Crisis Intervention with Children and Adolescents in School

fortnecessityusefulDéveloppement de logiciels

14 déc. 2013 (il y a 3 années et 8 mois)

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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

S
ubjective: What the client tells
you

O
bjective: Factual, quantifiable

A
ssessment: Summary of
client’s clinical thinking

P
lan: 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 &
c
ounseling 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