Transcript Crisis Intervention with Children and Adolescents in School

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
What 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.
Overview 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
Definition 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
Stages 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.
What 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
The Big Three
 Suicidal Ideation and current self harm
 Homicidal Ideation
 Psychosis
Some 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
From 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.
Assumption makes an … out of
you and me. Assessment does
not.
Most important step
 Never underestimate the importance of
assessment
Assessing 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.
IS PATH WARM?
 I = Ideation
 S = Substance Abuse
 P = Purposelessness
 A = Anxiety
 T = Trapped
 H = Hopelessness
 W = Withdrawal
 A = Anger
 R = Recklessness
 M = Mood Change
SAFE - 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
Is the student a member of
an at-risk, vulnerable or
socially marginalized
group? (e.g. male, older
adolescent, history of mental
illness, GLBT)
What historical or
predisposing factors may
elevate suicide risk? (e.g.
previous history of suicidal
behavior, family history of
suicide, history of child
abuse)
What 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)
What is the level of current
suicidal thinking and
planning? (e.g. duration,
specificity and intensity of
ideation, level of planning,
access to plan)
What 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)
Documentation
SOAP Method
Subjective: What the client tells
you
Objective: Factual, quantifiable
Assessment: Summary of
client’s clinical thinking
Plan: Parameters of treatment,
action plan and prognosis
Break 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
AISD 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 &
counseling 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
AISD 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