Theme: Critical Incident Management for International Students

DRAFT  Learning from critical incident case studies

 

Introduction

Case studies are useful learning tools to help practitioners and institutions respond better to critical incidents, which are events that may overwhelm the ability of an institution to respond. No matter how robust an emergency management plan is, it cannot outline every potential incident and response. Therefore, scenario-based, or problem-based, training has been shown to be the best way to improve non-specific problem solving skills, to enable practitioners to plan flexibly and manage a wide variety of incidents.

This module contains six real critical incidents involving international students at New Zealand institutions. We recommend reading the case study and taking time to think about and respond to the questions for reflection. This can be a useful exercise for your team to do together, to consider ways that your institution would manage a similar scenario. 

Then read on to learn some actions that we suggest you may need to think about in responding to critical incidents of this nature. Note that these are only suggestions and they do not constitute an exhaustive list of all of the actions you might need to undertake, depending on the particular circumstances of any individual incident.

Thanks to the individuals and institutions who provided case studies anonymously.

A road accident

Case study description

A group of four international students and one domestic student, who have been studying for a year at your institution, have become friends and decide to venture on a campervan holiday. The students are travelling on State Highway 1 from Hamilton to Taupo when their campervan hits an oncoming vehicle. 

The students are all taken to Taupo Hospital. One Chinese student and the New Zealand student have minor injuries and are recovering in Taupo Hospital. The Korean and Swedish students have significant injuries and are airlifted to Hamilton hospital. Both are in critical condition. The fifth student, a Chinese national, has major burns and is transferred to the Middlemore Hospital burns unit in Auckland.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who needs to be involved in responding?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

Establish a response team

When a complex critical incident like this occurs, one of the first things your institution should do is to establish (or activate) a response team to provide the necessary support for the people immediately affected by the incident. The team will also activate your tailored critical incident response plan (draft Tailored Critical Incident Plan topic to be released). Key staff involved in the pastoral care of learners should be part of this team. 

You will also need to decide on roles for the team members. Some possible roles include:

  • Leadership/coordination (making key decisions, leading the response)
  • Field liaison, support and logistics (travel plans, coordination with insurance, etc)
  • Incoming communications (managing calls and enquiries, communicating with doctors and students involved)
  • Internal communications (managing messaging to students and staff)
  • Staff wellbeing
  • Family liaison
  • Media communications 
  • Business continuity (how will your institution carry on with BAU as staff are occupied with managing the incident?)
  • Scribe (to record all events in writing as they unfold)

Depending on the size of your institution, each person may need to take on multiple roles. Organise a tasks timetable for the next few days. Plan ongoing feedback and regular meetings, so that the coordinating team is continually in touch and working together.

Working with students’ families

Your family liaison should carefully consider how and when you make contact with the students’ families. As a general rule, communicate as early and frequently as possible, while ensuring you have accurate and sufficient information for them to make any decisions. You may also need to think about facilitating their travel to New Zealand (e.g., arranging visas).

Communicating with other staff and students

The person on your team responsible for internal communications will need to make arrangements for contacting and informing other staff and students about the incident. What guidelines could you provide to staff about the information they give students? A written bulletin to staff may be helpful if the matter is complex. Also consider who may be most at risk and need additional support; for example, friends, supervisors or others who have experienced a similar trauma may be particularly vulnerable.

You may want to arrange a time and place for an initial group/individual debriefing session using counsellors. In this session, participants can be given an opportunity to share the impact of the event, discuss various cultural interpretations of the event, and work through painful emotions. 

Working with the police and emergency services

In a critical incident such as this, the police, hospitals and/or emergency services may have protocols that need to be followed. You should make contact with the appropriate authorities as early as possible, to understand their role and what they will require from you. Clarify things like who will contact the students’ families and how media enquiries should be managed.

Working with the media

Once you have identified your media spokesperson, make a plan for managing media enquiries (topic page due to be released). It is critical that you anticipate and respond to the media effectively in the event of a major incident like this. If the story does make it into the news, your organization needs to be ready to be a primary and definitive source of information if required, noting that police and/or emergency services may have protocols that need to be followed. If you are not the one telling the story, a story will nevertheless still be told and it may be one that is less accurate and less sympathetic to your organisation. 

You will also need to consider social media. If your organisation is established on a number of social media platforms, it could streamline communications to use a social media aggregator to quickly collect incoming and outgoing messages. Choose one platform such as your website, where you will be posting updates and responding to questions (it is no longer adequate to just transmit, you need to be prepared to interact), and push these messages out to other platforms. 

Supporting your staff

A complex crisis such as this will require a great deal of time and energy from your staff, and it will likely be emotionally taxing, particularly for those who know the students involved. How will your institution support their wellbeing, for example, by ensuring staff take adequate breaks and access support services such as counsellors

Your institution ideally has already made contingency plans for such an incident that includes additional resources that can be brought in to support staff. For example, you may have staff in other parts of the institution who are trained to support critical incidents, or external contractors or agencies you can call upon.

Suggested long-term actions

Once a critical incident is over, one of the most important things that your institution can do is to debrief and learn from the incident to prevent a recurrence and/or help you manage any future incidents effectively. The response team should discuss what went well and what could have been done better. How might you adapt and fine-tune your critical incident response plan with any learnings?

You will also need to consider how you will provide ongoing support for staff and students. For the students and families involved, this could include long-term medical treatment, insurance matters and travel planning. Staff involved in the response may need some time off to recover, and potentially counselling or other support.

You should also consider what other actions your institution might take to prevent incidents like this in the future. For example, in this particular situation, you might consider whether your motor vehicle policy for students was sufficient.

Resources for further information

 

A student death

Case study description

You receive a call at 8am to inform you that an international student died at a hall of residence last night after what is believed to be an asthma attack. Police say there are no suspicious circumstances. The student, from Malaysia, had moved into the halls two days earlier. 

The student was found unconscious in his room by other students at about 7pm last night. An ambulance was called and attempts were made to revive him, both by staff trained in first aid and subsequently by paramedics, without success.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who will need to be involved?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

The fatality of a student is obviously an extremely traumatic event for everyone involved. Your institution’s priority will need to be how to best support the student’s family and friends, other students, and staff. Communications will be critical to ensure everyone involved has adequate and accurate information.

Communicating with the family

Before contacting the student’s family, ensure that you have accurate and up-to-date information about what happened. This may involve talking with the hospital, friends of the student, people present when the deceased was found, and police. This needs to be done quickly so that the family can be notified as early as possible. 

Discuss with the police and other external agencies who will contact the student’s family, and ensure you understand your institution’s role and responsibilities in communicating with the family. Carefully consider who at your institution makes contact with the learner’s family in the case of a serious accident or death. This should be someone senior at your institution to show the significance of the event to your institution.  This may sometimes be done by police.  It is important to ensure clear understanding with external agencies as to roles and responsibilities.

Once the family is informed, it can also be helpful to have an ongoing designated family liaison, who may be someone on your pastoral care team, to maintain consistency and to build the relationship. They can assist the family with travel arrangements, if needed, and ensure their wishes for the burial and services are respected.

The family liaison will serve as the conduit for information going both ways, as well as an advocate for the family within the institution. They will periodically check in with the family to ask if they are getting what they need. In the event of a fatality, this person may need to maintain contact with the family for a protracted period. They may contact the family every few days at first, then once a week, then every other week, and so on, perhaps for years to come.

Cultural considerations

Your institution should ensure that any cultural or religious requirements associated with the death have been respected. What appropriate organisations might offer advice and support? In this case, the Islamic Centre on campus and the local mosque and Muslim community might be helpful. 

Contact consulate

Your response team will need to contact the relevant embassy, high commission or consulate to inform them of the incident and provide them with details about the student. Discuss with the consulate their role in things like contacting the student’s family, arranging a service, arranging travel for the family to New Zealand, temporary accommodation for relatives, and repatriation of the body.

Staff and student wellbeing

As with any critical incident, your institution must plan to support staff and students. Consider those involved in the event (e.g., the students who found the deceased) and those who had a relationship with the deceased (e.g., supervisors, other hall residents, friends). Ensure counselling staff are on standby to support those affected by the incident.

Keep careful records

Be sure to document events in a detailed, written log throughout the response period. This is a requirement of the Code of Pastoral Care and can be especially important in cases where there may be a coronial enquiry, media interest, or police involvement. 

Thanks to Vanessa James and John Pickering for providing this case study.

Suggested long-term actions

There will be many things that need to be managed if an international student dies. After the funeral or memorial service, consider the following:

  • Does a tapu lifting ceremony need to be conducted?
  • Who will obtain a copy of the death certificate and related documents?
  • Do you need to assist with repatriation and/or a family visit?
  • Should you offer the family a fee reimbursement?
  • Arrange condolence letters for the learner’s family.
  • Arrange thank you letters for key people involved in managing the incident.
  • Who will manage the student’s possessions?
  • Does an insurance claim need to be filed or managed?
  • Ensure all of the student’s information is removed from your website and databases to prevent inappropriate communications (e.g., marketing, library fines) going out to the family in the future.

As for any critical incident, ensure the response team conducts a thorough debrief afterwards to evaluate and improve your plans, policies, and procedures.

Resources for further information

 

A suicide attempt

Case study description

A 17-year-old student from Singapore has been one of your college’s most promising students. Her progress over the last eighteen months since she arrived has greatly pleased her teachers and family. 

During the school holidays, she spent time with a university friend at their flat, with her homestay parents’ knowledge and permission, although her parents had not been informed of this arrangement. 

You have just been contacted by the local hospital’s A&E to say that the student is in a critical condition and is fighting for her life. She is semi-conscious after being found in her friend’s flat having taken an overdose. Your business card was found in the student’s wallet. 

Her friend has yet to be located and is not answering her phone. 

The hospital supervisor tells you the police suspect a suicide attempt. Tomorrow is the first day of the new term when students return after a two-week break.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who will need to be involved?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

Communications

In this case, quickly forming and initiating a communications team and plan will be a crucial part of your institution’s response. Decide who on your response team will communicate with the hospital, and who will continue to try to contact her friend. How else might you contact the friend for more information? Can you enlist the help of police or other support services?

You will also need to carefully consider how the student’s family will be kept informed. Designate someone as a family liaison who will keep them regularly updated. This person may also need to facilitate their travel to New Zealand. 

You should be cognisant that cultural perceptions of suicide may be very different in the student’s home country (see below), and an awareness of this cultural context will be helpful in managing communications with the family.

Student and staff wellbeing

Consider who else may be affected by this incident and need support. Contact her teachers and close friends when you think it is appropriate to do so and be sure you have counsellors and other support services available to them. You’ll need to decide if/when you make others at your institution aware (e.g., if you think they may find out through other sources), and if you do, you may need to ramp up counselling support for other students who are triggered by the events.

Cultural considerations

Culture influences many aspects of mental illness and suicide, including what symptoms people show, how they cope, how willing they are to seek treatment, and what family and community support networks they have. 

Psychiatric treatment can be seen as a sign of weakness in many cultures, where students may be more likely to talk to their family or friends about their thoughts and feelings than to seek professional help. In some cultures, people are more likely to seek treatment for physical issues than emotional issues. It’s important for people who work with international students to know that students may experience their psychological distress as physical symptoms (known as somatisation).

Suggested long-term actions

There are many ways that the institution could learn from this case study to improve student safety in the future. For example, did the institution require parental permission for students under 18 to travel during the school holidays? If not, how should this policy be crafted to best protect students? If there was a policy in place, why was it not followed in this case, and how can you ensure it is followed in the future?

You could also consider what educational resources you can provide for students about mental illness and suicide. Isolation, loneliness, language barriers, adjusting to a new culture, and being away from support networks may put international students at particular risk of suffering from mental health conditions. How could you better support students with their mental health? Do students know where to go for help if they are having suicidal feelings or other mental health concerns

You may also want to consider how you can reduce the barriers that may make international students reluctant to seek help for mental health issues such as:

  • cultural values
  • stigma
  • language barriers
  • privacy and confidentiality
  • fear
  • poor understanding of the health system
  • cost.

Your institution might also consider providing training for staff and students to be able to recognise the warning sides for suicide and what to do if they’re worried about someone. In this case, the student’s family and teachers seemed unaware that she was struggling with suicidal thoughts. Further resources might help members of your community be more aware of signs and symptoms.

Resources for further information

 

Hallucinations

Case study description

A student at your institution has been having hallucinations for a couple of months. Her flatmates are very concerned about her wellbeing. They contacted their education agency, who then flagged the issue with your team. You meet with the student, and her symptoms are very concerning. She can’t say a full sentence as she gets distracted constantly by a voice that she can hear. She is very pale and thin, as she has not been sleeping or eating well for more than two months because of the hallucinations. She experiences several meltdowns during the meeting because of the distressing things that the voice is saying. 

You accompany her to a GP, who diagnoses the student with mild expression and prescribes some medications. The student is planning to return to her home country, China, in just three days, and the GP confirms that it is safe for the student to fly back to China on her own. However, the student later contacts you and asks to see a psychiatrist, as she wants to get some help and get well first before flying home.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who will need to be involved?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

Hallucinations and delusions are two cardinal symptoms of a serious mental health condition, and so as soon as the student contacts you, you should arrange for the student to receive medical attention. If you need urgent mental health support, you can ring your local mental health crisis team. If you’re worried about the student’s immediate physical safety, you should ring 111 or take her to the closest hospital emergency department.  

Some of the things that need to be considered in assessing the student’s safety include:

  • What sense(s) are the hallucinations affecting? Hallucinations can affect all five senses. Auditory hallucinations are the most common and may indicate a more serious underlying condition than tactile and visual hallucinations.
  • In the case of an auditory hallucination, is the voice commanding and is the person responding to it (e.g., talking back)? Both things might indicate a more serious safety concern.
  • Does the person have “insight” into their condition? In other words, do they feel they have a problem? If they don’t have insight, you might be more worried about their safety.
  • Is the person under the influence of drugs or alcohol? 
  • How long has the person been having hallucinations? In this case, the student has been experiencing them for an extended period, which would make you more concerned.

Accompany the student to her medical appointment to ensure appropriate pastoral case and language support. If the student is assessed and considered to be a risk to herself or others, she will be admitted to a secure mental health unit under the Mental Health Act.

Communicating with the family

As soon as possible, designate a team member to make contact with the student’s family in China. Be sure to ask the student’s permission to talk to her parents about her mental health issues. If a medical practitioner deems her to be in imminent risk, then you are obliged to contact the family, even if the student doesn’t want them to be contacted. You should maintain daily contact with the family throughout the incident to ensure they are kept informed. 

Also with the student’s permission, you may be able to request the support of a hospital translator to speak with the student’s family directly, so that they understand the situation first-hand and can ensure continuity of care when the student arrives home.

Communicating with medical staff

You should ensure that the medical staff involved with her case understand that the student does not have family in New Zealand and is estranged from her friends. Be sure to provide the medical team with a single point of contact and inform them that your institution is obligated under the Code of Practice to support at-risk students. You can ask to be kept informed regularly to get updates on the student’s condition, and to know when the student is discharged so that you can support her after she leaves the hospital. 

Be sure to keep everyone on the response team updated regularly, and to give the team the necessary support and resources to care for their own wellbeing. 

Suggested long-term actions

Some longer-term actions that your institution might consider after the incident include:   

  • Do you have adequate mental health resources at your institution? In this case, the institution decided to employ a mental health nurse, who can conduct mental health assessments and make triage plans. 
  • How can you create strong relationships with medical staff to ensure the best care of your students? You may wish to create a list of medical specialists that you can consult with about particular health issues should the need arise.
  • How can you support and protect staff during a protracted critical incident like this? Your staff will need back-up to be able to support the student over a long period, while maintaining business as usual. (The institution involved in this real example said they also changed several policies after this incident to better protect staff’s safety. They now order a taxi to pick-up or drop-off students, instead of staff providing student transport, and when possible, they have two staff accompany students who report mental health problems to their medical appointments.)

 

Resources for further information

 

Sexual assault

Case study description

It has come to your attention from a concerned friend of a young female Japanese student that last Sunday, while out for a walk by the river, the student was accosted and sexually assaulted. The circumstances and information are vague, and it seems from the information provided, that although the student is very upset by the incident, she is more concerned that if her family and school find out, she might be required to return to Japan.  

You gather from the informing student that apart from the student’s clothing being damaged and some grazing and bruising, the student appears outwardly okay. The student told her homestay host that she slipped.

The friend also tells you that she is concerned for her own and other friends’ wellbeing and safety. It is obvious to you that this ripple of concern is beginning to grow as more students seem to be gaining some awareness of the incident. 

At this point the incident has not been reported directly to you or any other person in authority. The student who has alerted you to the incident feels something needs to be done but does not want to betray her friend by reporting the incident.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who will need to be involved?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

Ensure students’ safety

In this situation, your immediate concern should be ensuring the safety of the student who was assaulted, as well as the safety and wellbeing of her friends (especially those with knowledge of the situation), and finally, ensuring everyone’s protection from future predatory behaviours by the perpetrator.  

Although the informer has asked for confidentiality, your duty of care is to protect the students from harmful behaviour. You have an obligation to speak with the student who was assaulted and to provide her with whatever resources she needs to feel safe and to manage the trauma she has been through. You should encourage her to see a doctor if she is willing, and offer counselling and other mental health support services. You should also ask if she wants to share any details about what happened so that you can better understand the event in more detail.

Consider privacy

A core issue in managing this incident is balancing the privacy rights of the student who was assaulted with your concerns for her (and others’) wellbeing and safety. Under the Privacy Act, institutions and individuals can report concerns if they believe it is necessary to prevent or lessen a serious threat to an individual’s safety or wellbeing, or for law enforcement purposes. 

Although this is not a black and white issue, in this case, you probably have enough concern to warrant sharing the information you have with both the institution’s leadership and the police. Note that it is always up to the student whether and how much information they want to share with the authorities and whether or not they want to pursue a criminal investigation. You can only share what you know and encourage the student to share what she knows to protect herself and others.

If the student is under 18, you may be obligated/allowed to share the information with the student’s family and homestay family. Speak with the privacy officer at your institution about what you can and cannot share, with whom, and make sure the student understands your reporting requirements. At the least, you will want to ask her homestay family to stay alert to the student’s mental health condition, and to inform you if they see any worrying signs.

Staff and student support

You will also need to offer support to the informant and other students who have heard about the situation and are concerned for their safety. Again, while respecting the privacy of the student who was assaulted, you can ensure other students have counselling and other mental health support services should they need them. 

You may also want to consider additional security and ways for students and others to report any suspicious activity. The police may have suggestions for actions that your institutions could take. 

As for all critical incidents, ensure you document all communication, and have your response team meet regularly to share information and stay up-to-date. Consider how your institution can support the wellbeing of staff on the response team, ensuring they take regular breaks, have adequate back-up and support, and access to counselling if desired.

Suggested long-term actions

Once this situation has been resolved, your institution should review the information provided to students about sexual assault during orientation and afterwards. Do students understand what sexual assault is and what to do if they are assaulted? Do they understand how to navigate the New Zealand health system to get support, and do they understand their legal rights and options? You should also revisit your health and safety plans and policies to consider if you can make any improvements in light of this situation to avoid and prevent such situations arising in future.

You will need to closely monitor the subsequent mental health condition of the student who was assaulted, in particular, and of the informant and other students (See upcoming Monitor Student Wellbeing page). Maintain close contact with homestay families and the students’ families at home so that you can quickly react if they detect any worrying signs in the students’ mental health. Pastoral care representatives for the institution should also continue to monitor the affected students for any changes in academic performance, mood, physical appearance, or behaviour that might indicate mental health problems.

Resources for further information

 

Earthquake

Case study description

You are at work at your institution when a large earthquake strikes. Your office is badly damaged, and once the shaking has stopped, you quickly make it outside with the other staff. There is widespread damage, sirens are blaring, and you’re concerned for your own family and how you will make it home.

Your institution’s international students are spread out across home stays and halls of residence, and you aren’t sure where they all are at the time the earthquake occurs. You have your cell phone, but not much else. The phone lines are completely engaged and you can’t get through to anyone.

Questions for reflection

  1. What immediate actions should you take to manage this incident?
  2. Who will need to be involved?
  3. What resources do you need to immediately support staff in managing this incident?
  4. Once the incident has been resolved, what longer-term actions might you take as an institution to prevent or ameliorate future similar incidents?

Suggested immediate actions (24-48h)

Secure your own safety first

The most pressing issue in this case is for you to look after your own safety. Hopefully, you and your family have an emergency plan that includes where to meet, as well as emergency supplies at home. Staff should have a grab-and-go bag at work with essential items like water, food, and walking shoes. Set a date for everyone at your institution to review and refresh the items in their go bag each year.

Communicating with students

Once you know that you and your family are safe, your next immediate concern is contacting your students to ensure they are safe, and to assess next steps. To effectively manage a complex situation like an earthquake or other natural disaster, planning is essential. Your international office should have a pre-prepared response plan that includes who in your office will be on the response team, where you will meet or how you will communicate (even if phone lines are down), and how information will be shared with international students and staff. 

Preparing students for a natural disaster is an essential part of this plan. In your orientation, you should ensure students know how to prepare their own emergency kit (or better yet – give them one), what to do if an earthquake strikes, and how/when to contact your office.

Once you have contacted your students and depending on the circumstances, make plans to either gather the students in one place or to regularly communicate with them if they are safer where they are. You will also need to liaise with homestay families and the halls’ management. 

Once you have adequate information about the students’ situation, communicate with their families, and establish when and how you will keep lines of communication open.

Information management

Another important aspect of your planning for natural disasters is information management. If your computer is at work and you cannot access it, you need a way to access student information quickly and easily via a cloud application from any device. Without this, you may be caught unable to reach out to your students, or to contact their emergency contacts.

Staff wellbeing

Such a widespread and complex situation is likely to take substantial resources to manage, and staff will all be dealing with their own stresses and worries at home. Everyone involved is likely to need some level of mental health support, now and some time into the future.  

You’ll likely need to draw on any additional resources that you may have outside of the affected area, and this is worth considering before an incident like this happens, so you have a plan in place if it does.

Suggested long-term actions

It’s easy to see how difficult a natural disaster can be to manage, and how quickly resources can run out. Planning is absolutely essential. Use this scenario to think about what your institution would need in the event of an earthquake or other major natural disaster. How can you put together a robust plan that gives your staff what they need to respond to such an event? How can you ensure your international students are prepared?

Resources for further information

 

Conclusion 

We have chosen these critical incidents because they reflect real cases and represent some of the situations that institutions are most likely to face with international students. Some of the themes that run across these case studies are:

  • the importance of forming a response team with clear roles and responsibilities
  • the need for frequent and open lines of communication with all stakeholders 
  • the consideration of privacy issues, and what information can be shared, when, and with whom
  • the importance of looking after your own wellbeing by maintaining professional boundaries and adequately resourcing the response effort.

You can come back to these case studies regularly to review your emergency planning and policies and to train new staff when they are onboarded. Better yet – create your own bank of scenarios. After an incident occurs, write up a summary of what happened, how your team responded, what worked well, and what could be improved in the future. This bank of case studies can be used for team training in the future, to ensure your staff have non-specific problem solving skills, and to enable them to plan flexibly and manage a wide variety of incidents in the future.

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