Crisis intervention

Crisis intervention is a time-limited intervention with a specific psychotherapeutic approach to immediately stabilize those in crisis.[1][2][3]

Implementation

A crisis can have physical or psychological effects. Usually significant and more widespread, the latter lacks the former's obvious signs, complicating diagnosis.[4] Three factors define crisis: negative events, feelings of hopelessness, and unpredictable events. People who experience a crisis perceive it as a negative event that generate physical emotion, pain, or both. They also feel helpless, powerless, trapped, and a loss of control over their lives.[5] Crisis events tend to occur suddenly and without warning, leaving little time to respond and resulting in trauma.[6]

At a global level, when a mass trauma from an event like as a terrorist attack occurs, counselors are trained to provide resources, coping skills, and support to clients to assist them through their crisis. Intervention often begins with an assessment.[7][8] In countries such as the Czech Republic, crisis intervention is an individual therapy, usually lasting four to six weeks,[9][10] and includes assistance with housing, food, and legal matters.[11] Long waiting times for resident psychotherapists[12] and in Germany, explicit exclusions of couples therapy and other therapies complicate implementation.[13] In the United States, licensed professional counselors (LPCs) provide mental health care to those in need. Licensed professional counselors focus on psychoeducational techniques to prevent a crisis, consultation to individuals, and research effective therapeutic treatment to deal with stressful environments.[14]

School-based

The primary goal of school-based crisis intervention is to help restore the crisis-exposed student's basic problem-solving abilities and in doing so, to return the student to their pre-crisis levels of functioning.[15] Crisis intervention services are indirect. People often find school psychologists working behind the scenes, ensuring that students, staff, and parents are well-positioned to realize their natural potential to overcome the crisis.[16] School psychologists are trained professionals who meet continuing education requirements after receiving their degree.[17] They help maintain a safe and supportive learning environment for students by working with other staff,.[18] such as school resource officers, law enforcement officers trained as informal counselors and mentors.[19]

At a school-based level, when a trauma occurs, like a student death,[20] school psychologists are trained to prevent and respond to crisis through the PREPaRE Model of Crisis Response, developed by NASP.[4] PREPaRE provides educational professionals training in roles based on their participation in school safety and crisis teams.[21] PREPaRE is one of the first comprehensive nationally available training curriculums developed by school-based professionals with firsthand experience and formal training.[22]

Misuse

When using crisis intervention methods for the disabled individual, every effort should first be made to first find other, preventative methods, such as giving adequate physical, occupational and speech therapy, and communication aides including sign language and Augmentative Communication systems, behavior and other plans, to first help that individual to be able to express their needs and function better. Too often, crisis intervention methods including restraining holds are used without first giving the disabled more and better therapies or educational assistance. Often school districts, for example, may use crisis prevention holds and "interventions" against disabled children without first giving services and supports: at least 75% of cases of restraint and seclusion reported to the U.S. Department of Education in the 2011–12 school year involved disabled children. Also, school districts hide their disabled child's restraint or seclusion from the parents, denying the child and their family the opportunity to recover.[23]

The U.S. Congress has proposed legislation, such as the "Keeping All Students Safe Act", to curtail school district use of restraint and seclusion. Even with bipartisan support, the bill has repeatedly died in committee.[24]

SAFER-R

The SAFER-R Model, with Roberts 7 Stage Crisis Intervention Model,[25][26] is model of intervention much used by law enforcement.[27] The model approaches crisis intervention as an instrument to help the client to achieve their baseline level of functioning from the state of crisis. This intervention model for responding to individuals in crisis consists of 5+1 stages.

They are:[28]

  1. Stabilize
  2. Acknowledge
  3. Facilitate understanding
  4. Encourage adaptive coping
  5. Restore functioning or,
  6. Refer

Other models include Lerner and Shelton's 10 step acute stress & trauma management protocol.[29]

Critical incident debriefing

Critical incident debriefing is a widespread approach to counseling those in a state of crisis. This technique is done in a group setting 24–72 hours after the event occurred, and is typically a one-time meeting that lasts 3–4 hours, but can be done over numerous sessions if needed. Debriefing is a process by which facilitators describe various symptoms related PTSD and other anxiety disorders that individuals are likely to experience due to exposure to a trauma. As a group they process negative emotions surrounding the traumatic event. Each member is encouraged to continue participation in treatment so that symptoms do not worsen.[23]

Many have criticized critical incident debriefing for its effectiveness on reducing harm in crisis situations. Some studies show that those exposed to debriefing are actually more likely to show symptoms of PTSD at a 13-month follow-up than those who were not exposed. Most recipients of debriefing reported that they found the intervention helpful. Based on symptoms found in those who received no treatment at all, some critics state that reported improvement is considered a misattribution, and that the progress would naturally occur without any treatment.[30]

See also

References
  1. Berger P & Riecher-Rössler A (2004) Definition von Krise und Krisenassesment. (in German) In Riecher-Rössler A, Berger P, Yilmaz AT, Stieglitz RD (eds.) Psychiatrisch-psychotherapeutische Krisenintervention. Göttingen: Hogrefe, 19–30
  2. Aguilera, D.C. (1998). Crisis Intervention. Theory and Methodology. Mosby, St Louis.
  3. Jackson-Cherry, L.R., & Erford, B.T. (2010). Crisis intervention and prevention. NJ: Pearson Education, Inc.
  4. Diraddo, J. D., & Brock, S. E. (2012). Is it a crisis. Principal Leadership, 12(9), 12-16.
  5. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
  6. Carlson, E. B. (1997). Trauma assessments: A clinician's guide. Guilford Press. pp. 26-34
  7. Everly, George S.; Mitchell, Jeffrey T. (2008). Integrative Crisis Intervention and Disaster Mental Health. Chevron Publishing Corporation. ISBN 978-1-883581-12-1.
  8. Waters, J.A. (2002). Moving Forward From September 11: A Stress/Crisis/Trauma Response Model. Brief Treatment and Crisis Intervention, 2(1), 55–74. doi: 10.1093/brief-treatment/2.1.55. ISSN: 14743310.
  9. Vodáčková, Daniela. Krizová intervence (in Czech). Portál. pp. 27–45. ISBN 80-7178-214-9.
  10. Baštecká, Bohumila (ed.). Psychologická encyklopedie: aplikovaná psychologie (in Czech). Portál. pp. 147–157. ISBN 978-80-7367-470-0.
  11. Zákon č. 108/2006 Sb., o sociálních službách (dále také jen "zákon o sociálních službách"), § 60. (in Czech) Accessed 2016-05-30.
  12. BPtK-Studie: Wartezeiten in der ambulanten psychotherapeutischen Versorgung. (in German) Archived from the original on 2014-07-05.
  13. Richtlinie des Gemeinsamen Bundesausschusses über die Durchführung der Psychotherapie Stand: 2015-01-03 (PDF; 139 kB), retrieved 2015-05-04.
  14. Who Are LPC's. American Counseling Association. Accessed 2020-06-19.
  15. Flannery, R.B., & Everly, G.S. (2000). Crisis intervention: a review. Internal Journal of Emergency Mental Health 2(2), 119–125. PMID: 11232174. ISSN: 15224821
  16. Harrison, Patti L.; Thomas, Alex (2014). Best Practices in School Psychology: Systems-level services (6th ed.). Bethesda, MD: National Association of School Psychologists. pp. 214–215. ISBN 978-0-932955-52-4. OCLC 889330863. Retrieved 2020-06-19.
  17. "Who Are School Psychologists". National Association of School Psychologists (NASP). Retrieved 2019-12-05.
  18. School Climate, Safety, and Crisis. National Association of School Psychologists. Accessed 2020-06-19.
  19. What is a School Resource Officer. FAQ of National Association of School Resource Officers. Accessed 2020-06-19.
  20. Hoff, Lee Ann; Brown, Lisa; Hoff, Miracle R. (2011). People in Crisis: Clinical and Diversity Perspectives. Taylor & Francis. ISBN 978-1-135-85353-2.
  21. PREPaRE
  22. "About PREPaRE". National Association of School Psychologists (NASP). Retrieved 2019-12-05.
  23. Lilienfeld S.O. (2007). Psychological Treatments That Cause Harm. Perspectives on Psychological Science: a journal of the Association for Psychological Science, 2(1), 53–70. doi: 10.1111/j.1745-6916.2007.00029.x. ISSN: 1745-6916.
  24. "Search results for "Keeping All Students Safe Act"". GovTrack.us. Retrieved 2020-06-20.
  25. Roberts, A. (2002). Assessment, Crisis Intervention, and Trauma Treatment: The Integrative ACT Intervention Model. Brief Treatment and Crisis Intervention, 2(1), 1-22. doi: 10.1093/brief-treatment/2.1.1. ISSN: 14743310.
  26. Roberts, Albert R. (2005). Crisis Intervention Handbook: Assessment, Treatment, and Research. Oxford University Press, USA. p. 157. ISBN 978-0-19-517991-0. Retrieved 2020-06-19.
  27. "International Police Association (IPA)". International Police Association.
  28. https://www.ncemsf.org/about/conf2010/presentations/polk_crisis_response.pdf
  29. http://www.aaets.org/ten%20stages%20atsm.pdf
  30. Regehr, C. (2001). Crisis Debriefing Groups for Emergency Responders: Reviewing the Evidence. Brief Treatment and Crisis Intervention, 1(2), 87–100. doi: 10.1093/brief-treatment/1.2.87. ISSN: 14743310.
  • Greenstone, J.L. & Leviton, Sharon. (1993, 2002,2011). Elements of crisis intervention: Crises and how to respond to them, Third Edition. Pacific Grove, CA: Brooks/Cole Publishing Company, Thomson Learning.
  • Greenstone, J.L. (2005). The elements of police hostage and crisis negotiations: Critical incidents and how to respond to them. Binghamton, New York: The Haworth Press, Inc.
  • Greenstone, J.L.(2008). The Elements of disaster Psychology: Managing psychosocial trauma – An integrated approach to force protection and acute care. Springfield, Illinois: Charles C. Thomas, Publishers.
  • Greenstone, J.L. & Leviton, Sharon (1981). Hotline: Crisis intervention directory. New York: Facts on File.
  • Greenstone, J.L. & Leviton, Sharon (1982). Crisis intervention: Handbook for interveners. Dubuque: Kendall-Hunt.
  • Greenstone, J.L.& Leviton, Sharon. (1983). Crisis intervention. In Raymond Corsini (ED) Encyclopedia of Psychology. New York: John Wiley and Sons.
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