To provide effective support and crisis intervention for your clients you will need a good understanding of the principles and practices of crisis intervention, including critical incident procedures and how to facilitate emergency interventions.
Maintaining the safety of everyone involved in a crisis situation is a primary concern, so you will also need to know how to identify safety issues and how to address them.
By the end of this topic, you will understand:
- basic crisis intervention principles and practices
- critical incident procedures
- the role of emergency services and emergency interventions
- principles of addressing safety concerns
- referral options and procedures
- how to recognise and respond to signs that there are safety issues.
Responding to crisis situations involves risks, so following principles and good practice guidelines is essential.
Remember that in responding to crisis situations you must always meet your legal and ethical obligations, work within the boundaries of your job role and follow your organisation’s policies and procedures. You should also refer to service standards and/or practice standards relevant to your industry sector.
Within these broad principles there are also principles and practices for responding to crisis situations.
Stages of Crisis
People experiencing crisis move through stages, which means that you must respond differently at different stages.
- Recognise that there is a crisis.
- Identify the significance of the triggering event and its impact on your client.
- Release tension by listening and providing emotional support.
- Encourage the person to be realistic and avoid catastrophising by focusing on the realities of the situation (this is sometimes called cognitive restructuring).
- Make plans with your client by prioritising needs and issues and set achievable goals.
- Build on existing strengths to empower your client and offer alternatives.
Although at some points you may need to be relatively directive, try to empower your client and allow them to feel in control as much as possible throughout the intervention.
EXAMPLE
Janice is a mental health support worker. She is visiting Joe, one of her clients. He lives alone in a small unit and receives regular support visits. Joe experienced severe trauma in the past and suffers from an anxiety disorder.
When Janice arrives today to go grocery shopping with Joe, she finds him pacing up and down the front path, muttering to himself, biting his hand and hitting his forehead. She encourages him to come inside and sit down. She gives him a glass of water and sits next to him, telling him to breathe slowly and calm down.
When Joe is a little calmer, she asks him what is wrong. Joe tells her that his lights went out last night and that he could not turn them on again. He has been awake all night sitting in the dark, and he began to have flashbacks to his past trauma which involved being kept in darkness for a long time. Joe also tells her that he tried to phone for help, but because his fixed line requires electricity to operate, and his mobile phone needed charging, he could not.
Janice uses active listening and encourages Joe to express his feelings. She praises Joe for trying to call for help and for staying at home when he could not contact anyone. She encourages him to tell her more about what he did to look after himself all night. Joe says he found a torch and used that to move around the house and to ‘keep him company’ during the night.
Janice then talks to Joe about what they might do about the problem with his electricity supply. He says he wants to contact the electricity company. They do this using Janice’s mobile phone and discover that there was a power outage in the area, and that the supply will be reconnected in about half an hour. She suggests that while they are waiting for the power to go back on, they could walk to the local café and have breakfast, because Joe has not eaten since yesterday.
While they are at the café, Janice talks to Joe about whether he wants to have a plan for what to do if there is another power outage and what he would be able to do to prepare for this. She also asks him if he would like to arrange an appointment with his therapist to talk about the flashbacks he experienced and how he could handle these if they happen again.
Principles
Principles provide guidelines for good practice.
A crisis involves opportunities for positive change as well as risks and dangers.
Crisis intervention can be seen as ‘first aid’ for mental health.
RESOURCE
For a comprehensive description of over-arching principles, read this article: National Emergency Mental Health Principles.
Psychological First Aid
Psychological first aid (PFA) is another approach based on providing psychological, social and practical support.
It provides non-intrusive practical support and follows these principles:
- Listen but do not pressure people to talk
- Provide comfort and help people to feel calm
- Connect people to information, services and social supports
- Protect people from further harm
WATCH
Checkout the following video by on Crisis Counselling. We a counsellor consulting a client during the COVID19 period.
Duration 5:15
The aims of crisis intervention include:
- Recognise and identify the crisis situation
- Assess and acknowledge the impact of the crisis on the person
- Act quickly and provide short term intervention
- Mitigate the impact of the crisis
- Support the person to regain their capacity to function effectively
- Refer to other resources, services and supports if necessary
In providing support, workers should:
- Show empathy and respect
- Remain non-judgemental and allow the person to express their own perceptions and feelings
- Develop their awareness of how the person sees their situation
- Use a task-oriented or problem-solving approach to help the person re-establish equilibrium
- Use an empowering approach and work in partnership with the person to make plans, identify and select resources and work towards solutions
- Seek feedback and evaluate outcomes
- Follow-up and refer to other resources or services if required
Roberts’ Seven Stage Crisis Intervention Model
This model outlines the following steps:
- Assess lethality (risk of harm) and mental health status.
- Establish rapport and engage the client.
- Identify major problems.
- Deal with feelings.
- Explore alternative coping methods and partial solutions.
- Develop an action plan.
- Develop a termination and follow up protocol’
https://www.slideshare.net/ruicoronha18/albert-r-robertscrisisinterventionhandbookbookzzorg
LEARN MORE
Roberts, Albert R & Ottens, Allen J The seven-stage crisis intervention model: a road map to goal attainment, problem solving, and crisis resolution, Brief Treatment and Crisis Intervention, 5(4) November 2005, pp 329-339, Oxford University Press
The World Health Organisation (WHO) describes a critical incident as an event out of the range of normal experience – one which is sudden and unexpected, involves the perception of a threat to life and can include elements of physical and emotional loss. Often such events are sufficiently disturbing to overwhelm, or threaten to overwhelm, a person’s coping capacity. Most people would be severely shaken by a critical incident but are likely to recover from its impact with appropriate support.
What is a Critical Incident?
Critical incidents include assault, threats, severe injury, death, fire or a bomb threat. In community services work, critical incidents may also include potential or actual self-harm, violent behaviours, missing clients, physical and sexual assaults, injuries, errors in medication and suicide or attempted suicide.
Critical Incidents in Community Services
You might encounter critical incidents if you work in contexts such as domestic and family violence, mental health services, child protection, youthwork, homeless support services, the criminal justice system, family mediation services, AOD services, aged care and disability services.
In all areas of community services work you will need to understand and follow your organisation’s critical incident procedures.
What is Included in a Critical Incident Procedure?
A critical incident procedure sets guidelines to follow when a critical incident happens or is likely to happen.
These procedures are intended to prevent critical incidents from occurring, to keep everyone as safe as possible and to deal with the aftermath of an incident.
RESOURCE
For examples of critical incident policies and procedures, explore the following links:
- Critical incident fact sheet, Critical Incident Reporting Requirements for Specialist Disability Service Providers, ACT Government, undated
- Workplace safety – coping with a critical incident, Better Health Channel, 2020
Responses to Critical Incidents
Your organisation will have its own policies and procedures for responding to critical incidents, but most include approaches such as that outlined below. The fundamentals of these approaches can be applied to anyone affected by a critical incident, including clients and staff members.
‘Debriefing’ is a crucial part of responding. Debriefing means providing an opportunity for those affected by an incident to process and reflect on what has happened.
‘Defusing’ provides an opportunity for those affected to ventilate and express their feelings immediately after the incident.
These processes should happen as soon as possible, preferably within three days, and if possible, at the site of the incident.
Critical Incident Stress Management
This approach includes these elements:
- Preparing for crisis by providing education and training.
- Large scale incident strategies that include information, networking and community support.
- Defusing immediately after an incident to address acute impacts.
- Debriefing (critical incident stress debriefing) after the crisis (usually within a week) to address acute impacts, decide on follow-up and provide a sense of closure.
- Crisis intervention counselling (individual face-toface support). This may be ongoing.
- If required, family intervention and support and/or organisational consultation.
- If required, referral to follow up supports and services.
WATCH
Watch the following YouTube video by CTRI called Critical Incident Group Debriefing: Example of Structure and Process:
Duration 23:23
WEBSITE
Debriefing critical incidents, Australian Government Department of Health, undated
The importance of critical incident debriefing in preventing psychological injuries, Work Options, 2021
A Critical Incident is any event that poses a serious risk to the life, health or safety, of an individual who is receiving services from your organisation.
Emergency Interventions
An emergency intervention can be any action taken in response to a sudden unforeseen event where a person’s life and wellbeing is at immediate risk of serious harm (an emergency). In the context of community services, an emergency can be any situation where clients and/or staff members are in immediate danger of harm, and where immediate action to prevent harm is required. Emergency events may include violent or aggressive behaviour, threats of harm, self-harm and attempted suicide. The aim of the intervention is to prevent or minimise harm.
Emergency interventions can include actions such as calling for assistance from emergency services (such as ambulance, medical, first aid or police services), ‘talking down’ a person intent on self-harm or suicide, protecting others at risk of harm, removing the person or others from the situation and as a last resort, using restraints (physical or chemical).
Crisis Assessment and Treatment Team (CATT)
A CATT responds to urgent requests to help people in mental health crisis 24 hours a day, 7 days a week. A mental health crisis can include:
- A psychotic episode
- Self-harm
- Feeling suicidal
- Feeling out of control
Case Study
Simon is a youth worker. His role includes running a recreation program for disengaged young people at a local community centre.
On Friday evening, a group of young people were playing snooker in the community centre, when Alex, a regular participant in the program, arrived. Alex appeared to be ‘high’ and was swearing loudly, pacing up and down and laughing hysterically.
Simon spoke quietly to Alex and tried to encourage him to sit down and relax or to come outside for a chat, but Alex became more and more agitated and aggressive. He picked up a pool cue and threatened to hit one of the players, then threw the billiard ball at another player, hitting him on the head. Alex then took a small knife from his pocket and started cutting up the felt on the snooker table.
Simon followed his organisation’s emergency procedures by moving all of the other clients out of the centre and locking Alex inside. He called an ambulance and the police. While waiting for them to arrive, Simon provided first aid to the boy who had been hit by the hard billiard ball and suggested that the other clients might like to go home.
When the ambulance arrived, Simon explained the situation and unlocked the centre so that the paramedics could enter. They found Alex lying unconscious on the snooker table, bleeding from a cut to his wrist, and took him to the emergency department. On the way, the paramedics called the CATT team.
Simon waited for the police to arrive, reported the situation to them and then went to the hospital to enquire about Alex.
What are Emergency Procedures?
In responding to emergency situations and events, you must follow your organisation’s emergency procedures. A procedure is a set of steps that tell you what to do. Community services organisations are required to have policies and procedures for dealing with emergencies.
LEARN MORE
Explore the following examples of guidelines and emergency procedures from community services organisations:
- Policies and procedures for disasters and emergencies, ACOSS, 2015
- Emergency preparedness policy for clients and services, NJERNDA, Victoria State Government Health and Human Services, 2017
- Baptist Care Emergency Action Plan, Aged Care Royal Commission, 2020
- Emergency and evacuation policy, Barcon Child Youth and Family, 2017
Researching and Reflecting on Emergency Procedures
Practice
This learning activity is intended to develop your understanding of emergency procedures in the context of community services.
Choose a community services sector with which you are familiar with or in which you are interested in working.
Identify at least one service or organisation in your local area from this sector. Use online and other sources to collect information to answer the following questions about this service or organisation:
- What does this organisation or service do?
- Who are its clients?
- What needs do these clients have?
- Are these clients vulnerable to any specific risks?
- What kinds of client-related emergency situations might staff members have to deal with? Give some examples.
- What are this organisation’s policies and procedures for dealing with this kind of emergency?
- Are these policies and procedures clear, practical and easy to follow? Why?
Safety Concerns
Keeping everyone safe will be a primary concern in responding to a crisis situation or emergency.
The skills you will need to respond effectively to crisis situations and to keep everyone safe include identifying:
- who is at risk?
- what is at risk?
- how serious is the risk?
- what to do and what procedures to follow
To do this, you will need to gather information about the situation by:
- Using your observation skills to see and analyse what is happening. This means watching and listening carefully and attentively.
- Asking questions to gather more information. This means using effective questioning and listening techniques.
- Referring to your organisation’s policies and procedures. This means reading and interpreting your organisation’s policies and procedures accurately.
Observation
Observation includes watching and interpreting events (what is happening) and behaviour (what people do).
To observe and interpret events accurately requires concentration and focus. Having a frame of reference such as a checklist or list of things to watch for also helps. Your organisation’s risk assessment policies and procedures can provide this kind of framework. You can also use your common sense to identify events that indicate that someone is at risk.
EXAMPLE
- Person Centred Active Approach, Online Learning Resource
- Suicide risk assessment, Department of Health and Human Services, State Government Victoria, 2020
Asking Questions and Listening
For an overview of the communication skills that you will need to use, including questioning and listening, please refer to your Fundamentals of Community Services Learner Guide, Chapter 6 Communication.
LEARN MORE
- Suicide prevention and recovery guide, a resource for mental health professionals, SANE 2014
- Risk assessment and initial management of suicidal adolescents, Gordon & Melvin, Australian Family Physician, Volume 43, No.6, June 2014 Pages 367-372
There can be direct and indirect signs and indicators that a client or other person is at risk.
Direct Signs
Direct indicators are those that you can observe, such as visible evidence of physical injury (bruises, wounds, etc.) and behaviours that indicate fear, threats and aggression or violence.
Indirect Signs
Identifying and responding to safety issues also requires awareness of less obvious signs of potential risk by being able to ‘read between the lines’ and pick up and interpret clues from context and background information.
Indirect indicators include verbal and nonverbal ‘hints’ that a person is fearful or at risk of harm, such as body language or changes in behaviour or patterns of behaviour. These may come from a person at risk and/or a person who threatens or intends harm to someone. Indirect indicators can act as ‘red flags’ to alert you to safety issues.
For example, facial expressions that indicate fear and contradict what the person says (‘everything is okay, thanks’ with a fearful facial expression, trembling etc.), inappropriate laughter, flinching or cowering in the presence of someone or frequently avoiding being alone with a particular person.
Examples of other behaviours include threatening gestures such as a raised fist, angry facial expressions, standing too close or invading personal space and other aggressive or threatening body language.
RESOURCE
Explore these links to information about identifying indicators of safety issues:
Suicide
- Identifying risk factors and warning signs for suicide, Headspace School Support, undated
- Suicidal warning signs, Beyond Blue, 2021
Child protection
- Recognising when a child is at risk, Better Health Channel, Victoria State Government, 2020
Domestic and family violence
- Risk assessment and safety planning, 1800RESPECT, 2021
Once the emergency has been dealt with and you have used strategies such as psychological first aid to address immediate needs and concerns, you may also need to refer your client to other services and resources for follow-up and to address longer-term needs and issues.
Your responsibilities when making a referral include:
- Discussing referral options with your client and making sure that they consent to a referral being made
- Providing your client with information about referral options that will allow them to make an informed choice
- Following your organisation’s policies and procedures for making referrals
- Checking the other organisation’s eligibility criteria, services and referral requirements
- Collecting and providing the other agency with information about:
- The client
- Their issues, history, needs and goals
- Your involvement
- What services are you requesting to support your client
- Following-up to check progress and outcomes
Case Study
Amanda is a support worker in a women’s health centre. One of her clients, Elena, has been experiencing symptoms of post-natal depression after the birth of her third child. She had a difficult birth and has not felt the same attachment as she did with her first two children. Her baby is not thriving.
Amanda has been visiting Elena at home and accompanying her on visits to the infant health clinic. Elena was very reluctant to accept help as she is ashamed of what she sees as her failure to love her baby. She feels that she is a failure as a mother and that she is worthless. She has been offered counselling at the women’s centre and it was suggested that she participate in a support group, but she has not accepted these offers.
Amanda is very concerned that Elena might harm herself or the baby. She does not believe that she has the skills or knowledge to support Elena effectively and is visiting her to discuss other options.
Over the course of the interview, she discovers that Elena’s grandmother suffered from chronic depression and was hospitalised for this on several occasions. The family saw this as a disgrace and Elena grew up with a fear of being shut away in an ‘asylum’ like her grandmother. Amanda listens to Elena’s fears and to her concerns about her inability to bond with her baby and asks Elena how she would like things to be different and what she would like to do to change this. After thinking for a while, Elena says she would like someone to talk to who understands how she feels and who can help her to work out what to do.
Amanda then provides Elena with information about a range of organisations and programs that support mothers with postnatal depression and asks her which one she would like to be referred to. She offers to accompany Elena to her first appointment and to keep in touch with her to see how the referral is working out.
Here are some links regarding postnatal depression:
This topic has equipped you with essential knowledge and skills to provide effective support and crisis intervention for clients. You have gained insights into fundamental crisis intervention principles and practices, critical incident procedures, and the role of emergency services. Emphasis has been placed on maintaining safety by identifying and addressing safety concerns promptly. Additionally, you are now familiar with referral options and procedures, enabling you to navigate through various aspects of crisis management. As a result, you have developed the ability to recognize and respond to signs indicating potential safety issues, enhancing your overall preparedness for crisis situations.
