Question

3. After helping a client through a crisis, you become interested in the role of crisis intervener.

    a. What are the most important skills for a crisis intervener and how these skills are implemented in a crisis?

    b. Compare and contrast the variations in crisis intervention, including the team approach, crisis groups, and families in crisis.

Answer 1

1. CRISIS INTERVENTION

THE SIX -STEP MODEL OF CRISIS INTERVENTION:

Six step model of crisis intervention.

This model provides a useful framework from which to work when confronted with crisis situations in a shelter setting.

ASSESSING: Assessment is an important part of each of the six-steps of crisis intervention. The first three steps of this model are usually more passive listening activities than actions. When safety considerations are presented that concern anyone’s potential to be hurt or killed you need to take action immediately. The final three steps are largely action behaviours on your part even though listening is always present along with assessment as an overarching theme.

LISTENING involves attending, observing, understanding and responding with empathy, genuineness, respect, acceptance, non-judgment, and caring. It is essential to establish an environment that provides individuals with “psychological first aid” which is defined as the establishment of safety of the client, reducing stress-related symptoms, providing rest and physical recuperation and linking clients to critical resources and social support systems is an essential part of the helping process .

The first three steps of the six-step model are:

1. Defining the problem: The first step is to define and understand the problem from the client’s point of view. You will need to use the core listening skills of empathy, genuineness, and acceptance.

2. Ensuring client safety: It is necessary that you continually keep client safety at the forefront of all interventions. Ensuring safety means constantly assessing the possibility of physical and psychological danger to the client as well as to others. This step is a fluid one in that assessing and ensuring safety is a continuous part of the process of crisis intervention.

3. Providing support: It is important that you communicate to the client that you care about her. The support given may be emotional as well as instrumental and informational.

ACTING: Steps 4, 5, and 6 involve acting strategies. Ideally these steps are worked through in a collaborative manner but if the client is unable to participate, you may need to become more directive in helping the client mobilize her coping skills. Listening skills are an important part of these steps.

4. Examining alternatives: Alternatives are examined from three possible perspectives. The first is supporting the individual to assess their situational supports or those people known to the client in the present or past who might care about what happens to the client. The second perspective is helping the client identify coping mechanisms or actions, behaviours, or environmental resources that she might use to help her get through the present crisis. The third perspective is assisting the client to examine her thinking patterns and if possible find ways to reframe her situation in order that the client’s view of the problem will be altered which will in turn lessen the client’s anxiety level.

5.Making Plans: The client is supported to make a plan that is very detailed and outlines the persons, groups and other referral resources that can be contacted for immediate support; provide coping mechanisms and action steps which are concrete and positive for the client to do in the present. As much as possible it is important that the planning be done in collaboration with a client in order that she feels a sense of ownership of the plan. It is important that she does not feel robbed of her power, independence and self-respect. The most important issues in planning are the client’s sense of control and autonomy. Planning is about getting through the short term in order to achieve some sense of equilibrium and stability.

6. Obtaining commitment. In this last step the issues of control and autonomy are also important to the process. This step involves asking the client to verbally summarize the plan. In some incidents where lethality is involved the commitment may be written down and signed by both individuals. The goal is to enable the client to commit to the plan and to take definite positive steps designed to facilitate them moving towards re-establishing a pre-crisis state of equilibrium. The commitments made by the client need to be voluntary and doable. A plan that has been developed by you will not be effective.

BASIC STRATEGIES OF CRISIS INTERVENTION

The nine strategies useful in crisis intervention include:

• Creating awareness.

Defining the problem.

• Allowing catharsis.

• Providing support.

• Increasing expansion means engaging the client in activities to expand her view of the situation.

• Emphasizing focus: Sometimes clients are unfocused and talk about numerous issues in their lives that are not working

• Providing guidance.

• Promoting mobilization means that you attempt to activate and organize the client’s internal resources and to find and use external support systems to assist in generating coping skills and problem solving abilities.

• Implementing order: There may be times where you need to assist a client to classify and categorize problems in order to prioritize and systematically deal with the crisis in a logical and linear manner.

• Providing protection. This is essential through out the six-step model.

b) Crisis Intervention Models

• BCD Crisis Intervention
• Critical Incident Stress Management (CISM)
• NOVA Crisis Intervention
• Psychological First Aid (PFA)

Disaster Mental Health and Crisis Response are terms frequently used interchangeably. However, Disaster Mental Health is actually a subset of Crisis Response and has dynamics and characteristics unique to large scale community-wide natural and man-made disasters.

Strategic Crisis Response planning is necessary for developing a comprehensive crisis intervention plan before deployment and providing services. Knowing what sequence of crisis intervention processes to use for which individuals or groups, at what times, and under what circumstances is crucial to all effective early intervention programs.

Critical Incident Stress Management (CISM)

CISM is considered comprehensive because it consists of multiple crisis intervention components, which functionally span the entire temporal spectrum of a crisis. CISM interventions range from the pre‐crisis phase through the acute crisis phase, and into the post‐crisis phase. CISM is also considered comprehensive in that it consists of interventions which may be applied to individuals, small functional groups, large groups, families, organizations, and even communities. The 7 core components of CISM are defined below: 1. Pre‐crisis preparation. This includes stress management education, stress resistance, and crisis mitigation training for both individuals and organizations. 2. Disaster or large‐scale incident, as well as, school and community support programs including demobilizations, informational briefings, “town meetings” and staff advisement. 3. Defusing. This is a 3‐phase, structured small group discussion provided within hours of a crisis for purposes of assessment, triaging, and acute symptom mitigation. 4. Critical Incident Stress Debriefing (CISD) refers to the “Mitchell model” (Mitchell and Everly, 1996) 7‐ phase, structured group discussion, usually provided 1 to 10 days post crisis, and designed to mitigate acute symptoms, assess the need for follow‐up, and if possible provide a sense of post‐crisis psychological closure. 5. One‐on‐one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum. 6. Family crisis intervention, as well as, organizational consultation. 7. Follow‐up and referral mechanisms for assessment and treatment, if necessary

Psychological First Aid (PFA)

Psychological First Aid may be thought of as a fundamental aspect of applied crisis intervention and disaster mental health. PFA can help everyone (children, adolescents, adults, elders, families, and communities) who has been exposed to a traumatic or emergency incident, including responders and support service providers. PFA is an evidence‐informed approach that is built on the concept of human resilience. PFA aims to reduce stress symptoms and assist in a healthy recovery following a traumatic event, natural disaster, public health emergency, or even a personal crisis. In addition, it is an important tool for assessment and can serve as the essential platform upon which survivors can be referred to a higher level of care for more advanced individual and group crisis disaster mental health interventions such as small group defusings and critical incident stress debriefings. Psychological First Aid Tasks:

1. Provide a safe physical environment.

2. Supply basic first order needs such as water.

3. Reduce psychological stressors.

4. Be a caring comforting presence.

5. Educate on common stress reactions.

6. Empower by supporting strengths and encouraging existing coping skills.

7. Provide connections to natural support networks.

8. Assess potential need to referral to the next level of care when needed.