2. 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.
3. 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.
4. Central Constructs
Crisis intervention derived from ego psychology and
ecological systems theory. Below are the ideas that
were derived from these two systems.
Ecological:
Psychosocial
crisis
Coping
skills
Homeostasis
Ego:
Life
Development
stages
Disequilibrium
Interdepe
ndence
Defense
mechanism
5. 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
6. 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.
7. 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
8. 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
9. 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.
10. 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.
11. 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.
12. 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.
13. 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
14. 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.
15. Seven Stage Crisis Intervention Model
(7) Establish Follow-Up Plan and
Agreement
(6) Develop and Formulate an Action
Plan
(5) Generate and Explore Alternatives
(4) Deal with Feelings and Emotions
(3) Identify Major Problems
(2) Establish Rapport and Rapidly
Establish Relationship
(1) Plan and Conduct a Crisis Assessment
16. 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.
17. 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.
18. 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.
19. Critical Incident Stress Debriefing and Management
Critical Incident stress debriefing is used for frontline
crisis workers who are exposed to gruesome and lifethreatening 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.
20. 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.
21. 10-step Acute Traumatic Stress Management Protocol
A guideline for critical incident stress debriefing for first responders
Assess for danger/safety for self and others
Consider the physical and perceptual mechanism of injury
Evaluate the level of responsiveness
Address medical needs
Observe and identify each individual’s sign of traumatic stress
Introduce yourself, state your role, and begin to develop a
relationship
7. Ground the individual by allowing him/her to tell his or her story
8. Provide support trough active and empathic listening
9. Normalize, validate, and educate
10. Bring the person to the present, describe future events, and
provide referrals
1.
2.
3.
4.
5.
6.
22. 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
24. 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.
