Crisis Intervention

views updated

Crisis Intervention

Critical incident stress debriefing and management

Medical crisis counseling

Definition

Crisis intervention refers to methods used to offer immediate, short-term help to individuals who experience an event that produces emotional, mental, physical, and behavioral distress or problems. A crisis can be any situation in which an individual perceives a sudden loss of ability to use effective problem-solving and coping skills. Any number of events or circumstances can be considered crises, including life-threatening situations such as natural disasters (e.g., earthquakes, tornadoes, hurricanes), sexual assault or other criminal victimization, medical illness, mental illness, thoughts of suicide or homicide, or loss or drastic changes in relationships (e.g., death of a loved one or divorce).

Purpose

Crisis intervention has several purposes. It aims to reduce the intensity of an individual’s emotional, mental, physical, and behavioral reactions to a crisis. Another purpose is to help individuals return to their level of functioning before the crisis. Functioning may be improved above and beyond this by developing new coping skills and eliminating ineffective ways of coping, such as withdrawal, isolation, and substance abuse. In this way, individuals are better equipped to cope with future difficulties. Through talking about what happened, and the feelings about what happened, while developing ways to cope and solve problems, crisis intervention aims to assist individuals in recovering from the crises and to prevent serious long-term problems from developing. Research documents positive outcomes for crisis intervention, such as decreased distress and improved problem solving.

Description

Individuals are more open to receiving help during crises. A person may have experienced the crisis within the last 24 hours or within a few weeks before seeking help. Crisis intervention is conducted in a supportive manner. The length of time for crisis intervention may range from one session to several weeks, with the average being four weeks. Crisis intervention is not sufficient for individuals with long-standing problems. Session length may range from 20 minutes to two or more hours. Crisis intervention is appropriate for children, adolescents, and younger and older adults. It can take place in a range of settings, such as hospital emergency rooms, crisis centers, counseling centers, mental health clinics, schools, correctional facilities, and other social service agencies. Local and national telephone hotlines are available to address crises related to suicide, domestic violence, sexual assault, and other concerns. They are usually available 24 hours a day, seven days a week.

Responses to crisis

A typical crisis intervention progresses through several phases. It begins with an assessment of what happened during the crisis and the individual’s responses to it. There are certain common patterns of response to most crises. An individual’s reaction to a crisis can include emotional reactions (e.g., fear, anger, guilt, grief ), mental reactions (e.g., difficulty concentrating, confusion, nightmares), physical reactions (e.g., headaches, dizziness, fatigue, stomach problems), and behavioral reactions (e.g., sleep and appetite problems, isolation, restlessness). Assessment of the individual’s potential for suicide and/or homicide is also conducted. Also, information about the individual’s strengths, coping skills, and social support networks is obtained.

Education

There is an educational component to crisis intervention. It is critical for individuals to be informed about various responses to crises and informed that they are having normal reactions to an abnormal situation. Individuals will also be told that the responses are temporary. Although there is not a specific time that people can expect to recover from crises, individuals can help recovery by engaging in coping and problem-solving skills.

Coping and problem solving

Other elements of crisis intervention include helping individuals understand the crisis and their response to it as well as becoming aware of and expressing feelings, such as anger and guilt. A major focus of crisis intervention is exploring coping strategies. Strategies that the individuals previously used but that have not been used to deal with the current crisis may be enhanced or bolstered. Also, new coping skills may be developed. Coping skills may include relaxation techniques and exercise to reduce body tension and stress as well as putting thoughts and feelings on paper through journal writing instead of keeping them inside. In addition, options for social support or spending time with people who provide a feeling of comfort and caring are addressed. Another central focus of crisis intervention is problem solving. This process involves thoroughly understanding the problem and the desired changes, considering alternatives for solving the problem, discussing the pros and cons of alternative solutions, selecting a solution and developing a plan to try it out, and evaluating the outcome. Cognitive therapy, which is based on the notion that thoughts can influence feelings and behavior, can be used in crisis intervention.

In the final phase of crisis intervention, the professional will review changes the individual made in order to point out that it is possible to cope with difficult life events. Continued use of the effective coping strategies that reduced distress will be encouraged. Also, assistance will be provided in making realistic plans for the future, particularly in terms of dealing with potential future crises. Signs that the individual’s condition is getting worse or “red flags” will be discussed. Information will be provided about resources for additional help should the need arise. A telephone follow-up may be arranged at some agreed upon time in the future.

Suicide intervention

Purpose

Suicidal behavior is the most frequent mental health emergency. The goal of crisis intervention in this case is to keep the individual alive so that a stable state can be reached and alternatives to suicide can be explored. In other words, the goal is to help the individual reduce distress and survive the crisis.

Assessment

Suicide intervention begins with an assessment of how likely it is that the individual will attempt suicide in the immediate future. This assessment has various components. The professional will evaluate whether or not the individual has a plan for how the act would be attempted, how deadly the method is (shooting, overdosing), if means are available (access to weapons), and if the plan is detailed and specific versus vague. The professional will also assess the individual’s emotions, such as depression, hopelessness, hostility, and anxiety. Past suicide attempts as well as completed suicides among family and friends will be assessed. The nature of any current crisis event or circumstance will be evaluated, such as loss of physical abilities because of illness or accident, unemployment, and loss of an important relationship.

Treatment plan

A written safekeeping contract may be obtained. This is statement signed by such individuals that they will not commit suicide, and that they agree to various actions, such as notifying their clinician, family, friends, or emergency personnel, should thoughts of committing suicide again arise. This contract may also include coping strategies that the individuals agree to engage in to reduce distress. If the individuals state that they are not able to do this, then it may be determined that medical assistance is required and voluntary or involuntary psychiatric hospitalization may be implemented. Most individuals with thoughts of suicide do not require hospitalization and respond well to outpatient treatment. Educating family and friends and seeking their support are important aspects of suicide intervention. Individual therapy, family therapy, substance abuse treatment, and/or psychiatric medication may be recommended.

Critical incident stress debriefing and management

Definition

Critical incident stress debriefing (CISD) uses a structured, small-group format to discuss a distressing crisis event. It is the best-known and most widely used debriefing model. Critical incident stress management (CISM) refers to a system of interventions that includes CISD as well as other interventions, such as one-on-one crisis intervention, support groups for family and significant others, stress management education programs, and follow-up programs. It was originally designed to be used with high-risk professional groups, such as emergency services, public safety, disaster response, and military personnel. It can be used with any population, including children. A trained personnel team conducts this intervention. The team usually includes professional support personnel, such as mental health professionals and clergy. In some settings, peer support personnel, such as emergency services workers, will be part of the debriefing team. It is recommended that a debriefing occur after the first 24 hours following a crisis event, but before 72 hours have passed since the incident.

Purpose

This process aims to prevent excessive emotional, mental, physical, and behavioral reactions and post-traumatic stress disorder (PTSD) from developing in response to a crisis. Its goal is to help individuals recover as quickly as possible from the stress associated with a crisis.

Phases of CISD

There are seven phases to a formal CISD:

introductory remarks: The team sets the tone and rules for the discussion, and encourages participant cooperation.
fact phase: Participants describe what happened during the incident.
thought phase: Participants state the first or main thoughts while going through the incident.
reaction phase: Participants discuss the elements of the situation that were worst.
symptom phase: Participants describe the symptoms of distress experienced during or after the incident.
teaching phase: The team provides information and suggestions that can be used to reduce the impact of stress.
reentry phase: The team answers participants’ questions and makes summary comments.

KEY TERMS

Coping —In psychology, a term that refers to a person’s patterns of response to stress.

Critical incident —Also known as a crisis event. An event that is stressful enough to overwhelm the coping skills of a person or group.

Stress —A physical and psychological response that results from being exposed to a demand or pressure.

Stressor —A stimulus or event that provokes a stress response in an organism. Stressors can be categorized as acute or chronic, and as external or internal to the organism.

Precautions

Some concern has been expressed in the research literature about the effectiveness of CISD . It has been thought that as long as the provider(s) of CISD have been properly trained, the process should be helpful to individuals in distress. If untrained personnel conduct CISD , then it may result in harm to the participants. CISD is not psychotherapy or a substitute for it. It is not designed to solve all problems presented during the meeting. In some cases, a referral for follow-up assessment and/or treatment is recommended to individuals after a debriefing.

Medical crisis counseling

Medical crisis counseling is a brief intervention used to address psychological (anxiety, fear, and depression) and social (family conflicts) problems related to chronic illness in the health care setting. It uses coping techniques and builds social support to help patients manage the stress of being newly diagnosed with a chronic illness or suffering a worsening of a medical condition. It aims to help patients understand their reactions as normal responses to a stressful circumstance and to help them function better. Preliminary studies of medical crisis counseling indicate that one to four sessions may be needed. Research is also promising in terms of its effectiveness at decreasing patients’ levels of distress and improving their functioning.

Resources

BOOKS

Echterling, Lennis G., Jack Presbury, and J. Edson McKee. Crisis Intervention: Promoting Resilience and Resolution in Troubled Times. Upper Saddle River, NJ: Prentice Hall, 2004.

Hendricks, James E., Jerome B. McKean, and Cindy Gillespie Hendricks. Crisis Intervention: Contemporary Issues for On-Site Interveners. 3rd ed. Springfield, IL: Charles C. Thomas Publisher, 2003.

Roberts, Albert R. Crisis Intervention Handbook: Assessment, Treatment, and Research. New York: Oxford University Press, 2005.

Thyer, Bruce A. “’Tis a Consummation Devoutly to Be Wished.” Foundations of Evidence-Based Social Work Practice, Albert R. Roberts, and Kenneth R. Yeager, eds. New York: Oxford University Press, 2006.

Wiger, Donald E., and Kathy J. Harowski. Essentials of Crisis Counseling and Intervention. New York: John Wiley & Sons, 2003.

PERIODICALS

Allen, Andrea, and others. “An Empirically Informed Intervention for Children Following Exposure to Severe Hurricanes.” The Behavior Therapist 29.6 (Sept. 2006): 118–24.

Basoglu, Metin, Ebru Salcioglu, and Maria Livanou. “A Randomized Controlled Study of Single-Session Behavioural Treatment of Earthquake-Related Post-Traumatic Stress Disorder Using an Earthquake Simulator.” Psychological Medicine 37.2 (Feb. 2007): 203–13.

Bruffaerts, Ronny, Marc Sabbe, and Koen Demyttenaere. “Who Visits the Psychiatric Emergency Room for the First Time?” Social Psychiatry and Psychiatric Epidemiology 41.7 (July 2006): 580–86.

Everly, George S., Jr., and others. “Introduction to and Overview of Group Psychological First Aid.” Brief Treatment and Crisis Intervention 6.2 (May 2006): 130–36.

Gard, Betsy A., and Josef I. Ruzek. “Community Mental Health Response to Crisis.” Journal of Clinical Psychology 62.8 (Aug. 2006): 1029–41.

Roberts, Albert R. “Applying Roberts’ Triple ABCD Model in the Aftermath of Crisis-Inducing and Trauma-Inducing Community Disasters.” International Journal of Emergency Mental Health 8.3 (Summer 2006): 175–82.

Roberts, Albert R. “Juvenile Offender Suicide: Prevalence, Risk Factors, Assessment, and Crisis Intervention Protocols.” International Journal of Emergency Mental Health 8.4 (Fall 2006): 255–66.

Singer, Jonathan B. “Making Stone Soup: Evidence-Based Practice for a Suicidal Youth With Comorbid Attention Deficit/Hyperactivity Disorder and Major Depressive Disorder.” Brief Treatment and Crisis Intervention 6.3 (Aug. 2006): 234–47.

Stapleton, Amy B., and others. “Effects of Medical Crisis Intervention on Anxiety, Depression, and Posttraumatic Stress Symptoms: A Meta-Analysis.” Psychiatric Quarterly 77.3 (Sept. 2006): 231–38.

Vingilis, Evelyn, and others. “Process and Outcome Evaluation of an Emergency Department Intervention for Persons with Mental Health Concerns Using a Population Health Approach.” Administration and Policy in Mental Health and Mental Health Services Research 34.2 (Mar. 2007): 160–71.