Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Introduction and Goals
Active Listening has proven useful in the fields of Crisis Intervention and Suicide Prevention.
Much of its success results from the fact that we generally do not listen to one another effectively.
When we use the Active Listening skills the novelty of the experience creates and strong
interactive bond between the worker and the Caller. This bond allows us to “hear the music”
behind the Caller’s spoken words and gain connection and understanding beyond that with which
we are familiar. That connection and understanding allows the Caller to objectively review their
situation and explore acceptable methods of resolving it.
We generally listen passively, as one does in a lecture. We are distracted by personal thoughts or
surroundings. We “listen” while thinking about what to say next. . .our related personal
experiences . . .the temperature of the room. . .the Caller’s demeanor. . .what we will order for
lunch. . .can we rap this up and get home early. What the Caller is saying is only a piece of this
serendipitous process and the depth of their message is often lost. Because of this, we do not
“hear”, much less understand, all that the Caller is relating. Important information that we can
help them use to resolve their crisis is not explored. Additionally, since the Caller feels they are
not actively engaged in the problem-solving process our message is not always made clear to
them. The seeds of miscommunication and misunderstanding are sown.
Before we get into a discussion of the Crisis Intervention Process and the role Active Listening
plays in it we should define what Crisis is. Crisis something each person has experienced in their
lives. However, when we are in crisis we do not know what it is. All we know is that things are not
going the way we would like them to and we do not feel too good about it. Technically, crisis is:
“A state of acute emotional upset in which an individual or group of individuals experience a
temporary inability to cope with a given situation by means of usual problem-solving devices."
Or
“A period of psychological disequilibrium, experienced as a result of a hazardous event or
situation that constitutes a significant problem that can not be remedied by using familiar coping
strategies
In short, some single thing happens that we cannot cope with in our usual way. We become
stressed, anxious, and confused and end up feeling crummy.
A crisis is different from a problem or an emergency.
 While a problem may create stress and be difficult to solve, the individual is capable of finding
a solution. Consequently, a problem that can be resolved by an individual outside intervention
is not a crisis. Oftentimes, a problem may seem like a crisis to the individual who is under
stress and not thinking clearly. Interventions that establish trust and provide reassurance,
advice or a referral by the worker may resolve such a problem.

An emergency is a sudden, pressing necessity, such as when a life is in danger because of
an accident, a suicide attempt, or family violence. It requires immediate attention by law
enforcement, CPS, or other professionals trained to respond to life-threatening events. If a
situation can wait 24 to 72 hours for a response, without placing an individual or a family in
jeopardy, it is a crisis and not an emergency.
In this session we will review the following:


The resources people use to cope and the Normal State
The “history” of personal crisis
1 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org





The three things we all have which can be changed to adapt to crisis
The concept of Caller Centered interaction, its rules and fundamentals
The Active Listening Skills. . .What they are and are not
The Physical Attending Skills
The Crisis Intervention Model
Coping and the “Normal” State
Generally, we function in a state of “homeostasis”. This is what we refer to when we say
someone or a situation is “normal”. In this state the trials and tribulations we face each day are in
balance. . .There is nothing we cannot handle. When that state is thrown out of balance by some
situation or action, we attempt “to cope”. Coping means using the any of the three “Coping
Resources” available to us. They are:
Primary Resources
Secondary Resources
Adaptive/Maladaptive Resources.
Primary Resources include our own interpersonal, mechanical skills, or experiences that we use
day in and out. They can include immediate family members and friends with whom we are
comfortable interacting. Primary Resources also include the Caller’s belief systems.
Secondary Resources are those resources that are less familiar to the Caller. They may include
relatives, clergy, teachers, and school counselors.
Adaptive/Maladaptive Resources are resources the Caller turns to when they feel their Primary
and Secondary Resources have not been helpful in resolving their situation. Adaptive Resources
are those that will assist the Caller in addressing their issues. They might include counseling,
calling a Crisis Hotline, going to a Crisis Center, substance abuse counseling, or hospitalization.
Maladaptive Resources are those people use mask the effect of the precipitating crisis and
ultimately harm the person in crisis. Turning to substance abuse would be an example of a
Maladaptive Resource as it is inherently damaging to the Caller.
Autonomic Coping Defenses
In our field we frequently speak of coping defenses. An understanding of the manner in which
coping defenses work can establish a basis upon which we can build a method for understanding,
accepting and dealing with Experienced Callers.
Coping defenses are designed to protect the individual from consciously experiencing anxiety and
engage automatically when the homeostatic balance of our thoughts, feelings, and behaviors is
upset. When the person’s established pattern of defense is initiated and is working they do not
experience the pain of anxiety and therefore would not seek the help.
When a person reaches out for help it is an indication their anxiety level has become untenable
and their usual defenses are not working. The reason for this situation lies in the fact that coping
styles are adapted to a specific developmental period in the Caller’s life. The youth who used
denial to cope with their life situation as a pre-teen will find denial doesn’t alleviate the anxiety of
their current crisis. This is because they do not take into account that there are more mature or
effective manners of coping. The basic reasoning here is, “If it worked before it has to work
again”.
An interesting dynamic occurs when a person reaches out for help. Because of their automatic
implementation The Caller is most likely not aware they are employing any coping defenses.
2 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Since they are not conscious of their attempt to cope they call hoping, if not directly asking, to be
told what to do. If it is pointed out that they have initiated their defense system they will respond in
a defensive manner. The automatic implementation of their defense strategy is transparent to the
Caller and they see their lack of awareness of its existence as a sign of personal weakness.
We have been talking about defenses in general terms. But just what exactly are these
“defenses”. The following is a list and description of the major coping defenses used by all of us,
Crisis Worker, Crisis Caller, Experienced Caller when we deal with life’s stresses and anxieties:

Avoidance: Involves the individual rearranging their life in a manner that allows them to
avoid whatever it is that causes them stress. A Caller who is uncomfortable with close
relationships will not enter into a situation where there is a risk of intimacy.

Delusions: When an individual presents a personal belief system or ethic that has little or no
grounding in reality they are experiencing delusion. Generally, delusions are either delusions
of grandeur (“I am the King of the World”) or persecution (“The UN is after me because I have
the nuclear secrets”). Delusions are attempts to resolve problems by a person whose
personality and sense of self is in severe disintegration.

Denial: Involves the individual saying that something too painful to bear just isn’t so. The
statement, “I don’t believe it!”, by a Caller faced with the death of a loved one is really saying,
“I don’t want to believe it!”

Displacement: When the individual expresses emotions caused by one person or situation
toward another person or situation they are exhibiting displacement. A familiar situation might
be the person who has a flat tire and kicks their car.

Dissociation: Think of the times you’ve left someplace and ended up at your destination but
can’t recall exactly how you got there. The sense of being on “autopilot” is an example of
dissociation. Amnesia or the sense of experiencing something from outside the individual’s
body is more serious manifestations of dissociation.

Hallucinations: When the individual substitutes sensory fantasies for a painful or conflicted
reality they are exhibiting coping thorough hallucination. Generally, the hallucinations are
initially a respite from whatever is causing the pain but they can become threatening to the
individual. As with delusion, hallucination reflects serious personality disorganization.

Intellectualization: The individual who discusses issues in a “hyper-intellectual” manner is
defending themselves from hurtful feelings by not allowing them into the consciousness.
Everything is analyzed in minute detail from every possible and impossible angle. Humor is
not a possibility for these individuals.

Isolation of Affect: When the individual defends their emotions by splitting their thoughts
and how they feel about them they are demonstrating Isolation of Affect. The EMT who can
discuss an accident scene in coolly and calmly in clinical terms is adaptively using Isolation of
Affect. Isolation of Affect is related to Intellectualization.

Projection: Involves the individual disowning painful or uncomfortable thoughts and
emotions. The statement, “I am not angry. You are angry at me”, demonstrates projection by
a Caller who may be angry with a teacher because they didn’t get the grade they felt they
deserved.
3 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org

Rationalization: Rationalization is when the individual offers sound, seemingly well thought
out reasons for a particular behavior or pattern of behaviors. This permits the person to keep
the actual, less acceptable, behaviors out of conscious awareness.

Reaction Formation: Involves the individual turning behaviors that are forbidden into
something eminently acceptable. An example would be someone who has an alcohol abuse
problem yet participates actively in measures and actions that would prohibit drinking. The
key here is that the involvement is generally unrelenting and rigid.

Repression: The individual dismisses the painful issue from conscious awareness. All the
psychological defenses mentioned here have a component of repression to a greater or
lesser degree.

Somatization: The individual translates an emotional conflict into a physiological symptom.
A mother who speaks of headaches and ulcers caused by an unruly child is demonstrating
somatization.

Splitting: When the individual identifies uncomfortable parts of themselves and separates
them from their total persona by burying them in a seemingly inaccessible part of their
personality they are practicing splitting. It is as if the person surgically removes a piece of
who they are that they are uncomfortable with and throws it “away”.

Suppression: While similar to repression, suppression is different in that it is a conscious
effort to forget that which is painful. The individual who says’ “I’m don’t want to think about
that”, is practicing suppression.
While the list is by no means complete we can see the defenses individuals utilize to cope are
many and varied. Germane to our discussion is the fact that the defenses are used day in and out
by persons, including ourselves, whom we consider “normal”.
Into the Valley (or The History of Personal Crisis)
Basic Crisis Theory maintains that people are generally “normal”, have basic coping skills
available to them, and that we all have to deal with day to day problems. When a specific event
precipitates a crisis the person's baseline functioning is no longer in balance. The inner stresses
of trying to cope with the effects of the outer stresses disrupt the person’s “normal” state. The
person reacts to the event with their usual coping resources. The situation is not resolved and
tertiary resources are sought. The result of the situation depends on which tertiary resources are
adopted and the persons desire to effect adaptation.
Normal State (Homeostasis)
4 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Crisis
Coping with Primary and/or Secondary Resources
5 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Coping with Adaptive Resources
No Intervention or Implementation of Maladaptive Resources
Crisis
=
We generally cope with life’s hassles by using our primary resources. If that does not work we
turn to our secondary resources. Usually this is enough to overcome most obstacles and we go
on functioning as we were before. On those occasions when the Primary and Secondary
Resources fail we turn to the third level of Adaptive/Maladaptive Resources. If Adaptive
resources are chosen we add needed strategies, abilities, and experience to our coping skill and
we are able to function at a higher lever than before. It is frequently mentioned that the Chinese
glyphs that represent the concept of Crisis are the glyphs for Danger and Opportunity. Effective
coping or Adaptive behavior during the Crisis allows the Caller to avoid the Danger of staying
6 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
mired in the pain of Crisis and the Opportunity to achieve a higher more effective level of coping.
The use of Maladaptive Resources traps the Caller in a state of crisis that continues until they opt
to use Adaptive Resources. If the decision is made to not attempt Adaptive Coping they will stay
in the crisis. Crisis then becomes the “Normal” state and the situation will have then have
become Chronic.
Changes: Can’t and Can
When someone calls or comes to us for help they are using us as an Adaptive Resource. In
working with the Caller we need to understand and accept that there are limitations to what we
can do to help them. We can not change who or what they are physically. We can not change
the situation or past activities that have bought them to us. Neither our Callers nor we have
control over these matters. However, there are three “parts” of the individual we can address to
effect change for them. These "parts" are things the Caller does have control over and can
therefore change or adapt. They are their Thoughts, Feelings, and Behaviors. In the “Normal”
state there is a homeostatic balance among the three. In the “Crisis” state there is imbalance.
Think of when you have been confronted by a situation you had no control over. The way you felt,
thought, and behaved became quite different from usual. You felt out of balance. To help the
Caller restore balance among the three parts we engage in the Crisis Intervention Process.
LIFE EVENTS AND WEIGHTED VALUES
Event
Value
Event
Value
1. Death of a spouse
100
22. Change in responsibilities at work
29
2. Divorce
73
23. Son or daughter leaving home
29
3. Marital Separation
65
24. Trouble with in-laws
29
4. Jail term
63
25. Outstanding Personal achievements 28
5. Death of a close family member
63
26. Wife begins or stops work
26
6. Personal injury or illness
53
27. Begin or end school
26
7. Marriage
50
28. Change in living conditions
25
8. Fired at work
47
29. Revision of personal habits
24
9. Marital reconciliation
45
30. Trouble with boss
23
10. Retirement
45
31. Change in work hours or conditions
20
11. Change in health of family
44
32. Change in residence
20
member
12. Pregnancy
40
33. Change in school
20
13. Sex difficulties
39
34. Change in recreation
19
14. Gain of a new family member
39
35. Change in religious activities
19
15. Business readjustments
39
36. Change in social activities
18
16. Change in financial state
38
37. Loan less than 50,000
17
17. Death of a close friend
37
38. Change in sleeping habits
16
18. Change to different line of work
36
39. Change in # of family get-togethers
15
19. Change in # of arguments with
35
40. Change in eating habits
15
spouse
20. Mortgage over $ 50,000
31
41. Vacation
13
21. Foreclosure of mortgage
30
42. Holidays
12
43. Minor violation of laws
11
SCORING
Each event should be considered if it has taken place in the last 12 months. Add values to the right of
each item to obtain the total score.
Your susceptibility to illness and mental health problems:
7 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Low
< 149
Mild
150-200
Moderate
200-299
Major
>300
References:
Holmes, T.H. & Rahe, R.H. (1967). The social readjustment rating scale. Journal of Psychosomatic
Research, 11, 213-218.
Horowitz, M., Schaefer, C., Hiroto, D., Wilner, N., and Levin, B. (1977). Life Event Questionnaires for
Measuring Presumptive Stress. Psychosomatic Medicine 39(6): 413-431.
What is Crisis Intervention?
Crisis intervention offers immediate, intensive and brief professional assistance to people who
have had a traumatic experience. The purpose is to help individuals cope and return to a previous
level of physical or emotional functioning without being at risk of endangering themselves or
others. This short-term professional support attempts to deal with the immediate crisis or problem.
Prompt and focused interventions help prevent the development of a serious long-term disability.
Crisis intervention also encourages the development of new coping skills to help the individual
function more effectively. It is important to keep in mind that Crisis Intervention is an active shortterm, supportive helping process designed to mitigate an individual’s response to the situation
precipitating the crisis. Crisis Intervention is not psychotherapy or a substitute for
psychotherapy.
Crisis Intervention is a process based on three basic rules and four fundamentals that allow us to
create a five step “Crisis Intervention Model” to guide the process of focused, effective
communication. There are seven Active Listening Skills involved in the process.
Caller Centered Rules and Fundamentals
The three basic rules governing our interactions with people in crisis are borrowed from Carl
Rogers Client Centered Treatment Theory. They are:
1. The Counselor and Caller are equals. This discounts the concept of the high and
mighty counselor enlightening the lesser, powerless Caller. It provides that counselor and
Caller work together, on an equal level, to help the Caller better understand themselves,
their situation, and their resources.
2. The Caller determines the pace of the interaction and can make their own choices and
decisions. This says that the worker accepts the Caller is a capable, competent person
who knows their life, situation, experiences, and abilities better than anyone else does. In
accepting this we conclude the Caller is best equipped to make the decisions that will
affect their lives. It also says the Caller best knows the rate at which they can explore and
resolve their presenting situation.
3. The worker “mirrors” the Caller through Active Listening. This rule refers to the
“reflective” Active Listening techniques used by the worker to help the Caller better hear
themselves and, therefore, gain greater objectivity in making the decisions regarding their
situation.
These three rules coupled with the following four fundamentals form the basis of the Caller
Centered school of therapeutic interactions. Literally, “Caller Centered” means the interaction is
centered on the Caller. What the Caller wants to do, feel, or desire is based on the Caller’s
judgment of what would ultimately be appropriate. In some forms of therapeutic interaction the
8 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
counselor is in the authoritative position offering their own insights and suggestions into the
Caller’s situation. In the Caller Centered interaction the worker would not offer their own insights
and suggestions. Instead they would facilitate the Caller making their own choices and decisions.
There are four fundamentals governing this interaction. The four fundamentals and their
explanations are:
1. Acceptance
This is the fundamental that maintains that regardless of what we think or feel
about the Caller we will not judge them, or their situation and actions, or their
ability in any way. Acceptance maintains that people, situations, actions, and
abilities are things to be acknowledged, not judged. Without the risk of judgment
people feel safe and become able to communicate freely.
2. Respect
Once we accept the need to be non-judgmental we can then embrace the idea of
respect. Acceptance means we will respect each person’s unique individuality. It
maintains that the worker will respect the Caller enough to accept they can, with
appropriate facilitation, resolve the crisis at hand.
3. Empathy
When we become accepting and respectful of the Caller we can then
communicate with them on a basic feeling level. This is the most powerful
fundamental because we seldom if ever communicate with others on an
empathic level. Once a person experiences communication on this level the
novelty of the “reflective” experience, within the perceived safety of the
accepting respectful environment, a bond is produced which permits open
interaction and effective problem solving.
A Few Thoughts About Feelings
 There is no such thing as "controlling" your feelings. However, you can
control your behaviors and actions.
 All feelings are positive, true, and provide information about what is going on
inside you.
 Feelings themselves are non-rational, but they arise for a reason that you
have decided is either positive or negative.
 You have a right to your feelings.
 Your feelings will never lie to you; your mind will.
 Your feelings do not make choices for you. They remind you of past choices,
which are now translated into emotional responses.
 You "lose touch" with your feelings when you disguise them or cover them up
with other emotions you think more appropriate.
 It is possible to have "mixed" or contradictory feelings.
 You can have feelings, as well as thoughts, about your feelings.
4. Hope
The fundamental of hope has it’s basis in the concept that each person has,
within themselves, the power to change, survive, thrive, and regain control of their
situation.
The Active Listening Skills
9 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
The seven active listening skills are listed below with a brief description of each. The skills allow
us to engage the Caller in a manner that will allow them to look at their situation objectively
according to the rules and fundamentals we have already reviewed. While they apply primarily to
telephone interactions they can, and should, play a major role in face to face interactions.
1. Silence
Silence conveys that the listener is willing to allow the Caller to speak their mind.
Silence also allows both parties room to think about and digest what has been
said. It also demonstrates respect for the Callers thoughts.
2. Encouragers
Encouragement is the skill of getting the Caller to elaborate on stated points or
feelings. Minimal Encouragers are the nodding head or the “uh huh” we are
familiar with. Standard Encouragers are statements much like, “Go on” or “Can
we talk some more about. . . ."
3. Reflection
Reflection is the verbal interpretation of the verbal and non-verbal expressions of
the Callers emotions. It establishes an empathic relationship with the Caller that
permits them to feel understood by and connected to the Listener. It also creates
an emotional mirror that lets them see an objective view of their situation and
their relationship to it.
When the topic of reflecting is discussed workers frequently mention that they feel
they keep repeating the same feeling over and over. They express concern that
the Caller will become bored and not respond. While this may seem the case the
reality is that interaction on a feeling level feels so good to the Caller they do not
notice any repetition. Any discomfort usually belongs to the worker. A useful
technique to avoid the repetition of the same feeling over and over is to recognize
that feelings do not exist in isolation. That is to say when we feel a particular
feeling we feel other feelings associated with it. If you think of a “connect the
dots” coloring book you can see how linking one feeling with another can
complete a full picture of the Caller and their situation. For example consider the
frustrated Caller. Feeling frustrated makes them feel tense. Feeling tense
makes them feel stressed which makes them feel anxious which makes them
feel alone and so on.
4. Paraphrasing
Paraphrasing is a short, concise review of what the Caller has relayed to the
Listener. It allows them to know we are trying to understand them and permits
them to correct any misunderstanding we, as listeners, may have. It also allows
them to review their own thoughts and gain insight to what they are experiencing
in their current situation. Basically it takes a long, detailed message and feeds it
back to the Caller in a condensed version.
5. Summarizing
Summarizing is the collection of the facts and feelings observed during the
interaction to verify that the Listener’s understanding of the situation is accurate.
6. Restatement
Restatement refers to the reflection of the Caller’s thinking, meanings, and, facts
as the Listener understands them. This shows our understanding of the situation
and allows the Caller to correct any misunderstanding.
7. Clarification
10 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Clarification, as the name implies, is the process of ensuring the Caller and the
Listener are as clear as possible on connections or issues that may not be initially
clear.
You will no doubt notice that “Asking Questions” is not listed as a skill. In this method of
interaction questions serve to create an inequality between the worker and the Caller. Questions
can also be non-accepting (judgmental), directive, and intrusive. Questions that can be answered
in one word serve to stifle the exchange of thoughts and feelings necessary to the Crisis
Intervention Process. However we do recognize there are times when we do need specific
information to assist the Caller. In these instances it is most effective if we phrase the question as
a Reflective statement. Another effective way to ask questions is to be sure the question is “open
ended”. This means the question is constructed in such manner that it has to be answered by a
thought not a single word. This serves to open the issue at hand to further exploration.
Also notable for its omission as a listening skill is the concept of self-disclosure. There will be
times when we are working with a Caller who is addressing a situation we either have had
experience with or been in ourselves. At these times we will feel we need to use our experience
to help the Caller through their crisis. This is not an acceptable practice for several reasons.
Primarily, we need to recognize that each Caller’s crisis is unique to themselves. Even though
we had the identical crisis our experience and resolution is unique to us and us alone. Our
resolution has no place being introduced as a solution for the Caller. Self-disclosure also upsets
the balance of equality in the interaction as the focus is shifted to the worker. The worker
becomes an authority as opposed to being an equal. Regardless of how appropriate we may feel
it is to share our experiences with the Caller it is not an acceptable practice.
Making promises is also not listed among the listening skills. The worker may assume the Caller
will be comforted by promises of what can be done to help them. The reality is that we have no
way at all to ensure a specific outcome of any intervention. To do so risks disillusioning a person
who is already sensitive to disillusionment and such a risk is indefensible.
At this time we must also address the issue of using the personal pronoun “I”. While it is probably
impossible to exclude the word from our vocabulary we do need to maintain an awareness that its
use connotes a level of inequality. It also shifts the focus of the interaction from the Caller to the
worker. Whenever possible is desirable to use inclusive pronouns such as “us”, “we”, or “people”.
You must always be honest with the Caller. You may feel the need to give the Caller what they
desire to avoid disappointing them. In such instances we may feel it would be OK to “stretch the
truth” a little bit. This is not acceptable. There may also be times we may feel we would not want
to be totally honest because we need to have some information from the Caller they may not feel
ready to provide. This, also, is not acceptable. The reality is that the fundamentals of Caller
Centering provide that you must respect them enough to maintain compete honesty and inform
them about the reality of any given situation. To do otherwise violates the tenet of respect and the
interaction breaks down.
Deal with specific tangibles. Always address the concrete in a situation. Editorializing or
speculation diffuse the focus of the interaction and allow for the contamination of
miscommunication. When working with feelings focus on behavior not traits. . .A person can feel
frustrated when they do something they feel was stupid. The Active Listener would address the
frustration instead of applying the trait “stupid”. Also the Caller may want to focus on the “What
could have beens." This is something we can not do because there is no way to change that,
which has not happened. In these instances we would focus on the thoughts and feelings about
as well as an exploration of what behaviors the Caller could engage in to achieve the goal of what
could have been.
11 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Physical Attending Skills
The above covers the verbal attending skills (Active Listening Skills) that we can use when
interacting over the phone as well as in face to face encounters. When working face to face with
a client we can also use physical attending skills. Gerard Egan, author of The Skilled Helper,
describes the basic elements of physical attending using the acronym SOLER.
S
Face the client Squarely. This sends the message that you are available and
willing to work with them.
O
Adopt an Open posture. This says that you are open to what the client has to say
and you want to be non-defensive.
L
Lean toward the client. This underscores your desire to be attentive and lets the
client feel you want to understand them.
E
Without staring maintain Eye Contact. This says you are interested in the client
and the concerns they have.
R
Be appropriately Relaxed in the presence of the Caller. This indicates you have
confidence in your ability to work with them and helps them to relax.
The above serves to physically and psychologically orient the worker in the presence of the Caller.
It accomplishes two tasks: It tells the Caller they have your undivided attention, and it puts you in a
position to use the Active Listening Skills. An attentive presence invites the Caller to trust you,
open up, and explore the significant dimensions of the issue at hand.
The Crisis Intervention Model
The Active Listening Model consists of five steps:
1. Defining
In this step of the Model we “listen” to the Caller. We define the situation with
them and identify and reflect how they feel about the situation that prompted the
interaction. We attempt to identify the root cause of the anomie. The Caller may
address many issues in this step it is the task of the worker to help them to sort
through those issues to come up with the one precipitating issue that will be
addressed with the intent of resolution.
2. Exploring Goals
To move on to this step we first clarify, summarize, and restate what was covered
in the Defining step. We do this to be sure we have reached consensus with the
Caller before moving on. If we are on the same page we move on to exploring
the immediate, short term, and long term goals of the Caller. We investigate the
Caller’s agenda and expectations with an eye on letting them decide which goals
would be realistic or not realistic given their situation, skills, and experience.
3. Generating Alternatives
Once again we clarify, summarize, and restate what was covered in the previous
step and then engage the Caller in a discussion of what resources, internal and
external, are available to ameliorate the situation at hand. We will encourage
input from the Caller concerning what they feel are plausible solutions. We will
respectfully accept any solution suggested. We will also engage the Caller in a
12 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
discussion of what solutions are realistic and those that are unrealistic as well as
the reasons for the ultimate acceptance of reality. We can also offer our own
ideas for resolution allowing the Caller to accept them or not. This does not
violate the concept of Caller Centering since it is the Caller ultimately deciding to
consider the additional options. Alternatives generated by the worker in this
instance should not come from, “I think you should. . .," but rather, “Would this
be a possible option." This allows the Caller the choice that is their right.
4. Planning
Again we clarify, summarize, and restate what transpired in the previous steps.
Once consensus is reached on the progress made thus far we engage the Caller
in deciding which alternative best meets both their needs and your ability to follow
through on that alternative. When a mutual agreement is reached clarify,
summarize, and restate what the final plan is and end the interaction. If a viable
Plan can not be mutually agreed upon then the process might have to return to a
previous step and the ensuing steps re-iterated until a viable, realistic, attainable
Plan is agreed upon. At all times during the process your goal is to balance what
is desired by the Caller while helping them to objectively determine what is
realistic.
5. Closure
In this step we, clarify, summarize and restate what has gone on before. We
focus on the mutually agreed on plan by reviewing what the plan is as well as the
steps and time frame for implementing it. We utilize the Fundamental of Hope by
validating our and the Caller’s shared belief that they can survive, thrive, and
regain control. At this point the interaction can be ended allowing the Caller to
implement their Plan. It is important to remain focused on the Caller’s need to
move on and not become involved in the “Farewell Party Syndrome” that would
serve to dilute the fact that the interaction was to resolve an issue or situation. It
is also important to watch for “Doorknob Disclosures”. These are disclosures the
Caller will make after the interaction is ended and they are leaving. The relief in
resolving the Crisis facilitates a clearer vision for the Caller and that vision may
focus them on another issue that was overshadowed by the presenting Crisis. It
is important to explore this newly presented issue with them to determine if it
needs to be presently addressed. As a rule, if the newly disclosed issue will not
interfere with the Callers ability to implement their Plan the issue can be
acknowledged and plans to address it in the future can be addressed. If the
issue will interfere with Closure than the Crisis Intervention process is to be
restarted with the new issue as the primary focus.
One might ask the reason for a Model? After all, the Caller has a problem. . .let’s solve it. Why
bother with all these steps and listening skills. In order to discuss this we need to recall that the
goal of Crisis Intervention is twofold: To resolve the issue precipitating the state of crisis and to
allow the Caller to develop new coping resources that facilitate a higher “Normal State”. Prior to
coming to the worker for help, the Caller tried their coping resources but was unable to succeed.
The reason for the failure is not the Caller’s inability to problem-solve but the fact they were able
to do so because their feelings, thoughts, and behaviors prevented them from forming an
objective view of the situation. By following the Crisis Intervention Model we address these issues
thus permitting the Caller to address the situation directly instead of through a veil of stressful,
anxiety producing feelings. A look at the drawing below illustrates some of the feelings that block
effective crisis resolution. Until those feelings are addressed and “erased” there is no way our
“person” can problem-solve. If we jump from the statement of the problem to the solution the
Caller is still left with their uncomfortable feelings and it becomes questionable if any plan created
could be accomplished. Additionally, jumping to a plan means we do not assess the Callers
strengths and abilities. We have not addressed what they have tried in the past. We have no
idea of what their goals are. By going right to the solution we do the Caller disservice because
13 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
there is no way we can ensure them of the fundamental Hope and Respect dictated by the Caller
Centered Fundamentals. Thus the reason for the Model.
14 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Listen
When I ask you to listen to me
and you start giving advice,
you have not done what I asked.
When I ask you to listen to me
and you begin to tell me why I shouldn’t feel that way,
you are trampling on my feelings.
When I ask you to listen to me
and you feel you have to do something to solve my problem,
you have failed me, strange as that may seem.
Listen! All I asked was that you listen;
not to talk or do – just hear me.
Advice is cheap; ten cents will get both Dear Abby
and Billy Graham in the same newspaper.
And I can do for myself; I’m not helpless.
But, when you accept as a simple fact that I do feel what I feel,
no matter how irrational, then I can quite trying to convince you
and get about the business of understanding
what’s behind this irrational feeling.
And when that’s clear, the answers are obvious
and I don’t need advice.
Irrational feelings make sense when we understand what is behind them.
Perhaps that’s why prayer works, sometimes, for some people.
Because God is mute, and he doesn’t give advice
or try to fix things.
He just listens and let’s you work it out for yourself.
So please, listen and just hear me.
And, if you want to talk, wait a minute for your turn;
And I’ll listen to you.
Anonymous
15 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
The Active Listening Toolbox
Answering the phone for the first time is a stressful experience. We want to use our newly
learned skills to help our callers. Our trainers have told us we are prepared but somehow we feel
we are not. Long hours of training and role play suddenly seem not long enough. We struggle to
remember what was said during the training. We can’t decide which active listening skill we will
use first. We know we will need to talk but feel no words will come out of our mouths. We find
ourselves filled with doubts and “what ifs”. Welcome to the Twilight Zone of:
THE FIRST CALL.
In reality, there is no way we can be 100% prepared for every call we will answer. This is true for
both new and seasoned Crisis Listeners. However, while each call is different, there are certain
questions and situations that will recur from call to call. We can prepare ourselves for situations
we will encounter regularly by planning how we will address those circumstances. The following is
a list of recurring situations and suggestions on how to address them. The idea is not to add the
suggested responses but to create responses you feel comfortable with and will complement your
individual style. One thing to keep in mind is that short and simple is usually the best way to
respond in the situations reviewed. You may want to review the responses you have
constructed with your trainers or experienced Listeners before you take your first call.
STYLE
Before we continue let’s think about the STYLE we mentioned previously and how it relates to
Crisis Intervention. We tend to think of style as the pinache, the flare, the fashion, the grace, the
elegance the “Je ne sais quois” in which we accomplish stuff. We think of style in terms of
clothes, cars, lifestyles, art, homes, and/or furniture. Crisis Intervention and style is not an
association we usually make. But each of us will develop our own styles of Crisis Intervention.
The reason for this is simple. Each of us is different in personality, values, abilities, and
experience. We bring these differences to our interactions with our Callers and thus our STYLE is
created. Our diversity in styles means our Callers can tap into many different insights regarding
their situations. BUT we must remember effective Crisis Intervention demands we interact with
Callers as equals and we must use the Active Listening Skills at all times. We cannot allow
STYLE to become an excuse or reason for avoiding the basic tenets of Crisis Intervention.
The style of the truly effective Crisis Listener balances their own individuality with the
needs, ability, and functionality of the Caller. Listen to some of the experienced workers at the
hotline and you will hear them subtly change in their manner of interaction with each call. As your
own STYLE develops keep in mind the person who will be most affected and helped by it. . .Your
Callers. In reality your style becomes the product of your individuality as it interacts with the
individual needs and persona of the Caller.
The Introduction
In the excitement of learning and practicing new listening skills we often forget to think about how
we will introduce ourselves to our callers. We pick up the phone and become tongue-tied. Before
you take that first call is a good time to develop an opening that is comfortable for you, allows the
caller to know to whom they are talking, and indicates our willingness to speak with them. Take
some time to create a phrase you feel comfortable with and enter it into your Toolbox.
16 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Questions: In General
Being people, our callers are like any of us in their curiosity about things new. When people are
curious they ask questions. Since the crisis intervention process is new to most of our callers they
will have questions they will want answered. Unfortunately, answering questions defeats the
power of the active listening skills. . .once an answer is given dialogue ends. We can put a
general rule in our tool box that says we will refrain from providing direct answers to direct
questions and all responses we make will be honest, accepting and reflect an appropriate
feeling. This does not mean we do not respond to questions. It means we will address the
questions in terms of the FEELINGS they engender for the caller. For example, a caller may ask
if we would be their friend. To respond that we cannot be friends with callers invalidates the
caller’s wish to make friends. However, a response that addresses the loneliness and isolation
one feels when in crisis provides an answer allowing the caller to feel heard and provides an
opportunity to explore the issue as it relates to them.
Asking questions presents another issue of concern. While there may be some questions we
need to have answered in order to help our Callers, it is preferable to ask questions in an
open-ended manner or to attach them to an applicable reflection. In this manner the Caller is
engaged in the information gathering process as opposed to feeling INTERROGATED.
Questions that can be answered by a yes or no response are not acceptable except when
addressing issues of personal safety, abuse, or suicide.
Do/Don’t You Give Advice?
While our training has taught us that advice giving is not an appropriate Crisis Intervention
technique, our callers assume that advice is something we do. They equate Crisis Intervention
with Dear Abby and Ann Landers, who are “advice” columnists. To keep this difference in
perception from interfering with the process we can create, ahead of time, a statement that
explains to the caller that advice is something that works for the giver and not, necessarily, the
receiver. We might expand this by mentioning their call indicates past advice has not worked as
well as they hoped and maybe we need to try something completely new. There are many ways
to approach this question without resorting to the invalidating, “We don’t give advice." Be
appropriately creative in adding this response to your Toolbox.
Who, What, Or Where Are You?
While this question can be used in a manipulative manner by the caller, it generally comes from
the curiosity we mentioned when we discussed Questions: In General. Our response to this
question should be constructed in such a way that it doesn’t invalidate the caller’s curiosity, yet
maintains a sense of propriety and boundary. The caller in actual crisis is interested in relieving
their sense of powerlessness and anxiety. They are interested in the crisis worker only as a
facilitator, not as a person. An example in this case would be the often-asked question, “What’s
your name?”. We may be tempted to say we don’t give out our names. While this might be
appropriate, we risk having our message be heard as, “It’s none of your business." Worse, it may
force a struggle over the caller’s right to know or not know the requested information. A more
powerful way of responding might be to say, “It can be scary to share what your going through
with strangers. . .Let’s talk about what’s making you hurt." This identifies and focuses the caller
on their fear and loneliness and lets them feel heard. Thus the name issue is usually forgotten. A
general response to personal questions can go into your Toolbox.
Is It Normal To. . .?
17 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Like us, each of our callers has their own concept of normal. Mathematically, normal is a point of
perpendicularity tangent to a specific type of curve. There are statistical normals, cultural
normals, societal normals, political normals. . .In short there are many kinds of “normal”. All this
makes as much sense to us as it would to our callers. When asked about normal we need to
answer with the caller’s viewpoint in mind. If the caller thought their situation normal they probably
would not be on the phone with us. Their calling indicates the situation feels less than normal to
them. This means we would not judge their sense of normalcy by saying something is or is not
“normal”. More appropriately, we could reply their call indicates they feel the situation does not
feel normal for them and they feel uncomfortable being in the situation. In short, nothing is
normal. . . situations are either comfortable or uncomfortable.
Another thought about normalcy stems from our tendency to judge a caller's behavior during the
call as being normal. This is exemplified when we tell a caller who cries during a call it is normal
to cry. We must remember that while we, as crisis workers, may see tears as normal in a given
situation the caller may not feel the same way. A more appropriate response would be to observe
that people sometimes cry when in situations such as the caller’s. We would then reflect the
sadness or isolation the tears represent.
Can We Talk About Anything?
We tend to answer this question with an immediate, “Yes” or, “We’re here to listen." In both cases
these are well meaning, but not honest, replies. Depending on the caller's motivation and subject
matter there are some things we will not address. If we attempt to explain this to the caller the
call’s focus might become, “Well is this or that OK and if that ain’t OK is whatchamacallit OK?”.
Again, take some time to create an accepting reply to put into your Toolbox. Possibilities may be,
“Sounds like you have something on your mind you want to talk about” or, “It sounds like you feel
upset no one will talk to you about what is going on for you." Responses such as these allow you
to discover what the caller has to say without trapping yourself in an inappropriate situation without
invalidating the caller.
Can I Talk To A Male/Female?
This is another very common question. Unfortunately, the most common answer, “We do not
transfer calls” is not the most honest or accurate. The reality is we generally do not transfer calls
but there are limited circumstances when we do. This response can also send the message we
have the capability to do so but choose not to do so for the caller in question. Keeping in mind our
phone system, not human beings, determines who speaks to which caller, we can honestly
answer the requested person is not available at the moment. This is so because the phone
system sends incoming calls to the first available worker. Our Toolbox response might begin by
reflecting the frustration at not being connected to the worker of choice, then an offer to the caller
of either the choice to speak with us, or end the call and call back.
Hi. . .How Are You?
Politeness is usually the driving feeling behind this question and we have the tendency to politely
reply that we are OK. While this might be appropriate we need to be aware there is a risk the
caller may get an, ”I’m OK. . .you’re not” message. Realizing we want to interact with our callers
as equals we need to respond in an equivocating manner. This is not an easy one but something
like, “It’s nice of you to ask. . .how are you? It sounds like you’re feeling. . .”, allows the caller to
feel heard and opens the door to interaction. Again, construct a response and add it into your
Toolbox.
18 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
The Sounds of Silence
Simon and Garfunkel sang of the message silence conveys. There are many times we answer
the phone and we hear no words. Since the use of the active listening skills does require words to
be heard silence on the part of the caller represents an impediment to crisis intervention. So what
to do with the silent caller? Think of when you are silent. We are silent when we are confused.
We are silent when we are thinking. We are silent when we are upset. Any one of these feelings
we can reflect to the silent caller. A general rule is to allow the silent caller a minute before we
end the call. We can use our introduction. Then we can reflect that it can be frustrating when we
do not have the words to explain how we feel. Then we can reflect how difficult it is to express
ourselves when we feel stressed. Then we can explain to the caller that we would enjoy helping
them but they need to talk for us to work with them. At this time we can explain we are going to
hang up but when they have collected their thoughts and feel comfortable talking we would be
more than happy to speak with them.
Is This Call Confidential/Anonymous?
As with other questions we looked at, our callers are not so much interested in an answer as they
are expressing a fear someone will find out about their situation. It is usually sufficient to reflect
the fear and worry the question represents and the issue disappears. The call will then address
the actual issue of the inability to share with the caller’s usual caregivers. In those rare instances
where a caller persists in wanting a concrete answer we can make a reply based on the following:
Every call we take is confidential. We do not release the content of any call to any person or
agency outside the agency unless the caller is:
1) An immediate danger to themselves
2) An immediate danger to another
3) A victim of child abuse
The caller’s anonymity is their responsibility. Each caller contacting us is anonymous until they tell
us their name. Actually, our callers seem to use “confidential” and “anonymous” interchangeably.
The gist of either question is, “Are ya gonna rat me out?”. Your Toolbox response might reflect
that fear.
Yes. . . But. . .
Most of our callers in crisis will willingly work with you to develop a resolution to their situation.
However, there will be the occasional caller who will agree every option is an option and only that.
They will then offer you a basic, “Been there, done that, it won’t work. . .nothing will work."
Eventually, one feels they are going in an endless circle of suggestion followed by rejection. It is
helpful in this frustrating situation to have a prepared statement that is complimentary of the
caller’s efforts while reflecting the frustration that nothing works. By complimenting the caller’s
perseverance we can invite the caller to take some time following the call to review what they
have tried, what was discussed in the call, and invite them to see what may be worth trying again.
We can address the frustration of repeating past efforts by reminding them we do not always see
the full picture in one glance. This is not always an easy response to construct but is helpful to
have in your Toolbox.
You’re No Help At All.
This statement is usually associated with the “Yes. . .But...” caller. It is painful for us to hear a
statement like this because it is our intent to help our callers. This statement invalidates the nifty
feelings we feel are our due as caregivers. It makes us frustrated and, dare I say, angry. When
19 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
we are frustrated and angry we are not always able to control the way we present ourselves. For
these occasions it is beneficial to have a response for the caller that reflects their frustration at not
finding a solution. The response can remind them we are only one person and if they continue
reach out in other directions they may find resolution.
If I Need, Can I Call Back And Talk To You?
For the caller we often represent the first and only person who has “listened” to them. Feeling
“listened” to, coupled with the crisis intervention process, creates a wonderfully positive feeling in
our crisis callers. For this reason they may express a desire to speak with you again to sustain
that feeling. We can address this feeling of need but cannot facilitate an inappropriate
dependence. Our Toolbox response could address that we are but the first of many steps to be
taken by the caller and that by opening up to others they will increase their base of support and
emotional strength.
Can I Call Back Anytime?
As a 24/7 agency any caller can call us any time. Like the previous question, we don’t want to run
the risk of creating an inappropriate dependency. When you create your reply to this question
structure it in such a way that allows the caller to understand we are only a first step and it is up
to them to exercise and practice their newly learned coping strategies. Your response should take
the tone of that an individual’s “practicing of new coping skills makes perfect."
Your Call Is Inappropriate.
As you will find out, if you don’t already know, the vast majority of the people contacting agency
are not crisis callers. Of this number a large percentage are people making inappropriate phone
calls. Our inclination when we receive the prank call is to tell the caller, “Don’t prank us!” and
hang up in anger and frustration. This phrase and its many variations are in direct conflict with the
non-directive stance we have learned. Our response in this situation needs to address the
reasons we are deeming the call inappropriate, a brief explanation that such calls do tie up our
lines, and a respectful yet firm ending to the contact which allows the caller to understand we will
work with them should they ever have a crisis. Create a statement for your Toolbox that will be
brief and simple enough to use when you are feeling stressed.
CONFRONTATION (The gauntlet cast)
In training we learn how to work with our Caller’s on an equal, shared, non-judgmental level.
However, there are times when the interaction is not as level as we would expect. There will be
times when we will feel the need to address the appropriateness of the Caller’s contact, their
honesty, previous contacts, their situation as presented, or their attention or participation in the
interaction. This means we need to “CONFRONT” the Caller. Since we generally see
confrontation as a clash between people we are uncomfortable with it. Add to this that the need to
confront Callers usually occurs at a point in the call where we are feeling stressed or frustrated
and that it seems to be contrary to the tenets of Crisis Intervention, confrontation becomes
something we end up not doing well. All to often confrontation becomes a, “Yes you did. . .No I
didn’t” affair. To avoid this “battle of the wills” situation we need to develop a strategy for
confrontation.
When confronting a Caller we will review the facts we are questioning, inform the Caller the facts
don’t seem to add up and then state the confusion that represents for us. This needs to be done
20 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
firmly. It is important to remember that “firm” does not mean angry or punitive. Firm means we
are stating our observations in a focused, clear, and precise manner with the express intent of
clarifying that which we don’t understand.
For example take the Caller who seems well versed in our methods and capabilities yet claims to
have never contacted us before. We might be tempted to “confront” them by asking, “Have you
called us before?”. The “Yes” or “No” response elicited by this question does little to assist the
flow of the call. Better, we might tell them we are confused by the fact they say they have never
called before, yet they speak in terms of feelings which many people don’t do, seem to know your
operation, and sound familiar. We could then explain that we need to know if they have called
previously so we don’t duplicate referrals that seemed to have not worked before. Confrontation
in this manner lets the Caller know we are not judging him but we need the facts to serve his
needs best. It also opens new avenues for the call to follow. So think of a confrontation method
you can feel comfortable with and add it to your Toolbox.
I (anything). . .
This is not so much an addition to your Toolbox but a general rule. Just as we need to refrain
from judging things normal or not normal we need to realize that anytime we use the personal
pronoun “I” we present a judgmental, exclusionary stance to our callers. While it may not
be possible to eliminate this particular pronoun from our vocabulary, it is desirable we attempt to
communicate with our callers on a generalized, inclusive level. This is a difficult yet
extremely powerful concept to master. Think about it a bit. As a suggestion you may want to
think of “I” in terms of “you” or the inclusive “people”. As an example: Instead of, “I think you
need to talk to your worker”, we might say, “In a situation like this some people might think about
talking to their worker."
The Call with No End in Sight
We all hope to have calls where the Caller has enjoined in the Crisis Intervention Process and has
concrete plan to implement once we end the call. We write our reports and follow-ups and we feel
fine. More often than not we work through The Crisis Intervention Process and there is no
definitive plan to be implemented. This becomes easy to accept if we remember the call
belongs to the caller and The Active Listening Skills are designed to permit the Caller to
progress at their pace. It can be difficult to know what to say when goals are not clear and the
call can become circular. A response might be to review what options were explored and how
such an exploration can be exhausting as well as confusing. We can then suggest the caller take
some time to think about what went on in the call and how it relates to what they want to do as
opposed to making an immediate decision. Think about the times when we were faced with
important decisions. . .the greater the impact of the decision (should I but those shoes or the
sneakers vs. should I buy the Cape Cod or the Victorian House) the more we tend to reflect on
that decision. . .the exact same is true of our Callers facing the cusp of crisis.
How To End the Call.
So here it is. . .you and the caller have reached consensus. The caller feels empowered and
ready to embark on new levels of coping. The time has come to bid adieu. At a time when both
you and the caller feel bonded by the Model Experience somehow “Bye” or “See ya” does not
seem appropriate. The technical reason for this probably involves some kind of “ference” (trans
or counter-trans or both) but we do not have to mire ourselves in that discussion to create a
response. Our response needs to address how the caller has managed to see their situation
more clearly. It needs to remind the caller they now have either a definite plan of action or some
21 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
concrete issues to think about. We should reinforce the caller’s sense of ability, hope, and
power. Having done that we need to offer a firm good-bye and end the call. This kind of
concrete closure can foster a sense of independence for the caller who, perhaps, has not felt
independent. We will often hear Listeners suggesting Callers reconnect with us should the need
arise. While there is nothing inappropriate with this, we need to keep in mind the caller knows
they can call back and will should they feel the need. We do not need to reinforce this. What the
caller may not be sure of is their ability to accomplish what they have decided to do. Their crisis
may erode their confidence in their ability to function on their own. By not reminding them to call
back we tacitly let them know we have confidence in their ability and share that confidence with
them. The trust established in the call enables the caller to assume a dose of that confidence.
Something to think about is our tendency to offer our callers, “Good Luck”. While it may be an
appropriate phrase for a lottery agent we may want to think about the message it relays to our
callers. We have taken our callers out of crisis to a point where they have arrived at a plan they
see as a way out of their anomie. They feel empowered, secure, and ready to confront their life’s
issues. . .and we offer them “Good Luck”? Is the phrase correct or not correct to use? Neither. .
.The point is made to illustrate that we need to always think about what we say and how what we
say may be heard by our callers.
22 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
A suicidal person like any person in crisis is, by definition, a person faced with an intolerable life
issue for which they are seeking a solution. In working with the Suicidal Caller we must remember
that the suicidal activity is not, in itself, a crisis. Suicidal activity is both a means for resolving this
situation and a method of communicating the intense feelings of hopelessness and helplessness
surrounding it. As such our goal in working with the suicidal caller is twofold:
1. To assist the caller in focusing on the issue thus enabling them to
communicate their feelings verbally instead of behaviorally;
2. To explore more adaptive resolutions to the issue presented.
In interacting with the suicidal caller we operate under the assumption that the Caller is
ambivalent about their decision to suicide otherwise they would not be contacting us. This
bestows upon us the moral right and responsibility to attempt to intervene. To effectively
intervene with the Suicidal Caller we need to accomplish three tasks:
1. Establish a relationship
2. Evaluate the suicidal potential
3. Formulate a plan and mobilize resources
Establishing A Relationship
Suicidal callers present themselves in a variety of ways, ranging from vague allusions to death, to
specific verbal threats, to actual suicide-in-progress calls. When the communication of the
ideation is indirect it is the task of the Crisis Worker to recognize the intent of the disguised
message and bring the issue of suicide up for open discussion. If the Caller shares anything with
you that gives you the impression they are considering suicide a coping mechanism ask them if
they are feeling suicidal. Directly asking a Caller if they intend to commit suicide will not
cause them to do so. The asking of the question establishes an atmosphere of openness and
honesty will encourage fruitful exploration of the issue they are experiencing. On the other end of
the spectrum, suicide-in-progress calls require special efforts toward obtaining intervention and/or
medical assistance without neglecting the Caller and the problem that has led them to the action.
All suicide threats must be taken seriously. Some suicidal activity may have a manipulative
quality, but that characteristic in itself does not make the situation any less dangerous. There is
strong evidence that a number of completed suicides were attempts by persons who did not
actually intend to take their lives. The unfortunate reality is that accidents happen when one
attempts manipulation through the use of suicide.
The methods of establishing a relationship of trust and open communication in the suicidal call are
the same ones we use in all our calls. In all calls the Crisis Worker should be accepting,
respectful, and empathic. They should present themselves as being patient, interested, selfassured, and knowledgeable. Through their attitude the Crisis Worker will communicate to the
Caller that they have done the right thing in contacting the hotline. The message the Crisis
Worker’s attitude sends to the Caller is that they are concerned and both able and willing to help.
Many suicidal situations will arouse within the Crisis Worker feelings of inadequacy and selfdoubt. They can begin to feel their skills will not enable them to handle such a critical situation.
While moderate anxiety is appropriate and actually expected, too much anxiety will seriously
hamper the Worker’s ability to interact with the suicidal caller who, at the time of their contact, is
depending on the Worker to solve their problem. It is possible the anxiety of the Crisis Worker
may be transmitted to the Caller reinforcing their own sense of stress and anxiety. In other words,
23 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
the Crisis Worker needs to try to stay calm and sound confident even if they do not feel either.
The Crisis Worker can develop greater poise and confidence through continuing training and
experience.
The fact the suicidal caller contacted the Hotline indicates they have at least some desire to get
help in resolving their problem. The suicidal caller, just as with any other Caller, should be
accepted without challenge or criticism. They should be allowed to explain and explore their
situation in their own way and time. We may feel it appropriate to manipulate the Caller through
moralistic pronouncements about suicide: They will not go to heaven; It’s against the law; It’s a
sign of emotional or moral weakness. We might be tempted to point out how the Caller’s suicide
will affect those closest to them in an effort to have them stop feeling suicidal. It’s possible we
might think it helpful to point out that there are those who are dependent on them. We might feel
that pointing out the Caller’s responsibility to others would be appropriate. We might even
consider minimizing the Caller’s presenting problem by trying to convince them “it’s not so bad” or
trying to perk them up (the “Don’t Worry Be Happy Syndrome”). These actions are
unacceptable, will prove ultimately unsuccessful, and have the potentiality to compound
the problem. The most useful thing the Crisis Worker can do is to listen, empathize, and accept
the Caller’s feelings without argument. It is through the use of the Crisis Intervention Skills that a
trusting relationship between Caller and Worker is established. In this manner the Caller
becomes empowered to share their pent up pain, anxiety, and stress. It is this empowerment can
lay the groundwork for resolution of the situation that led to the suicidal ideation.
Establishing our relationship with the Suicidal Caller does not mean we cannot take a stance that
would encourage the Caller to choose to live. A basic tenet of Suicide Intervention is that the
Suicidal Caller who contacts a crisis hotline is ambivalent about committing the act. The
level of the ambivalence is unique to each Caller. The Crisis Worker should listen for, indicate,
and support any and all messages from the Caller that reflect a reluctance to die. Working on
short-term goals without trying to remove suicide as a later option can help the Caller to retain a
feeling of control without actually having to kill themselves. Statements to the effect that suicide
can continue to remain an option if they continue to live but that life will not be a future option if
they die serve to reframe the perspective of the Suicidal Caller.
Some Crisis Workers will protest that there is not enough time to establish open, trusting
relationship in life threatening situations. This is a mistaken assumption. Granted the process
can be time consuming but unless the Caller feels safe in their interaction with the Worker they
will not stay on the phone. Once the Caller ends their contact with us there is nothing we can do
to protect their lives. The relationship also becomes important when it is time to formulate a plan.
If the Caller is not secure in their relationship with the Worker there is no way the Worker will have
all the information necessary to formulate a plan the Caller can follow. For example, if the
possibility of past hospitalizations is not explored the Crisis Worker may suggest the Caller go to
the hospital. Since the Caller is looking to us to help them, and in seeking help see us as an
authority figure, they will quite possibly agree. However, if past hospitalizations were painful for
the Caller once the call is ended they will opt not to follow through with the plan.
Evaluation of Suicide Potential
As the trusting relationship is developed and the presenting life problems are being defined and
explored, The Crisis Worker needs to make a mental evaluation of the seriousness of the Caller’s
suicidal intent. Threats to kill oneself mean different things to different people and careful
attention to certain factors in the presented situation may be helpful in allowing us to evaluate the
degree of probability the Caller will actually kill themselves in the immediate or relatively near
future. This evaluation will, in turn, help us to determine the best plan of intervention: Calling an
ambulance; Engaging significant others; A referral to a mental health agency, etc. A Callers'
degree of lethality can be accurately determined using the P - A - R Scale. This scale allows the
Worker to explore, with the Caller, their Plan - Attempts - Resources in an attempt to evaluate the
current danger to the Caller. Let’s look at each assessment criterion individually.
24 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Suicidal Plan
This is the most significant criterion of suicidal potentiality. Three main elements are involved and
all three must be explored with the Caller. These main elements are:
The inherent lethality of the proposed method;
The availability of the means;
The specificity of the plan.
In addressing the inherent lethality of the proposed method we examine how likely the chosen
method of suicide could result in serious or irreversible injury or death. A person planning to hold
their breath until they die represents a low level of lethality. The Caller who is considering pills,
wrist cutting, or gas represents a substantially higher level but these methods take time and their
effects can be reversed through timely intervention. At the high end of the scale we find gun
shots, car crashes, and hanging which represent high lethality because the effect of these
methods is generally instantaneous and irreversible without appropriate intervention.
The availability of the means of suicide to the Caller also influences the level of lethality. The
question to be answered here is, “Does the Caller have immediate access to the weapon, drugs,
or other implements they plan to use in their suicide attempt. The Caller who intends to shoot
themselves but does not have a gun available represents a lower lethality than the Caller who is
calling from a pay phone on a subway platform intending to throw themselves in front of an
oncoming train. Someone, who calls and is active in the process of their plan, having consumed
pills, cut themselves, or sitting with a loaded gun represents an extremely high level of lethality.
Such circumstances generally call for immediate intervention.
When we explore the specificity of the plan with the Caller we are attempting to explore how
carefully the details of implementation have been worked out. The Caller who indicates they have
made concrete efforts to prepare for their death represents a marked rise in lethality. Writing a
will or notes, collecting or hoarding pills, giving away possessions, making funeral arrangements,
buying a gun, setting a definite time or place are all actions that indicate heightened lethality.
History of Previous Attempts
A person with prior suicide attempts represents a higher suicidal risk than the Caller
contemplating suicide for the first time. The individual presenting suicidal ideation who has had
significant others attempt or complete a suicide also present an elevated risk factor. Additionally,
what happened to the Caller following previous attempts can also affect the level of lethality in the
current attempt. How their attempt was responded to and treated influences the lethality of the
current attempt. So let’s look at the three elements of Attempts that are:
The previous method
History of attempts by significant others
Response and treatment
In assessing the previous method we need to determine if it was a lethal attempt or a gesture.
Most individuals who successfully commit suicide have made one or more failed attempts in the
past. If the Caller has made previous attempts it is useful to evaluate the previous attempts.
Were those attempts a gesture or lethal in intent? Frequently, successive attempts to suicide
escalate in their level of lethality. Explore with the Caller if they actually wanted to die in their past
attempts. Have they used them as “practice runs” for their current plan? Were the previous
attempts an effort to communicate what they were going through to those around them? Did the
Caller hope to manipulate the actions of those around them through their past attempts? Were
the previous attempts something the Caller simply talked about and planned or an active attempt?
Indications that the individual has made seriously lethal attempts, or a series of progressively
more lethal attempts, indicates a current level of high lethality. The Suicidal Caller who has had a
25 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
recent attempt and is presenting themselves in high spirits may be feeling relaxed because their
previous attempt has shown them a way to escape their problems. The risk for this kind of Caller
is greatly elevated.
It is significant to the assessment of lethality if there is a history of attempts by significant
others. If the Suicidal Caller has had close family members, friends, or idols who have a history
of suicidal behavior there is an elevation in lethality represented for the current attempt. The
Caller will see the suicide or attempted suicide of a role model as an acceptable solution to a life
problem resulting in an escalation of lethality.
The response and treatment experienced by the Caller following previous attempts also
influences lethality. It is important to explore how those around them treated them following the
attempt. Does the Caller view their treatment in a positive or negative light? Does the Caller view
the responses of those around them regarding their previous attempt as a reason to suicide or a
reason not to suicide? Exploring any psychological treatment and the individual’s response to or
feelings about that treatment, or lack of treatment, needs to be figured into the level of lethality as
well as any intervention that may be planned.
The Caller’s Resources
A sense of physical and/or emotional isolation is a major factor in the suicidal situation. An
examination of resources not only helps to establish a level of lethality but also become important
in formulating a viable intervention plan. An exploration of the Caller’s resources encompasses
three general areas:
Internal resources
External Resources
Communication with their external resources
When we evaluate the internal resources of the suicidal Caller we engage the Suicidal Caller in
a discussion of how they see themselves. A person reacting to fear or panic has a lower level of
lethality than the one who sees themselves as worthless or no good. The feelings of
worthlessness or feeling “no good” are subjective judgments over which the Caller feels no power.
The reason for this sense is that judgments are something placed on us involuntarily and as such
are assumed to be unaddressable. However, the person who is suicidal because of fear or panic
does not have to address intangibles such as judgments. They can explore, with the Crisis
Worker, the source of their fear or panic and attempt to develop a concrete plan to cope with it.
This possibility of empowerment decreases the level of lethality.
The external resources of the Suicidal Caller include the significant others in an individual’s life.
Explorations of these resources helps to not only establish lethality, but can help us in formulating
a plan for intervention. The individual who does not seem to have relationships with anyone,
either through death, separation, or an inability to form personal ties, represents a serious
concern. Those who live and work alone are considered high suicide risks. External
resources include, but are not limited to family, friends, clergy, coworkers, teachers, and social
agencies. When we explore external resources it is important to address the Caller’s perception
of these sources of support. While they may have many people available to them as potential
resources they may not view some or any of them in a positive light. Where there has been a
history of previous attempts the Caller may see potential external resources as being fed up, worn
out, or not taking them seriously. In this case their lethality is increased. Another external
resource to explore would be the Suicidal Caller’s belief system. Does the Caller believe in a deity
or a higher power? How do they currently see themselves in relation to that power? Do they see
themselves as being abandoned by that belief system? Do they see themselves as unworthy of
intervention by that system? In either case there would be an elevation in lethality.
26 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Another area to explore in addressing external resources is to determine if the Caller has been
able to have communication with their external resources. Has the Caller shared their suicidal
thoughts? Many well-meaning family members and friends will choose to ignore hints of suicide
because of their own feelings of inadequacy in addressing the situation and providing help. Some
significant others may react with anger and resentment when the suicidal communication is
perceived as a threat or an attempt to provoke guilt. Others may see the situation as “crying wolf”
and ignore the Caller and their calls for help. Just because there are people and resources in
proximity to the suicidal person does not mean those people are “available” to them. The Caller
who feels rejected and unheard by those around them is at a much higher risk of suicide.
Beyond the basic lethality assessment the P - A - R Scale provides there are other factors to
consider when assessing lethality. These factors are as follows:
Changes Related to Loss or Threat of Loss
Symptomatic Patterns
Statistical Patterns
Cultural Influences
Physiological Changes
Psycho-Sexual Changes
Changes Related to Loss or Threat of Loss
Any recent loss indicates heightened lethality. The loss can be the death of a significant other
(this can include an idol, role model, or even a pet), divorce or separation, the breakup of a
relationship, the loss of a job or housing. The threat of any of any of the above losses can also
trigger elevated lethality. The onset of illness for either the Caller or a significant other also
indicates heightened lethality. The anniversary of a loss can trigger suicidal thoughts. Other
losses may not be quite as evident. A move to a new area represents a loss of a familiar way of
being. A situation where a guardian is absent, for whatever reason, can signal a loss of
boundaries and guidelines. The onset of physical and emotional disabilities can represent a loss
of normalcy. In this case something the Worker may view as mundane, such as new glasses or
braces, may actually be a suicidal trigger for the Caller.
Symptomatic Patterns
Suicidal behavior can occur in many different psychological states. Many people who have
completed suicide exhibited signs of severe long-term depression. Some of these signs are:
Sleep disorders
Loss of appetite
Major weight change
Panic attacks
Changes in sexual activity (promiscuity or abstinence)
Social withdrawal
Apathy
Despondency
Physical and psychological exhaustion
The depressed individual may present themselves as feeling sad experiencing crying spells when
alone or in the company of others. When we talk to the depressed person on the phone the
person will sound lethargic, speaking in a slow labored manner. Conversely, the depressed
person can sound agitated and restless citing their inability to contain the pressure of their feelings
and anxieties. The presence of any or all of the symptoms in their severe form would indicate
high lethality.
Psychotic states when combined with suicidal ideation represent a highly lethal situation. A
psychosis will usually be characterized by delusions (irrational beliefs), hallucinations (visual or
auditory distortions), loss of contact with reality, disorientation (not knowing who or where on is,
27 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
etc.), or highly unusual ideas or experiences. A Caller whose suicidal plans are obviously bizarre
or who claims to have voices telling them to suicide represents a high risk factor. Callers who are
changing medications either at the recommendation of their doctor or by their own choice also
represent increased intent. Exploration of past psychiatric history or current treatment might
prove helpful in this instance.
Substance abuse is also connected to high suicidal risk. It may be the abuse is used to mask the
depression. It is also possible the drugs and alcohol are being used destructively as a slow form
of suicide. In either case the fact that substance abuse clouds one’s judgment increases the risk
of suicide as an impulsive act. It is important to keep in mind the that person contemplating a
suicidal gesture by using drugs can accidentally overdose due to the synergistic effect of mixed
drugs. Taking all this into consideration shows that substance abuse is an indicator of heightened
risk.
While on the topic of drugs we need to address the issue of drug overdose. When a person talks
to use about suicide by drug overdose they will sometimes ask us if a certain quantity of a specific
drug will be sufficient to kill them. The asking of the question itself indicates elevated lethality.
However, our tendency to want to consult the Physician’s Desk Reference or Poison Control is not
appropriate. The effect of any drug on any person is dependent on many variables: Weight; Age;
Tolerance; Other drugs consumed; Timing of meals; Shelf life of the drug, etc. Our stance is that
if a person is considering consuming, or has consumed, any amount of drugs in an effort
to suicide, that dosage is lethal.
Statistical Patterns
Statistical patterns can be a window into the level of risk. The elderly represent the highest
suicide rate, followed by the 15-24 age group. More females attempt suicide than males. Males
complete more suicides then females and their method of suicide is generally more violent.
Young people attempt suicide in the morning and late afternoon when there is a chance for them
to be found and “rescued”. Adult attempts happen in the very late night or early morning hours
when there is little risk of discovery. Guns represent the prevalent means of attempted suicide
and the account for the majority of completed suicides.
Cultural Influences
The society in which we live places many pressures upon us. Generally, people handle the
pressure without feeling the need to escape through suicide. However, some people can feel
crushed by the effects and demands of society on their lives. Family breakdown is a fact in our
society. Divorce, death, family members focused on careers instead of the family unit all
contribute to the dissolution of the nuclear family. Without the perceived support, nurturing, and
safety of a stable family a Caller can have a sense of no belonging and no direction. This can
contribute to the Caller’s feeling the world would be better off without them.
The increased mobility of our society is another factor in suicidal risk. For any of a number of
reasons ranging from employment issues to the desire to live someplace new, families frequently
pack up and move to new places. These moves often distance the family from what and whom
they have been accustomed. This creates a sense of impermanence, instability, and lack of
continuity, all of which represent another factor in suicidal risk.
We are constantly bombarded with messages to strive for success, for something bigger and
better. Television, family, friends, teachers, coaches, bosses, and, most importantly, ourselves
urge us to reach higher and farther with our goals and dreams. The person who feels obliged to
respond to these messages can come to feel overwhelmed. When they feel they are not living up
to the expectations they feel others have of them or, more importantly, feel they have not lived up
to their own expectations, suicide can become a factor in their lives. Additionally, perceived
28 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
inability to cope with successive failures in school performance, peer and family relationships are
an another suicidal indicator.
Physiological Changes
When we talk about physiological changes and suicide we generally think in terms of adolescent
suicide. The adolescent has to cope developmentally with their physical growth rate as well as
puberty and the hormonal changes that accompany it. These changes place a large emotional
pressure on youths and they have been cited for the increase in adolescent suicide. However, we
cannot let ourselves forget that as we age we undergo physical changes. Though the changes of
an adult are of a more gradual nature they represent change and can be an indicator of suicidal
risk. The Caller saying they cannot keep up with the younger people on the job or talking about
the effects of menopause is dealing with a physiological change they feel helpless to control. It is
these senses of helplessness could be an indication of suicidal risk.
Psycho-Sexual Changes
Again adolescent suicide is what we think about when we discuss psychosexual change.
Adolescents have a short time to come to terms with relationships, dating, first sexual experience,
and their own sexuality. With so much to cope with developmentally the adolescent can come to
feel overwhelmed by the changes within themselves and the worries about how their world views
them. Again, as with physiological changes, psychosexual changes are not limited to adolescents
and can represent a suicide risk for adults. The aging process does produce psychosexual
changes in persons over the age of 18. While these changes would seem not to be
as many or as intense as those experienced in adolescence, it is the perception of the person
involved in the changes who decides the impact the changes have over their lives.
When evaluating suicidal risk and lethality, no single criterion need be alarming. The only
exception to this is if the plan is very specific and lethal. The situation should be appraised on the
general pattern of all the above criteria within the individual case. When we establish a trusting
and open relationship with the Suicidal Caller we create a mosaic of their situation. Just as one
tile of the mosaic does not detail the whole picture neither does one criterion of suicide
assessment necessarily indicate suicidal risk. The Crisis Intervention Skills enable us, and our
Callers to stand back from the presenting situation and see the whole picture. It is the picture
seen in its entirety that will form the basis of our assessment of risk and danger.
We should note that many of the factors that indicate suicidal risk relate to change. Change is
something that can be exciting or scary. Some changes we are initiate ourselves other changes
happen without our active participation. The changes we are not actively involved in have the
potential to make us feel helpless and powerless. When interacting with all our Callers it is a
prudent idea to thoroughly explore what changes they are experiencing and how they view the
impact of those changes.
Also important is the evaluation of the Caller as they respond to the Crisis Intervention Process.
This response permits a window into how the Caller is using their internal resources.
Improvement in mood from a depressed state, where the Caller feels unequipped and unable to
assist in the resolution of their situation, to a state where they become actively involved in the
process indicates a lessening of suicidal risk. That the Caller begins to think about what they can
do, instead of what they cannot do, is a positive sign indicating the Caller’s ability to respond to
offered help. Verbalizations from the Caller that they are feeling better, indications they are
actively participating in exploring alternatives to suicide or that they are trying to resolve the
precipitating issue, or commitments to future plans of action are all signs that suicide is not
imminent.
Formulating A Plan and Mobilizing Resources
29 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Although we accept a strong stance against interfering in the lives of our Caller’s the suicide in
progress call presents us with a unique set of circumstances that require deviation from this rule.
We will not make a judgment against a person for deciding to take their own life. However, if an
individual calls the hotline to discuss their intent to suicide we then become involved in their
decision making process. Being involved in that process confers on us the moral and ethical
obligation to prevent death. It is always our hope that though sensitive crisis intervention and
support the Caller will make their own choice to live. However, if that is not the case, we will take
what steps we can to prevent their death. In this matter the Caller has no choice. . .as an agency
we will always opt for life in a suicidal situation.
Suicide in Progress
If the suicide in progress involves a drug overdose we will, as mentioned previously, explain there
is no way we can determine what a fatal dose would be and we would have to assume that any
quantity of drugs taken by a Caller for the express purpose of suicide is considered life
threatening. An immediate offer to dispatch assistance will be made. If the Caller declines such
assistance, focus should be placed on establishing a trusting relationship with the Caller in the
hope that the offer of help will be eventually accepted.
Another situation Crisis Workers face is the Suicidal Caller who has initiated their suicidal plan
and calls to have someone to talk to while they die. In this situation the Crisis Worker can reflect
the loneliness and isolation such a request represents then continue with Crisis Intervention. In
this case it can be helpful to focus on how important it seems to the Caller to have someone to
talk to. By focusing the Caller on their desire to have someone to talk to, we can work into an
exploration of what can be done to get someone for them to talk to. This will generally lead to the
Caller permitting us to get aid to them.
Do’s and Don’ts
Do offer to call emergency services
Don’t instruct the Caller to call 911 unless you are instructed to do so by emergency services
once you call them.
Do get the Caller’s complete address, including apartment number and telephone number.
Do conference the Caller with emergency services if they are unsure of their exact location.
Do explain how the process will work. Basically, both police and an ambulance will be dispatched
to the Caller’s location. We can explain that the purpose for the police presence (the need for
their presence is usually frightening to the Caller) is to ensure the safety of the Caller and the
emergency personnel as well as getting aid to the location as quickly as possible. The emergency
services people will evaluate the situation and if warranted will transport the Caller to the hospital.
Do instruct the Caller to collect the containers of any substance they may have consumed to help
those responding accurately assess what steps need to be taken.
Do inform the emergency services people of any weapons the Caller may be planning to use to
complete their suicide.
Do ask the emergency services people how they wish the issue of weapons handled.
Do stay on the phone until the emergency services arrive.
Do let the emergency services worker you contact talk to the caller. Many of these workers have
training similar to yours and will work with the Caller until help arrives. To avoid confusion just
listen to what is going on unless asked by the worker to join. However, if something is being said
that would confuse the situation you should interrupt to clarify.
Do explain the situation to the emergency service workers when they arrive and get names and/or
badge numbers. As this is a life-threatening situation be concise and recognize the duty of the
workers responding is not to talk to you but to help your Caller.
30 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Don’t make any promises to the Caller. As we are away from the situation we have no way of
guaranteeing what will happen. Caller’s may request the agencies responding not use lights or
sirens. We can request this but the decision to use lights and sirens lies with the responding
services. The Caller may request a specific hospital. Again, we can make that request on their
behalf but the people responding are the ones who will make that decision.
Suicide Attempt Has Not Been Initiated and High Lethality Is Indicated
In the vast majority of our calls where suicide is an issue, the attempt has not been initiated. In
these cases our plans for assistance of the Caller will be determined by the severity of the
situation and the Caller’s own desires. In cases of high suicidal potential, efforts should be made
to help the Caller engage resources within their own environment. As a general principle, it is
wise to have the responsibility for a suicidal person shared by as many individuals as is possible.
We can offer to talk to or contact immediate family members. If the Caller is already in contact
with mental health professionals, communication with this resource should be encouraged or
facilitated. In any case, efforts should be made to guarantee that a person seriously
contemplating suicide is not left alone or permitted an opportunity to act upon their plan. Before
closing the call the Crisis Worker should attempt to have the Caller to eliminate the lethal means
by encouraging them to flush pills down the toilet, give the gun to another, responsible person,
etc.
In the case of very high lethality, it may be necessary to arrange for immediate professional
intervention. If the Caller doubts their ability to control their suicidal impulses and wishes help the
Worker can explain that the Caller can voluntarily present themselves at the emergency room of
any hospital with a psychiatric component or at the admissions office of the state psychiatric
hospital and ask to be evaluated. To alleviate any apprehension the Caller may have about this
step a call to the nearest appropriate facility can be made so the Caller can have the exact
procedure for that facility explained to them. Engage the Caller in an exploration of what family
members or friends might be available to help them negotiate this process.
Do’s and Don’ts
Do listen for any input from the Caller that would indicate they have decided to initiate the suicide
process. Point out to the Caller what gave you that impression and allow them to respond.
Do explore what significant others or caregiving professionals are most able to assist the Caller.
Explain to the Caller we can contact immediate family members and professionals on their behalf.
Do ask the Caller if there are responsible people at the location they are calling from and ask the
Caller if you can talk to them about the situation you have been discussing.
Do be candid with any person you talk to on behalf of the Caller. Explain the situation as the
Caller has explained it to you, your concern about the situation, and invite the person to add any
input they may have regarding the Caller.
Do contact the local hospital or mental health facility to find out what their emergency admission
procedure is.
Don’t promise that emergency services will transport the Caller. Generally, emergency services
will only transport in cases of immediate life or death.
Do have the Caller repeat to you, in their own words, the plan the two of you have developed. If
there are any discrepancies point them out and then have the Caller repeat the plan again.
Don’t insist the Caller dispose of or remove the means of their suicide until the end of the call.
Doing so prematurely can interfere with the establishment of the openness and trust necessary in
such situations.
Suicide Attempt Has Not Been Initiated and Low Lethality Is Indicated
In a situation of less immediate danger, assistance of an outpatient nature can be offered the
Caller. If the Caller wishes we can make conference calls to appropriate agencies of treatment
31 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
centers to make arrangements. In such cases, it is important to be candid with the resource
about the suicidal element so the Caller can be seen without undue delay. In circumstances
where suicide is an issue many agencies will circumvent waiting lists so a Caller can be seen as
quickly as possible.
In cases of very low suicidal potentiality Callers can be referred to community resources that will
allow them to address the situation that led them to consider suicide a problem-solving tool. Our
database provides thousands of such referrals.
Do’s and Don’ts
Do listen for any escalation in lethality during the call and address any change with the Caller.
Do make conference calls to agencies and advocate for the caller if there is any indication they
do not have the ability or resources to do so.
Do remind the Caller they can involve significant others in helping resolve their problems.
Do have the Caller repeat to you, in their own words, the plan that the two of you have
developed. If there are any discrepancies point them out and then have the Caller repeat the plan
again.
The Role of the Crisis Intervention Model in the Suicide Call
We can use The Crisis Intervention Model to effectively establish an open and trusting relationship
with the Suicidal Caller. Let’s look at how to use The Model with the at risk Caller. One thought to
keep in mind when dealing with the Suicidal Caller is that the suicidal ideation is not the crisis
issue the Caller is addressing. The suicidal ideation is the Caller’s method of resolving the crisis.
What this means to us as Crisis Workers is that, as with any other call, we need to work with the
Caller in an effort to generate other resolutions. For example, we get many calls from kids who
want to run away. That is their solution for coping with what is going on in their lives. We work
with Caller’s such as these to generate other solutions because, as an agency, we do not
condone running away as a solution. The same is true with the Caller who sees suicide as a
solution to their situation.
Reminder: If at any time you sense that suicide is an option for the caller ASK them and request
supervisory or peer. If the Caller replies they are suicidal assess lethality using the P -A - R
Scale.
Define the Problem


Make contact at a feeling level.
 Be patient and listen carefully.
 Identify and reflect the Caller’s feelings.
 Let the Caller tell their story in their own words and time. This means being patient.
Asking the Caller how they thought we could help them does not allow them this privilege.
 Simply note any factual information about possible resources that the Caller may share
(names, addresses, telephone numbers, etc.). You can clarify the particulars once
openness and trust are established.
 Control your personal feelings of stress and anxiety by reflecting them to the Caller
(Parallel Process).
 Avoid any sermons about suicide or policy.
Explore and define the problem in the here and now.
 What is the specific intolerable problem facing the Caller?
32 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org




In what manner did the Caller arrive at suicide as a solution?
Did a recent loss or major frustration precipitate the suicidal thoughts?
Explore, with the Caller, how they perceive the reactions of others to themselves and their
situation.
Summarize.
 Clarify and restate what the problem is.
 Reach a consensus with the Caller as to what the problem area is.
 Remind the Caller that their call is a cry for help and that you are able and willing to help.
 At this point there should be a clear answer to the question, “How likely is this person to
suicide?”
Explore Goals



Focus.
 Break the problem into specific goals
 Start with the immediate situation that the Caller is trying to resolve through suicide.
 Focus on getting through whatever time span the Caller can relate to: Week, Day, Night,
Hour, or Moment.
 Help the person look beyond the desire to kill themselves.
Maintain contact at a feeling level.
 Recognize, reflect and address the painful feelings the Caller is experiencing.
 Continue to allow the Caller to progress in their own words and time.
Summarize
 Clarify and restate what the goals are.
 Reach a consensus with the Caller as to what the goals are.
 Remind the Caller that their call is a cry for help and that you are able and willing to help.
 At this point the worker should reassess the suicidal risk of the Caller.
Generate Alternatives




Explore Resources
 Who does the Caller feel they can talk to?
 Who does the Caller feel they cannot talk to?
 Who, if anybody has the Caller been talking to?
Explore Strengths and Weaknesses
 How does the Caller perceive his abilities relative to the presenting problem?
 What has the Caller already done, other than suicide, to resolve the issue?
 How does the Caller perceive his problemsolving abilities compared to those around
them?
Maintain contact at a feeling level.
 Recognize, reflect and address the painful feelings the Caller is experiencing.
 Continue to allow the Caller to progress in their own words and time.
Summarize
 Clarify and restate who the Caller feels they can communicate with.
 Reach a consensus with the Caller as to what their strengths are.
33 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org


Remind the Caller that their call is a cry for help and that you are able and willing to help.
At this point the Crisis Worker should reassess the suicidal risk of the Caller.
Develop a Plan




Agree on a plan of action.
 Review the Callers resources and strengths.
 Point out how these resources and strengths can be used to resolve the identified crisis
situation.
 Explore the Callers feelings about the developing plan.
Keep the plan manageable.
 Identify small steps: Getting through the moment at hand; What needs to be done the
following day or when they wake up or, if necessary, the following hour.
 In suicide in progress or high lethality situations initiate the process of getting appropriate
help.
 Develop the plan at the Callers pace and ability. This can be difficult considering your
own sense of urgency.
Maintain contact at a feeling level.
 Recognize, reflect and address the painful feelings or fears the Caller is experiencing.
 Continue to allow the Caller to progress in their own words and time.
Summarize.
 Clarify and restate then plan step by step.
 Reach a consensus with the Caller as to their confidence in implementing the plan.
 Remind the Caller that their call is a cry for help and that you are able and willing to help.
 At this point the Crisis Worker should reassess the suicidal risk of the Caller.
Closure


Summarize.
 Concisely review what transpired in the call.
 Point out the Caller’s involvement in the process.
 Indicate the Caller’s initial emotional state and point out their current state.
 Validate that the plan seems to be something that they can accomplish.
Encourage toward action.
 Give the Caller the message that they seem hopeful the plan will help them in their
situation.
 Point out that it will be themselves who will be helping themselves as soon as they start
on their plan.
 Review the plan briefly, offer a few words of encouragement and end the call.
34 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Suicide Risk Assessment Tool
(Prompt questions to be utilized whenever a Caller presents any possibility of suicidal ideation or is facing
intolerable depression, hopelessness, or helplessness.)
Are you thinking of suicide?
Have you thought about suicide in the last two months?
Have you ever attempted suicide?
(Complete the following risk assessment addressing Desire, Capability, Intent, and Buffers if you receive an
affirmative answer to any of the above prompt questions.)
Crisis Worker:
Date:
Suicidal Desire
Ideation (How often do you
think about suicide?)
Hopelessness (Do you see
any hope? Is there anyway out of
this situation?)
Helplessness (Do you feel
any control over what is
happening? How much?)
Psychological Pain (How
Low
burden on those around you?)
Trapped (Do you feel trapped
by your situation?)
Aloneness (Do you feel you
High
Increasing frequency of
thoughts
Sees few resolutions
Constant, pervading
thoughts
Sees no solutions at all
Feels control over
situation
Feels some control over
situation
Feels no control over the
situation
Pain comes and goes
Feels pain most of the
time
Feels in constant pain
Feels connected with
significant others in their
life and understand the
impact of their actions on
them
Feels ambivalent about
their connections with
significant others in their
life
Feels significant others in
their life would be better
off without them
Doesn’t feel trapped by
their situation
Feels connected to others
Feels somewhat trapped
by their situation
Feels disconnected or
distanced from others
Feels incredibly
trapped…No way out
Feels intolerability
alone…There is no one
who cares
are facing this all alone and
nobody cares?)
Suicidal Capability
Current Method (How are
Medium
Passing or occasional
thoughts
Envisions many other
resolutions
much and how often do you feel
the pain of this situation?)
Burden (Do you feel you are a
Time:
Low
Medium
High
Low lethality
Moderate lethality
High Lethality
None or one of low
lethality
Repeated threats of low
lethality or indication of
escalation in lethality
Previous attempts of high
lethality
Never or more than two
years
6 months to 2 years ago
Within 6 months
Never lost anyone to
suicide
Lost someone who wasn’t
close or a long time has
passed
Lost significant person in
their life or the suicidal
loss is recent
None
Isolated incidents of
violence
Repeated incidents of
violence
you planning to kill yourself?)
Number and lethality of
previous attempts (Have
you ever thought about/attempted
suicide before? How many
times?)
Timeline (When did your
previous attempts occur? How
long since your last attempt?)
Suicide Exposure (Has
anyone you’ve known or is special
to you committed suicide?)
Violence to Others (Have
you ever been violent or physically
hurtful to others?)
35 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Intoxication/Substance
Abuse (Do you drink or take
No history
Past history
Past and current history
No
Currently drinking or
drugging
Is drunk or high
drugs?)
Currently Intoxicated (Are
you drinking or taking drugs now?)
Suicidal Capability
Low
(continued)
Mood Changes (Has your
mood recently changed?)
Out of Touch With Reality
Do you feel you have a grasp of
reality?)
Sleep Patterns (Since all this
Medium
High
Mood has been consistent
and stable
Seems in touch with
reality
There has been some
change of mood
Somewhat in touch with
reality
There has been a recent,
dramatic mood change
Out of touch with reality
Normal
Some disturbances
Difficulty sleeping
No, mild, or slight
discomfort
Moderate discomfort or
discomfort is increasing
but not overwhelming
High anxiety, fells
overwhelmed or panicked
None
Increased
levels/occurrences
Violent aggression or rage
has been going on how have you
been sleeping?)
Increased Anxiety (Have
you been feeling more anxious
lately?)
Threats or Acts of
Aggression (Have you felt
angry at others?)
Suicidal Intent
Attempt In Progress Right
now, are you doing anything to kill
yourself)
Low
Medium
Not in progress, means
not readily at hand
Not in progress, has
means in hand or readily
accessible
No plan or vague plan
Not readily available
Plan with some specifics
Available, close by
No specific time or in the
future
Nothing
Within several hours
None
Some expressed intent
Details (Do you have a specific
plan to kill yourself
Availability of Means (Do
High
Is currently in the process
of attempting
Very specific. Knows,
how, when, and where
In hand or in progress
you have the means to kill
yourself?)
Time When do you plan on
killing yourself?)
Preparatory Behaviors
(What have you done to
accomplish your plan to die?)
Expressed Intent To Die
Has thought about
preparation, or has a few
preparations in progress
Is dying something you want to
do?)
Buffers/Connectedness
Immediate Supports (Is
Low
people in your life you are
comfortable talking too?)
Future Planning (What kind
of plans do you have for the
future?)
Ambivalence Toward
Living (Can we talk about some
High
Has frequent contact with
several significant others,
views contacts as positive
No, but there are others
nearby or expected shortly
Has contact with at least
one significant other,
views contact as positive
There are not others, feel
isolated
Little or not contact with
significant others, and
perceives contact as poor
Has plans beyond a week
from present
Has plans for the next
couple of days
Has no future plans or
goals
Immediately offers
reasons for living
Has difficulty giving
reasons to live
Sees no reason for living
Yes, others present
of your reasons for living?)
36 of 46
106750244
Sees death as the only
option
Medium
there, with you, who can help?
Social Supports (Are there
Immediately, or in
progress
Many preparations, given
items away, made will,
funeral arrangements, etc
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Feels living is good and
suicide is wrong
Feels their life has a
purpose and can name it
Displays ambivalence
about the value of life
Has difficulty naming a
purpose
Sees no value in life or
living
Sees their life as having
no purpose
this caller…?)
Open, honest, and willing
to talk and problem-solve
with worker
Hesitant to openly
communicate with worker
Either not willing to
interact or resistant to
interaction
Summarize/Check (We've
Definitely will not
Core Values/Beliefs (Is life
something that you value?)
Sense of Purpose (Do you
feel there is a purpose in your life?
Rapport With Worker (Is
Closure
Still has the idea to die but
will try suggested
options/referrals
been talking about many things
and before we go can you tell me
how likely are you to kill yourself?)
Still feeling suicidal and
plans to die
Action Taken
Emergency Services Dispatched
Assistance Refused or location not available
Other (Please describe)
Agreed to professional help
Agreed to use supports and connections
Follow-up Call
Agreed to Follow-up Call (If Caller aggreed to a Follow-up
Declined Follow-up Call
Call please attach Incident Report)
Suicide Call Follow-up (Caller)
(When making the Followup call refer to the Suicide Assessment Tool to assess the Caller's current suicidal ideation)
Worker:
Caller's Name:
Caller's Telephone #:
Date:
Time:
Follow-Up Contact
Details:
1)
Telephone number for follow-up call:
2)
Best days & times to call:
3)
4)
"The telephone number you gave me, is it for a cell phone?"
 Yes
 No
Alternate Telephone number for follow-up call: (___ ___ ___) ___ ___ ___-___ ___ ___ ___
5)
Best days & times to call:
6)
Caller ID?
7)
If Yes, “Should we block our identity when we call you?”
8)
Do you have an answering machine?  Yes
 Yes
(___ ___ ___)
 No
37 of 46
106750244
___ ___ ___-___ ___ ___ ___
 No
 Yes
 No
(If "No",skip to question 10)
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
9) If 8 is "Yes": If you're not at home when we calls is it okay for them to leave a message on your answering
machine? They could say "this is (agency) calling to see if you'd be interested in participating in a telephone
survey", or they could leave a different message.
Do Not Leave Message
Leave Agency Message
Leave Different Message: (If "Yes", write down exact message to be left):
10) If someone else answers when Columbia University calls, is it okay for them to leave a message with the
person who answers the phone? If you wanted them to leave a message, they could say "this is (agency) calling
to see if you'd be interested in participating in a telephone survey", or they could leave a different message.
__ Do Not Leave Message
__ Leave Agency Message
__ Leave Different Message: (If "Yes", write down exact message to be left):
Caller's Address: (Must include at least state)
Follow-up Attempts and Outcome(s)
Date/Time
Outcome
First Attempt
Second Attempt
Third Attempt
Summarize/Check (We've
Definitely will not
been talking about many things
and before we go can you tell me
how likely are you to kill yourself?)
Still has the idea to die but
is working with suggested
options/referrals
Still feeling suicidal and
plans to die
Suicide Call Follow-up (Professional)
Worker:
Professional’s Name/Affiliation:
Professional’s Affiliation:
Professional's Telephone #:
Date:
Follow-up Attempts and Outcome(s)
Date/Time
First Attempt
Second Attempt
Third Attempt
38 of 46
106750244
Time:
Outcome
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
39 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
CRISIS INTERVENTION STANDARD
Although most I&R services do not promote themselves as formal crisis intervention centers, most
receive occasional requests for assistance from people in crisis and must therefore equip their
staff to handle them appropriately. The I&R service shall be prepared to assess and meet the
immediate, short-term needs of inquirers who are experiencing a crisis and contact the I&R
service for assistance. Included is assistance for individuals threatening suicide, homicide or
assault; suicide survivors; victims of domestic abuse or other forms of violence, child
abuse/neglect or elder/dependent adult abuse/neglect; sexual assault survivors; runaway youth;
people experiencing a psychiatric emergency; chemically dependent people in crisis; survivors of
a traumatic death; and others in distress.
Criteria
1.
The I&R specialist shall have the skills to recognize when an inquirer is experiencing a
crisis and shall determine whether the individual is in immediate danger and take steps to
assess that s/he is safe before continuing with the interview. In assault and sexual assault
cases, for example, the specialist shall assess that the assailant is not still in the vicinity and
that the individual does not need emergency medical treatment. In domestic violence
situations, the specialist shall determine that the abusive person is not present and
threatening the inquirer. The specialist shall follow the I&R service’s protocol for when to
access 911 or other emergency rescue services.
2.



The I&R specialist shall have the intervention skills to:
De-escalate and stabilize the individual and help him/her remain calm;
Help the inquirer talk about and work through his/her feelings as part of the assessment
and problem solving stages of the interview;
Endeavor to keep the inquirer on the telephone pending referral or rescue.
3.
The I&R specialist shall have the skills to recognize the warning signs of persons at
imminent risk of suicide, violence or victimization (including signs of abuse/neglect, domestic
violence and risk of homicide or self-harm) whether the risk issues are explicitly stated or
implicit. In cases of suspected child abuse or elder abuse, the I&R specialist shall be familiar
with his/her responsibilities under the prevailing legislation of the jurisdiction regarding
mandatory reporting and shall file a report when indicated.
4.
In situations involving suicide or homicide, the specialist shall understand the
circumstances under which a lethality assessment1 is required and shall conduct an
appropriate assessment when necessary. Lethality assessments shall be documented and
shall include a description of specific actions taken in response to the situation.
5.
The I&R specialist shall have the skills to recognize when an inquirer is in immediate need
of intervention, (e.g., when a person is in medical crisis due to alcohol or drug intoxication,
has taken steps to end his or her life, is experiencing violence or is experiencing a psychiatric
1
A lethality assessment is an evaluation based on research of how dangerous a situation is and
addresses issues such as the person’s intention, method, timing and state of mind. Questions
include: Has the person already taken steps toward committing suicide by swallowing pills,
slashing their wrists? Have there been previous attempts? Does the person have a specific
plan? Are the means to carry out the plan readily available? What is the likely timeframe for a life
threatening event – the next few minutes or hours or longer? Has the individual had psychiatric
help in the past and how do they feel about it? Are there other risk indicators such depression,
hopelessness, feelings of isolation, intoxication, and significant recent loss?
40 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
6.
emergency) and shall follow the I&R service’s rescue protocol for when to access 911 or
other emergency personnel to intervene and save the individual’s life.
7.
In cases of domestic violence and other endangerment situations, the I&R specialist shall
take special precautions to safeguard the inquirer’s identity and all aspects of their interview.
8.
The I&R service may utilize a variety of means to support their ability to conduct rescue
services including Caller ID or a call tracing arrangement with the telephone company or the
appropriate 911 service. At a minimum, there must be a separate telephone that is available
for initiating rescue procedures without interrupting the crisis call. The specialist shall follow
the I&R service’s protocol for addressing callers who wish to remain anonymous yet require
rescue.
9.
When feasible, I&R specialists shall connect inquirers in crisis situations to a formal crisis
intervention service in their community for longer-term assistance and support once the
inquirer’s immediate, short-term needs have been met. The connection shall be made by
direct transfer, when possible, and the specialist shall follow the protocol established by
agreement with the crisis center.
10.
In cases where the inquirer has been referred to a formal crisis intervention service rather
than transferred directly, the I&R specialist shall follow up to ensure that the individual has the
ongoing support s/he needs.
11.
If the I&R service does not itself provide a formal crisis intervention service but receives
calls from people who are in crisis, it shall have prearranged protocols with an appropriate
crisis center that does. The arrangements shall be documented in a written MOU, MOA or
SLA.
12.
The I&R service shall have written crisis intervention policies and procedures that provide
call handling protocols for specific types of emergencies. Included shall be lethality
assessment procedures, protective measures relating to inquiries from individuals in
endangerment situations, protocols that address inquirers who wish to remain anonymous yet
require rescue and the organization’s rescue protocols.
Add to Training Standard (#18) as a new Point #4
4. Pre-service training shall include a module that prepares I&R specialists to deliver
effective crisis intervention services related to a broad range of problem areas including
assistance for individuals threatening suicide, homicide or assault; suicide survivors;
victims of domestic violence, child abuse or elder/dependent adult abuse; sexual assault
survivors; runaway youth; people experiencing a psychiatric emergency; chemically
dependent people in crisis; survivors of a traumatic death; and others in distress. The
curriculum shall include attitudinal, knowledge and skill outcomes. Attitudinal outcomes
include:
 Ability to provide a non-judgmental response to sensitive issues (e.g., not discussing
suicidal ideation with a Caller in terms of moral rightness or wrongness).
 A balanced and realistic attitude toward oneself in a helper role (e.g., not expecting to
“save” all potential suicides by one’s own single effort, or to solve all of the problems of
the distressed person).
 A realistic and humane approach to death, dying, self-destructive behavior and other
human issues.
 Coming to terms with one’s own feelings about death and dying insofar as these feelings
might deter one from helping others.
Knowledge outcomes include:
41 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org









Crisis theory and the principles of crisis management.
Basic suicidology including suicide/lethality assessment, use of assessment tools and
related legal issues.
Victimology including assessing the risk of an individual assaulting others or being
assaulted.
Community resources.
The consultation process (who to contact and the conditions under which contact should
be made).
Voluntary and involuntary hospitalization criteria and procedures.
Organizational policies and procedures related to crisis intervention.
Warning signs or risk indicators for various issues.
Helpful initial strategies to use for each issue.
Skill outcomes include:
 Assessment techniques in life-threatening situations including risk of suicide or homicide.
 Crisis management techniques including strategies for keeping inquirers on the line while
a rescue or transfer is being made.
 Efficient and effective mobilization of community resources.
 Effective use of the consultative process.
Adopted By AIRS Standards Committee October 14, 2004
Adopted By AIRS Board October 15, 2004
42 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
A Few Things About Role-plays and Feedback
Feedback Ground Rules
 Have fun!
 Don’t be afraid to make mistakes. You are learning something new. Mistakes teach us how to
improve our skills
 Participate in feedback.
 Track your progress through the Model.
 Vary the Active Listening Skills you use.
 The person receiving feedback should be in charge.
 Corrective feedback should be balanced and address specifics while offering alternatives.
 The person receiving the feedback should summarize.
Feedback should:
 Focus on strengths.
 Be helpful, not harmful.
 Be concrete and specific.
 Be non-judgmental.
 Be focused and precise
43 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Role Play Feedback Form
7 Active Listening Skills are:
Silence; Encouragement; Reflection;
Paraphrasing; Summarizing; Restatement; and
Clarification
Role Play was about:
5 steps of the Crisis Intervention Model are:
Defining The Problem; Exploring Goals;
Generating Alternatives; Planning; Closure
Listening Skills used:
What step in the Model was attained:
2 Items of Positive Feedback:
1 Suggestion for improvement:
44 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
Stem Statements
•Could it be that you’re feeling...
•If I’m hearing you correctly...
•I wonder if...
•It’s almost like you are saying...
•I’m not sure if I’m with you, but...
•So, you are feeling...
•What I guess I’m hearing is...
•So, as you see it, you feel...
• Let me see if I’m following you
•It sounds as though you are saying...
•You appear to be feeling...
•I wonder if you are saying...
•It appears you...
•I hear you saying...
•Perhaps you’re feeling...
•So, it seems you...
•Maybe you...
•So, from where you are...
•Maybe this is a long shot, but...
•Right now you feel...
•From what you’re saying
•I sense that you’re feeling...
•It seems that you...
•You must have felt...
•As I hear it, you...
•It appears
•Seems to make you feel…
•Listening to you, it seems as if...
•It seems you…
•I gather you feel...
•What I think I’m hearing is...
•Sounds like…
•Let me see if I’m with you; you...
•If I’m catching what you say...
•I get the impression that...
•As I think about what you say...
•The message I’m getting is that...
•It occurs to me...
•As I get it, you felt that...
•I’m picking up that you...
•It seems that sometimes you think....
•It might help if you could tell me...
•Tell me more about
•Say something about…
•Let’s talk about...
•I’m wondering if...
45 of 46
106750244
Crisis Intervention For I&R Workers
John Plonski – Covenant House International – 212-727-4040 – jplonski@covenanthouse.org
A Sense Of Loss
Abominable
Absorbed
Accepting
Aching
Admiration
Affected
Affectionate
Afflicted
Afraid
Aggressive
Agonized
Alarmed
Alienated
Alive
Alone
Amazed
Angry
Anguish
Animated
Annoyed
Anxious
Anxious
Appalled
Ashamed
At Ease
Attracted
Bad
Bitter
Blessed
Boiling
Bold
Bored
106750244
Brave
Bright
Calm
Certain
Challenged
Cheerful
Clever
Close
Cold
Comfortable
Comforted
Concerned
Confident
Confused
Considerate
Content
Courageous
Cowardly
Cross
Crushed
Curious
Daring
Dejected
Delighted
Depressed
Deprived
Desolate
Despair
Desperate
Despicable
Determined
Detestable
Devoted
Diminished
Disappointed
Discouraged
Disgusting
Disillusioned
Disinterested
Dismayed
Dissatisfied
Distressed
Distrustful
Dominated
Doubtful
Doubtful
Drawn Toward
Dull
Dynamic
Eager
Earnest
Easy
Ecstatic
Elated
Embarrassed
Empty
Encouraged
Energetic
Engrossed
Enraged
Enthusiastic
Excited
Fascinated
Fatigued
Fearful
Festive
Forced
Fortunate
Free
Free And Easy
Frightened
Frisky
Frustrated
Fuming
Gay
Glad
Gleeful
Good
Great
Grief
Grieved
Guilty
Happy
Hardy
Hateful
Heartbroken
Helpless
Hesitant
Hesitant
Hopeful
Hostile
Humiliated
Hurt
Important
Impulsive
In A Stew
In Despair
Incapable
Incensed
Indecisive
Indifferent
Indignant
Inferior
Inflamed
Infuriated
Injured
Inquisitive
Insensitive
Inspired
Insulting
Intent
Interested
Intrigued
Irritated
Joyous
Jubilant
Keen
Kind
Liberated
Lifeless
Lonely
Lost
Lousy
Love
Loved
Loving
Lucky
Menaced
Merry
Miserable
Misgiving
Mournful
46 of 46
Nervous
Neutral
Nonchalant
Nosy
Offended
Offensive
Open
Optimistic
Overjoyed
Pained
Panic
Paralyzed
Passionate
Pathetic
Peaceful
Perplexed
Pessimistic
Pessimistic
Playful
Pleasant
Pleased
Positive
Powerless
Preoccupied
Provocative
Provoked
Quaking
Quiet
Reassured
Rebellious
Receptive
Rejected
Relaxed
Reliable
Repugnant
Resentful
Reserved
Restless
Sad
Satisfied
Scared
Secure
Sensitive
Serene
Shaky
Shy
Skeptical
Snoopy
Sore
Sorrowful
Spirited
Strong
Stupefied
Sulky
Sunny
Sure
Surprised
Suspicious
Sympathetic
Sympathy
Tearful
Tenacious
Tender
Tense
Terrible
Terrified
Thankful
Threatened
Thrilled
Timid
Tormented
Tortured
Touched
Tragic
Unbelieving
Uncertain
Understanding
Uneasy
Unhappy
Unique
Unpleasant
Unsure
Upset
Useless
Victimized
Vulnerable
Warm
Wary
Weary
Woeful
Wonderful
Worked Up
Worried
Wronged
Zany