Crises affecting individuals are part of social workers' roles to intervene in to bring about suitable solutions. The appropriate approaches and strategies should be implemented depending on the particular situation of the client. One such approach that has been useful in social work is crisis intervention. Lindemann and Caplan pioneered crisis intervention after they got involved in the Cocoanut Grove nightclub catastrophe that led to the death of 493 people. Treatment of the survivors revealed a typical emotional response. At the time, there were no standard measures to address individuals that suffered trauma and loss but did not have a particular psychological diagnosis.
Lindemann developed a theory for crisis intervention centered on people who demonstrated disorganization in their daily operations by conducting therapy sessions to help them restore balance in their lives. The concept of community mental health was introduced to support individuals by using clergy, social workers, and other community helpers. The Wellesley Project established after these findings had the objective of initiating early interventions as preventive measures for persons with traumatic experiences. According to this approach, crisis mainly refers to a traumatic event's impact, not the traumatic event itself. It is the imbalance state created by such circumstances that the intervention should address.
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The crisis intervention theory initial model was the ABC-X Model of Crisis. There is continuous interaction between the traumatic event, the family's resources, and the family's perception of the event. The authors of an article titled: "Correction to An Examination of Crisis Intervention Teams in Rural Jurisdictions" suggest that this interaction leads to the crisis, which manifests as imbalance and stagnation of the family (2021). This model, although it targets family systems, may still apply to individuals. The model has since been expanded to the Double ABC-X Model of Crisis, which considers the natural evolution of systems into complexity. In the perceptive of crisis, development takes growth and recovery (Bratina et al., 2021). After a crisis has occurred, new factors in the trauma may develop, new resources may be added, and the perception may be altered.
Elements of Crisis Intervention
Provoking Stressor Events
A risk assessment study in youth titled "Risk Assessment and Crisis Intervention for Youth in a Time of Telehealth" identified stressor events as traumatic situations that initiate the imbalance in the individual's system. These events could be negative or positive, and though normal, many are unpredictable. Stressors can be classified as either nonnormative or normative. Normative stressors are expected developmental changes like moving, advancing into high school, or reaching puberty. On the other hand, nonnormative stressors are unexpected events such as terrorist attacks or a family member's sudden severe illness. Stressor events are also grouped by type, source, and severity. According to the study, the source could be from within the family or from external from the family. Internal stressors within the family include events like alcoholism or abuse by a family member.
An alcoholic or abusive family member's actions often solicit distinct behavior from other family members as they attempt to cope with that person's behavior. Such a family may devolve into a series of crisis events as the survival strategies prove ineffective with time. External stressors are those traumatic situations whose source is not from the family but impact the family. Natural disasters, economic problems, and pandemics are examples of external stressors. Families often have little control over the development of external stressors like economic recessions, natural calamities, and disease outbreaks. The severity of the crisis in both external and internal stressors is dependent on the resources at the disposal of the family or individual and their perception of the stressor event (Holland et al., 2021). In situations where a natural calamity affects a community, those families with adequate resources will have a lower degree of crisis.
Stressors can also be categorized based on their duration of time. Some stressors occur as a single event that happens quickly, known as acute stressors. A serious illness that quickly heals may disrupt the family's balance, becoming a crisis, but the balance is restored once healed. Chronic stressors are those that happen over a long period, causing severe stress such as chronic illness. Also, it is essential to consider whether stressors are a series of events or a single event.
Resources
In another study, "COVID-19 Epidemic Peer Support and Crisis Intervention Via Social Media", the authors identified resources in a crisis as the abilities that can be utilized to satisfy the needs of stressor events at the family or individual. Resources may be material such as money or intangible such as a supportive community. Insufficient resources to satisfy these needs make the stressor event have a less severe impact. Resources can help mitigate the effects of the provoking stressor event or assist in strengthening a crisis. Finances, knowledge, and health are individual resources, while family resources are the traits of supportiveness, harmony, and resilience. External support and social structures that aim to help individuals are examples of community or societal resources (Cheng et al., 2020).
Meaning and Perception
The third element is the perception that is tied to the stressor event. This perception is subjective and comes about as a result of cognitive processes. Research by Tyuse supports that perception is subjective and comes about due to cognitive processes (Tyuse, 2020). Additionally, unavailable information about the development of the stressor event contributes to a vague perception of the event. This factor raises the uncertainty of the individuals about the reliability of their families and other support mechanisms. This limited understanding makes it difficult for specific roles and functions to support the individual to be carried out.
Many individuals resort to denial as a coping strategy to shield themselves from the harsh perception. However, this strategy may be helpful in the short term but proves ineffective in the long run. Coping strategies are the mechanism individuals use to address the perception that a stressor causes in a person (Tyuse, 2020). Coping strategies are, in essence, a defense mechanism that shields people from the impact of the stressor event. People employ coping strategies also to manage the emotions that develop from the event. Arguably, coping mechanisms substitute for the relevant social support in scenarios where they are inadequate or inexistence.
The Crisis intervention model has seven-stage stages that are critical in stabilizing the imbalance caused by stressors. These essential stages include:
Biopsychosocial and lethality assessment; in this phase, a quick evaluation is conducted by the crisis worker. This assessment is designed to identify the client's stressors, support systems, resources, and coping strategies.
Establishment of rapport, which is facilitated to prompt genuineness and acceptance from the client. Rapport is meant to instill confidence in the client. Aspects of proper communication such as eye-contact, positivity, and flexibility are crucial in this stage.
Identification of crisis precipitants; this stage's focus is to conduct a diagnosis that will portray the client's current problems. This stage also enables the crisis worker to prioritize those identified problems.
Deal with emotions; in this stage, the worker encourages the client to express their feelings freely. The crisis worker then gives responses that are challenging to loosen the client's negative perceptions.
Generate coping strategies; in this stage, the crisis worker should provide practical solutions to help the client. This stage requires unique solutions since every crisis must be handled on a case-by-case basis.
Implement an action plan; the strategies are put into practice as an intervention. The implementation of the strategy involves safeguarding the client and increasing their safety.
Follow-up; this stage is planned to evaluate the client's progress and the effectiveness of the strategy being implemented. If there is a need to change some ineffective strategy, this will be considered in this stage.
The crisis intervention approach is a valuable mechanism in addressing a client's challenges in a deep crisis. Careful implementation of the model has proved to be effective in the short term in helping individuals and families restore balance in their lives after a crisis has occurred. Uniqueness and specificity are crucial in successfully utilizing the crisis intervention model, and the crisis worker should carefully analyze the situation before suggesting strategies.
Assessment and Intervention Strategy
The client is a 23-year-old heterosexual female who prefers to be identified with the pronoun "she." She is also ethnically identifying as an African American with no particular religious affiliation. She suffers no known physical disability but maybe presenting an undiagnosed mental illness. She previously worked as an exotic dancer at a famous strip club in Brooklyn, New York. The business has been closed for six months now due to Covid-19 regulations prompting the management to lay off all workers. She struggles with getting money for food and other basics and has been contemplating suicide for one month.
The client sought the student social worker's help after hitting rock bottom in her life. She seeks direction and balance, but she cannot find the motivation to find a job or have hope again in life. She also reports having an alcohol problem for the past four years, which seems to have gotten worse since she lost her job six months ago. She also came out of an abusive relationship three months before meeting the student social worker, an experience she claims to have not fully healed of yet. A new job would be a good step towards healing from depression and suicidal thoughts, but this is proving very difficult given the current economic situation.
The client and I took the first step to carry out an assessment session to determine the client's stressors and any social support. Also, it was my immediate priority to assess the lethality of the client's suicidal thoughts. I asked about any suicide attempts she has had recently and in the past, of which the client assured me that she had had none. I also inquired if the client had any concrete plans for committing suicide to gauge the level of lethality of her motives. The client had no plan in place but still faced many risks since her economic situation had not improved.
Her life's immediate stressors were her loss of employment, her abusive relationship, and the breakup that followed. I also identified another stressor event in the client's life when she was 12 years of age. During this time, she was continuously sexually abused by her stepfather, an act which she never disclosed to anyone, including her emotionally distant mother. This event has given her insecurities which have made it difficult for her to form stable relationships. She also attributes the abuse in her teens to significantly contribute to her alcohol abuse and strip dance job, of which she is not proud. Her goals are to retain balance and achieve happiness in her life.
During this session, I also established rapport by informing the client of my qualification as a social worker. I reassure her that it is my purpose and happiness to help individuals find balance after a crisis in their lives. Our sessions took place in complete privacy and comfort to make the client have the necessary confidence to open up. In these sessions, her loss of job was identified as her most significant crisis precipitant. The client escalated her alcohol abuse problem as a coping mechanism from the harsh realities she was facing. The sexual abuse was also a significant stressor event that has affected her relationships.
Together with the client, we came up with a series of alternatives to her problems. We identified her strengths as resilient and diligent qualities that should be portrayed much more in her life. She also has a passion for music and singing, particularly a talent that should be nurtured and developed to advance her career and well-being. First, we decided that linking her to a job club focused on encouraging creative skills would help her with her unemployment problem and give her the necessary social support. I also directly linked her with a professional community psychologist who would resolve her abusive past and alcohol problem. The client is a robust and resilient person who lacked an adequate social support system to encourage her through the stressor she encountered in her life.
The action plan to be implemented requires putting the identified alternative coping strategies into practice. We put measures to ensure the client does not stay in isolation, sinking into depression and suicidal thoughts. This measure was implemented through the job club. The client would have the opportunity to meet and interact with other unemployed individuals, thereby lifting off some emotional burdens. I would also maintain regular contact with the client through the phone and weekly visits to evaluate progress and challenges. Bi-weekly scheduled sessions with the community psychologists were planned to address some of the more profound mental illness issues and alcoholic problems. Finally, the continuous follow-up to assess her job situation, alcohol problem, and mental stability will be the intervention's last step.
References
Bratina, M. P., Carsello, J. A., Carrero, K. M., & Antonio, M. E. (2021). Correction to: An Examination of Crisis Intervention Teams in Rural Jurisdictions. Community Mental Health Journal . https://doi.org/10.1007/s10597-021-00812-x
Cheng, P., Xia, G., Pang, P., Wu, B., Jiang, W., Li, Y.-T., … Bi, X. (2020). COVID-19 Epidemic Peer Support and Crisis Intervention Via Social Media. Community Mental Health Journal , 56 (5), 786–792. https://doi.org/10.1007/s10597-020-00624-5
Dmitrijeva, N., & Razgale, I. (2018). Social worker intervention performance in work with unemployed adults. SHS Web of Conferences , 51 , 03005. https://doi.org/10.1051/shsconf/20185103005
Holland, M., Hawks, J., Morelli, L. C., & Khan, Z. (2021). Risk Assessment and Crisis Intervention for Youth in a Time of Telehealth. Contemporary School Psychology , 25 (1), 12–26. https://doi.org/10.1007/s40688-020-00341-6
Tyuse, S. W. (2020). Crisis Intervention Team (CIT) Programs and Suicide. Journal of Psychosocial Rehabilitation and Mental Health , 7 (3), 221–229. https://doi.org/10.1007/s40737-020-00186-5
