The Crisis Intervention Approach By: Kharel B. Patentis The Crisis Intervention Approach Is an approach that is being used with individuals, families, groups and communities that are in a state of disequilibrium because of a crisis they have experienced. Social workers are now doing a great deal of crisis-related work in their practice. The term “CISD” or Crisis Incident Stress Debriefing which is a form of crisis intervention has bedame popular in the country and many social workers are being trained in it because it has been found to be very helpful particularly for victims of natural disasters. What is Crisis? A crisis is an “upset in a steady state” an emotional reaction on the part of the individual, family, or group to a threatening life event. In a state of crisis, there is a temporary disturbance in one's equilibrium resulting in the immobilization of problem-solving abilities and other aspects of daily functioning. The following are the main elements of a crisis: 1. Stressful event or precipitating stress, A. A hazardous circumstance or experience ( an accident, the sudden death of a loved one, a natural disaster) B. A developmental/ maturational stress ( puberty, entering school, becoming a parent, going through menopause, retiring) C. A transitional, situational stress ( getting leaving or losing a job, relocating, separating form a husband) 2. Perception of stress, it os a threat to important life goals, security, or a affectional needs. 3. Response phase characterized by an acute period of disequilibrium manifested in rising tension; marked discomfort and disturbance in thinking, feeling and day-to-day behaviour; dusruption of familiar routines; over-burdenes coping capacities; feelings of helplessness and inability to manage within the predictable future; feelings of considerable pressure and anxiety. 4. Resolution phase The problems caused by the stressful event are resolved adaptively or maladaptively depending on the nature and perception of the stressful event, the coping and response patterns of those affected, and the availability of support and problem solving resources. Crisis Intervention Crisis intervention is a process for actively influencing the psychosocial functioniong of individuals, families and groups during a period of acute disequilibrium. The aim is to help these systems, through differential assessment and intervention techniques, to move toward adaptive and away from maladaptive resolution. Characteristics of Crisis Intervention Crisis intervention involves crisis-oriented, time-limited work. It should be readily available and properly timed in order to be effective. This means making help accessible within 24 to 72hours of the request or “cry for help.” Since prompt intervention is necessary, there should be no intake procedures and no waiting lists and no transfer of workers. The Assessment Planning-Intervention Or ( Study-Diagnosis-Treatment) sequence is not always followed because the urgency of the person's undertaken. Participation in the helping process is usually voluntary and client system is supposed to have a reasonable commitment to it. Since most crisis states are limited to four to six weeks, a minimum of six sessions of crisis, intervention work with individuals is seen an adequate. Two major goals of crisis intervention: 1. To cushion the immediate impact of the disruptive stressful event 2. And to help those directly affected as well as significant others in the social environment mobilize and use their psychosocial capabilities, interpersonal skills, and social resources for coping adaptively with the effects of stress. PHASES IN CRISIS INTERVENTION A. Assessment This involves an evaluation of the five components of a client’s situation to determine whether a crisis exists and what its current status is. B. Implementation The “middle phase” is about setting up and working out specific tasks(primarily by the client, but also by the worker and significant others) designed to solve specific problem in the current life situation, to modify previous inadequate. Golan presents two of tasks involved in Crisis Intervention which maybe carried out concurrently: 1. Marital-arrangement tasks Which are concerned with the provision of concrete assistance and services(recall resource provision as a generic interventive role of social workers);and 2. Psychosocial tasks Which are concerned with dealing with client’s feelings, doubts, ambivalences, anxieties, and despair, which arise while trying to carry out what both worker and client agree needs to be done. The following treatment techniques are used in the Crisis Intervention approach: ● ● Sustaining techniques with reassurance and encouragement predominant to lower anxiety, guilt,and tension, and to provide emotional support. Direct influence procedures like giving advice(particularly when the client is feeling overwhelmed and need help in choosing a course of action);advocating a particular course of action; and warning clients of the consequences of maladaptive resolution of the situation. ● ● Direct intervention in extreme situations such as threats of or attempts at suicide or where the client is deteriorating rapidly. Reflective discussion techniques as the client becomes more integrated, e.g., of her current and recent past situation and patterns of interaction. C. Termination ● As the end of the time-limited helping relationship nears worker and client review their progress, focusing on the key themes and basic issues. Target Population Crisis intervention with groups would have the following as targets of assistance: 1. Individual in crisis(e.g. victims of rape and domestic violence) 2. Those in collective crisis(e.g. victims of natural disasters);and 3. Those associated with persons in crisis(e.g. professionals and volunteers helping people in crisis). ADVANTAGE OF GROUP CRISIS INTERVENTION 1. 2. 3. 4. 5. The crisis group allows the ventilation of feelings and emotions in the presence of others in the same situation; Group support helps to assuage pain and offers hope; Group sharing helps to mobilize personal strengths and resources; Group participation makes for mutual assistance in considering alternative ways of coping with the crisis; and Group members help each other in identifying community resources that may be needed for problem solving. SPECIAL FEATURES OF CRISIS INTERVENTION GROUPS Membership may be open or closed,depending on the situation and need. 2. There is no rule about group size,but membership ranging from four to twelve is considered more manageable 3. Groups are time-limited,usually up to six sessions per person(our sources however,admit that there is no “magic” in this six weeks patter,and that there are many variations in practice,from marathon weekend groups to weekly sessions over six to twelve weeks,depending on expediency and worker style). 1. SPECIAL FEATURES OF CRISIS INTERVENTION GROUPS 4. 5. 6. Group process is usually accelerated in a crisis group because of the sense of urgency inherent in crisis and the constraint of time limits. The worker assumes a very active directive role in order to hold on to the goal of the crisis group which has to be achieved within a tight time structure. Individual assessment of group members is necessary because individuals differ in terms of vulnerability to crisis and crisis-coping ability. THE 4-STEP APPROACH IN GROUP CRISIS INTERVENTION Step 1. The Search for the Participating Event and Its Meaning to the Client 1. When did the discomfort begin, or when did the client start feeling worse? 2. What recent change represents a threat to instinctual needs, or threatened or actual loss of a significant role relationship? How does the client interpret this event 21 3. What reminders have there been of a previous situation that was upsetting? 4. Why is the client coming for help now? 5. What non-verbal cues as to affect the impact of current distress does the client exhibit in discussion of recent and past events? 22 Step 2. The Search for Coping Means Utilized by the Client 1. What has the client tried to do to cope with the stress produced by the participating event? 2. What means of coping did the client use in the past to cope with similar situations? 3. Why is there a lack of “fit” between the particular dilemma(problem-to-be-solved) and the coping means the client has employed? 24 Step 3. The Search for Alternative Ways of Coping that Might Better Fit the Current Situation 1. What different approaches to modifying the problem might be feasible to try out? 2. What outside resources might be needed and tapped for helping to resolve the problem/dilemma? 3. What new plan for action can be tested out now? 26 Step 4. Review and Support of Client’s Efforts to Cope in New Ways; Evaluation of Results 1. What worked, what did not work,in client’s experimentation with new approaches to solving the problem? 2. What additional efforts might pay off? 3. When does the client begin to show signs of relief, improved ego functioning, and readiness to carry on alone? 28 CRISIS INCIDENT STRESS DEBRIEFING Reporter: ANGEL D. MANGURAY Crisis Incident Stress Debriefing The “CISD” is a form of crisis intervention that has been found helpful to many Filipinos in collective crisis caused by natural disasters like earthquakes and floods. -is a preventive stress management strategy designed to assist affected people in handling normal severe stress. 30 The affected people are victims, who may classified as: 1. 2. 3. Direct victims: those hurt or injured, or who escaped harm; Indirect victims: family, friends and others identifying with the direct victims. Hidden victims: the crisis workers, helpers or rescuers who are “silent sufferers “ though not directly affected by crisis. 31 CISD is tool to achieve the following purposes: 1. Assist victims to deal positively with the 1 emotional effects of a severe stressproducing event. 2. Provide education about current and anticipated stress responses 3. Provide information and support for coping and stress management. 32 How is CISD done? A. Administrative Preparation 1.Timing. It is preferred that CISD be held immediately after the critical incident for three to four hours. 2. Physical arrangements. The group should be small enough- ideally, not more than 10 participants- so that everyone has a chance to speak and be listened to. There should be uninterrupted use of room/space during the CISD sessions and also privacy and reasonable noise levels to allow intent listening. 33 Continuation… 3. Facts of the critical incident. The facts of the incident and the roles of the participants should be ascertained. 4. The debriefing group. The composition of the debriefing group should be discussed. As much as possible, individuals, with the same experience should be grouped together. 5. Announcements of debriefing. Assistance should be offered in preparing debriefing announcements. 34 B. The “CISD” Process Phase I. Start-Up 1. Introduction of the participants. The worker/facilitator welcomes the participants introduces herself (and the co-facilitator, if any) and the members of the group (self- introductions can also be done. The need for participation is emphasized, i.e., for each one to express thoughts, feelings and reactions to the critical incident, and to listen to each other . She points out the importance of confidentiality. 35 2. Conduct of a 5-minutes experimental exercise. The following instructions are given to the group: a. Close your eyes, breathe in , breathe out ( slowly, RELAX) b. Recall a crisis experience in your personal life or work (if the group has just gone through a collective experience, the group is instructed to recall the recent crisis that happened. ) c. Think of scenes from that experience and notice that feelings that return in relation to the experience (5 minutes of silence is allowed, then group members are instructed to open their eyes but to remember the event and the feelings associated with it. ) 36 Phase II. Sharing the Crisis/Stressful Experience 1. The worker/facilitator asks each participant: a. What happened to you ? b. How did you feel then ? c. How do you feel now ? 2. The worker/facilitator identifies a participant who is ready to share or who seems to be in need to talk and share with the group. If there are no volunteers, the worker can give an example by briefly sharing her own experience similar to the shared critical incident. 37 The worker/facilitator mentions that each participant is given 10 to 15 minutes to share (the time limit depends on the group size. ) ▪︎ Identify for appropriate referral participants who show signs of serious stress reactions or who experienced something in the past which has not been resolved. ▪︎ Elicit feelings instead of facts surrounding the experience; ▪︎ Encourage everybody to share 38 continuation…. ▪︎ Take note of stress reactions while the participants are sharing ( i. e., physical, emotional, cognitive, behavioral and spiritual aspects) to prepare for the discussion of their Stress Responses and Reactions. 39 4. After sharing, the worker/facilitator compliments the group members for their openness and willingness to share their thoughts, feelings and reactions. It would be helpful to do the following at this point: ▪︎ Point out the commonality of the participants, responses, and that their feelings and reactions are normal reactions of normal people exposed to an abnormal situation ml. 40 ▪︎ Comment how the sharing has recreated the critical incident in the room, with the group reexperiencing the tension of the past. ▪︎ Conduct breathing exercises, e.g., a. The Noisy Sigh, a quick and easy method of discharging tension (The worker illustrates the deep breath, breathing in, then exhaling with a sound while relaxing the shoulders; she invites the group to do likewise, then comments on the release of tension that is achieved. 41 b. Optional Breathing Exercise (The worker instructs the participants to close their eyes and breathe naturally without any extra effort but just to heighten their awareness of the flow of air in and out of their nostrils; this is maintained for a few minutes. ) The worker declares a short break ( refreshments may be served. ) 42 Phase III. Understanding Symptoms /Stress Responses 1. The worker/facilitator leads the participants in an interactive discussion of their stress responses during and after the critical incident, at home, at school, or at work and further elicits other stress responses through questioning. 43 2. The worker guides the group in categorizing the responses shared through the following questions: a. Do you see similarities and differences in these responses ? b. Is it possible to group some of the responses together ? C. What responses do you think are related to our body, feelings, behaviors, etc. ? 44 Based on their responses, the worker points out that there are four types of stress responses which show that an individual’s body, feelings, thoughts, and actions can be affected by a crital incident, and that these can interfere with or impair one’s functioning (a fifth category , spiritual stress responses has been reported to have emerged from CISD sessions in the country. ) 45 What are the Stress Responses ? a. Physical Stress Response: responses that relate to bodily functions (e.g., loss of energy, palpitations, headaches, muscle aches, dizziness, etc.) b. Emotional Stress Response : responses that relate to feelings affected by the incident (e.q., fear, anger, shock, panic, depression, worry, sense of helplessness) 46 c. Cognitive Stress Response : responses that indicate how the stress affects the way the participants think (e.g., concentration problems, absent- mindedness, confusion, difficulty in making decisions, thoughts of death. ) d. Behavioral Stress Response : responses that show the effects of the stress on the behavior of participants (e.g., running, screaming, shaking, being hysterical, withdrawal, sleep difficultly, crying, irritability.) 47 e. Spiritual Strength Response: Responses that relate to, the spiritual dimension (e.g., feelings and attitudes about and toward God or a Supreme Being .) 48 Phase IV. Understanding Grief and Loss 1. The worker/facilitator elicits the participants’ concept of loss (It should be stressed that loss does not mean only death of an important person in one’s status, reputation, separation from loved ones, and impaired physical, social or psychological functioning. ) 49 2. The worker explains that when we lose something/someone important, we go through a grieving process as a five-part reaction which consists of denial, bargaining, anger and frustration, depression/sadness, acceptance/resignation. 50 3. The worker helps the group to deepen their understanding of crisis (the worker shares the “basics” that she knows about crisis; she emphasizes that if a crisis is well managed, growth to a stage of competence higher than the pre – crisis period may occur; however; if damage has occurred , return to pre – crisis functioning may not immediately follow; making contingency plans will prevent, control or limit possible damage and shorten the trial and error period leading to a quicker resolution) 51 Phase V. Coping with Stress 1. The worker/facilitator asks the participants what they did or are doing to cope with the stressful situation (she takes note of their coping responses, their similarities and differences; she helps the participants to identify the most and least effective coping behaviors; she asks them to explain why.) 52 2. The worker emphasizes that their coming to the group session is a form of coping by using communication among them. 3. The worker points out that stress can be managed without the use of pills , cigarettes, alcohol or other drugs. She shares the following basic stress management strategies: (a) exercise; (b) proper nutrition, (c) rest and relaxation time; (d) Spiritual/praying. Phase VI . Planning for a Contingency The worker/facilitator asks the group about their plans after the incident. They may have personal plans for the family, work, school, community, the group, etc. They may now want to be prepared in case another earthquake/flood/fire occurs by securing money/documents/ jewelry, etc. or by having disaster exercises; they may want to replicate the CISD with other groups; if death occurred, the group may want to plan for memorial events. 54 Phase VII. Summarizing and Evaluating 1. The worker/facilitator asks the participants to review their CISD experience. She lets them comment if anything has been missed in the discussion; if the session was helpful and if so, in what way and how they felt after the session. 2. The worker summarizes discussion on ways in which participants can help themselves ( she emphasizes the need to accept the current situation, to develop short term goals, and to promote self-care ) 55 Team Presentation Thank You ! 56