Compare And Contrast Crisis Intervention Model And Suicide
Homicidal or Violent There are clients who reach out to the crisis line due to having thoughts of wanting to hurt others. At times, family members may reach out to the crisis line after getting into a fight with the client or if they see the client engaging in pre-violent behaviors. The clients may have low tolerance and high agitation levels or have mood disorders.
Mental Health Some clients dial into the crisis line due to mental health crises like a psychotic episode or severe depression. Some clients become regular callers but may have to be monitored for when they go below baseline as that is when they can become suicidal. These clients may require the most follow-up services after a crisis.
Crisis Intervention Models and Suicide …show more content…
Prevention Models The crisis intervention model used by ACS is a form of the Eight Step Model or psychological first aid.
The company sometimes combines the steps to make it more cohesive and includes the Transtheoretical Model. The Transtheoretical model is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change which was conceptualized by Prochaska, Diclemente, and Norcross (1992) (Calderwood, 2011). The company utilizes the Columbia which is a Universal suicide prevention model and has a rating scale and questions that help determine suicide risk. The questions in the Columbia include questions about pain, urgency, acquired capability, intent, measures degrees of hopelessness, loneliness, and perceived burdensomeness (Hill, Hatkevich, Kazimi, & Sharp, 2017). The company also pulls concepts from the Crisis Triage Rating scale which steps include the recognition of warning signs, exploration of crisis situation and psychopathological symptoms, assessment of protective and risk factors, estimation of suicide risk and a plan for management of suicidal patients through different levels of interventions (Turner & Turner, 1991) and made it the Revised-Crisis Triage Rating Scale which includes the Transtheoretical …show more content…
Model.
Process for Intervening in Crisis and Eight Step Model
The process of intervening in a crisis fro ACS is similar to the Eight Step Model as described by James and Gilliland (2017). Though the names may be different, it consists of the same concepts. Most crisis work follows the same formula of Contact and Engagement, Safety and Comfort, Stabilization (if needed, Information Gathering on Current Needs and Concerns, Practical Assistance, Connection with Social Supports,Information on Coping, and Linkage with Collaborative Services (Jacobs, Gray, Erickson, Gonzalez, & Quevillon, 2016). The steps at ACS are interwoven and at anytime the clinician must provide the client with distress tolerance techniques as needed.
Precipitating Factors and Chief complaints The first step in dealing with a crisis is to understand the crisis. It is important for the clinician to understand what precipitated the event, the people who were involved, and the timeline of the events. It is important that throughout the crisis, the client is given empathy and validation. Although the clinician may find the client’s concerns to be menial, he or she has to accept that this is what the client has defined as a crisis event and take it seriously.
Collecting Data The next step is to collect data on the client after understanding what the client has defined as being the crisis. In this stage, the clinician will do a full assessment which delves into the client’s mental health history, medical history, substance use, role functioning declines, housing, finances, support, history and current suicidal behavior, and history and current homicidal behavior. This in depth data collection is pertinent in understanding the depth of the crisis.
Collaborating with Collateral Third, the clinician is to attempt to reach out to any family or friends of the client. This is to verify the client’s account of the crisis and understand from a different viewpoint on how the crisis has affected the client. Speaking to family or friends is necessary in safety planning or implementing recommendations. If a client has a support team, the clinician is supposed to strengthen the support by helping them learn ways to help the client cope or where to get medications. If the client does not have a support team, the clinician forms one by involving the local mental health clinic.
Consultation
Fourth, during a high risk call or a mobile crisis assessment, it is necessary that all clinicians consult with an on-call supervisor. The consultation is usually 10 to 15 minutes and it covers all the data that was collected from the client and third parties. This is to help the clinician analyze information that he or she did not see, and to help facilitate ethical decisions.
Providing Recommendations Fifth, the counselor must, after consulting, provide the recommendations, that were co-conceptualized between the clinician and the supervisor, to all parties involved. The recommendations involved may be a combination of requiring a robust safety plan, going to the hospital, or finding resources on the outpatient basis. During this time, all concerns must be neatly summarized, and the client must have feasible opportunity to implement the recommendation and full understanding of it as well.
Follow-up Services After the clinician has dealt with the crisis situation, follow-up with the client must be made with 24 hours. Clinicians that are working in the call center will follow-up with the client and see how the client has implemented the recommendations. If necessary, the clinician may decide to request a face-to-face follow-up assessment. There are no follow-up services for clinicians after a difficult case or secondary trauma.
Types of Training
Suicide Risk Assessment Tool All clinicians are trained before taking crisis calls or even stepping out into the field on the company suicide risk tool the Revised-Crisis Triage Rating Scale (R-CTRS) and the Columbia. The R-CTRS is used to help determine the client’s level for suicide risk using the basis of pain, urgency, and acquired capability. Clinician are expected to understand the scoring of the C-TRS when consulting with supervisors.
Psychopathology and Substance Use The Diagnostic Statistical Manual (DSM) is highly used in training.
The clinicians are expected to learn the most common diagnoses and be able to cite to the essential criteria. The diagnoses that must be learned by the end of all training for a final test at the end where the clinician must obtain an 80 percent or higher. It is important that the clinician also understands the effects of various drugs as that can have similar presentation as some diagnoses like Bipolar Disorder and Schizophrenia. Clinicians are expected to understand which drugs when going through withdrawal can be lethal. Understanding these is important in providing provisional diagnoses for clients as the company uses diagnoses to help determine care and proper
follow-up.
Satori Alternatives to Managing Aggression
Satori Alternatives to Managing Aggression (SAMA) is a training that focuses on de-escalating aggressive behavior and harm management. The training consists a variety of questions, phrases, body language to de-escalate violence. The training also covers various techniques to reduce harm to both the client and a clinician in the instance that the client becomes aggressive.
ANSA and CANS
The Adult Needs and Strengths Assessment (ANSA) is a multi-purpose tool to support decision making to help facilitate improvement goals.The Child and Adolescent Needs and Strengths (CANS) is like the ANSA but is a multi-purpose tool developed for children’s services. Clinicians must complete this training before serving clients alone.
Stressors
Work Hours Work hours are the primary stressor in ACS. The issue lies in the fact that no two client situations are exactly the same and can require more than two hours. All sessions with clients must be documented either concurrently in the field or once arrived at the call center. Sometimes, crisis calls at the last 30 minutes of a shift can determine whether the clinician leaves on time or not. With all these considered, clinicians may be getting off two to three hours after their shift.
Emotional Burnout It is not uncommon for people who do crisis work to experience a lot of mental fatigue or emotional fatigue. If the counselor does not have a robust wellness plan it is easy for that to turn into emotional burnout. The clinician may not take crises as seriously since he or she is constantly bombarded by difficult emotions and suicidal risk. On average, the clinicians at the call center will get 30 calls a shift, and the clinician in the field will see four to five clients. Unfortunately, the company does not offer services to alleviate emotional burnout.
Conclusion
ACS is a company in Dallas that provides crisis services for the communities that it serves. Ciara is an employee that works at ACS and was interviewed for this literature. She provided information on the services that were provided at ACS, training, crisis intervention models, suicide intervention models, and stressors on the job. Overall, the work of a crisis worker is full of responsibility and education at various levels.
Mental Health Some clients dial into the crisis line due to mental health crises like a psychotic episode or severe depression. Some clients become regular callers but may have to be monitored for when they go below baseline as that is when they can become suicidal. These clients may require the most follow-up services after a crisis.
Crisis Intervention Models and Suicide …show more content…
Prevention Models The crisis intervention model used by ACS is a form of the Eight Step Model or psychological first aid.
The company sometimes combines the steps to make it more cohesive and includes the Transtheoretical Model. The Transtheoretical model is an integrative, biopsychosocial model to conceptualize the process of intentional behavior change which was conceptualized by Prochaska, Diclemente, and Norcross (1992) (Calderwood, 2011). The company utilizes the Columbia which is a Universal suicide prevention model and has a rating scale and questions that help determine suicide risk. The questions in the Columbia include questions about pain, urgency, acquired capability, intent, measures degrees of hopelessness, loneliness, and perceived burdensomeness (Hill, Hatkevich, Kazimi, & Sharp, 2017). The company also pulls concepts from the Crisis Triage Rating scale which steps include the recognition of warning signs, exploration of crisis situation and psychopathological symptoms, assessment of protective and risk factors, estimation of suicide risk and a plan for management of suicidal patients through different levels of interventions (Turner & Turner, 1991) and made it the Revised-Crisis Triage Rating Scale which includes the Transtheoretical …show more content…
Model.
Process for Intervening in Crisis and Eight Step Model
The process of intervening in a crisis fro ACS is similar to the Eight Step Model as described by James and Gilliland (2017). Though the names may be different, it consists of the same concepts. Most crisis work follows the same formula of Contact and Engagement, Safety and Comfort, Stabilization (if needed, Information Gathering on Current Needs and Concerns, Practical Assistance, Connection with Social Supports,Information on Coping, and Linkage with Collaborative Services (Jacobs, Gray, Erickson, Gonzalez, & Quevillon, 2016). The steps at ACS are interwoven and at anytime the clinician must provide the client with distress tolerance techniques as needed.
Precipitating Factors and Chief complaints The first step in dealing with a crisis is to understand the crisis. It is important for the clinician to understand what precipitated the event, the people who were involved, and the timeline of the events. It is important that throughout the crisis, the client is given empathy and validation. Although the clinician may find the client’s concerns to be menial, he or she has to accept that this is what the client has defined as a crisis event and take it seriously.
Collecting Data The next step is to collect data on the client after understanding what the client has defined as being the crisis. In this stage, the clinician will do a full assessment which delves into the client’s mental health history, medical history, substance use, role functioning declines, housing, finances, support, history and current suicidal behavior, and history and current homicidal behavior. This in depth data collection is pertinent in understanding the depth of the crisis.
Collaborating with Collateral Third, the clinician is to attempt to reach out to any family or friends of the client. This is to verify the client’s account of the crisis and understand from a different viewpoint on how the crisis has affected the client. Speaking to family or friends is necessary in safety planning or implementing recommendations. If a client has a support team, the clinician is supposed to strengthen the support by helping them learn ways to help the client cope or where to get medications. If the client does not have a support team, the clinician forms one by involving the local mental health clinic.
Consultation
Fourth, during a high risk call or a mobile crisis assessment, it is necessary that all clinicians consult with an on-call supervisor. The consultation is usually 10 to 15 minutes and it covers all the data that was collected from the client and third parties. This is to help the clinician analyze information that he or she did not see, and to help facilitate ethical decisions.
Providing Recommendations Fifth, the counselor must, after consulting, provide the recommendations, that were co-conceptualized between the clinician and the supervisor, to all parties involved. The recommendations involved may be a combination of requiring a robust safety plan, going to the hospital, or finding resources on the outpatient basis. During this time, all concerns must be neatly summarized, and the client must have feasible opportunity to implement the recommendation and full understanding of it as well.
Follow-up Services After the clinician has dealt with the crisis situation, follow-up with the client must be made with 24 hours. Clinicians that are working in the call center will follow-up with the client and see how the client has implemented the recommendations. If necessary, the clinician may decide to request a face-to-face follow-up assessment. There are no follow-up services for clinicians after a difficult case or secondary trauma.
Types of Training
Suicide Risk Assessment Tool All clinicians are trained before taking crisis calls or even stepping out into the field on the company suicide risk tool the Revised-Crisis Triage Rating Scale (R-CTRS) and the Columbia. The R-CTRS is used to help determine the client’s level for suicide risk using the basis of pain, urgency, and acquired capability. Clinician are expected to understand the scoring of the C-TRS when consulting with supervisors.
Psychopathology and Substance Use The Diagnostic Statistical Manual (DSM) is highly used in training.
The clinicians are expected to learn the most common diagnoses and be able to cite to the essential criteria. The diagnoses that must be learned by the end of all training for a final test at the end where the clinician must obtain an 80 percent or higher. It is important that the clinician also understands the effects of various drugs as that can have similar presentation as some diagnoses like Bipolar Disorder and Schizophrenia. Clinicians are expected to understand which drugs when going through withdrawal can be lethal. Understanding these is important in providing provisional diagnoses for clients as the company uses diagnoses to help determine care and proper
follow-up.
Satori Alternatives to Managing Aggression
Satori Alternatives to Managing Aggression (SAMA) is a training that focuses on de-escalating aggressive behavior and harm management. The training consists a variety of questions, phrases, body language to de-escalate violence. The training also covers various techniques to reduce harm to both the client and a clinician in the instance that the client becomes aggressive.
ANSA and CANS
The Adult Needs and Strengths Assessment (ANSA) is a multi-purpose tool to support decision making to help facilitate improvement goals.The Child and Adolescent Needs and Strengths (CANS) is like the ANSA but is a multi-purpose tool developed for children’s services. Clinicians must complete this training before serving clients alone.
Stressors
Work Hours Work hours are the primary stressor in ACS. The issue lies in the fact that no two client situations are exactly the same and can require more than two hours. All sessions with clients must be documented either concurrently in the field or once arrived at the call center. Sometimes, crisis calls at the last 30 minutes of a shift can determine whether the clinician leaves on time or not. With all these considered, clinicians may be getting off two to three hours after their shift.
Emotional Burnout It is not uncommon for people who do crisis work to experience a lot of mental fatigue or emotional fatigue. If the counselor does not have a robust wellness plan it is easy for that to turn into emotional burnout. The clinician may not take crises as seriously since he or she is constantly bombarded by difficult emotions and suicidal risk. On average, the clinicians at the call center will get 30 calls a shift, and the clinician in the field will see four to five clients. Unfortunately, the company does not offer services to alleviate emotional burnout.
Conclusion
ACS is a company in Dallas that provides crisis services for the communities that it serves. Ciara is an employee that works at ACS and was interviewed for this literature. She provided information on the services that were provided at ACS, training, crisis intervention models, suicide intervention models, and stressors on the job. Overall, the work of a crisis worker is full of responsibility and education at various levels.