Crisis Intervention PPT.pptx by Dr. Sukhbir Kaur

crisis and its intervention
BY:
Dr.Sukhbir Kaur
Associate Professor
SGRD College of Nursing, SGRD University of Health Sciences, Amritsar.

1. Unit : XIII PSYCHIATRIC EMERGENCIES AND CRISIS INTERVENTION TOPIC: Crisis Interventioin

2. Definition: Crisis: Crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms. (James & Gilliland, 2001)

3. Crisis Intervention: Crisis intervention is emergency first aid for mental health & domestic violence. It requires that the person experiencing the crisis receive timely and skillful support to help cope with his/her situation before physical or emotional deterioration occurs. Crisis intervention therefore involves three major components: The actual crisis – victim’s perception of an unmanageable situation, The individual in crisis, and The helper who provides aid.

4. A stressful event alone does not constitute a crisis; rather, crisis is determined by the individual’s view of the event and response to it. ( Smead , 1988).

5. Types of crisis : Dispositional crisis : an acute response to an external situational stressor. 2. Crisis of anticipated life transitions : normal life – cycle transitions that may be anticipated but over which the individual may feel a lack of control.

6. 3. Crisis resulting from traumatic stress: crises precipitated by unexpected external stresses over which the individual has little or no control and from which he or she feels emotionally overwhelmed an defeated. 4. Maturational / development crisis:- Crises that that occurs in response to situation that trigger emotions related to unresolved conflict’s in one’s life.

7. 5. crises reflecting psychopathology:- emotional crises in which pre-existing psychopathology has been instrumental in in precipitating the crisis e.g , personality disorders. 6. Psychiatric emergencies :- crisis situation in which general functioning has been severely impaired and individual rendered incompetent or unable to assume personal responsibility.

8. Characteristics of a Crisis: Time limited: Generally lasting no more than six weeks. Typical phases: Traditional attempt to problem solve Attempts to try alternative methods Disorganization People are more open to change Opportunity to resolve previously unresolved issues Successful experience

9. It is precipitated by specific identifiable events. Crises are personal by nature. Crises are acute not chronic. It contains the potential for psychological growth or deterioration.

10. Process or phases of crisis: Phase 1 : the individual is exposed to precipitating stressor. Anxiety increases , previous problem solving techniques are employed.

11. Phase 2 : When previous problem solving techniques do not relieve the stressor, anxiety increases further. Feeling of confusion and disorganization prevails.

12. Phase 3 : All possible resources both internal and external are called on to resolve the problem and relieve the discomfort. New problem solving techniques may be used.

13. Phase 4 : if resolution does not occur in previous phases , major disorganization of the individual with drastic result often occurs. Anxiety may reach panic levels, cognitive functions are distorted., emotions are labile and psychotic thinking can develop.

14. Auguilera and M essick crisis model – (1982)

15. Crisis Intervention Goal is to stabilize the family situation and restore to their pre-crisis level of functioning. Opportunity to develop new ways of perceiving, coping, and problem-solving. The intervention is time limited and fast paced. Worker must take an active and directive approach.

16. “Principles of Crisis Intervention: Simplicity – People respond to simple not complex in a crisis Brevity – Minutes up to 1 hour in most cases (3-5 contacts typical) Innovation – Providers must be creative to manage new situations Pragmatism – Suggestions must be practical if they are to work Proximity – Most effective contacts are closer to operational zones Immediacy – A state of crisis demands rapid intervention Expectancy – The crisis intervener works to set up expectations of a reasonable positive outcome”

17. Process Phase 1 : Assessment Phase 2 : Planning Phase 3 : intervention Phase 4 : Termination or evaluation of crisis resolution and anticipatory planning. Assessment includes: the stressor event; the person experiencing the crisis; and the meaning of the event to the person in crisis. Important to assess risk factors.

18. Risk Factors Suicide or homicide Risk of physical or emotional harm to the children Risk of break from reality (psychosis) Risk of client fleeing the situation.

19. Performing the Assessment Conducting the interview History: personal and familial of risk behavior Any means and plans the client may have about carrying out the risk behavior Controls: internal and external that are stopping the client from undertaking the risk behavior. Observations during the interview Level of anxiety; desperation; despair; sense of hopelessness; contact with reality.

20. The skill and technique most essential at this stage is that of focusing while allowing the client to ventilate and express the overwhelming flood of emotions. Focusing technique can elicit more coherent information for assessment as well as help the client pull themselves together cognitively and emotionally. A focused interview can serve as an instrument of both assessment and intervention.

21. Intervention Planning occurs simultaneously as assessment is made about how much time has elapsed between the occurrence of the stressor event and this initial interview. How much the crisis has interrupted the person’s life; The effect of this disruption on others in the family; Level of functioning prior to crisis and what resources can be mobilized.

22. The goal of intervention is to restore the person to pre-crisis level of equilibrium, not of personality changes. Worker attempts to mobilize the client’s internal and external resources. Exact nature of the intervention will depend on the client’s pre-existing strengths and supports and the worker’s level of creativity and flexibility.

23. Dealing with Crisis Behavior Be supportive Be calm Be honest & direct State your concern Don’t act shocked or surprised Gather pertinent information Refer to counseling

24. Three Approaches Affective: Expression and management of feelings involving techniques of ventilation; psychological support; emotional catharsis. Cognitive: Helping the client understand the connections between the stressor event and their response. Techniques include clarifying the problem; identifying and isolating the factors involved; helping the client gain an intellectual understanding of the crisis Also involves giving information; discussing alternative coping strategies and changing perceptions.

25. Environmental modification: Pulling together needed external, environmental resources (either familial or formal helping agencies) Any and all three approaches may be used at any time depending where the client is, emotionally and cognitively. The goal is to help the client restore pre-crisis levels of functioning.

26. PERSONNELS WHO PROVIDE CRISIS INTERVENTION : psychiatrists • psychologists • counsellors • fire fighters • emergency medical staff • search and rescue staff • police officers • doctors • nurses • soldiers • clergy • communications personnel • community members • hospital workers and so on.

27. Warnings Danger of misunderstanding the client’s nonverbal behavior as well as spoken words due to cultural differences or the client’s state of disorganization. Imperative for the worker not to assume that they understand what the client means by his spoken word or non-verbal behavior and vice versa. It is best to clarify and make sure.

28. TECHNIQUES OF CRISIS INTERVENTION: 1. Critical Incident Stress Management – CISM is a comprehensive, organized approach for the reduction and control of the harmful aspects of stress in the emergency services. It is a comprehensive, integrated, systematic intervention containing multiple tactics to dealing with the crisis after traumatic events. CISM is a coordinated programme of tactics, linked together to alleviate reactions to traumatic events.

29. 2. Critical Incident Stress Debriefing – CISD is a seven step, group psychological process developed as a method for mitigating the harmful effects of work-related trauma and mitigating post-traumatic stress disorder.

30. 3.Medical Crisis Counselling – This is a brief intervention used to address psychological and social problems related to chronic illness in a health care setting. It uses coping techniques and builds social supports for the patient to cope with the stress of the diagnosis and their responses to the stressful circumstances.

31. 4. Psychological Debriefing Psychological debriefing is a structured group meeting where participants are able to review traumatic events that they have experience and how they have responded to it. What is debriefing? Debriefing is a specific technique that is used to help others deal with the physical and psychological symptoms associated with exposure to a trauma. Debriefing allows those involved to process the event and reflect on the impact of it. Debriefing should usually occur near the site of the event.

32. Summary: A crisis is a disturbance resulting from a perceived threat that challenges the person's usual coping mechanisms. Crises are a time of increased vulnerability, but they can also stimulate growth. There are two types of crises: maturational and situational. Crisis intervention is a brief, active therapy with the goal of returning the individual to a precrisis level of functioning.

33. In assessing a patient the nurse should identify the patient's behaviors, precipitating event, perception of the event, support systems and coping resource, and previous strengths and coping mechanisms. The expected outcome of nursing care is that the patient will recover from the crisis event and return to a precrisis level of functioning. Levels of crisis intervention include environmental manipulation, general support, generic approach, and individual approach.

34. The nurse and patient should consider the following factors in evaluating nursing care: the patient's level of functioning, symptoms, coping resources, coping mechanisms, evidence of adaptive coping responses, and need for referral for further treatment. Crisis intervention can be implemented in any setting, including hospitals, clinics, community health centers, and the home. It should be a competency skill of all nurses. Modalities of crisis intervention include mobile crisis programs, group work, telephone contacts ,disaster response, victim outreach programs, and health education.