CRISIS INTERVENTION

CRISIS DEFINITION
Seeger, Sellnow and Ulmer that crises have four defining characteristics that are "specific,
unexpected, and non-routine events or series of events that [create] high levels of
uncertainty and threat or perceived threat to an organization's high priority goals." Thus
the first three characteristics are that the event is
1. Unexpected (i.e., a surprise)
2. Creates uncertainty
3. Is seen as a threat to important goals
Venette argues that "crisis is a process of transformation where the old system can no
longer be maintained." Therefore the fourth defining quality is the need for change. If
change is not needed, the event could more accurately be described as a failure.

Crisis Intervention can be defined as emergency psychological care aimed at

assisting individuals in a crisis situation to restore equilibrium to their biopsychosocial
functioning and to minimize the potential for psychological trauma . Crisis can be defined
as one’s perception or experiencing of an event or situation as an intolerable difficulty that
exceeds the person’s current resources and coping mechanisms. The priority of crisis
intervention/counseling is to increase stabilization. Crisis interventions occur at the spur
of the moment and in a variety of settings, as trauma can arise instantaneously. Crisis
counselors must keep in mind that crises are temporary, no longer than a month, although
the effects may become long-lasting.

TYPES OF CRISIS
POVERTY RELATED CRISIS
Not paying rent may lead to homelessness through foreclosure or eviction. Being
unemployed, and the financial difficulties and loss of health insurance benefits that come
with it, may cause malnutrition and illness, and are major sources of self-esteem which may
lead to depression, which may have a further negative impact on health.
Lacking a job often means lacking social contact with fellow employees, a purpose for many
hours of the day, lack of self-esteem, and mental stress.
ENVIRONMENTAL CRISIS
 An environmental disaster is a disaster that is due to human activity and should not be
confused with natural disasters . In this case, the impact of humans' alteration of
the ecosystem has led to widespread and/or long-lasting consequences. It can include the
deaths of animals (including humans) and plant systems, or severe disruption of human
life, possibly requiring migration.

ECONOMIC CRISIS

A financial crisis may be a banking crisis or currency crisis. It is used as part

of Marxist political economy, usually in the specific formulation of the crisis of capitalism. It
refers to a period in which the normal reproduction of an economic process over time
suffers from a temporary breakdown. This crisis period encourages intensified class
conflict or societal change— or the revival of a more normal accumulation process.

INTERNATIONAL CRISIS

An international crisis is a crisis between states. There are many definitions of an

international crisis. Snyder "...a sequence of interactions between the governments of two
or more sovereign states in severe conflict, short of actual war, but involving the perception
of a dangerously high probability of war".

DEVELOPMENTAL CRISIS

It’s also called as maturational crisis. This occurs during the developmental event or life
transition leads to stress.

DISPOSITIONAL CRISIS

It’s an acute response towards external situation and emotional stress.

SITUATIONAL CRISIS

It precipitating event or a stressful external stimulus which is unexpected leads to no or

little control. It is causing the over whelmed or defeated.

CRISIS FROM PRE EXISTING CRISIS

ADVENTITIOUS CRISIS 

It is an unexpected or uncommon crisis causing strike in the entire community.

PERSONAL CRISIS
A personal crisis can occur when events of an extraordinary nature extreme tension and
stress within an individual which require major decisions or actions to resolve. A crisis
situation can revolve a dangerous situation such as extreme weather conditions or a
medical emergency or long-term illness. A crisis can also be related to a change in events
that comprise the day-to-day life of a person and those in their close circle. Such situations
may be loss of a job; extreme financial hardship; alcoholism or addiction and other
situations that are life altering and require action that is outside the "normal" daily routine.

STATE OF CRISIS
 A fragile state is significantly susceptible to crisis in one or more of its sub-systems.
It is a state that is particularly vulnerable to internal and external shocks and
domestic and international conflicts.
 In a fragile state, institutional arrangements embody and perhaps preserve the
conditions of crisis: in economic terms, this could be institutions
(importantly, property rights) that reinforce stagnation or low growth rates, or
embody extreme inequality (in wealth, in access to land, in access to the means to
make a living); in social terms institutions may embody extreme inequality or lack
of access altogether to health or education; in political terms, institutions may
entrench exclusionary coalitions in power (in ethnic, religious, or perhaps regional
terms), or extreme factionalism or significantly fragmented security organizations.
 In fragile states, statutory institutional arrangements are vulnerable to challenges
by rival institutional systems be they derived from traditional authorities, devised
by communities under conditions of stress that see little of the state (in terms of
security, development or welfare), or be they derived from warlords, or other non-
state power brokers.

Universal principles for crisis intervention

 While dealing with crisis, both personal and societal, there are five basic principles
outlined for intervention.
 Victims are initially at high risk for maladaptive coping or immobilization.
Intervening as quickly as possible is imperative.
 Resource mobilization should be immediately enacted in order to provide victims
with the tools they need to return to some sort of order and normalcy, in addition to
enable eventual independent functioning.
 The next step is to facilitate understanding of the event by processing the situation
or trauma.
 This is done in order to help the victim gain a better understanding of what has
occurred and allowing him or her to express feeling about the experience.
 Additionally, the counselor should assist the victim(s) in problem solving within the
context of their situation and feelings.
 This is necessary for developing self-efficacy and self-reliance.
  Helping the victim get back to being able to function independently by actively
facilitating problem solving, assisting in developing appropriate strategies for
addressing those concerns, and in helping putting those strategies into action.
 This is done in hopes of assisting the victim to become self-reliant 

Response to crisis
 Counselors are encouraged to be aware of the typical responses of those who have
experienced a crisis or currently struggling with the trauma.
 On the cognitive level they may blame themselves or others for the trauma.
Oftentimes the person appears disoriented, becomes hypersensitive or confused,
and has poor concentration, uncertainty, and poor troubleshooting.
 Physical responses to trauma include: increased heart rate, tremors, dizziness,
weakness, chills, headaches, vomiting, shock, fainting, sweating, and fatigue. Some
emotional responses the person may experiences consist of apathy,
depression, irritability, anxiety, panic, helplessness, hopelessness, anger, fear, guilt,
and denial.
 When assessing behavior some typical responses to crisis are difficulty eating
and/or sleeping, conflicts with others, withdrawal from social situations, and lack of
interest in social activities 

Approaches to crisis intervention

 The first step is the assessment stage; this is done by determining the needs of
victims, other involved persons, survivors, their families, and grieving family
members of possible victim(s) and making appropriate referrals when needed.
Three types of assessments need to be conducted.
 The first is triage assessment, which is an immediate assessment to determine
lethality and determine appropriate referral to one of the following: emergency
inpatient hospitalization, outpatient treatment facility or private therapist, or if no
referral is needed.
 A crisis assessment also needs to be completed which consists of gathering
information regarding the individual’s crisis state, environment, and interpersonal
relationships in order to work towards resolving the current crisis.
 This step helps facilitate development of an effective and appropriate treatment
plan. The last area of assessment includes a biosocial and cultural assessment. This
 would be completed by using systematic assessment tools to ascertain the client’s
current level of stress, situation, present problem, and severe crisis episode.
 The goal of the crisis intervention stage of Robert’s ACT model is to resolve the
client’s presenting problems, stress, psychological trauma, and emotional conflicts.
 This is to be done with a minimum number of contacts, as crisis intervention is
intended to be time limited and goal directed.
 Stage one of the seven step approach focuses on assessing lethality. The clinician is
to plan and conduct a thorough biopsychosocial and lethality/imminent danger
assessment; this should be done promptly at the time of arrival.
 Once lethality is determined one should establish rapport with the victim(s) whom
the clinician will be working with.
 The next phase is to identify major problem(s), including what in their life has led to
the crisis at hand. During this stage is it is important that the client is given the
control and power to discuss their story in his or her own words. While he or she is
describing the situation the intervention specialist should develop a
conceptualization of the clients “modal coping style”, which will most likely need
adjusting as more information unfolds, this is referred to as stage three.
 As a transition is made to stage four feelings will become prevalent at this time thus
deal with those feelings will be an important aspect of the intervention.
 While managing the feelings the counselor must allow the client(s) to express his or
her story, and explore feelings and emotions through active listening and validation.
 Eventually, the counselor will have to work carefully to respond to the client using
challenging responses in order to help him or her work past maladaptive beliefs and
thoughts, and to think about other options.
 At step five, the victim and counselor should begin to collaboratively generate and
explore alternatives for coping.
 Although this situation will be unlike any other experience before the counselor
should assist the individual in looking at what has worked in the past for other
situations; this is typically the most difficult to achieve in crisis counseling.
 Once a list has been generated a shift can be made to step six, development of a
treatment plan that serves to empower the client.
 The goal at this stage it to make the treatment plan as concrete as possible as an
attempt to make meaning out of the crisis event.
 Having meaning in the situation is an important part of this stage because it allows
for gaining mastery.
 Finally, step seven, the intervention specialist is to arrange for follow-up contact
with the client to evaluate his or her post crisis condition in order to make certain
resolution towards progressing.
 The follow up plan may include “booster” sessions to explore treatment gains and
potential problems.
 After the situation has been assessed and crisis interventions have been applied the
aim is at eliminating PTSD symptoms, thus treating the traumatic experience.
 These steps relate similarly to the crisis intervention steps. The first step is to assess
for danger/safety for self and others, this means for the victim, counselor, and
others who may have been effected by the trauma.
 Then the counselor should consider the physical and perceptual mechanisms of
injury.
 Once injury is assessed the victim’s level of responsiveness should be evaluated and
any medical needs should be addressed.
 Each individual who witnessed or is experiencing a crisis should be observed to
identify his or her sign’s of traumatic stress.
 After the assessment of the situation is completed the interventionist should
introduce his or her self, state their title and role, and begin building rapport.
 Building this relationship allows for a more fluid approach to grounding the
individual, this can be done by allowing him or her to tell his or her story.
 Again, the counselor is encouraged to provide support through active and
empathetic listening, normalize, validate, and educate.
 Finally, the intervention specialist is to bring the person to the present, describe
future events, and provide referrals as needed.
Implementation Strategies
There are several key strategies organizations can utilize to implement the Crisis
Intervention guideline. These strategies are comprised of the following:

■Identification of an individual to lead the project that will dedicate time to

implementation of the Crisis Intervention guideline. Nurse will provide support, clinical
expertise and leadership to all nurses involved in implementation.

■Utilization of a systematic approach to planning, implementation and evaluation of the

guideline initiative. A work plan is help full to keep track of activities and timelines.

■ Provide opportunities for staff to attend interactive, adult-learning programs which

incorporate the key recommendation from the guideline.

■ Teamwork and collaboration through an interdisciplinary approach is essential.

■ Consider establishing an implementation team that includes not only the organization
implementing the guideline, but others such as community partners (referral sources) and
support groups.

RECOMMENDATION FOR CRISIS INTERVENTION

Recommendation 1

 Crisis intervention is founded on a particular set of values and beliefs, and guiding
principles.

Recommendation 2

 Knowledge of the three core components of crisis intervention theory (a

precipitating event, client perception of the event, and the client’s usual coping
methods) is fundamental to identify clients in crisis.
 Crisis care should be incorporated into all areas and units of healthcare where
nurses and other healthcare disciplines work with clients. It is important for nurses
to recognize that crisis intervention is integral for all environments and contexts
where care is provided, including hospital and community settings.

Recommendation 3

 The delivery of crisis intervention is based on an integrative framework.

Recommendation 4

 A wide array of therapeutic communication skills is a pre-requisite to effective

intervention with clients in crisis.

Recommendation 5

 A comprehensive holistic assessment is performed prior to engaging in any plan to

resolve crises.
 When considering a client’s potential for suicide, nurses must also examine both
protective factors and risk factors for suicide.

Recommendation 6

 Nurses are directly involved in all aspects of crisis intervention including

assessment, intervention, referrals and linkages, and short-term follow up.
 Nurses ensure that there is appropriate follow up and linkages to services and
resources when necessary.

Recommendation 7

 Teaching and educating clients, families, colleagues, and the community about crisis
intervention and prevention are essential to promote mental health.

Recommendation 8

 Education and ongoing learning opportunities are required for nurses to implement
best practices in crisis intervention.

Recommendation 9

 The core curriculum in nursing education includes the following key components:

■ Crisis intervention theory and practice;

■ Sound knowledge of the principles of the therapeutic relationship, and their application
to crisis intervention; and

■ The provision of regular clinical supervision.

 Nurses educated in crisis theory and intervention can improve outcomes for clients
in crisis.
Recommendation 10

 Organizational commitment to providing quality crisis intervention services is

reflected in its mission and vision statements, as well as through allocation of
resources to develop, implement, and support the services.

Recommendation 11

 To enhance the continuum of crisis care, the organization continuously strives to

achieve a collaborative and integrative crisis intervention practice model within an
interdisciplinary team.

Recommendation 12

 The organization actively advocates for the provision of quality crisis intervention
care on multiple levels (individual, family, and community).

Recommendation 13

 Nursing best practice guidelines can be optimally implemented when adequate

planning, resources, organizational and administrative support, as well as the
appropriate facilitation, exist. An organizational plan for developing and
implementing crisis intervention services includes:

■ An assessment of organizational readiness and barriers to education;

■ Involvement of all members (whether in a direct or indirect supportive function) who

will contribute to the implementation process;

■ Dedication of a qualified individual to provide the support needed for the education and
implementation process;

■ Ongoing opportunities for discussion and education to reinforce the importance of best
practices; and

■ Opportunities for reflection on personal and organizational experience in implementing

guidelines.