Presentations text content in Remaining calm in a crisis:
Slide1
Remaining calm in a crisis: Effective ways to intervene when a child or adolescent presents in psychiatric crisis.
Brooke Anderson, LCSW / AISD School to Community Liaison
Laura Slocum, LPC / ATCIC MCOT Mobil Crisis Team Manager
Dianna Groves, LPC AISD Learning Support Services Crisis Coordinator
Slide2What you will walk away with today:
Understand the principles behind crisis intervention theory and how to apply them to realistic
situations
Feel
confident and comfortable asking the “tough questions when it comes to children or adolescents in crisis
Conduct a thorough suicide risk assessment including next steps and problem solving for safety.
Be knowledgeable of community resources that help children in psychiatric crisis.
Slide3Overview of Crisis Intervention Theory
Developed November 28, 1942 after the fire at the Coconut Grove night club by Dr. Eric
Lindemann
Continued to be developed in the social work profession and was discovered to be a highly effective time to intervene and make change in clients’ lives
Crisis intervention theory believes that a crisis can either result in a highly positive or a highly negative change. The goal of crisis intervention theory is to remove vulnerabilities from the person’s past and bolster them with new coping skills to serve as a buffer to stressful situations in the future.
“
A little help, rationally directed and purposefully focused at a strategic time is more effective than more extensive help given at a period of less emotional accessibility.” Lydia
Raporport
Slide4Definition of Crisis
(
simplified in a children’s dictionary
)
1 : the turning point for better or worse in a disease
2 : a turning point (as in a person's life or in the plot of a story)
3 a : an unstable or difficult time or state of affairs <a financial crisis> b : a situation that has become very serious <the energy crisis>
Danger and Opportunity- Pictogram in Chinese for Crisis
Slide5Stages of a Crisis
Hazardous
event – something happened
Vulnerable
state – how the client feels
Precipitating
factors – stress, etc.
Active
crisis – outcry of suicide
Phases
of Crisis Intervention:
Goals
Relief of
symptoms – How can we get you feeling better
Restoration of pre-crisis level functioning
Understanding precipitating events and their contributions to disequilibrium
Remedial measures to address results of crisis and prevent future ones.
Slide6What do I do now?
Establish contact
Assess, Assess, Assess
:
Actual
Crisis Event (What happened)
Student’s subjective
responses
Historical and current coping skills, resources and strengths
Student’s functional skills and abilities
Triage the most critical concerns
Spell out specific next steps : Take Action
Slide7The Big Three
Suicidal Ideation and current self harm
Homicidal Ideation
Psychosis
Slide8Some Sobering Statistics
Suicide is the 3rd leading cause of death for youth ages
10-24
One
in 11 high school students made a suicide attempt in the past 12
months
86
% of school
counselors surveyed
reported that they had counseled a student who had threatened or attempted
suicide
62
% of school
counselors
surveyed reported that they have had a student make a nonfatal suicide attempt at
school
From the American Association of
Suicidology
Slide9From SAMHSA
A nationwide survey of youth in grades 9-12 across the US found that 15% of students reported seriously considering suicide.
11% reported creating a plan
7% reported trying to take their own life in the 12 months preceding the survey.
Over 40% of surveyed gay or lesbian youth seriously considered attempting suicide.
Slide10Assumption makes an … out of you and me. Assessment does not.
Most important step
Never underestimate the importance of assessment
Slide11Assessing Suicide Risk
According to the
Harvard Medical School Guide to Suicide Assessment and Intervention
, "There is no psychological test, clinical technique, or biological marker sufficiently sensitive and specific to support accurate short-term prediction of suicide in an individual person" (Jacobs et al., 1999, p. 4). However, the guide also suggests that the use of a suicide assessment can "allow for a more informed intervention" (p. 6). These interventions can include decisions about whether additional expertise, medication, or hospitalization is warranted.
Slide12IS PATH WARM?
I = Ideation
S = Substance Abuse
P = Purposelessness
A = Anxiety
T = Trapped
H = Hopelessness
W = Withdrawal
A = Anger
R = Recklessness
M = Mood Change
Slide13SAFE - T
Suicide Assessment Five Step Evaluation and Triage
1) Identify Risk Factors
2) Identify Protective Factors
3) Conduct suicide inquiry
4) Determine Risk Level/Intervention
5) Document
Slide14Is the student a member of an
at-risk, vulnerable or socially marginalized
group? (e.g. male, older adolescent, history of mental illness, GLBT)
Slide15What
historical or predisposing factors
may elevate suicide risk? (e.g. previous history of suicidal behavior, family history of suicide, history of child abuse)
Slide16What are the presenting problems or
current risk factors
? (e.g. mental health status, impulsivity, aggression, stressful life events, relationship break-up, conflict with a family member, failure, disciplinary problems)
Slide17What is the level of
current suicidal thinking and planning
? (e.g. duration, specificity and intensity of ideation, level of planning, access to plan)
Slide18What are some specific
protective factors
(e.g. coping and problem-solving skills, supportive family, relational connections and social support, plans for the future, willingness to ask for help)
Slide19Documentation SOAP Method
S
ubjective: What the client tells you
O
bjective: Factual, quantifiable
A
ssessment: Summary of client’s clinical thinking
P
lan: Parameters of treatment, action plan and prognosis
Slide20Break into Small Groups
Please select a “recorder” to document
Decide on the person at risk for suicide to give the details for assessment
Chose the individual who is going to ask the questions (everyone can participate, but one person leads)
Decide how to ASK the questions and what ACTION to take
Document your assessment and plan
Slide21AISD Guide for Counseling Support Following a School Crisis
AISD Crisis Counseling Support Team is the 12 District’s SSS Social Service Specialist Coordinator by Dianna Groves
Team assist campus counselors in monitoring &
c
ounseling students following campus crisis
SSS will work directly with Principal/Counselor to determine the LEVEL of crisis and support needed
Campus Level Crisis
/ Handled by Campus Staff
District Level Crisis
/ Need additional support from district
Community Level Crisis
/ Community Involvement
Slide22AISD Suicide Intervention Protocol
AISD Protocol provides specific steps for counselors and school staff
If student has specific plan /previous attempt/ or presenting
imminnent
danger, contact the SRO immediately
Contact Parents & Campus Administrator Immediately
Slide23
Remaining calm in a crisis:
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