Crisis Intervention Using the NASP PREPaRE Model (2nd ed.)

Crisis Intervention Using the NASP 

PREPaRE Model (2 nd ed.) 

Presented by: Stephen E. Brock, Ph.D., NCSP 

WS2 Author & PREPaRE Workgroup Co-Chair 

1

P 

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E 

P 

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Conceptual Framework of the 

PREPaRE Model 

Prevent and Prepare for psychological trauma 

Reaffirm physical health and perceptions of security and safety 

Evaluate psychological trauma risk 

Provide interventions 

and 

Respond to psychological needs 

Examine the effectiveness of crisis prevention and intervention

Preface 

On the importance of being prepared to intervene 

with children: 

• “It is generally accepted now that children represent a highly vulnerable 

population, for whom levels of symptoms may often be higher than for 

adults.” 

• “Recent literature also suggests that childhood trauma can have a lasting 

impact on child cognitive, moral, and personality development, and coping 

abilities.” 

Note. Barenbaum, Ruchkin, & Schwab-Stone (2004, p. 42).

Preface 

On the need for a “school” crisis management 

model and 

training program. 

• “As outside providers enter the school setting specifically to provide mental 

health services, a clear understanding of the school structure and culture is 

warranted.” 

• “School-based screening and treatments should be considered after 

community-level traumatic events because this is an efficient way of 

identifying and treating affected children.” 

Note. Brown & Bobrow (2004, p. 212); Cohen et al. (2010, p. 421).

Basic Assumptions 

Crisis Event Characteristics 

a. Perceived as extremely negative 

b. Generate feelings of helplessness, powerlessness, and/or entrapment 

c. May occur suddenly, unexpectedly, and without warning 

Note. APA. (2000); Brock (2002a; 2006, July; 2006); Brock et al. (2009); Carlson (1997).



1. Crisis classifications 

a. Acts of war and/or terrorism 

b. Violent and/or unexpected death 

c. Threatened death and/or injury 

d. Human-caused disasters 

e. Natural disasters 

f. Severe (nonfatal) illness or injury 

Note. Brock et al. (2001)



2. Variables that affect an event’s traumatic potential 

a. Type of disaster 

i. Human caused vs. natural 

ii. Intentional vs. accidental 

Note. Charuvastra & Cloitre (2008).



b.Event predictability, consequences, duration, and intensity – 

interaction with the crisis event (or disaster type) 

Note. Brock et al. (2009). 

Predictability Consequences 

Crisis Event 

Duration Intensity 


Devastation


Levels of School Mental Health Crisis Response 

1. Minimal response 

2. Building-level response 

3. District-level response 

4. Community- or regional-level response 

Note. Brock (2002b); Brock, Sandoval, & Lewis (1996, 2001).

The crisis state is 


“…a temporary state of upset and disorganization, characterized 

chiefly by an individual’s inability to cope with a particular situation 

using customary methods of problem solving, and by the potential 

for a radically positive or negative outcome.” 

Other characteristics of the crisis state 

•More than simple stress 

•Not necessarily mental illness 

Note. Slaikeu (1990, p. 15).


© Yuri Arcurs | Dreamstime.com 

Note. Brock & Jimerson (2004); Cohen et al. (2010). 

Mental Illness 

• Anxiety disorders 

• Substance-related disorders 

• Dissociative disorders 

• Mood disorders 

• Disorders of infancy, childhood, or 

adolescence 

• Sleep disorders 

• Adjustment disorders


The Consequences of Crises on School Functioning 

• School behavior problems (aggressive, delinquent, & criminal behavior) 

• School absenteeism 

• Academic decline 

• Exacerbation of preexisting educational problems 

Note. Azarian & Skriptchenko-Gregorian (1998); Brock & Jimerson (2004); Cook-Cattone (2004); March et al. (1997); Monahon 

(1993); Nader & Muni (2002); Sharkey (2010); Silverman & La Greca (2002); Vogel & Vernberg (1993); Yule (1998).

© Monkey Business Images |Dreamstime.com 

Note. Moos & Billings (1984); Sandoval & Brock (2009). 


School Crisis Intervention 

• Facilitate adaptive coping 

Restore basic problem-solving 

abilities 

Begin to return to pre-crisis 

levels of functioning

P 

R 

E 

P a 

R 

E 


Prevent and Prepare for psychological trauma 

Reaffirm physical health and perceptions of security and safety 

Evaluate psychological trauma risk 

Provide interventions 

and 

Respond to psychological needs 

Examine the effectiveness of crisis prevention and intervention


The Incident Command System (ICS) 

1. Incident Command (the managers) 

2. Planning Section (the thinkers) 

3. Operations Section (the doers) 

a. Student Care Group 

i. Mental Health Response Strike Team 

4. Logistics Section (the getters) 

5. Finance Section (the payers)

Prevent & Prepare for Psychological Trauma 

© Elena Elisseeva | Dreamstime.com 

Note. Reeves, Nickerson, & Jimerson (2006). 

Prevent Crises 

1. Ensure physical safety 

a. Crime prevention through 

environmental design 

i. Natural surveillance 

ii. Natural access control 

iii.Territoriality 

b. Vulnerability assessment

Prevent & Prepare for Psychological Trauma 

Prevent Crises 

2. Ensure psychological safety 

a. School-wide positive behavioral supports 

b. Universal, targeted, and intensive academic and 

social–emotional interventions and supports 

c. Identification and monitoring of self- and otherdirected 

violence threats 

d. Student guidance services 

Note. Reeves et al. (2006).

Reaffirm Health & Safety 

“The first step following a disaster is to ensure the 

safety, shelter, and sustenance of children and their 

caregivers. In our experience, mental health 

interventions are secondary. Once these basic needs 

are met, there is a role for mental health 

professionals.” 

Note. Brown & Bobrow (2004, p. 212).


Psychological Health & Safety 

1. Recognizing the importance of adult reactions and 

behaviors 

2. Minimizing crisis exposure 

3. Reuniting/locating caregivers and significant others


Psychological Health & Safety 

4. Providing facts and adaptive interpretations 

5. Returning students to a safe school environment 

6. Providing opportunities to take action


“Once traumatic events have stopped or been 

eliminated, the process of restoration begins. Nonpsychiatric 

interventions, such as provision of basic 

needs, food, shelter and clothing, help provide the 

stability required to ascertain the numbers of youth 

needing specialized psychiatric care.” 

Note. Barenbaum, Ruchkin, & Schwab-Stone (2004, p. 49).

Evaluate Psychological Trauma 

Rationale for Assessing Psychological Trauma 

1. Unique consequences of crisis exposure. 

a. Not all individuals will be equally affected. 

b. Recovery is the norm. 

i. Crisis intervention should be offered in response 

to demonstrated need. 

ii.“Not everyone exposed to trauma either needs 

or wants professional help.” (McNally et al., 

2003, p. 73) 

iii. Exception: students with preexisting 

psychopathology. 

Note. Brock et al. (2009); Cohen et al. (2010)


Rationale for Assessing Psychological Trauma 

2. Unique consequences of crisis intervention 

a. Crisis intervention may cause harm if not truly needed. 

i. It may increase crisis exposure. 

ii.It may reduce perceptions of independent 

problem solving. 

iii. It may generate self-fulfilling prophecies. 

Note. Berkowitz (2003); Everly (1999).



Crisis 

Event 

Variables 

Risk 

Factors 

Predictability Consequences 


Duration Intensity 

Threat Perceptions 

Exposure Vulnerability 

Early Warning Signs 

(reactions displayed during 

impact and recoil phases) 

Enduring Warning Signs 

(reactions displayed during 

postimpact and 

recovery/reconstruction 

phases) 

Initial Crisis 

Reactions 

Durable Crisis 

Reactions 

Common 

Reactions 

Psychopathological 

Reactions


Assessment Variables 

Variable 1: Crisis Exposure Risk Factors 

a. Physical proximity 

b. Emotional proximity 

*Risk factors increase the probability of psychological trauma and, as such, should result in increased 

vigilance for symptoms of traumatic stress (or warning signs). 

Note. Brock (2002d).



Variable 1a: Crisis Exposure Physical Proximity Risk Factor 

On Playground 

In School 

On Way Home 

In Neighborhood 

At Home 

Absent 

Out of Vicinity 

Note. Pynoos et al. (1987). 

PTSD Reaction Index × Exposure Level 

0 2 4 6 8 10 12 14 

Reaction Index Score (≥ 12 = Severe PTSD)



Variable 1b: Crisis Exposure Emotional Proximity Risk Factor 

Percentage with PTSD 

60% 

50% 

40% 

30% 

20% 

10% 

0% 

PTSD and Relationship to Victim×Outcome (i.e., injury or death) 

22% 

15% 

15% 

52% 

25% 

12% 

8% 

18% 

11% 

Person Injured Person Died 

Outcome Category 

Parent/Sibling Other Family Friend Other Person No one 

Note. Applied Research and Consulting et al. (2002, p. 34). 

9%



Variable 2a: Internal Vulnerability Risk Factors 

i. Avoidance coping style 

ii. Pre-crisis psychiatric challenges 

iii. Poor ability to regulate emotions 

iv. Low developmental level and poor problem solving 

v. History of prior psychological trauma 

Note. Brock (2002d); Brock et al. (2009).



Variable 2b: External Vulnerability Risk Factors 

i. Family resources 

1. Not living with a nuclear family member 

2. Family dysfunction (e.g., alcoholism, violence, child maltreatment, 

mental illness) 

3. Parental PTSD/maladaptive coping with the stressor 

4. Ineffective and uncaring parenting 

5. Poverty or financial stress 

ii. Extra-familial social resources 

1. Social isolation 

2. Lack of perceived social support 




Variable 3: Threat Perception Risk Factor* 

a. Subjective impressions can be more important than actual crisis 

exposure. 

b. Adult reactions are important influences on student threat 

perceptions. 

*Risk factors increase the probability of psychological trauma and, as such, should result 

in increased vigilance for symptoms of traumatic stress (or warning signs). 




Variable 4: Crisis Reaction Warning Signs* 

a. Early warning signs 

b. Enduring warning signs 

c. Developmental variations 

d. Cultural variations 

*Warning signs are symptoms of traumatic stress. 




Variable 4a: Crisis Reaction Early Warning Signs 

i. Most are common reactions to unusual circumstances. 

ii. Some are mental health referral indicators: 

1. Reactions that interfere with daily functioning. 

2. Acute reactions (panic, dissociation, extreme fright). 

3. Increased arousal (exaggerated startle, hypervigilance, and sleep 

disturbance). 

4. Maladaptive coping (suicidal or homicidal thoughts and behaviors). 

Note. Brock (2002d); Brock et al. (2009); Cohen et al. (2010)



Variable 4b: Crisis Reaction Enduring Warning Signs 

i. Reactions do not remit or worsen after a week or more. 

ii. Acute stress disorder 

iii. Acute posttraumatic stress disorder 

Note. Brock (2002d); Brock et al. (2009); Nickerson et al. (2008).



Variable 4c: Developmental Variations 

i. Preschoolers 

1. Reactions not as clearly connected to the crisis event as those 

observed among older students. 

2. Reactions often expressed nonverbally. 

3. Given equal levels of distress and impairment, may not display as 

many PTSD symptoms as older children. 

4. May include a temporary loss of recently achieved developmental 

milestones. 

5. Trauma-related play. 

Note. American Psychiatric Association (2000); Berkowitz (2003); Cook-Cottone (2004); Dulmus (2003); 

Joshi & Lewin (2004); Yorbik et al. (2004).




ii. School-age children 

1. Reactions tend to be more directly connected to crisis event. 

2. Event-specific fears may be displayed. 

3. Reactions are often expressed behaviorally. 

4. Feelings associated with the traumatic stress are often expressed 

via physical symptoms. 

5. Trauma-related play becomes more complex and elaborate. 

6. Repetitive verbal descriptions of the event. 

7. Problems paying attention. 






iii. Preadolescents and adolescents 

1. More adult like reactions 

2. Sense of foreshortened future 

3. Oppositional and aggressive behaviors 

4. School avoidance 

5. Self-injurious behavior and thinking 

6. Revenge fantasies 

7. Substance abuse 

8. Learning problems 





Variable 4d: Cultural Variations 

i. Other important determinants of crisis reactions in general, and of 

grief in particular, are family and cultural and religious beliefs. 

ii. Crisis interveners should inform themselves about cultural norms 

with the assistance of community cultural leaders who best 

understand local customs. 

Note. Sandoval & Lewis (2002).

Evaluate Psychological Trauma


Conducting Psychological Triage 

Levels of Triage 

Level Timing Variables 

considered 

Primary Before immediate 

crisis intervention 

Secondary During the 

provision of crisis 

intervention 

Tertiary As crisis 

intervention 

concludes 

Selected risk 

factors and 

early warning 

signs 

Risk factors 

and warning 

signs 

Risk factors 

and warning 

signs 

Goals 

1. Establish initial intervention 

priorities 

2. Make initial decisions about 

intervention needs 

1. Refine intervention priorities 

2. Match interventions to 

individual needs 

3. Begin to consider mental 

health referrals 

1. Identify individuals who 

need mental health referrals 

2. Make appropriate referrals

Conducting Psychological Triage 

Levels of Triage 

aImmediate mental health referrals should be made for students who, during any crisis phase, manifest grossly maladaptive coping 

(e.g., suicidal or homicidal ideation). 

Note. Adapted from Conolly-Wilson (2008).

1. Reaffirm physical health. 

2. Ensure perceptions of safety. 

3. Evaluate psychological trauma. 

4. Make initial crisis intervention 

treatment decisions. 

5. Reevaluate degree of 

psychological injury and make 

more informed crisis intervention 

treatment decisions.

Levels of School Crisis interventions

Provide Interventions and Respond to Student Needs 

Reestablish Social Support Systems 

Social Support Defined 

“. . . an individual’s perception that he or she is loved or cared for, esteemed, 

and valued by people in his or her social network, which enhances personal 

functioning, assists in coping adequately with stressors, and may buffer him or 

her from adverse outcomes.” 

Note. Demaray et al. (2005, p. 691).


Reestablish Social Support Systems 

Strategies 

1. Reunite students with primary caregivers. 

2. Reunite students with peers and teachers. 

3. Return students to familiar environments and routines. 

4. Facilitate community connections. 

5. Empower caregivers with crisis recovery information. 

Note. Brock and Jimerson (2004).


Crisis Psychoeducation Defined 

The provision of direct instruction and/or the 

dissemination of information that helps crisis 

survivors and their caregivers in understanding, 

preparing for, and responding to the crisis event, and 

the problems and reactions it generates (both in 

oneself and among others).


Psychoeducation Strategies 

1. Informational documents 

2. Caregiver trainings 

3. Classroom meetings 

4. Student psychoeducational groups 

Note. Brock et al. (2009); Reeves, Kanan, & Plog (2010).


Psychological Crisis Interventions Defined 

1. Active and direct attempts to facilitate adaptive 

coping and directly respond to symptoms of traumatic 

stress 

2. Aim at reestablishing immediate coping (not 

necessarily crisis resolution) 

3. Designed to help students cope with crisisgenerated 

problems, and/or to allow them to access 

more intensive psychotherapeutic treatment


Psychological Intervention Strategies 

1. Immediate classroom-based (or group) crisis intervention 

2. Immediate individual crisis intervention 

3. Long-term psychotherapeutic treatment interventions 

Primary Considerations 

1. How can these interventions be counterproductive? 

2. When is parental permission required or not required for 

these interventions? 

3. Are there limits to what the school-based mental health 

professional can and should do?


Psychological Intervention Strategy 1 

Classroom-Based Crisis Intervention (CCI) 

1. Explores individual experiences and reactions 

2. Helps students feel less alone and more connected to classmates, 

and normalizes experiences and reactions 

3. Recognizes the need for and advantage of groups 

4. Is a psychological triage tool 

5. Is similar to “debriefing”



Classroom-Based Crisis Intervention 

Indicated 

1. For students who are secondary or vicarious crisis survivors 

2. When offered as a part of a comprehensive crisis intervention 

program 

3. When offered as a more involved, longer crisis intervention 

4. When used in a group setting with individuals similarly exposed to a 

common crisis event 

Note. Brock et al. (2009).




Not indicated 

1. For physically injured or acute trauma victims 

2. As a stand-alone or brief crisis intervention 

3. As an individual crisis intervention 

4. With individuals exposed to different crises 

5. With groups that are historically hurtful or nonsupportive 

6. When witness credibility is a concern 




Classroom-Based Crisis Intervention Goals 

1. Immediate coping improved. 

2. Crisis facts understood and rumors dispelled. 

3. Experiences/reactions are understood and normalized. 

a. Greater connection to peers comes from recognizing 

common experiences and reactions. 

4. Psychopathological reactions and maladaptive coping are 

identified (secondary triage). 

5. Self-referral procedures identified. 

6. Strategies for managing stress and addressing crisis problems. 





General Considerations 

1. Who should participate 

2. CCI group size 

3. Where to offer CCI 

4. When to offer CCI 

5. CCI providers 

6. Role of the teacher 

7. Follow-up 

8. Parental permission 

9. Limits of confidentiality 

Note. Brock & Jimerson (2004); Brock et al. (2009).



Classroom-Based Crisis Intervention Elements 

1. Introduce session (10–15 min). 

2. Provide crisis facts and dispel rumors (30 min). 

3. Share crisis stories (30–60 min). 

4. Identify crisis reactions (30 min). 

5. Empower students (60 min). 

6. Close (30 min).



Individual Crisis Intervention (ICI) 

Preliminary Considerations 

1. Addresses the immediate needs 

2. Is not psychotherapy 

3. Does not require crisis resolution 

a. Establishes momentum leading to crisis resolution 

4. Is a first-aid response 

Note. Brymer et al. (2006); Hobfoll et al. (2007); Ruzek et al. (2007).



Immediate Individual Crisis Intervention Goals 

Reestablish immediate coping 

1. Ensure safety, provide physical and emotional support. 

2. Contain distress. 

3. Identify crisis-generated problems. 

4. Support adaptive coping and begin problem solving. 

5. Assess trauma risk and link to helping resources. 

Note. Brymer et al. (2006); Litz et al. (2002); Phipps & Byrne (2003); Ruzek et al. (2007); Slaikeu (1990); Wilson et al. (2000).



Individual Crisis Intervention 

General Considerations 

1. Participants 

2. Location 

3. Timing 

4. Providers 

5. Follow-up 

6. Parental permission 




Individual Crisis Intervention Elements 

1. Establish contact. 

2. Verify readiness. 

3. Identify and prioritize problems. 

4. Address crisis problems. 

5. Evaluate and conclude. 

4. Address 

Crisis Problems 

5. Evaluate & 

Conclude 

Not necessarily 

a linear process 

3. Identify & 

Prioritize Crisis 

Problems 

1. Establish 

Psychological 

Contact 

2. Verify 

Readiness to 

Proceed



Psychotherapeutic Treatments: Trauma-Focused 

Therapies 

Trauma-focused psychotherapies should be considered first-line 

treatments for children and adolescents with PTSD. These therapies 

should 

1. Directly address children’s traumatic experiences 

2. Include parents in treatment in some manner as important agents 

of change 

3. Focus not only on symptoms improvement but also on enhancing 

functioning, resiliency, and/or developmental trajectory. 

Note. Cohen et al. (2010, pp. 421–422)



Psychotherapeutic Treatments: Cognitive– 

Behavioral Therapies 

1. Imaginal and in vivo exposure 

2. Eye-movement desensitization and reprocessing 

(EMDR) 

3. Anxiety management training 

4. Cognitive–behavioral intervention for trauma in 

schools (CBITS; group delivered) 

5. Parent training 

Note. Brock et al. (2009); Cohen et al. (2010).



Psychotherapeutic Treatments: 

Psychopharmacological Treatments 

1. Used in combination with ongoing psychotherapy 

2. Most appropriate for youth who do not respond to 

psychosocial interventions 

3. Tailored to the needs and symptoms of the individual 

Note. Brock et al. (2009); Cohen et al. (2010).



Psychotherapeutic Treatment Interventions 

“Overall, there is growing evidence that a variety of CBT programs are 

effective in treating youth with PTSD . . . Practically, this suggests that 

psychologists treating children with PTSD can use cognitive–behavioral 

interventions and be on solid ground in using these approaches.” 

Note. Feeny et al. (2004, p. 473).



Psychotherapeutic Treatment Interventions 

“In sum, cognitive behavioral approaches to the treatment of PTSD, 

anxiety, depression, and other trauma-related symptoms have been 

quite efficacious with children exposed to various forms of trauma.” 

Note. Brown & Bobrow (2004, p. 216).

Examining Effectiveness 

Strategies 

1. Needs assessment 

2. Process analysis 

3. Outcome evaluation

Concluding Comments 

About the PREPaRE Model or Workgroup 

Melissa A. Reeves, PhD, NCSP, PREPaRE Chair 

– mereev@aol.com 

Stephen E. Brock, PhD, NCSP, PREPaRE Cochair 

– brock@csus.edu 

Regarding PREPaRE Workshops 

• Workshop 1: Crisis Prevention & Preparedness: The Comprehensive School 

Crisis Team 

Primary Contact: 

– Melissa A. Reeves, PhD, NCSP 

• mereev@aol.com 

• Workshop 2: Crisis Intervention & Recovery: The Roles of the School-Based 

Mental Health Professional 

Primary Contact: 

– Stephen E. Brock, PhD, NCSP 

• brock@csus.edu

Questions and Comments 

• Immediate Crisis Intervention Consultation 

NASP National Emergency Assistance Team (NEAT) 

– Susan Gorin, Executive Director NASP, or Kathy Cowan, Director of 

Communications – (301) 657-0270 

• Various handouts for information and dissemination 

http://www.nasponline.org/resources/crisis_safety/schoolsafety.aspx 

• To order the book School Crisis Prevention & Intervention: The PREPaRE 

Model 

http://www.nasponline.org/publications/booksproducts/prepare.aspx 

• To join the Crisis Management in the Schools Listserv 

Send an e-mail to NASP-IG-CrisisManage-subscribe@yahoogroups.com 

Or go to http://groups.yahoo.com/group/NASP-IG-CrisisManage/ and click 

on “Join This Group” 

• NASP Members can also join the Crisis Interest Group NASP Community 

Go to www.nasponline.org and click on “Communities” – follow instructions 

to join

Concluding Comments 

Acknowledgment 

Brock, S. E., Nickerson, A. B., Reeves, M. A., Jimerson, S. R., 

Feinberg, T., & Lieberman, R. (2009). School crisis prevention and 

intervention: The PREPaRE model. Bethesda, MD: National 

Association of School Psychologists. 

$52 NASP Members 

$65 Regular Cost 

• brock@csus.edu 

• http://www.csus.edu/indiv/b/brocks/ 

Available from: http://www.nasponline.org/publications/booksproducts/prepare.aspx

Crisis Intervention Using the NASP PREPaRE Model (2nd ed.)

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