1. Crisis Response: The Role of the Crisis Worker Amanda Varnish-Sharma, M.Ed. Early Intervention Family Worker Schizophrenia Society of Ontario

2. Agenda What is Crisis and Crisis Intervention? What is Crisis and Crisis Intervention? Roles & Goals of Crisis Workers Roles & Goals of Crisis Workers Best Practice Guidelines Best Practice Guidelines Integrative Model of Crisis Intervention Integrative Model of Crisis Intervention What Can Families Do? What Can Families Do?

3. What is a Crisis? An emotional upset, arising from situational, developmental, biological, psychological, socio- cultural and/or spiritual factors. This state of emotional distress results in a temporary inability to cope by means of one’s usual resources and coping mechanisms. Unless the stressors that precipitated the crisis are alleviated and/or the coping mechanisms are bolstered, major disorganization may result. It is recognized that a crisis state is subjective and as such may be defined by the individual, the family, or other members of the community. (Hoff, 1995; Ontario Ministry of Health and Long-Term Care 1999)‏

4. What is Crisis Intervention? A process that focuses on resolution of the immediate problem through the use of personal, social and environmental resources. The goals of crisis intervention are rapid resolution of the crisis to prevent further deterioration, to achieve at least a pre-crisis level of functioning, to promote growth and effective problem solving, and to recognize danger signs to prevent negative outcomes (RNAO, 2006; Hoff, 1995)‏

5. The Dichotomy of Crisis Opportunity Develop new coping skills Develop new coping skills Alter perceptions Alter perceptionsDanger Avoid seeking help Avoid seeking help Lowered level of functioning Lowered level of functioning

6. Roles & Goals of Crisis Workers Support individuals and families in crisis Support individuals and families in crisis Mental Health Assessment Mental Health Assessment Liaise with ER physician Liaise with ER physician Liaise with Community Support Liaise with Community Support Referral-community, hospital, etc. Referral-community, hospital, etc. Liaise with psychiatrist Liaise with psychiatrist

7. Best Practice Guidelines 1. Crisis intervention is founded on a particular set of values and beliefs, and guiding principles 2. A comprehensive holistic assessment is performed prior to engaging in any plan to resolve crises 3. To enhance the continuum of crisis care, the organization continuously strives to achieve a collaborative and integrative crisis intervention practice model within an interdisciplinary team 4. The organization actively advocates for the provision of quality crisis intervention care on multiple levels including individual, family, and community (RNAO, 2006)

8. Develop rapport Maintain contact Identify the Problem Explore Coping Assess Risk to Life Collaborative action plan Implement the plan Follow up on the plan Integrative Model of Crisis Intervention Therapeutic Communication Problem SolvingProblem Solving Decision MakingDecision Making

9. Develop Rapport and Maintain Contact Rapport, trust, and active listening Rapport, trust, and active listening “I can see that you are very distressed. I am concerned about you. Can you tell me what is upsetting you?” Maintain ongoing contact Maintain ongoing contact Therapeutic communication skills- validation Therapeutic communication skills- validation Active listening, paraphrasing in the individuals own words regarding his or her description of the current situation.

10. Identify the Problem & Therapeutic Interaction Information collection Information collection Clinical judgment and expertise Clinical judgment and expertise Facilitation of individual's understanding of the crisis Facilitation of individual's understanding of the crisis Collaborate on new ways of appraising the situation Collaborate on new ways of appraising the situation

11. Mental Status Exam Appearance Appearance Age, sex, posture, eye contact, dress, grooming, manner, facial expression Age, sex, posture, eye contact, dress, grooming, manner, facial expression Motor Motor Retardation, agitation, unusual movements, gait, catatonia Retardation, agitation, unusual movements, gait, catatonia Speech Speech Rate, rhythm, volume, amount, articulation, spontaneity Rate, rhythm, volume, amount, articulation, spontaneity Affect Affect Stability, range, appropriateness, intensity, affect, mood Stability, range, appropriateness, intensity, affect, mood

12. Mental Status Exam Thought Content Thought Content Suicidal or homicidal ideation, depressive cognition, obsessions, ruminations, phobias, ideas of reference, paranoid ideation, magical ideation, delusions, overvalued ideas, other major themes Suicidal or homicidal ideation, depressive cognition, obsessions, ruminations, phobias, ideas of reference, paranoid ideation, magical ideation, delusions, overvalued ideas, other major themes Thought Process Thought Process Coherence, logic, stream, perseveration, neologism, blocking, attention Coherence, logic, stream, perseveration, neologism, blocking, attention Perception Perception Hallucinations, illusions, depersonalization Hallucinations, illusions, depersonalization Insight Insight Awareness of illness Awareness of illness

13. Explore Coping & Collaborate on Action Plan Explore new ways of problem solving and decision making Explore new ways of problem solving and decision making What have you done in the past to get through difficult times? What else can you think of to try to get through this? Facilitate and mobilize support networks Facilitate and mobilize support networks

14. What Families Can Do DO’S Remain as calm as possible Remain as calm as possible Decrease other distractions Decrease other distractions Allow the person to have personal “space” in the room Allow the person to have personal “space” in the roomDON’TS Don’t shout Don’t criticize Don’t challenge Avoid continuous eye contact Don’t block the doorway Don’t argue with other people

15. What Families Can Do Have a family crisis plan- contact SSO for more details on crisis plans Have a family crisis plan- contact SSO for more details on crisis plans Keep a written record of treatments given including dates and times Keep a written record of treatments given including dates and times Be polite but assertive with hospital staff Be polite but assertive with hospital staff Keep conversations to the point- ask specific questions Keep conversations to the point- ask specific questions Try to form a partnering relationship between hospital staff, the individual in crisis and yourself Try to form a partnering relationship between hospital staff, the individual in crisis and yourself

16. Thank You!