CRYSTAL ANDERSON

ALICIA BOOKER

ANDREW GARCIA

Crisis Intervention

Historical Foundation

Crisis intervention is an action-oriented model that is present-focused, with the objective for the intervention being specific to the hazardous event, situation, or problem that precipitated the state of crisis

Crisis intervention focus on the Here and now and only addresses past issues when needed.

Historical Foundation

Dr. Eric Lindemann was one of the pioneers of crisis intervention.

Dr Lindemanns pioneering study on the loss and bereavement with 101 survivors and family members of the victims of the Coconut Grove nightclub fire in Boston was one of the first efforts to develop a more systematic way of helping people in crisis.

Through his research, theories of grief process and typical reactions to crisis were developed.

Central Constructs

Crisis intervention derived from ego psychology and ecological systems theory. Below are the ideas that were derived from these two systems.

Ego:

Life Developmentstages

Psychosocialcrisis

Copingskills

Defensemechanism

Ecological:Homeostasis

Disequilibrium

Interdependence

Crisis Intervention

Two important concepts in crisis intervention include: Levels of crisis & Stages of Crisis

Level of crisis include: Somatic Distress, Transitional Stress Crisis, Traumatic Stress Crisis, Family Crisis, Serious Mental Illness, Psychiatric Emergencies, and Catastrophic Crisis

Stages of Crisis include: Outcry, Denial or Intrusiveness, Working Through, and Completion or Resolution

Levels of Crisis in detail

Ann Wolbert Burgess and Albert R. Roberts developed the model for assessing emotional stress and acute crisis using seven main levels of crisis along a stress-crisis continuum.

Although each crisis is unique, this stress-crisis continuum can be used in assessment and intervention planning to determine the level of care that is needed, as well as the most effective treatment modality.

Levels of Crisis Continued

Level 1: Somatic Distress- Biomedical causes, situational problems, health problems, relationship conflicts, work-related stressors, chemical dependency issue

Level 2: Transitional Stress Crisis- Stressful events that are expected in part of one’s lifespan development. Examples include premature birth, bankruptcy, divorce, relocation

Level 3: Traumatic Stress Crisis- Unexpected and/or accidental situations outside the individuals locus of control. Crisis can be life threatening. Examples include disasters, crime victimization, family violence, child abuse, sexual assault

Level 4: Family Crisis- Issues related with interpersonal and family relationships that are unresolved and harmful psychologically, emotionally, and physically. Examples include child abuse, family violence, homelessness, and parental kidnapping

Levels of Crisis Continued

Level 5: Serious Mental Illness- relates from preexisting psychopathology. Examples include schizophrenia, dementia, and major depression

Level 6: Psychiatric Emergencies-When situations in which general functioning have been severely impaired. Examples include a drug overdose, suicide attempts, or the acute onset of a major mental illness

Level 7- Catastrophic Crisis- This level involves 2 or more level 3 traumatic crisis in combination with level 4,5, or 6 stressors. Examples include loosing all family members in a disaster or multiple homicides

Stages of Crisis

The stages of crisis resemble the stages of the grief process. Individuals can skip a stage, can get stuck in a stage, or can even move back and forth throughout the stages.

The four stages of crisis include: outcry, denial or intrusiveness, working trough, and completion or resolution.

Stages of Crisis

Outcry: The earliest reactions after the crisis event, which are reflexive, emotional, and behavioral. The reactions can very depending on the person. Some examples include panic, screaming, shock, anger, defensiveness, moaning, flat affect, crying, and hyperventilation.

Denial or Intrusiveness: Outcry can lead to denial, which eliminates the impacts of the crisis through emotional numbing, dissociation, cognitive distortion, or minimizing. Outcry can also lead to intrusiveness , which includes the involuntary flooding of feelings about the crisis, such as flashbacks, nightmares, and automatic thoughts.

Stages of Crisis Continued

Working Through: This is the stage of recovery or healing in which thoughts, feelings, and images of the crisis are expressed, acknowledged, explored, and reprocessed

through adaptive and healthy coping skills.Completion or Resolution: This stage can take

months or even years to complete. Some individuals may never even complete this process. This process allows the individual to reorganize their life, and use the resolution of the trauma in positive meanings of growth or change. Many crisis survivors reach out through volunteer work to help others who suffer similar traumas.

ACT Model (Assessment, Crisis Intervention, and Trauma Treatment Service)

The ACT model is a conceptual three-stage framework and intervention model.

This model amalgamates various assessment and triage protocols with three primary crisis intervention strategies: the seven stage crisis intervention model, critical incident stress management, and the 10-step acute traumatic stress management protocol.

ACT Model

A: Assessment/appraisal of immediate medical needs, threats to public safety and property damage

-Triage assessment, crisis assessment, trauma assessment, and the biopsychosocial and cultural assessment protocols

C: Connecting to support groups, the delivery of disaster relief and social services, and critical incident stress debriefing

-Crisis intervention implemented through a strengths perspective and coping skills bolstered

T: Traumatic stress reactions and posttraumatic stress disorders

-Ten step acute trauma and stress management protocol, trauma treatment plans, and recovery strategies implemented

Seven-Stage Crisis Intervention Model

Seven-stage crisis intervention model is effective when dealing with a diverse population, and when dealing with traumatic situations.

This model adapts easily to different level of crisis and to different timeframes for intervention.

All of these stages can be completed within one contact if necessary.

Seven Stage Crisis Intervention Model

Seven- Stage Crisis Intervention Model

Stage 1: Plan and Conduct a Crisis Assessment: When conducting an assessment the crisis worker needs to evaluate how severe the crisis is, the emotional state of the client, the clients immediate psychosocial needs, and the level of the client’s current coping skills and resources.

Stage 2: Establish Rapport: This can be done in stage 1. This stage involves the initial contact between the client and the crisis worker. The main goal is to establish rapport with the client by being genuine. Active listening and empathetic communication are important to be successful at establishing rapport. Crisis workers must be conscious of their own body language and facial expressions because trauma survivors may be sensitive to physical space and body movements. Being observant of the survivors physical and facial reactions can give insight to the workers level of engagement with the client.

Seven-Stage Crisis Intervention Model

Stage 3: Identify the Major Problem: The crisis worker should help the survivor arrange the most important problems by identifying the problems by how they affect the survivors current status. The crisis worker must make sure not to overwhelm the survivor while focusing on the most important problems needing intervention.

Stage 4: Deal with Feelings and Emotions: During this stage the clients primary task is ventilation and exploration of his or her feelings about the crisis. The crisis worker should be actively listening to the survivor. It is necessary for the crisis worker to demonstrate empathy when with the survivor. The crisis worker must also be aware of his or her own emotions and levels of comfort when helping clients. Crisis workers should also attend to their own self-care to prevent burn out.

Seven-Stage Crisis Intervention Model

Stage 5: Generate and Explore Alternatives: In this stage the crisis worker will work with survivor to explore alternatives for restoring a precise level of functioning. Some alternatives would include using support systems, developing coping skills, and increasing positive thinking to reduce the survivors anxiety and stress.

Stage 6: Develop and Formulate an Action Plan: The main goals are to help the survivor achieve an appropriate level of functioning and maintain adaptive coping skills and resources. The survivor must feel ownership in the treatment plan. Termination should begin when the client has met their goals of their action plan or has been referred for additional services.

Stage 7: Establish Follow-Up Plan and Agreement: This stage helps determine if the desired results were maintained, or if further work is needed. This is typically done 4-6 weeks after termination.

Critical Incident Stress Debriefing and Management

Critical Incident stress debriefing is used for frontline crisis workers who are exposed to gruesome and life-threatening situations.

Examples: suicides, homicides, natural disasters, terrorist attacks, hostage situations.

This allows the worker to discuss the traumatic event, promote group cohesion, and educate first responders on stress reactions and coping techniques.

Critical Incident Stress Debriefing and Management

This typically occurs 24 to 72 hours after the traumatic accident.

This can be done individually or with a group.

These debriefing meetings should encourage the first responders to be supportive and to not be critical of each other.

10-step Acute Traumatic Stress Management Protocol

A guideline for critical incident stress debriefing for first responders

1. Assess for danger/safety for self and others2. Consider the physical and perceptual mechanism of injury3. Evaluate the level of responsiveness4. Address medical needs5. Observe and identify each individual’s sign of traumatic stress6. Introduce yourself, state your role, and begin to develop a

relationship7. Ground the individual by allowing him/her to tell his or her story8. Provide support trough active and empathic listening9. Normalize, validate, and educate10. Bring the person to the present, describe future events, and

provide referrals

Critique of Crisis Intervention

There is not much literature on cultural, gender, or age differences among crisis client populations. It is important that crisis workers be culturally competent.

A drawback is that the crisis worker usually does not see the end result of the initial interventions

Helpful Books for Crisis Intervention

References

Coady, Nick, & Lehmann, Peter. (2008). The Crisis Intervention Model. In Coady, Nick & Lehmann, Peter (Eds.), Theoretical Perspectices for Direct Social Work Practice (pgs.249-274). New York : Springer.