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Investigation of crisis

Discuss about the Crisis Intervention Changing and Moving.

In the modern day society, everything is changing and moving quickly with the fast pace, where people tend to lack patience, it is not surprising that the mental health field has added specialists known as the crisis intervention professionals. They bridge the services of mental health and police (France, 2015). A crisis is said to be situation where things become difficult to cope up as a consequence of past and present events in life leading to distress and functional impairment. A crisis may cause an individual to lose focus on life feeling helpless and hopeless affecting the overall physical and mental wellbeing (Brecher & Wilkenfeld, 2014). Therefore, without intervention, attaining the present and the future goals become impossible. The essay discusses the crisis intervention in response to a case study. The essay begins with the explanation of crisis and its impact on the person’s functioning. Later, the essay discusses the “MYER, JAMES and MOULTON's 7-task hybrid model of crisis intervention” and describes how it is implemented for the person in crisis to guide them in right direction. Lastly, the essay discusses the challenges of this crisis intervention model and the strategies to overcome these challenges.

It was in the month of November, 2016, when a women called a crisis intervention shelter in the afternoon to intervene a women in crisis. When the team reached the scene, it was a women named as Anne for this paper, She was complete emotional wreck due to her husband’s suicide recently. On arriving the scene, the crisis intervention worker met a woman of 45 years  who then introduced him to Anne and said it was she who called him  for help. It was evident from Anne’s swollen and red eyes that she has been crying since a long time. She appears to be highly exhausted and agitated and preferred to avoid eye contact with the couselor. Her eyes were focused on a piece of paper kept in front of her on the table. Prior to initiating any communication with the client, the crisis intervention worker obtained some information from her neighbourhood. The rationale for not directly communicating with the client was need of assessing the situation effectively that will help the professional to deduce the appropriate approach of intervention (James & Gilliland, 2012). Since the lady was in crisis and it was a delicate issue the aim is to proceed in manner that does not hurt her and lead her in right direction to resolve the problem (France, 2015). As per the given information, Anne and her husband John were happily married for years. Recently, John lost his job for embezzlement. After her husband’s death Anne had discovered that she is left with huge debt and financially unstable.

Impact of crisis on the functioning

An individual experiences poor physical and mental health condition during crisis (Caplan, 2013). Extremely traumatising situation particularly due to sudden death in family increases heart palpitation, chills, profuse sweating, with changes in sleep pattern (Murphy et al., 2012). Such people also lose appetite and are highly vulnerable to harm themselves. Due to mental instability and loss of psychological homeostasis a person becomes startled with sudden noise and highly panic during any situation reminding them of trauma. They also tend to have nightmares and their behaviour appears irritating for others (Brecher & Wilkenfeld, 2014).

After careful observation of Anne, the counselor learned that she was not in the state to deal with her daily circumstances, as she was completely distraught of with her loss. According to Parkes & Prigerson, (2013) an individual experiencing bereavement of loved one’s suicide tend to feel beyond those of a loss from different type of death. Unlike other types of death, the loss occurring due to suicide leaves the surviving partner with deep guilt. Laura was highly depressed and filled with burden of catching and preventing the signs of death. She is regretting that if only she could sense her husband’s feelings earlier that she could have prevented his death. However, she seems to have lost the balance of her life with disturbed cognitive thinking unable to sought the problem created by her husband. According to the “American Association of suicidology” person in crisis with high level of depression, stress and anxiety believe that they never will be able to return to the state before the crisis has occurred (Dinakar et al., 2015). It was also true for Anne as it is obvious that the severe financial crisis have led to high mental pressure. During the initial meeting with Anne she was avoiding eye contact with the worker. She was motionless and deflated. It was difficult for the crisis intervention worker to identify what she was thinking, what would be her next move, and if she was planning to harm herself or if she was under the influence of any drug to free herself from depression or is in any state of illusion.

Without gaining sufficient details about Anne’s mental state and impact of crisis on her functioning it is difficult to resolve the crisis. Therefore, in the process of gaining additional information on the client, the 7 task hybrid model (introduced by Myer, James & Moulton in 2011) was implemented.

Development of crisis intervention model

The hybrid model of crisis intervention is used here to deescalate the crisis being discussed here. These will be implemented using seven tasks hybrid model which is a framework for the crisis workers to deal with the people in crisis and mentally ill (James & Gilliland, 2012). This model contains seven steps acting as roadmap to solve the problem, attain goal and resolve the crisis (Erber, 2014).

The first task is to predispose, engage and initiate contact with Anne. He may begin by asking her “We are here to help you...would you like to talk to us?” At this stage, the worker allows her to vent out inner frustration and be empathetic to make her built trust in the services. This will thus help the client to be more receptive to the intervention.

The second task of the model is to explore the problem situation. At this stage the crisis worker have to ask some close and open ended questions to define the crisis. He can start with questions like “can you describe what happened then?”, “well what did your husband say?” and then later paraphrase her statements. The aim of this step is to understand the client’s perspectives by demonstrating the core listening skills which are acceptance, empathy, genuineness (Spielfogel & McMillen, 2016). This helps to identify the immediate factors that led to crisis.

The third task is to provide adequate support to the client. At this stage the crisis worker will deliver physical and psychological support to Anne.  He can use statements like “I can understand it is difficult to clear all the debts in single day, I can understand your worried about how to survive without money.” Next thing is the professional can provide Anne with informational support such as a good job that can relieve some of her problems, alternate solutions to prevent eviction from her apartment, request the official people for delayed payment.

The fourth task is to ensure the safety of the client. Anne confessed that she is finding difficult to reasoning critically so the crisis worker ensured that she does not have a weapon in her proximity to harm herself or commit suicide.

The fifth task is to examine the alternate solution for her crisis. The interventionist may ask Anne to jot down all the thought in her mind in a piece of paper. This will allow addressing any negative thoughts that she has in mind.

Challenges of crisis intervention model

The sixth stage is to plan for reestabilising control. Anne may be referred to counselor for long term therapy as she is distracted and distraught or to the local offices of the “cabinet for families and children that can help her with resources such as shelter, food and medical facilities. At this stage, Anne will be asked to describe her feelings about the current situation as the action plan is implemented and what steps she would prefer to solve her situation. The crisis worker at this point obtains commitment from the client to fight the crisis and assure that client is okay with solutions provided.

The seventh stage is the follow up of the plan and includes booster sessions. It may include evaluating the post crisis status of Anne including assessment of overall functioning, presence of current stressors.

While implementing the 7 hybrid task model the counselors face several challenges. According to Rodda et al., (2015), while providing psychological debriefing to the client which are mandatory, the crisis worker may also be psychologically effected. The crisis intervention process is nonlinear and does not contain organized discourse and method of evaluation. Additional challenges include arranging the seven tasks of the intervention model in discrete manner (Spittal et al., 2015). The researchers therefore develop the hybrid model where victims can be reached through phones or web based counselling. However, it is not always easy to segment the events. Since during the crisis patients like Anne are extremely distracted and distraught other issues may crop up while trying to sort one issue with equal severity (Dinakar et al., 2015). It becomes strenuous for the counselor to prioritize the issues as delay may cause the client to harm herself unable to reason her life. The interventions had to be developed keeping all the moral and ethical parameters in view (Caplan, 2013). The client may not reveal or disclose all the information in one go delaying the process of planning appropriate interventions (Brecher & Wilkenfeld, 2014). For example, the client may hide about her alcohol or drug addiction due to weak report with the counselor, which disturbs the whole intervention plan.

The interventionist can overcome the above-mentioned challenges. The interventionist must be able to make the client believe that he is her ally in the very first stage that may probably eliminate the chance of Anne to hide any necessary information from him (Dinakar et al., 2015). The counselor should be tactful while preparing the questionnaire for the Anne. The questions should be short and designed in a manner that will extract all the client related information in second stage of the model itself. It will thus help in designing the intervention effectively without needing to go through the previous stages of the hybrid model. The counselor must have active listening skills to prevent missing out any important data from the client as it is not possible for the client vent out her feelings multiple times when distraught  (Murphy et al., 2012). The couselor must demonstrate positivity, empathy, sensitivity in every word he utters and in every action only then it is possible to reinforce positivity in client. The counselor should also cultivate high mental resilience and self-awareness to maintain his own psychological balance while dealing with grief, and pain of other people. He must not cross his professional boundaries while trying to be emphatic towards the client (Spittal et al., 2015). The client must be able to provide support to Anne at all levels that are psychosocial, physical, emotional and logistic support since crisis is multifactorial (Rodda et al., 2015).

Conclusion

The paper has discussed how the hybrid model of crisis intervention has helped the client to undergo positive transition. Undergoing traumatic experiences changes the pattern of daily living diminishing the motivation to live. Therefore, the crisis intervention professionals assist the clients to overcome crisis by communicating and observing the client assessing their strengths, weaknesses, shirt term and long-term goals. The paper has clearly demonstrated how can a counselor initiate communication and build rapport with an individual in crisis. With close and open-ended questions, it is convenient to make the client feel comfortable with the counselor. The counselor may not always handle all the challenges diligently or have strategies for all types of complication arising in the process of intervention. In such situation, experience and farsightedness may help deal with the crisis.

References

Brecher, M., & Wilkenfeld, J. (2014). A study of crisis. University of Michigan Press.

Caplan, G. (2013). An approach to community mental health (Vol. 3). Routledge.

Dinakar, K., Chen, J., Lieberman, H., Picard, R., & Filbin, R. (2015, March). Mixed-initiative real-time topic modeling & visualization for crisis counseling. In Proceedings of the 20th International Conference on Intelligent User Interfaces (pp. 417-426). ACM.

Erber, N. (2014). Outlining a Crisis Management Plan for a Community: Crisis Planning in Michigan. Michigan Journal of Counseling, 41(1), 38.

France, K. (2015). Crisis intervention: A handbook of immediate person-to-person help. Charles C Thomas Publisher.

Hoefer, R., & Chigbu, K. (2015). The Motivation and Persuasion Process (MAP): Proposing a practice model for community intervention. Journal of Community Practice, 23(1), 51-75.

James, R. K., & Gilliland, B. E. (2012). Crisis intervention strategies. Nelson Education.

Murphy, S., Irving, C. B., Adams, C. E., & Driver, R. (2012). Crisis intervention for people with severe mental illnesses. The Cochrane Library.

Parkes, C. M., & Prigerson, H. G. (2013). Bereavement: Studies of grief in adult life. Routledge.

Rodda, S. N., Lubman, D. I., Cheetham, A., Dowling, N. A., & Jackson, A. C. (2015). Single session web-based counselling: a thematic analysis of content from the perspective of the client. British Journal of Guidance & Counselling, 43(1), 117-130.

Spielfogel, J. E., & McMillen, J. C. (2016). Current use of de-escalation strategies: Similarities and differences in de-escalation across professions. Social Work in Mental Health, 1-17.

Spittal, M. J., Fedyszyn, I., Middleton, A., Bassilios, B., Gunn, J., Woodward, A., & Pirkis, J. (2015). Frequent callers to crisis helplines: Who are they and why do they call?. Australian and New Zealand Journal of Psychiatry, 49(1), 54-64.

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