VINAYAKA MISSION’S COLLEGE OF NURSING, PUDUCHERRY

VINAYAKA MISSIONS RESEARCH FOUNDATION

PUDUCHERRY

LESSON PLAN – CRISIS INTERVENTION

General Objective:

At the end of the class the students will acquire in-depth knowledge on crisis intervention and to develop a positive attitude towards
handling the crisis in day to day clinical practice and also develops a competent skill in applying this knowledge in taking care of clients both in
wellness and sick.

Specific Objectives:

At the end of class the student will be able to

1. define crisis and crisis intervention.

2. mention the types of the crisis.
3. list the signs of crisis
4. enumerate the universal principles of crisis.
5. state the aims of crisis intervention.
6. mention the goals of crisis intervention.
7. list the purposes of crisis intervention.
8. discuss the techniques of crisis intervention.
9. describe the phases of crisis intervention.
10. discuss the general approaches of crisis intervention.
Time Specific Sub Topics Teaching Students A.V. Evaluation
Objectives Learning Activity Aids
Activity
2 min The students will Introduction Teacher Students
be able to Crisis intervention is emergency first aid for mental health introduces the listen
introduce the (Ehly, 1986).The Chinese language contains two characters topic.
topic. which, taken together, connote the concept of crisis. The
first character, wei, indicates a critical or dangerous
situation, while the second one, ji, means an opportunity
for change. Thus, these characters together indicate that
crisis is a point in time that allows the opportunity to
change.
4 min Define crisis and Definition Teacher defines Students Chart What is crisis
crisis intervention. Crisis - Crisis can be defined as one's perception or crisis and crisis listen and and crisis
experiencing of an event or situation as an intolerable intervention taking intervention?
difficulty that exceeds the person's current resources notes
and coping mechanisms. Crisis can occur on a personal
or societal level.
Crisis Intervention - Crisis intervention is an immediate
and short-term psychological care aimed at assisting
individuals in a crisis situation in order to restore
equilibrium to their biopsychosocial functioning and to
minimize the potential of long-term psychological trauma.
5 min Mention the types Types of crisis Teacher Students Charts What are the
of the crisis. There are 3 types of crisis – discuses types listen and types of
1) Maturational Or Developmental Crisis – it may of crisis. clear crisis?
occur at any transitional period in normal growth doubts
 and development. The transitional period where
individuals move into successive stage often
generate disequilibrium. Individuals are required to
make cognitive and behavioral changes that
accompany development, precipitate factors are
normal stress of development.

2) Situational Crisis – it is a response to a sudden and

unavoidable traumatic event that largely affects a
person’s identity and roles.
3) Adventitious Crisis or Social Crisis – social crisis
is accidental, uncommon and unanticipated and
result in multiple losses and radical environmental
changes. An adventitious crisis occurs outside the
person precipitate by an unexpected event.

2 min List the signs of Signs of Crisis- Teacher Students Handouts. What are the
crisis  Counselors are encouraged to be aware of the explains signs listen and signs of
typical responses of those who have experienced a and symptoms clear crisis?
crisis or are currently struggling with a trauma. of crisis. doubts.
 On the cognitive level, they may blame themselves
or others for the trauma.
 Often, the person appears disoriented, becomes
hypersensitive or confused, has poor concentration,
uncertain, and poor troubleshooting capabilities.
Physical responses to trauma include increased
heart rate, tremors, dizziness, weakness, chills,
headaches, vomiting, shock, fainting, sweating, and
fatigue.
 Among the common emotional responses of people
who experience crisis in their lives include 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 and lack of
interest in social activities.
3 min Enumerate the Universal Principles – Teacher explain Students Handouts List out the
universal the universal listen universal
principles of crisis There are four basic principles outlined for principles of principles of
intervention for individuals dealing with personal and
intervention. societal crisis: crisis crisis
intervention. intervention?
 Prompt intervention – Since victims are initially at
high risk for maladaptive coping or immobilization.
Providing intervention 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 independent
functioning.
 Facilitate comprehension – processing the situation
or trauma is necessary in order for the sufferer to
understand what the traumatic event was all about.
This is done in order to help the victim gain a better
understanding of what has occurred and allowing him
or her to express feelings about the experience.
 Problem-solving – The counselor should assist the
victim(s) in resolving the issue within the context of
their situation and feelings. This is necessary for
developing self-efficacyand self-reliance.
 Return to normalcy – counselor must help the victim
get back to being able to function independently by
actively facilitating problem solving, assisting him/her
 in developing appropriate strategies for addressing
those concerns, and in helping putting those strategies
into action. This is done in hopes of enabling the
victim to become self-reliant.

1 min State the aims of Aims of Crisis Intervention – Teacher Students Handouts What are the
crisis intervention.  To provide a correct cognitive perception of the discusses aims listen and aims of crisis
situation. of crisis asking intervention?
 To assist the individual in managing the intense and intervention. doubts
over whelming feelings associated with the crisis.

1 min Mention the goals Goals of Crisis Intervention – Teacher Student Handouts What are the
of crisis  To decrease emotional stress and protect the crisis discuses goals listen goals of
intervention. victim from additional stress. of crisis crisis
 To assist the victim in organizing and mobilizing intervention. intervention?
resources or support system to meet unique needs
and reach a solution for the particular situation that
precipitate the crisis.
1 min List the purposes Purposes of Crisis Intervention – Teacher Student Pamphlet Enumerate
of crisis  To reduce the intensity of an individual’s discusses the listen the purposes
intervention. emotional, mental, physical and behavioral reaction purposes of of crisis
to a crisis. crisis intervention?
 To help the individuals return to their level of
intervention.
functioning before the crisis.

6 min Discuss the Techniques of Crisis Intervention- Teacher Student Slides What are the
techniques of crisis  Catharsis – the release of feelings that take place describes the listen and techniques
intervention. as the patient talks about emotionally charged techniques used taking used for
areas. in crisis notes crisis
 Clarification – encouraging the patient to express
intervention. intervention?
 more clearly the relationship between certain
events.
 Suggestions – influencing a person to accept an
idea or belief, particularly the belief that the nurse
can help and that person will in time feel better.
 Reinforcement of Behavior – giving the patient
positive response to adaptive behavior.
 Support of Defense – encouraging the use of
healthy, adaptive defences and discouraging those
that are unhealthy or maladaptive.
 Rising Self Esteem – helping the patient regain
feelings of self worth.
 Exploring of Solution – examining alternative
ways of solving the immediate problem
10 min Describe the Phases of Crisis Intervention – Teacher Student Slides What are the
phases of crisis 1) Immediate crisis intervention – explains all the listen and phases of
intervention. It involves establishing a rapport with the phases of crisis asking crisis
victim, gather information for short term
intervention doubts intervention?
assessment and service delivery and averting a
potential state of crisis. Immediate crisis
intervention also include caring for the medical,
physical, mental health and personal need of the
victim about local resources or services.
2) Second Phase –
It involves an assessment of needs to
determine the service and resources required by the
victim in order to provide emotional support to the
victim. The purpose of this phase is to determine
how the crisis affects the victim’s life, so that a
plan for recovery can be developed, allowing the
victims to begin towards the future.
3) Third Phase-
 Recovery intervention helps victims re-
stabilize their lives and becomes healthy again. It
also involves helping the victim prevent further
victimization from the criminal justice system or
other agencies, the victim may come into contact
with in the aftermath of victimization.

15 min Discuss the General Approaches - Teacher Students Slide What are the
general approaches explains general listen general
of crisis A general approach of crisis intervention integrates approaches of approaches
intervention. numerous assessment tools and triage
procedures. Roberts' 7-Stage Crisis Intervention crisis of crisis
Model, SAFER-R Model and Lerner and Shelton's 10- intervention. management
step acute stress & trauma management ?
protocol creates one comprehensive model for responding
to crisis that can be utilized in crisis situations.
The ACT (Assessment Crisis Intervention Trauma
Treatment) model of crisis intervention developed by
Roberts as a response to the September 11, 2001 tragedy
outlines a three-stage framework. This tool is a guide and
not to be followed rigidly.
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.
These are the three types of assessments that
need to be conducted:

1. Triage assessment - 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;
2. Crisis assessment - consists of gathering
information regarding the individual's crisis state,
environment, and interpersonal relationships to be
used in working towards resolving the current
crisis. This step helps facilitate development of an
effective and appropriate treatment plan.
3. Biosocial and cultural assessment - systematic
assessment tools are used to ascertain the client's
current levels of stress, situation, present problem,
and severe crisis episode.
The goal of the crisis intervention stage of Roberts'
ACT model is to resolve the client's present
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.
1. Intake and Assessing the person who is in
Crisis/Suffering from the aftereffects of Crisis
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.
2. Exploring the Crisis Situation of the person
The next phase is to identify major problem(s), including
what in their life has led to the crisis at hand. During this
stage it is important that the client is given the control and
power to discuss their story in his or her own words.
3. Understanding the Coping Style employed by the
person
While he or she is describing the situation, the intervention
specialist should develop a conceptualization of the client's
"modal coping style", which will most likely need
adjusting as more information unfolds. This is referred to
as stage three.
4. Confronting Feelings, Exploring Emotions and
Challenging the Maladaptive Coping Style
As a transition is made to stage four, feelings will become
prevalent at this time, so dealing 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.
5. Exploring Solutions and Educating the client in best
practices of Coping
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.
6. Developing a concrete treatment plan/structure of
activities and Reassuring the clients newly gained
healthy perspective
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 which could be
followed by the client and implemented as an attempt to
make meaning out of the crisis event. Having meaning of
the situation is also an important part of this stage because
it allows for gaining mastery.
7. Follow-Up
Step seven is for the intervention specialist 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.
[8]

SAFER-R Model
The SAFER-R Model is a much used model of
intervention[12] with Roberts 7 Stage Crisis Intervention
Model. The model approaches crisis intervention as an
instrument to help the client to achieve his or her baseline
level of functioning from the state of crisis. This
intervention model for responding to individuals in crisis
consists of 5+1 stages.
They are:[13]

1. Stabilize
2. Acknowledge
3. Facilitate understanding
4. Encourage adaptive coping
5. Restore functioning or,
6. Refer
Lerner and Shelton's 10 step acute stress & trauma
management protocol[14]
A comprehensive view of how to treat the trauma consists
of ten stages outlined by Lerner and Shelton (2001). These
10 steps relate similar 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 affected by the trauma.
 Then consider the physical and perceptual mechanisms
of injury.
 Once injury is assessed the victim's level of
responsiveness should be evaluated.
 If any medical needs are there, it should be addressed.
 The individual who witnessed or is experiencing a
crisis, should be observed to identify his or her signs of
traumatic stress.
 After the assessment of the situation is completed the
counselor should introduce his or her self, state their
title and role, and connect with the individual by
building rapport.
 A good rapport building allows for a more fluid
 approach in grounding the individual, this can be done
by allowing the client/person to tell their story.
 The interventionist provides support through active and
empathetic listening,
 Normalize, validate, and educate the individuals
emotions, stress and adaptive coping styles.
 Finally, the intervention specialist is to bring the
person to the present, describe future events, and
provide referrals as needed.
After the crisis situation has been assessed and crisis
interventions have been applied, the aim is at eliminating
stress symptoms, thus treating the traumatic experience.

Summary:

So far we have discussed about definition, types, signs, universal principles, aims, goals, purposes, technique, phases, general approaches of
crisis intervention.

Conclusion:

From this class students gain adequate knowledge regarding crisis and its intervention.

Bibliography:
Teacher reference

 Mary C. Townsend’s, “Psychiatric Mental Health Nursing”, sixth edition, F. A. Davis publication

Student reference:

 R. Sreevani’s, “A Guide To Mental Health and Psychiatric Nursing”, 3rd edition Jaypee Brothers Publication