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Crisis Intervention

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on 5 December 2014

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Transcript of Crisis Intervention

Crisis Intervention

Stage 1:
Assess Lethality
Plan and conduct a thorough biopsychosocial and lethality / imminent danger assessment
Stage 2:
Establish Rapport
Make psychological contact* and rapidly establish the collaborative relationship
Stage 3:
Identify problems
Identify the major problems, including crisis precipitants (ie: the "last straw")
Stage 4:
Deal with feelings
Encourage an exploration of feelings and emotions (including active listening and validation)
Stage 5:
Explore alternatives
Generate and explore alternatives, resources and new coping strategies
Stage 6:
Develop an action plan
stage 7:
Rosemary Campbell
Kari Cunningham
Chelsea Williamson

Crisis intervention is recommended for time-limited responses to people in acute crisis.
definition of "crisis"
An acute disruption of psychological homeostasis in which
one's usual coping mechanisms fail
and there exists evidence of distress and
functional impairment
...The main cause...is an intensely stressful, traumatic, or hazardous event.

A "crisis" often has five components:
1. a hazardous or traumatic event
2. a vulnerable or unbalanced state
3. a precipitating factor
4. an active crisis state based on the person's perception
5. the resolution of the crisis

Roberts, 2005
How crisis intervention developed
Dr. Erick Lindemann, psychiatrist, conceptualized crisis theory based on his work with acute and grief-stricken survivors and relatives of 493 victims of a Boston nightclub fire in the early 1940s.

Gerald Caplan, psychiatry professor, expanded Lindemann's work in the 1960s.

Albert R. Roberts, Ph.D. built upon their thinking and created Roberts' Steven-Stage Crisis Intervention Model (R-SSCIM) in 1991.

R-SSCIM 1991
Restore functioning through implementation of an action plan
Plan follow-up and booster sessions
*psychological contact
From Carl Rogers's "Necessary and Sufficient Conditions" for therapeutic change.

"Psychological contact" means a relationship between client and therapist must exist, and it must be a relationship in which each person's perception of the other is important.
strengths & weaknesses
Fit of approach
case scenario & Role play
A mom comes to the emergency room in distress because her 3-year-old daughter S'KyeLeigh just returned from a weekend visit at her dad's house and mom suspects someone sexually abused her. The mom is panicked and wants a doctor to examine her daughter to determine what happened.
Crisis intervention is the recommended approach when working with people in acute crisis and time is a factor.

Health care settings provide many crisis situations where patients need help right away.

The strengths of this approach outweigh the weaknesses. Intervening in crises is an important skill to use as health care social workers.
Brown, F., Rainer, J. (2006). Too much to bear: An introduction to crisis intervention and therapy.
Journal of Clinical Psychology, 62
(8), 953-957

Dziegielewski, S. (2004).
The Changing Face of Health Care Social Work.
New York: Springer Publishing Company.

Roberts, A.R. (2002). Assessment, crisis intervention, and trauma treatment: The integrative ACT intervention model.
Brief Treatment and Crisis Intervention, 2
(1), 1-21

Roberts, A.R., Ottens, A.J. (2005). The seven-stage crisis intervention model: A road map to goal attainment, problem solving, and crisis resolution.
Brief Treatment and Crisis Intervention, 5
(4), 329-339

provides a concrete way for the clinician and patient to identify the crisis
provides clinician with tools for responding to the crisis in a productive way
using the crisis intervention model, a clinician can help the patient gain control and lessen the crisis
can help a patient "discover an adaptive means of coping with a particular life stage, tragic occurrence, or problem" that becomes a crisis
helps the patient prepare for the what the aftermath of the crisis might look like
can exacerbate the problem if the clinician using crisis intervention doesn't know what they are doing
can be limited in a health care setting depending on resources, agency role, and function
Crisis intervention is a necessary model to use in clinical health care social work settings.

A patient in crisis in a health care setting is usually experiencing not only a disruption in their psychological homeostasis, but also in theirs or a family member or friends physical homeostasis.

Client self-determination is especially important among diverse populations
Allowing the client to define their cultural influences, traditions, beliefs, etc.
Be careful not to assume cultural competency, especially during crisis
Crisis can occur as a result of a cultural clash or "mismatch" as when values or customs of traditional culture are ignored or violated.
Talk with client about how they have coped with or negotiated previous cultural clashes.
If there are no previous experiences, brainstorm (outlandish) alternatives that could be applied to to the current event.
Allow for the client to find the solution within their own cultural awareness, do not create it for them.
(Roberts & Ottens, 2005)
Things to consider when assessing the socio-cultural experiences and cultural background of the client:
Ex: Stockton Schoolyard Shooting
Spiritual Beliefs
Environmental Connections
Community Ties
Economic Conditions
Crucial in Health Care Settings
Availability of food and shelter
Social Networks and Relationships
Diverse Populations Cont.
Remember that a lack of culturally sensitive services can greatly increase chaos and confusion in a crisis situation
(Roberts, 2002)
crisis intervention with diverse populations
what do you think?
not very much literature or research about the weaknesses and disadvantages of crisis intervention
have to establish rapport very quickly
"The health care social worker is essential in helping the client reach a healthier resolution of the problem."
Dziegielewski, 2004
addresses acute problem situations
ability to assess the risk, danger and severity of the crisis
known to be successful in health areas with victims of rape, domestic violence, mental illness and other medical/life-threatening issues
provides a quick way to assess problems and needs
helps patients examine options
helps patients and clinicians create a plan of action
helping a patient when they are in a state of crisis increases the chance for patient-oriented change
Fit of approach
Dzielgielewski, 2004
Roberts, 2005
Dzielgielewski, 2004
Roberts, 2005
Full transcript