Crisis Intervention
Note Taking Outline
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Define Crisis
An internal disturbance caused by a stressful event or which an individual’s usual
coping skills don’t work.
Anxiety level is high and problem solving usually is impaired
Crisis is both a danger and an opportunity
Crisis theory/principles also may be applied to groups and communities
Types of Crisis
 Maturational or Developmental; adolescence, marriage, parenthood
 Situational Crisis; --loss of job, loss of loved one, divorce, homelessness,
--acute severe illness (health crisis)
 Adventitious Crisis: --mass disasters: fire, flood, tornadoes, war, airline crash, etc.
--unexpected, traumatic event such as crime or rape
Purpose of Crisis Intervention
 To prevent illness; both physical and emotional. Illness results from being
overwhelmed and from maladaptive coping.
Three Levels of Prevention
 Primary Prevention: Prevents illness from occurring
 Secondary Prevention: Early Dx and treatment
 Tertiary Prevention: Rehabilitate to get patient to highest level of wellness possible
Balancing Factors
 Some events become crisis and some don’t, depending on Balancing Factors,
Perception of the Event
Situational Supports
– Coping mechanisms
If:
Perception of event = realistic
Situational support = adequate
Coping mechanisms =adequate
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No crisis
If:
Perception of event = distorted
Situational support = inadequate
Coping mechanisms = inadequate
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Crisis
Assessment of Balancing Factors
 Perception of Event
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Cognitive/intellectual skills
Ability to maintain self image and sense of purpose
Ability to redefine the event
 Situational Supports
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How well does patient utilize other people for support?
 Coping Skills
 Does client have ability to express strong emotions?
 Preferred modes: does client prefer or have skill with actions, like exercise,
writing, crying, talking?
 Ability to tolerate uncertainty
 Problem solving ability; making plans
BALANCING FACTORS SCENARIO: In the following scenario, compare the balancing
factors that influence each clients’ response to the crisis situation.
 There was a fire at an apartment building, which severely damaged it.
 Residents were brought to the Emergency Department for evaluation for possible
smoke inhalation. Fortunately, there were no serious injuries.
 Two residents in their twenties spoke with the nurse in the ED . . . . . . . . . . .
Client “A”
 Perception: “I lost my home, but I’m safe and that’s what matters.”
 Supports: “My church is already taking up a collection.”
 Coping: “The first thing I’m going to do when I leave here is blog about this
incredible experience.”
Client “Z”
 Perception: “I lost everything that means anything to me.”
 Supports: “My Dad always told me it was a bad neighborhood. He says no wonder
there was a fire .“
 Coping: “Now what do I do? I can’t think straight about this.”
COPING ASSESSMENT:
See Clinical Example (“Jalen”) on p. 90 (5th ed. p.126-127) of Keltner to complete this
exercise:
 Identify Adaptive, Palliative, Maladaptive and Dysfunctional coping behaviors of the
client in crisis portrayed in the example.
 What were his usual coping resources?
Principles of Crisis Intervention
 Focus is on the “Here and Now”
 Past traumas may create a current crisis, BUT:
 Crisis counselors do NOT explore early life events
 Assumption is that client will be able to cope if given necessary basic information
and support.
 Length of crisis treatment is no more than 6 weeks
 Client usually very receptive to help. May be open to change.
 Excellent time for teaching, referrals
Primary and Secondary Prevention:
Community Resources
 Walk-in centers, Emergency services
 24 hr. Hotlines
 Disaster planning for vulnerable populations
 Disaster teams, go-to mobile services