Sanford Brown College Crisis Discussion

CRISIS M o d u l e05 Discussion – Antonio’s Crisis
Consider the scenario below, then follow the instructions underneath it to complete the discussion.
Supporting Antonio and his Grandmother
Antonio is a 17-year old young man who lives in the inner-city of Chicago. Last night, he witnessed the
fatal shooting of a female classmate. Concerned about Antonio’s psychological and emotional
wellbeing, Antonio’s grandmother brought him to the community mental health clinic.
As a Human Services Professional who has training in crisis intervention, you begin to interact with
Antonio. Though responsive throughout the session, Antonio refuses to hold back his tears any longer
and says, “Man, she didn’t deserve that. All my friends are dying. Why do I have to feel like there is no
way out?” Antonio excuses himself to go to the restroom to dry his face.
Antonio’s grandmother says, “What do I do? How do I help him? Please, please, please, I’m begging
you; how can I help my grandson?” Moments later, Antonio walks back into your office.
In your initial post, address the following:
1. As the Human Services Professional, how would you respond to Antonio and what would you
recommend to Antonio’s grandmother?
2. Explain two things you would avoid saying/doing during your professional interactions with
Antonio?
Review the posts made by your classmates. Choose someone who has not already received a reply, and
suggest an alternative crisis strategy; explain why you think it would be a good fit.
Importance of Research -Based and Evidence -Based Practice
How Research Informs Evidence-Based Practice
Human Services is an important
discipline that has the integral professional role consisting of assisting individuals, families, groups, and
communities towards addressing the complex stressors that exist within society. These stressors require
the application of tools that allow for strategically making progressive steps towards change. This is why
Human Services Professionals work with client systems (e.g. individual, family, group, community) based
upon the ideology of “starting where the client is.” What this means is that, as Human Services
Professionals, we must understand the perspective of the problem(s) identified and/or observed so that
strategic steps can be taken towards appropriately addressing the area(s) of conflict.
Although evidence-based research plays a vital role in Human Services practice, it is important to
combine it with other professional skills and experience. Human Services practice occurs under
circumstances where information may be incomplete and conflicting, and for various reasons, this may
lead to biases in the decision-making process. Therefore, Human Services Professionals must have an
in-depth understanding of how research informs evidence-based practice because published evidence
ensures that the practice of Human Services Professionals is ethically performed and based upon
objective (or factually-based insight). Therefore, evidence-based practice and research are necessary for
ensuring that strategies and resolutions are aligned closely with best practices. With crisis intervention,
research and evidence-based practices involve remaining current with the literature that explains an
assortment of models that have worked in a variety of settings.
Defining and Responding to a Crisis
Researchers have concluded that crisis situations are subjective and involve a temporary state of
emotional disorganization after an experienced crisis event. A crisis event is different from a problem or
an emergency. While a problem may be stressful and difficult to solve, it can be solved with one’s
customary problem-solving resources. An emergency is a sudden, pressing situation which requires
immediate attention (e.g., when someone’s life is in danger because of an accident, a suicide attempt or
an act of violence). A crisis on the other hand, constitutes circumstances or situations which cannot be
resolved by one’s typical problem-solving processes. With respect to most people, the mere exposure to
a crisis event is not enough to produce a state of emotional turmoil. Because of this, crisis intervention
has been shown to be a best practice because the intervention is immediate and is designed to serve as
a general counseling tool towards assisting clients after a crisis towards individualized crisis
management.
The Phases of a Crisis
Many crisis intervention models will resemble steps towards working with a client who has experienced a
crisis and may be struggling to work through the situation. All models of crisis intervention will identify that
there are elements of crisis that occur in stages. Crisis intervention is a rehabilitative experience in which
Human Services Professionals work with the client on processing the event before long-term effects
potentially surface (e.g., Post-Traumatic Stress Disorder (PTSD) or depression and anxiety disorders).
Based upon research, crisis events tend to result in several psychological dysfunctions such as
disorganized thought, preoccupation with insignificant detail, aggression, emotional distancing, passivity,
impulsiveness, lowered self-esteem and dependence. The five phases of a crisis are as follows:
Phase One: This first phase is the experience of an event. The individual has endured the crisis event
that is perceived to be threatening and overwhelming.
Phase Two: Disorganized responses occur during the second phase. The affected individual begins to
show signs of distress and becomes more and more disorganized in his/her behaviors, skills, and the
utilization of resources that may have worked in resolving conflict.
Phase Three: In the third phase, there is a sense of “blowing up”, in which the individual may lose control
of his/her thoughts, behaviors, and feelings. This is where inappropriate and destructive behaviors may
envelope.
Phase Four: The fourth phase involves stabilization. Affected persons may begin to calm down as they
are able to progressively draw upon their resources. This is typically when crisis intervention occurs, with
the assistance of a Human Services Professional. The individual remains vulnerable and begins to
address the crisis and works towards achieving a degree of balance without the feeling of being
threatened.
Phase Five: Adaptation occurs. The individual develops a sense of feeling calm and regaining control
over their thoughts, feelings, and behaviors. This is when, depending upon the crisis intervention model
used, that the individual works towards understanding how to address the crisis matter through ownership
of developing an individual plan towards feeling secure post-crisis.
Crisis Intervention Strategies: What W orks and What Doesn’t Work
The Importance of Building Rapport
Crisis intervention, like traditional
counseling, involves being able to connect with persons enduring a crisis. Because building a rapport
must be conducted at the beginning stages of working with a client, it is important that Human Services
Professionals understand that individual experiences are diverse and vast. People are exposed to
stressful life events and situations with relative frequency — meaning, some persons may have gone
through singular instances of perceived or actual crisis situations, while others may have endured
habitual circumstances that have been highly stressful or traumatic. Either way, the Human Services
Professional performing in the role of the crisis interventionist must be sensitive, careful, and empathic to
the experiences of the clients with whom s/he works.
High stress levels and poor coping skills are frequently associated with a range of mental and physical
illnesses. Historically, people were hospitalized or received services through the emergency departments
of hospitals. Although there are emergent circumstances that do warrant intensive, inpatient services,
generally speaking, this would be considered an expensive and ineffective way to de-escalate crisis
situations. Usually, effective crisis intervention prevents situations from escalating to the point where
there are limited options and unnecessary hospital admissions. The point of a crisis is the time (and for
many, the only time) that people will accept help to resolve their problems. Depending upon the
geographic location to include the scope of practice for an agency or organization, Human Services
Professionals often have the flexibility of helping someone in the office, by telephone, by email, or by
attending an event in the community.
Crisis Intervention Strategies
Crisis intervention focuses on the present experience of the client, or the “here and now” and is not meant
to be a long-term professional experience between the Human Services Professional and the client. The
work of the Human Services Professional, or crisis interventionist, is to empower the client (e.g. learn
effective problem-solving and networking skills) so that they become more self-reliant, and less
dependent upon outside resources. Recovery from a crisis event depends heavily on the severity of the
event, the personal resources of those exposed to the event, and the availability of support from
significant others. A crisis is considered resolved when emotional equilibrium has been restored and
when those involved once again feel in control. The length of crisis intervention varies from one or two
sessions to several interventions over a period of one to two months.
What Doesn’t Work
Below are some “should nots” to keep in mind when Human Services Professionals are dealing with
individuals in crisis:
•
Human Services Professionals should never probe a person in crisis to the point where she or
he feels under attack.
•
Human Services Professionals should not criticize or embarrass individuals in crisis.
•
Human Services Professionals should not “preach” to clients enduring stress after a crisis.
•
Human Services Professionals should not become analytical as to place judgement on clients.
•
Human Services Professionals should not question beyond the point where “closure” can be
attained.
•
Human Services Professionals should not become impatient and/or appear rushed.
•
Human Services Professionals should not draw unnecessary attention to the person in crisis.
•
Human Services Professionals should not provide the client with false hope and state the
opposite of what s/he means throughout the crisis intervention process.
•
Human Services Professionals should not trivialize threats of suicide or homicide and must take
all instances of potential harm seriously.
•
Human Services Professionals should not become over-involved in a crisis situation, to the point
where s/he feels overwhelmed.
What Works
The following are techniques that should be employed to bring about resolution of a crisis:
•
Human Services Professionals should establish rapport with the person in crisis.
•
Human Services Professionals should sensitively (and without force) explore in detail the events
that led up to the crisis and the significance of the crisis.
•
Human Services Professionals should identify the maladaptive responses which the crisis
triggered.
•
Human Services Professionals should collaboratively come up with and examine more adaptive
alternative responses with the client.
Human Services Professionals, in concert with the client and identified client support systems,
should decide on a plan of action which resolves the crisis and restores the affected person to
independent functioning.
•
•
Human Services Professionals should sensitively review with the client what happened to
facilitate learning and growth.
In the final stage of crisis intervention, an important “do” is to progressively work towards the termination
of the intervention process. Clients need to know in advance when services are to be terminated, based
upon the collaborative plan developed and resources and any aftercare services have been identified.
Crisis Intervention: Difficult Clients
Difficult Clients
In a perfect world, when interacting
with Human Services Professionals, clients would fully comply with intervention services and never
present a challenge. Unfortunately, this will not be the case. Though the majority of clientele will be
pleasant throughout the experience of working with a Human Services Professional, there are a subset of
persons within the overall client population of organizations that will be resistant and/or difficult to work
with. Difficult or challenging clients deserve the same degree of respect that is given to the client who is
not difficult or challenging. Ethically speaking, Human Services Professionals are always required to
remain professional and practice unconditional positive regard — meaning, exhibiting professional
behaviors and a positive work performance that seeks to illicit progressive change.
Avoid Escalating
When faced with a challenging client or situation, Human Services Professionals should not escalate the
situation by reacting to it in kind. Instead of fighting back, it is necessary for professionals to be aware of
his/her emotional and physical state (e.g., such as a racing heart, surging adrenaline, confusion and
dread). Through daily practice of mindfulness, Human Services Professionals can learn to notice
sensations arising in the body and thoughts arising in the mind without judgment. They can also keep in
mind the core values of intervention services. If the Human Services Professional connects with those
values, it can pull him/her through some of these charged moments.
Empathize
The expression of empathy is important when working with difficult clients. There is a reason why the
client may be exhibiting behaviors that make it difficult to work with him/her. Therefore, it is important to
validate the feelings and experiences of clients and to allow the client to express themselves in a manner
that allows you to develop the rapport and to provide empathic responses. When validating the feelings of
clients, Human Services Professionals can say things as such: “You’re angry because…” and asking “Am
I hearing you right?” This can help de-escalate any negative views clients present and to ultimately begin
the process towards providing a professional intervention. Expressing empathy must be done right or
challenging clients may see it as phony. Difficult, suspicious clients may be put off by expressions of
empathy, so it is important that Human Services Professionals understand that s/he must earn the right to
be empathic with such clients and to avoid clichéd expressions.
Share with Colleagues
Some clients say they really want to change, then fight every inch of the way to make sure they don’t.
When the client is resisting the Human Services Professional and the Human Services Professional starts
getting irritated with the client, then you have two people resisting each other. That’s not intervention;
that’s called war. Human Services Professionals should strive to be patient not only with challenging
clients, but also with themselves. Human Services Professionals can feel a lot of shame when they’re
having trouble with clients. A big reason for that is because people don’t talk enough about their
difficulties. Professionals often think they are the only ones. Respectfully conversing with colleagues
about experiences with challenging clients (while respecting client confidentiality) can not only help end
that isolation but also lead to constructive suggestions about how to deal with such challenges. It can also
be helpful to get a second opinion by consulting on specific cases with colleagues.
Sometimes the “Fit” Just Isn’t Right
Clients who think a Human Services Professional is terrible at his or her job have every right to question
credentials, challenge therapeutic decisions, or even decide to end the relationship. Sometimes, matching
clients with a Human Services Professional is not a good fit. It is okay if the professional relationship
between client and Human Services Professional ends and the client is transferred to another Human
Services Professional or agency. Ending a professional relationship is not a sign of failure due to the high
importance of keeping client’s needs first so that s/he can achieve a level of satisfaction towards
addressing the identified areas that warrant intervention services.
Fostering Resiliency and Empowerment in Clients after a Crisis
Helping Clients Develop Resilience
Everyone goes through a crisis or two
or three in his/her life. Managing these crisis situations involves developing resiliency towards overcoming
the stressor(s) and feeling empowered towards change and growth. A crisis occurs when an individual
feels overwhelmed by events. The crisis may be precipitated by events which bring about sudden change
to the person’s environment (e.g. bereavement, other losses, divorce, childbirth, negative financial
situations). It may also be linked to factors unrelated to any mental health issues such as the illness of a
career, which in turn precipitates a crisis requiring intervention. For some, usual coping mechanisms may
fail and new strategies may be tried but, and if these also fail, an increasing state of anxiety and poor
morale may develop.
Maladaptive coping strategies, such as substance abuse, deliberate self-harm, or violent behavior, may
also be applied as a poor coping strategy by the individual who is struggling. Further escalation leads to a
state of decompensation in which normal psychological functioning breaks down, most commonly causing
panic attacks and disabling anxiety, suicidal intent or psychosis. Successful crisis intervention processes
involve looking at the individual and helping the individual to strategically overcome factors relative to the
crisis that s/he can control. Fostering resiliency and empowerment post-crisis means that the client
eventually develops a new coping strategy in which s/he attaches meaning and understanding of what
s/he has endured. The attachment of meaning provides the individual with strategies that can be utilized
when faced with crisis situations of varying magnitude in the near to distant future.
The Important Role of Crisis Counseling
Crisis counseling aims to intervene as soon as possible after the onset of the crisis to enable the
individual to overcome it, minimize the usage of negative coping strategies and avoid complete
psychological breakdown. It is a short-term intervention, which may require intensive involvement of the
Human Services Professional with the client, and sometimes also members of their family. Throughout
the intervention experience, empowerment involves helping the survivor of a crisis or trauma to
reestablish a sense of control and agency. This may happen by allowing the survivor to recognize their
own strengths and capabilities (instead of insisting that they are strong for having gone through
something so horrific), helping them find the information necessary to make their own decisions (instead
of making decisions without consulting them or against their wishes), and allowing them to take actions
they feel comfortable with (instead of pressuring them to do things they don’t want to do). When Human
Services Professionals fail to empower survivors to make their own choices within their personal healing
process, it can feel re-traumatizing because the survivor is again in a situation beyond their control.
Responding from a place of empowerment, however, restores control to the survivor and allows recovery
to happen at a pace that feels comfortable.
Human Services Professionals serve an important role, ensuring positive outcomes are made when
working with client’s post-crisis. Human Services Professionals should hold victims up as survivors and
heroes that have survived the hardship(s). This is done through validation and empathic responding that
leads towards the client beginning to feel a sense of beginner’s autonomy. Empowerment helps build a
space for survivors to claim their experience (and all the emotions and reactions that go along with it),
make their own decisions, and reclaim control over their life, which is a key step toward healing.
Supporting survivors along their own path to healing is the most important way that friends, family, and
loved ones can help.
Shields
model 5
COLLAPSE
I would tell Antonia that his feeling is valid. I would let his grandmother now that
something like this can take some time to heal he saw something that he doesn’t
understand why it happens. I would let the grandmother now that I would take him to
group counseling and find anything else that he could go and talk about how he is feeling.
You don’t want him to feel like is dealing with his feeling by himself. Just being there for
him and to let him know anytime he needs to talk that you are there to listen.
I would tell Antonia that his feeling is valid. I would let his grandmother now that
something like this can take some time to heal he saw something that he doesn’t
understand why it happens. I would let the grandmother now that I would take him to
group counseling and find anything else that he could go and talk about how he is feeling.
His grandmother just needs to be there for him when he is ready to talk about it or listen to
how he is feeling.