Patricia Napolitano mSW LISW Cuyahoga County Court of Common Pleas Crisis Intervention behavioral health specialist Individuals in crisis Largely feel unheard Central Nervous System is in fightflightfreezefaint mode ID: 697800
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Slide1
Crisis De-Escalation Basics
Patricia Napolitano, mSW, LISWCuyahoga County Court of Common PleasCrisis Intervention behavioral health specialistSlide2
Individuals in crisis
Largely feel unheardCentral Nervous System is in fight/flight/freeze/faint modeRequire calm intervention that soothes and attempts to help the person vocalize complaints
May require police response
May require medical response
May result in the person leaving on their ownSlide3
Crisis Intervention Team (CIT) model is a
police-based training and intervention program.
Ohio CIT Programs
Goals are to
Increase Safety for officers and persons with mental illness
Divert persons with mental illness away from the criminal justice system
2006 study in Akron found that there was an increase in the number of calls identified as mental health-related, and increase in CIT officers transporting to the hospital for evaluation, but no change in arrest rate.1999 study indicates 10% of police contacts with the public involve persons with mental illness.
Difficulty in studying CITOfficers participate voluntarilyDepartment personnel assignments are internalRecord keeping does not track health informationCIT Outcomes in Chicago – 2010Increased linkage to mental health servicesImproving safety in calls Improve outcomes for officers and clientsDeane et al 1999Teller et al 2006Slide4
Communication
ACES study; Factors of Household Dysfunction and Abuse are strongly correlated with antisocial behaviors and criminal justice involvement in teen and adult years
Deficiencies in social communication
Impulsive Cognitive Style
Independence
Rigidity of Ideas
Tendency towards social distrust and suspicion
Focus on communication strategiesMoreno-Manso et al 2016Slide5
Image from Conscious
DisciplineSlide6
Escalational commitment
Image from modernman.comSlide7
Clients in distressSlide8
4 step crisis intervention model
1. Rapport Building
Reflective Listening
2. Information Gathering
Focusing on the here and now
Using risk tools
Assessing lethality, strengths, and needs
3. AssessmentDetermine level of immediate service needPlan for face to face contact if necessary4. Problem SolvingImplement and Evaluate“Help me understand….”
“It is surprising to hear you say…”
“When you said…. I felt…”
Simple rephrasing siding with client emotion
“When he said go away, you felt like he didn’t care at all”Slide9
4 step Crisis Intervention model
Information Gathering Prompts
1. Rapport Building
Reflective Listening
2
.
Information GatheringFocusing on the here and now
Using risk toolsAssessing lethality, strengths, and needs3. AssessmentDetermine level of immediate service needPlan for face to face contact if necessary4. Problem SolvingImplement and Evaluate“How much has this bothered you in last 24 hours?”
“Who lives with you?”
“What part of this is bothering you the most”
“When was the last time you dealt with something like this? How did you do it?”Slide10
Call For Help
216-623-6888 Cleveland Mobile CrisisNational - 800-273-TALK (8255) (national suicide lifeline)
216-619-6194
(Cleveland Rape
C
risis
Center)National - 800-656 HOPE (4673)216-391-HELP (4357) (Cleveland Domestic Violence HotlineNational - 800-799-7233
Rapport BuildingReflective Listening2. Information GatheringFocusing on the here and nowUsing risk toolsAssessing lethality, strengths, and needs3. AssessmentDetermine level of
immediate
service need
Plan for face to face
contact
if necessary
4. Problem Solving
Implement and Evaluate
4 step Crisis intervention modelSlide11
4 step Crisis Intervention model
1. Rapport BuildingReflective Listening2. Information Gathering
Focusing on the here and now
Using risk tools
Assessing lethality, strengths, and needs
3. Assessment
Determine level of immediate service needPlan for face to face contact if necessary4. Problem SolvingImplement and Evaluate
Avoid Power StrugglesMake the Client set the Most Important goalInvite the client to set as much of the plan as possibleGive multiple options in brainstorming, not just an obvious right or wrong oneDiscuss whether options are possible or notMake the client the expert “You are probably in the best place to make a decision, it’s your life.” Slide12
References
Moreno-Manso, J., Garica-Baamonde, M. E., Blazquez-Alonso, M., Pozueco-Romero, J. M., Godoy-Merino, M. J. (2016). Social Communication Disorders and Social Cognitive Strategies and Attitudes in Victims of Child Abuse. Journal of Child and Family Studies. 25: 241-250
Deane, M. W., Steadman, H. J.,
Borum
, R.,
Veysey
, B., & Morrissey, J. (1999). Emerging partnerships between mental health and law enforcement. Psychiatric Services, 50. 99-101