ANA VERONICA M.

CONCEPCION Master in Psychology

INSIGHT PAPER ON CRISIS INTERVENTION MODELS

The readings have clearly discussed about the different crisis assessment

and intervention. These models can be used depending on the situation present. It

includes crisis assessment and intervention models with children and youth, crisis

intervention and crisis prevention with victims of violence as well as in health-related

and mental health-related crises. Different models such as the ABC and LAPC

models were also discussed.

According to the what I have read, in order to develop basic crisis intervention

skills, it is necessary to have a model on which one can work from, allowing us to

understand the situations that bring a person into crisis that overwhelm a person’s

coping strategies, where they find themselves unable to take further positive action,

and the tasks that must be completed to help them successfully navigate such a

crisis.

Although the model is presented in a linear fashion, in actuality a client may

move between these steps, moving forward and then regressing back as their

situation changes. It is important for the worker to be at least somewhat certain of

the stage his client is in so that he can respond appropriately.

1. The Six Stage Model of Crisis Intervention

This model of crisis intervention is from James (2008) who has adapted it

from Gilliland (1982). These steps form the foundation of intervening with an

individual to help give them a sense of control and help to restore basic coping skills.
 The first step in crisis intervention process is to determine exactly what the

problem is. This part of the process helps establish a connection between yourself

and the client. The active listening process is important here: open-ended questions

and the core factors of empathy, genuineness and positive regard.

The second step is to ensure the safety of the client. This involves suicide

risk assessment, as well as checking homicide risk. Removing access to

lethal means of suicide as well as other items that can be used to hurt yourself and

the client are important. For instance, in an average office, scissors, paper cutters,

staplers and three-hole punches can all be used to injure self or others.

After the client is physically safe and the problem has been adequately

defined, the third step is for the crisis worker to accept the client as a person of

value and communicate that they care about them. This can involve simply talking to

the client about what’s going on in their life, taking care of basic needs such as food

and shelter.

Once the client has their basic needs met, the next part of providing support is

ensuring the client has enough information to understand their available options for

dealing with their situation.

Step four is where the client is encouraged to explore potential solutions to

what they’re dealing with. A client whose coping skills are suspended will have

difficulty coming up with options and this is where the crisis worker comes in.

James identifies three categories of potential alternatives named: situational

supports, coping mechanisms, and positive and constructive thinking patterns.

Situational supports refer to individuals around the client who might care about what

happens to the client. Coping mechanisms on the other hand refer to actions,

behaviors or environmental resources where the client can draw on to help get
through their situation. Assessing coping skills is a key part of telephone crisis

intervention, which should explore what they did in the past, present, and then future.

And lastly, positive and constructive thinking patterns refer to new ways of thinking

about the client’s situation that can help them reframe.

Now that the client trusts the crisis worker, they have provided immediate

safety and met basic needs, explored alternatives, it’s time for the fifth step which is

to make a plan. The goal of this step is to focus on concrete steps that can help

restore control in the client’s life, and identify other referral resources that can help

provide the client additional support.

Making sure the plans are realistic and not overwhelming is a key part of step

5. Clients must feel empowered by the plan in order for them to proceed with it,

therefore working collaboratively is extremely important. Many clients have been

disempowered or oppressed before seeking (or being forced into) treatment, and

continuing this pattern will lead to poor outcomes.

The final step of the process, is obtaining commitment. If you’ve worked

together with your client, obtaining commitment should be easy. You may need to

write down the plan for the particularly overwhelmed client to keep track of it, and

follow up with them to ensure that they have followed through with the plan.

2. ABC Model of Crisis Intervention

A simple model of crisis intervention is the ABC Model. A number of crisis

intervention models use this same three step process. Essentially, it involves

establishing a relationship (A), understanding the problem (B), and taking action (C).

On the other hand, this model uses Achieving Rapport, Boiling down the

Problem and Contracting for Action.

 Achieving rapport describes the emotional and physical aspects used to

establish a connection with the suicidal person you’re working with. This involved

physical safety, emotional connection and good rapport. Some physical ways that

you can establish rapport include the following:

o Ensuring there is no obstacles between yourself and the suicidal

person such as chairs and tables: rapport is improved when there is

nothing between you;

o Solid eye contact: when you look at someone rather than looking away

it establishes that you’re able to talk openly about suicide;

o Orienting your body towards someone: this is a subconscious cue that

you think positively of that person; and

o Keeping your arms uncrossed and legs open: crossed-arms and legs

pressed together are signs of anxiety or dislike.

Meanwhile, you can establish emotional safety and comfort through the

following:

o Validate what the person is saying;

o Use empathy statements, which are statements that highlight an

emotion while responding. For instance, if someone says that they’ve

had a fight with their wife, and that it keeps happening you might say “It

sounds like you’re feeling really frustrated.” This captures the emotion

underlying the experience and is an important part of helping someone

feel understood;

o Use a calm, even voice-tone – don’t speak too quickly and don’t cut off

the other person; and

 o Avoid judgement such as “why” questions. Instead ask “How come?”

When rapport is established, the suicidal person will be comfortable and able

to express themselves.

The next step in the ABC Model of Crisis Intervention is boiling down the

problem. This involves a careful mix of open and closed questions to make sure that

you fully understand what is making the person suicidal. You can start by asking

them what they think is the source of their suicidal pain.

Suicidal thoughts are often the result of events that overwhelm a person’s

personal coping methods. These methods can be different for every person and so it

is unwise to assume that something isn’t an issue for the suicidal person unless

you’ve spoken to them about it.

For example, a student who has never failed a test before could become

suicidal over a perceived threat to their Ivy League college hopes based on failing a

test, while another student may have had many ups and downs and therefore has

learned to cope with this loss.

When you feel that you have a good understanding of the suicidal person’s

problems, it’s important to work with them to implement some long-term changes. If

you think back to the CPR Model, we need to assess whether the person is Low

Risk, Medium Risk or High Risk.

Contracting for action means developing plans with the client that they can do

within the next 24 hours (or another short period) in order to ensure their safety.

When the suicidal person is low risk, your role should be to help with any practical

referrals and building up their support network. For instance, someone who is having

financial issues, referral to debt counselling would be helpful. Exploring the person’s
resources to see if there are those, they can rely on who they may not be seeing will

also be helpful.

Emotional support is most important at this stage so that the person feels

comfortable expressing themselves without feeling judged or stigmatized.

When the suicidal person is medium risk, it’s important to work collaboratively.

Getting the suicidal person to agree to more comprehensive support will be easier if

they know that you care. Taking steps to reduce risk by encouraging the person to

remove access to suicide methods is also important.

Ensure that you follow up with the person to make certain that they’ve taken

advantage of the referrals. By checking in with them frequently and continuing to

assess their suicide risk even on a simple 1-10 scale will help you tell if their suicidal

risk is being reduced.

When the suicidal person is high risk, it’s important to take immediate steps to

reduce that risk. You should be directive with the person, taking immediate steps to

guarantee their safety. This will involve checking for suicide attempts in progress,

referrals that you make with the suicidal person and possible hospitalization if they

don’t think they can remain safe throughout the night.

In order to assess for immediate risk, you should ask questions like, “Are you

in danger?”, “Have you taken anything tonight?”, “Have you done anything tonight to

hurt or kill yourself?” If the person admits that yes, they have, then it’s important to

get details and make the call to 911 if necessary.

If not, you should explore what they can do to ensure their safety. This may

involve calling a crisis line if they don’t feel safe, calling 911 or going to a hospital

emergency room or staying with you (or someone else they can rely on) to keep

them safe.
 This ABC Model of Crisis intervention is supported by scientific methods with

evidenced based practices. They are used to treat crisis situations, change

behaviors, and reduce suicidal ideation. These practices use the reframing of

perception of events (thoughts about the event) to help. By helping a person to

change the way that they see the event, a human services crisis worker can do the

work of crisis intervention in a short amount of time.

An example that many may be familiar with is at the loss of younger loved one

(crisis), wherein one might ask themselves why this had to happen and why were

they taken away when they were so young, it’s not fair! (perception) and the crisis

begins with resistance of acceptance.

With the help of the ABC Model of Crisis intervention, the crisis worker can

help the person suffering from the crisis. It can change that viewpoint or accept it by

reframing. The helper may have to go with age old maxims like life must go on. They

are in a better place. We just don’t know what god has planned or even that person

just might be needed some place else.

Any one of these are valid reframing or cognitive disputation techniques.

These could assist in changing the way that the viewer sees that event. The ABC

Model of Crisis intervention can help move a person from one perception which can

cause great pain like, “it’s not fair” to another thought which may reduce crisis

situation levels (the pain will probably still be there but the person can function again)

like, “although it does not seem fair, how am I to question life and its plans, there

may be something bigger involved here.”

This ABC Model of Crisis intervention may seem simplistic or even unreal.

During a crisis, when a person needs help as quickly as possible, a rewrite of their

perception is crucial. It can help that person to cope. The intervention may not
completely alleviate the situation. It might just bring the levels of crisis down enough

so that it can be managed. The person receiving the intervention can be helped to

begin functioning again.

3. LAPC Model of Crisis Intervention

The LAPC model was created by Cavaiola and Colford (2006) in their

textbook Crisis Intervention Case Book . The advantage of the LAPC process is that

it is easy to remember and apply, whether you are a degreed professional or a

layman who has received a short amount of training. One of the difficulties of other

crisis intervention models is that it can be difficult to recall the processes when they

are needed most.

A client who is at high risk of danger will need a very directive approach

where the crisis worker directs the intervention, a client at a moderate risk of danger

will work best with a collaborative approach where control is shared, and a client at a

low risk of danger should have a very non-directive approach where they lead.

The four steps of the LAPC Model include Listen, Assess, Plan and

Commit. The first step in the crisis intervention process is to listen. This seems

obvious but, in a crisis, it can be very easy to fall into the trap of hearing what

we think is happening, rather than what is actually happening. If we fail to

understand what the person in crisis is actually experiencing, we will respond

inappropriately.

Techniques used in the listening process include open-ended questions,

paraphrasing and clarifying, and summarization. These are all primary counselling

skills and are an inherent part of the active listening process.

 In addition to hearing what a client is actually telling you, you should work

carefully to avoid facial expressions or reactions which could be seen as judgmental.

This is especially important when disturbing or scary content like suicidal or

homicidal thoughts, sexual abuse or others are covered.

Assessment is the next part of the process. This may be a structured and

formal process such as if you choose to use the CPR or DCIB Suicide Risk

Assessments or may be a much more informal process of synthesizing what you

have learned in order to formulate an accurate picture of where needs are unmet or

risk is present.

If you have failed to listen correctly, your assessment will not target the

correct areas the client will not feel heard. Additionally, if you’ve missed signs of

suicide or homicide risk or in children, neglect or abuse you may place the client or

others at risk.

The third step in the process is planning. In cases of suicide or homicide

risk, safety planning will be the first order of business. For instance, someone who

wants to overdose may give the pills to someone who can safeguard them, employ

coping strategies to help ground themselves watching their favorite movie or

exercising for instance, or agreeing to call a crisis line if they can’t stay safe.

Once immediate safety concerns have been taken care of, other planning can

take place. This may involve referrals to organizations for longer-term support like

counselling or case management, or otherwise performing the first steps to restoring

equilibrium.

Planning should be a collaborative process between you and the client. If you

simply take control and do everything for the client, they will feel disempowered and

dependency may result.

 Finally, it’s important for the client to commit to the plan. If they have been

involved in the process up until now, they should have little concern with committing.

In some situations, like child welfare, there will be no option for them to “opt out” and

they may be upset but getting them involved is still required.

Overall, whatever model a mental health professional will use in response to

crisis, it is important to always ensure the betterment of the patient. Selection of

appropriate model to be used also depends upon the situation and other factors

involving the patient.