Transcript CRISIS INTERVENTION

CRISIS INTERVENTION
Components of crisis intervention
Guidelines
Crisis at various stages of life
Special challenges
Definition
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“the helping response of a crisis worker
to a victim in crisis”. (Mitchell, Resnik)
An active but temporary entry into the
life situation of a person, family or group
during a period of stress
Paramedic needs to be alert, flexible,
resourceful and willing to get involved
Intervention targets the response – NOT
the event per se.
Goals of crisis intervention
Earmarked by narrow goals of short duration
1. Shield the person from additional stress
2. Assist the person in organizing and mobilizing
their resources
3. Return the person, a much as possible, to a
pre-crisis level of functioning
Five major components of crisis
intervention
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Intervention is flexible but structured – not
haphazard or sloppy
Consider the stages the individual is going through
during your intervention
Assist you [the paramedic] to decide what to do
1. Assessment
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First priority is safety – is there any danger to you
or others
What has happened?
Who is involved?
What was the cause?
How serious is the problem?
2. The plan
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Preliminary plan of action based on assessment
Does not need to be detailed; the crisis will not
wait!
Doing something positive is better than doing
nothing
3. Implementation of the plan
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Act, intervene
What ever the plan, get going!
4. Reassessment
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Once a plan has been implemented, it needs to be
monitored for success
If the plan is working, keep going!
If not, formulate a new plan
5. Recapping
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Victims of crisis have a difficult time following what
is going on around them
The person may need someone to tell them what is
happening
This may need to be done repeatedly
Remember
Most important tools are verbal and non
verbal communication. Careful use of
these skills will:
 Help the person reduce emotional
reactions
 Make sense out of what is happening
 Find short term solutions to the problem
Guidelines
The DO’s and DON’T’s of
Intervention
 Application
Crisis pt
Most incidents
1. Provide a reality base
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Be calm
Identify yourself and your position
Explain the presence of others such as
police and fire fighters
Use the person’s name
Reassure the person of confidentiality
Give supportive and truthful information
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Let the person know what you expect of
them and what they can expect of you
Explain why you are doing or not doing
something
Explain unusual equipment or procedures
Anticipate the concerns of the person and
family
Be non judgmental
Be aware of your reactions
2. Provide verbal and non verbal
support
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Maintain a relaxed posture
Be near and at their level, if appropriate
Touch is important, if appropriate
Encourage communication
Realistic reassurance with reasonable expectations
Stay with them if possible
3. Listen and respond
Effective listening
 Attending
 Paraphrasing
 Reflection of feelings
 Summarizing
 Probing
 Helper self disclosure
4. Ask clear, simple questions
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Ask open ended questions
Questions should be understandable and focused
One at a time
A definite plan of questioning is helpful
Remember the Goal
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Get the person to talk freely and
frankly about the present situation
Obtain background info about the
problem - detail
Help the person understand about the
situation
Consider if time permits alternative to
resolve problems...usually more the
crisis Interventionalist
Precautionary Measures
(the don’ts )
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1. Don’t deny the possibility of violence when
the early signs of agitation are first noticed.
2. Don’t dismiss warnings from records, family
authorities or fellow workers (dispatch).
3. Don’t become isolated with potentially violent
patients
4. Don’t engage in certain behaviors that may
be interpreted as aggressive.
7/20/2015
Precautionary Measures
(don’ts) continued
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5. Don’t allow a number of emergency personnel
to interact simultaneously with the pt.
6. Don’t make promises that can’t be kept !!
7. Don’t argue, give orders, or disagree unless
absolutely necessary.
8. Don’t become condescending by using cynical,
satirical or otherwise confrontational mannerisms.
9. Don’t attempt to reason with pts who are under
the influence of a mind altering substance.
7/20/2015
Precautionary Measures
(don’ts) continued
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10. Don’t attempt to gain compliance based
upon the assumption that the patient is as
reasonable about things as you are.
11. Don’t keep the pt waiting or leave a
potentially violent pt alone with freedom to
move about.
12. Don’t allow a crowd to congregate as
spectators to an altercation.
13. Don’t use why and what questions that put
the pt on the defensive.
7/20/2015
Danger signs to watch out for
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Living in a fantasy world, has difficulty
separating fact from fiction
Won’t accept or ask for help
Uses extreme withdrawal, retreat,
avoidance
Turns to drugs/alcohol
Consumed with rage
Acts on impulse after the stage of emotional
shock has passed
Danger continued…
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Becomes hopeless and gives up
Very dependent on others
Comes across as ‘a rock’ – may be denying or
suppressing emotions
Usual patterns are disrupted to the extreme
Can apply to the patient, family
member or the paramedic – watch
out for them
Do’s and Don’ts use the
Dual Action Approach
In approaching the situation
A – Assess
C – control
T – treat
I – Inform
O – Okay
N - Notate
Check personal Action
A – Attitudes
C – Concern
T – Thinking ability
I – Interactions
O – Objectivity
N - Needs
Crisis at various stages of life
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Beyond the expected…
Consider a “Normal” cycle of events
Children
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Children in various age groups have
specific needs and respond to crisis in
different ways
May regress or return to behaviour of
another age
Assessment and Intervention
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Consider the child’s age, past experience
with injury, what they were doing when the
event occurred and their developmental
level
Look at the child’s relationship with adults –
if his physical, social and emotional needs
are being met, his response to you will be
different than if they are not being met
Children under six years old
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Greatest anxiety is separation from a parent
or caregiver – include the parent in care
provided
Fear pain and disapproval
Allow them to keep a favorite toy or blanket
Children between 6 and 12
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Often fear retaliation or punishment from a
parent
Let the parent know that although they may
be angry, they need to give support and
comfort
All children
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Remember; children listen to everything
that is said
Escort away from the scene
Give brief explanation of what is happening
Always tell the child if you will be doing
something painful before hand and tell them
when you are finished
Don’t
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Leave a child alone
Threaten a child with punishment if they are
unco-operative
Lie or frighten
Talk about the child’s family or living
conditions
Criticize the parents
Student [17-?]
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Not doing well at school
Lost scholarship
$$
School complete NOW WHAT
Job search
Interview...
Adult [beyond school]
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Job loss
2nd career – forced on them
Marriage
– May have more conflict
– Sexual difficulties often increase due to
health problems or fear of health
problems
Retirement – the mature adult
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May have a sense of worthlessness
Possibly forced to retire due to age
Some become depressed
Sensory loss – not age dependent
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Decrease in sight, hearing and smell
May increase anxiety
Does not mean they are intellectually
inferior
Physical appearance
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Accept the changes of aging
Never joke about or unnecessarily discuss these
changes
Emotional changes
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Slowed thinking, forgetfulness, rigid
thought patterns, irritability
May be anxious about security
Depressed and feel a loss of social status
Grief is common due to loss of loved ones,
friends, health status and activity level
Suicide risk increases in the elderly
Illness or death of a spouse
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Linked to decline in the health and
functioning of the survivor
Often the most serious loss the person
faced
Crisis intervention with the elderly
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Often find it difficult to ask for help because
of sense of privacy and pride
May have a sense of immediacy – may
become demanding
Reassurance is important
Use touch – if appropriate
Be patient
Sudden Infant Death Syndrome
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Make every attempt to resuscitate the baby
Do not give false hope
Do not be overly silent
Do not accuse the parent
Gather information from the parents
Listen
Provide supportive care to the family
Only provide the information you can
The silent patient
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Depression, organic brain condition,
muscular impairment, stroke, lack of trust,
quiet person
Observe for non verbal clues
Encourage speech
Are your actions contributing to the silence
– talking too fast, have you frightened or
offended
Always keep safety in mind - yours
Language barriers
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Try to locate an interpreter (verbal)
The interpreter may paraphrase what is
being said. The true meaning may not be
conveyed
Don’t try to interpret yourself unless you are
fluent
Most Common Interpreter Errors
Glenn Flores, MD, FAAP, Medical College of Wisconsin
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Omission (52%), in which the interpreter left out an
important piece of information.
False fluency (16%), in which the interpreter used
words or phrases that didn’t exist in a specific
language.
Substitution (13%), in which a word or phrase is
replaced with another word or phrase of a different
meaning.
Editorialization (10%), in which the interpreter’s
opinion is added to the interpretation.
Addition (8%), in which a word or phrase is added
by the interpreter.
Blindness
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Identify yourself
Explain who you are and what you are doing
Touch is important
Remember; your voice is your only means of
communication
Guide dogs are working dogs. Do not touch or feed
them
Cultural differences
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Both you and the patient bring cultural stereotypes
to the situation
Some are more comfortable with different distances
and may or may not be receptive to touch
It is important to be aware of various cultures
Recap…
Remember you may encounter the pt at
any point during their critical event
 Emotional shock
 Denial
 Anger
 Remorse
 Grief
 Reconciliation
Crisis Intervention
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A short term helping process
Acute intervention designed to
mitigate the crisis response
Not psychotherapy
Crisis Intervention
Goal: To foster natural resiliency through...
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Stabilization
Symptom reduction
Return to adaptive function or
Facilitation of access to continued care