that she punished me really hard.


" (child


abuse)

"I'm concerned about being in the house alone with my father." (incest)

"I wish I had some other disease so that people wouldn't be scared to be around me."

(AIDS or similar stigmatizing disease)





89


"Ever since September 11, people have treated my whole family like we are going to


hurt them.


" (racial prejudice)


" I feel really dirty when I'm around my uncle.


" (incest)


"Just because I'm sick, grown-ups cry around me all the time and kids are afraid to


play with me.


like I'm already dead."


(terminal illness)


10. "My brother came home from Los Angeles and told my parents that he doesn't like


girls.


Now my dad says he's


not his son anymore.


" (homosexuality)


rape

spouse abuse

child abuse

incest


fear of alcoholism


. racial prejudice

. incest

. terminal illness


AIDS


10. homosexuality














APPENDIX B


TRAINING MATERIALS


- LECTURE GROUP


Set Up

Participants will not be provided with any training materials for the lecture format.

We hope they will gain knowledge and skills through listening to your presentation


and asking questions.


Specifically, the lecture will involve the facilitating trainer


speaking to the whole group and asking simple questions. Any questions asked by the

pre-service teachers will be answered by the facilitating trainer and documented by

the training partner.


Introduction


Thank you all for agreeing to participate in our research study.

During this class period, I will be conducting a 45-minute presentation on providing


emotional support to students in crisis.


Following training, you will be asked to


answer some questions, which should take approximately 15 minutes to complete.

You are not required to participate in our study and you do not have to answer any

question you do not wish to answer.

Some of the concepts that we will be presenting during training may be different from


your normal understanding of how to provide emotional support to others.


We ask


that you give us your trust for the next 45-minutes by suspending disbelief and





91


What is a Crisis?


* Crisis is a relative term.


We have all experienced a crisis at some time in our lives.


Crises can come in many forms including but not limited to (ask participants for their

ideas before, any not mentioned by the participants should be presented to them):

* suicide,

* death of a student or teacher by natural causes,

* murder,

* rape,

* auto accidents,

* natural disasters,

* gang warfare,

* kidnapping,

* hostage situations in and outside the school,

* and national emergencies.

Other forms of crisis that are not as apparent, but equally as real to the individual are

(again, ask the participants for their ideas before providing the list to them)

* divorce of parents,

* moving away from friends or family,

* separation from parents,

* unsuccessful relationships,

i ^ ,j ^ -_ j '