Running head: MODELS OF CRISIS INTERVENTION 1

Models of Crisis Intervention

Trudi Boyd

Troy University
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Models of Crisis Intervention

Crisis situations have always existed in some form or another. However, in recent history

crisis events seem to be more prevalent. Those in the helping professions are usually on the front

lines when a crisis situation occurs. In particular, mental health professionals will undoubtedly

face crisis situations within community mental health facilities, outpatient clinics, school

counseling centers, and even hospital emergency departments. It is important to have a crisis

intervention plan in place when presented with a crisis situation, especially an acute crisis

situation such as suicide. (Roberts & Ottens, 2005) For counselors, dealing with a suicidal client

is one of the most challenging and difficult situations one can face. (Granello, 2010) According

to a study by Rogers, Gueulette, Abbey-Hines, Carney, and Weth, (2001), 71% of counselors

reported at least one of their clients had attempted suicide and another 28% reported that a client

had actually completed suicide. (p. 368)

Adolescent Suicide Crisis

Unfortunately, one crisis that has been on the rise in recent years is suicide among

adolescents. The largest increase in suicide rates over the past ten years has been in the age

group of 15 to 24 year olds. (Centers for Disease Control and Prevention, 2020) [CDCP]

Additionally, the Youth Risk Behaviors Survey of 2017 reported that 7.4% of adolescents in

grades 9 through 12 had attempted suicide at least once within the past year. ("Suicide Statistics",

2020) These are alarming statistics and have brought about a shift in suicide awareness and a

focus on prevention. There are many risk factors associated with suicide and the causes are very

complex. This makes it difficult to determine the reasons for the rise and fall of suicide rates.

(Weir, 2019)
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Suicide attempts and ideation are often brought about by some negative factors, whether

social contextual or personal. However, many adolescents who attempt suicide already have a

psychological disorder such as anxiety or depression. Many have also experienced some type of

trauma or life-altering event. This could include abuse, death of a loved one, or a significant

change within their school or home environment. (Murrell, Al-Jabara, Moyer, Novamo, &

Connally, 2014) In fact, a study by Dube et al. (as cited in Murrell et al., 2014) concluded that

80% of suicide attempts of children and adolescents would not have occurred if they had not

experienced a negative event. One negative event can increase the risk of suicide by 1.4% in

children and adolescents. Seven or more negative events increased the risk of suicide by 51-fold

in this age group. (p. 41)

Granello and Granello 2007 (as cited by Granello, 2010) found that fortunately, a widely-

held belief of suicidologists is that most people do not want to die, but are just unable to continue

living in their current state of physical or psychological pain. (p. 219) This means that mental

health professionals must respond quickly to a presented crisis situation and be knowledgeable in

the practices and principles of crisis intervention. (Roberts & Ottens, 2005) A crisis situation is

an important opportunity for significant change. (Ginnis, White, Ross, & Wharff, 2015) For this

reason, crisis workers need to have a crisis intervention model in place to guide them when

responding to a suicidal crisis. (Roberts & Ottens, 2005) Two such models of crisis

interventions are the Attachment -Based Family Therapy (ABFT) Clinical Model and the Seven-

Stage Crisis Intervention Model.

Attachment-Based Family Therapy Clinical Model

Depression is prevalent among adolescents and is significantly co-morbid with the risk

of suicide. Family-based treatments for adolescent depression and suicide are promising because
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much of the depression and suicide risk has been associated with family stress, conflict, and

negative functioning of the family. (Ewing, Diamond, & Levy, 2015) ABFT is a family-based

approach that is used for treating depression in youth, including those with a suicide risk and

their families. ABFT is related to attachment theory and has clinical roots in emotion focused

therapy and structural therapy. ( Ewing et al., 2015) The goal of ABFT is to build reconnection

and attachment between adolescents and their parents during a time of crisis. (Bickerton, Ward,

Southgate, & Hense, 2014) In ABFT, the counselor conducts individual sessions with both the

adolescent and the parents, as well as combined sessions with both the adolescent and the

parents. ABFT uses five treatment tasks to move through the treatment process. Task 1 is the

Relational Reframe. This is done in the first session with the adolescent and the parents. This

task involves shifting the way the family members view the problem and the solution. The goal

is for everyone to agree to participate in relational-focused therapy. This task is essentially the

assessment phase to gather information from the adolescent and the parents. Task 2 is The

Adolescent Alliance task. This usually last 2 to 4 sessions and is a way to gain a better

understanding of their attachment narrative, such as thoughts, memories, and feelings. The goal

of this task is to revive the value of attachment and the willingness to renegotiate it. The Parent

Alliance Task is the third one. This task can also last 2 to 4 sessions and focuses on the parent's

caregiving and reshaping the ways in which parents interact with the troubled adolescent. Fourth,

this Task is the Repairing Attachment Task. This tasks only occurs once goals have been met

from task 2 and 3. Task 4 usually takes place over 1 to 3 sessions. This task uses the parent-child

interactions to create in vivo experiential episodes in order to restructure intrapsychic and

interpersonal functioning. The fifth task can take 4 to 8 sessions and is called the Autonomy

Promoting Task. This task allows parents to help the adolescent to resolve issues that are not
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family based, such as school, a job, or depression. The ultimate goal is to resume negotiation of

more normal issues related to the development of the adolescent. (Ewing et al., 2015)

The Seven-Stage Crisis Intervention Model

This model of intervention has crisis theory as its theoretical foundation and offers

counselors a strategy to work with suicidal clients. According to Roberts & Ottens (2005),

"Crisis intervention is no longer regarded as a passing fad or as an emerging discipline. It has

now evolved into a specialty mental health field that stands on its own" (p. 332). The first stage

in this model is to access lethality. An accurate assessment is the first and most important step

when working with suicidal people. The counselor must ensure the immediate safety of the

individual and follow the existing emergency suicide plan already in place. Stage two is to

establish rapport. The therapeutic relationship is a determining factor on positive treatment

outcomes. The counselor should stay with the client through the assessment phase, initial

treatment plan, and hospital intake, if necessary. The third stage involves listening to the story of

the client. Counselors should listen, understand, and validate what the client is saying. It is

important to slow things down and help ease the anxiety of the client while identifying the

message that the client is giving. Stage four is to manage the feelings. This includes encouraging

emotional ventilation by allowing the client to feel safe in expressing their emotions without fear

of being judged. This stage also involves acknowledging the pain that the person is in and

teaching them how to tolerate negative emotions. The fifth stage is to explore alternatives. It is

critical for the client to explore alternatives to their current situation. Establishing a problem-

solving framework is also important because it takes the focus from suicide being the solution to

coming up with different solutions. Stage six involves using behavioral strategies. The counselor

and client should jointly come up with a positive behavioral management plan that addresses
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what needs to be done over the next few days. A safety plan should also be created. A safety

plan allows the client to know what to do when they have thoughts of suicide. This could include

names and contacts for people to be called upon for support, including contact information for

the counselor, and for local community resources. The last and seventh stage is follow-up. The

type of follow-up required will vary depending on the risk level of the client. Follow-up can

include telephone contacts, home visits, cognitive behavioral therapy and of course a clear safety

plan. (Granello, 2010)

Comparison and Contrast of the Two Models

These two models of crisis interventions share some similarities. In both models, the

assessment phase is very important in gathering information about the person and being able to

determine a level of lethality. Both models require coming up with a safety plan to keep the

client from immediate harm and including a support system, such as family. In contrast the two

models differ greatly because the ABFT focuses on repairing the attachment issues that have

developed within the adolescent, while The Seven-Stage Crisis Intervention Model focuses

more on the individual in crisis. The two models could be applied to any person in crisis, not

just suicidal clients.

Gaps and Limitations of the Two Models

ABFT is a promising empirically supported and evidence-based treatment for

adolescents with depression and anxiety. However, there are still some limitations that need to

be addressed. One question that needs to be answered is if the efficacy of ABFT treatment will

hold up with a more stringent control condition as compared to treatment as usual. Another

question is if ABFT-related reductions in depression can maintain and continue at follow-up

points after treatment. Also, the accepted mechanisms of ABFT-related change and the impact it
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has on the outcome of treatment have not yet been thoroughly tested. Despite some limitations,

ABFT is a promising family-based treatment but can benefit from additional empirical evidence

to help clinicians and researchers develop a complete understanding in regards to the nature of

suicide. The Seven-Stage Crisis Intervention Model is an evidence-based approach used to assist

clinicians in quickly addressing acute crisis situations. However, although there are promising

treatment effects, there needs to be longitudinal studies to determine the long-term impact of

this treatment. Crisis intervention needs to be refined by implementing booster sessions after

sessions 1, 6, and 12 months. If not, then after 12 months postcrisis intervention, the positive

outcomes may wash out.

Psychological First Aid

Individuals who survive a traumatic experience or event sometimes develop challenges or

enduring problems. In an effort to better assist these survivors, The National Child Traumatic

Stress Network and the National Center for PTSD collaborated to design a set of helping actions

called Psychological First Aid (PFA). PFA is intended to be used by mental health responders,

including mental health counselors, to provide immediate support for survivors of traumatic

events.(Ruzek et al., 2007) The goal of PFA is to reduce initial post-trauma distress and it can be

delivered anywhere that survivors can be found. PFA is designed for practical and simple

administration in field settings. There are 8 core actions and goals of PFA:

1. Contact and Engagement-the goal is to respond to those affected persons and /or

initiate contacts in a compassionate, helpful manner, yet to be non-intrusive.

2. Safety and Comfort-the goal is to ensure the immediate safety for the individual/s and

provide comfort, both physical and emotional.

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3. Stabilization(if this is necessary)-the goal is to calm down the traumatized survivors

who are emotionally overwhelmed.

4. Information Gathering: Current Needs and Concerns- the goal is to gather information

and identify the immediate concerns and needs of the survivors in order to determine PFA

interventions.

5. Practical Assistance- the goal is to help the survivor address their immediate needs by

offering practical help.

6. Connection with Social Supports- the goal is to structure opportunities for ongoing or

brief support with support persons, such as family members, community resources, and friends.

7. Information on Coping Support-the goal is to provide information to the survivors that

can help them deal with the aftermath of the event, such as education on coping skills and stress

reactions.

8. Linkage with Collaborative Services- the goal is to link survivors with the services

they need and inform them about services that they may need in the future. (Ruzek et al., 2007)

Conclusion

Adolescent suicide has been a growing problem over the last decade. Crisis situations are

going to inevitably occur. It is the responsibility of mental health professionals to have a plan in

place when faced with these crisis situations. The two models of crisis intervention presented

here can be used for the treatment of suicidal crisis situations, however, there are numerous

others as well. It is important that mental health professionals use evidence-based, empirically

supported models of intervention in order to ensure the best outcome of those affected

individuals.
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Ewing, E. S. K., Diamond, G., & Levy, S. (2015). Attachment-based family therapy for

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