Crisis Intervention Program Research Articles

High Schools Respond to Crises

Schools across the nation have increasingly coordinated crisis intervention programs to minimize the impact felt by students as the result of a crisis, such as national events and school violence. Through the development of response plans and crisis teams, as well as the instrumental work of school counselors in promoting intervention plans and prevention programs, school systems have taken steps toward assisting students in recovery from crises. Theories of crisis intervention emerge from direct practice; however, minimal research has been conducted to examine how schools plan to respond to crises versus their actual response. This research investigated what high schools in one Massachusetts county have learned from actual response to crises. The study was conducted via written surveys of administrators and qualitative interviews with school counselors.

The Effects of a Police/Victim Assistance Crisis Team Approach to Domestic Violence

A police/victim assistance crisis intervention program was evaluated over a 6-month period for its effect on police-related outcomes. Police report data on crisis team cases (N = 96) were compared to a random selection of family violence cases (N = 80) that were not served by the crisis team. The crisis team cases generated more arrests; however, victim cooperation was lower than in noncrisis intervention cases. Implications for work with family violence and victim assistance are discussed, as well as needs for future research.

The role of psychotherapy in the treatment of acute mental disorders

This work is directed to further investigate the significant relevance of psychotherapy to better management of acute psychiatric disorders. Over the last years, there was impressive increase of the amount of psychiatric patients referred to emergency and in-patient treatment and such increase all most resulted from subjects with acute emotional discontrol associated with affective, personality and stress related disorders. According to such change of the clinical scene of contemporary psychiatry, more attention and funding are needed in the field of acute treatment services and combined treatment innovation and research is become a major challenge for community psychiatry. A real progress in the field is not, however a simple matter of psychotherapy technology transference. While several recent studies suggest that well designed combined treatment is cost-effective in these patients, new nosographic, management and dynamic models are required for succesful development of new crisis intervention programs within general psychiatry services.

Effects of Using a Nursing Crisis Intervention Program on Psychosocial Responses and Coping Strategies of Infertile Women During In Vitro Fertilization

Infertility and its treatment may cause life crises in infertile women. The purpose of this study is to evaluate the effects of a crisis intervention program on improving psychosocial responses and enhancing coping strategies for infertile women attending different stages of an In-Vitro Fertilization V Embryo Transfer (IVF-ET) treatment program. Using an experimental study design, infertile women attending an IVF-ET treatment program were randomly assigned to experimental and control groups. In the experimental group, infertile women completed and answered a questionnaire and received nursing crisis intervention at the initial stage of treatment (day 3). This included (1). viewing a video explaining the therapeutic process of IVF-ET, (2). self-hypnosis and muscle relaxation training, and (3). provision of cognitive-behavioral counseling. The same questionnaire was used again for subjects at the stage of embryo transfer and before taking a pregnancy test. The women in the control group were only interviewed using the same questionnaire and at the same times as the experimental group. Analysis by repeated measurement ANOVA demonstrated that there was a reduction in psychosocial response in terms of interpersonal relationships, and there was an interaction between intervention effects and stage of treatment. However, there was no statistically significant difference in the level of psychosocial responses between the experimental and control groups although some meaningful findings were made. However, in terms of state of anxiety, confrontational problems, and isolated mind/body relaxation, there were significant differences between the two groups of infertile women at some stages of IVF-ET treatment. The women in the experimental group perceived a positive effect of the nursing intervention in relieving their psychosocial responses. The results of this nursing crisis intervention could be helpful in nursing practice when dealing with infertile women attending IVF treatment programs.

Quality of Life Perception in Transitional Housing Demonstration Projects: An Examination of Psychosocial Impact

This study examines life quality perceptions and changes in these perceptions for a sample of aid to families with dependent children (AFDC) women (N = 78) where homelessness led to their participation in publicly funded transitional housing. Questionnaires were administered to these women at three times: upon their entry into the program, 3 to 5 months after entry, and 3 to 5 months after graduation. Panel data were analyzed using static score and conditional change autoregressive models. Results of these analyses indicate that this type of serial crisis intervention program can change perceptions of life quality positively, with the change especially apparent among women with lower preprogram dissatisfaction levels. Findings are interpreted within the framework of system inertia proposed by James Coleman. [Brief Treatment and Crisis Intervention 3:99–118 (2003)]

Staff victims of elder patient abuse and the Assaulted Staff Action Program (ASAP): preliminary empirical inquiry.

Patient assaults on healthcare staff are a serious and ongoing issue in long-term care facilities. Emerging studies have begun to empirically document assaults by elders in skilled nursing facilities as well as the negative impact of these events on healthcare staff victims. This study examined assaults by elders and their impact on staff over a six-year period within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention program for staff victims to address the psychological aftermath of patient assaults. Findings confirmed both elder assaultive behavior and its negative impacts on staff victims. The efficacy of ASAP in ameliorating these negative impacts was presented. The implications of the findings for long-term care settings were discussed.

Community Responses to Violence in Holman, Northwest Territory

When we talk about narrative, we often focus on the story and the teller, but rarely on the listener. Yet often the first step in healing is finding someone who will listen to you and truly hear your story. Alice Kimiksana and others in the Canadian Arctic village of Holman, who are concerned about the community’s high suicide rate, understand this basic healing principal very well. They have worked together to create a Help Line—a confidential listening and crisis intervention program—for their community. Kimiksana talks about how in Holman, as in other northern communities, trauma led parents to teach their children not to talk about their pain, their fear, or their abusive experiences, including those that occurred in the residential schools. As a result, even years later, the pain, fear, and hurt can become unbearable, leading sometimes to alcohol and drug abuse, and sometimes to violence toward oneself or others. Educational groups, Healing Circles, and youth groups are starting to help. However, unless there are helpers who will listen when people begin to tell their stories, this first step in healing cannot take place and the cycle of intergenerational trauma will not be broken.

M ENTAL H EALTH N EEDS FOR P ROVIDERS OF E MERGENCY M EDICAL S ERVICES FOR C HILDREN (EMSC): A R EPORT OF A C ONSENSUS P ANEL

On October 5, 2000, the select Consensus Panel on Mental Health Needs for Providers of Emergency Medical Services for Children (EMSC) was convened in Washington, DC, by the American Psychological Association. This paper reports the results of that two-day meeting. Major topics addressed by the consensus panel were the need for acute psychological support services for providers of EMSC, identification of especially stressful clinical stressors for emergency caregivers, stressors within the health care system, adverse psychological and behavioral reactions among EMSC providers, a review of intervention strategies, and recommendations for future directions. The select panel agreed that there exists an extraordinary need for acute psychological support services in venues that provide EMSC. The panel recommended the proliferation of state-of-the-art information to settings that provide EMSC in order to assist in the implementation of acute psychological support services to assist EMSC providers as well as the pediatric patients and their families. The Critical Incident Stress Management (CISM) crisis intervention program was viewed as one such system of psychological support services that should be pursued.

Characteristics of assaultive psychiatric patients: ten year analysis of the Assaulted Staff Action Program (ASAP).

Nearly thirty years of published research has documented the continuing presence of patient assaults on staff. These studies have included the traditional male patient with a diagnosis of schizophrenia and histories of violence and substance use disorder and the newer female, personality-disordered individual. This study reports on a ten-year longitudinal analysis of assaultive patients in one public-sector mental healthcare system during a period which included the national shift toward managed care initiatives. Data were gathered in the context of the Assaulted Staff Action Program, a crisis intervention program for staff victims. Patient assailants in both inpatient and community settings included both the traditional and newer personality-disordered individuals. The majority of assailants were females. Managed care initiatives appeared to have had little impact on type of assailants. Implications for safety and treatment are discussed.

Assessing the impact of community-based mobile crisis services on preventing hospitalization.

This study evaluated the impact of a community-based mobile crisis intervention program on the rate and timing of hospitalization. It also explored major consumer characteristics related to the likelihood of hospitalization. A quasi-experimental design with an ex post matched control group was used. A community-based mobile crisis intervention cohort (N=1,696) was matched with a hospital-based intervention cohort (N=4,106) on seven variables: gender, race, age at the time of crisis service, primary diagnosis, recency of prior use of services, indication of substance abuse, and severe mental disability certification status. The matching process resulted in a treatment group and a comparison group, each consisting of 1,100 subjects. Differences in hospitalization rate and timing between the two groups were assessed with a Cox proportional hazards model. The community-based crisis intervention reduced the hospitalization rate by 8 percentage points. A consumer using a hospital-based intervention was 51 percent more likely than one using community-based mobile crisis services to be hospitalized within the 30 days after the crisis (p<.001). Treating a greater proportion of clients in the community rather than hospitalizing them did not increase the risk of subsequent hospitalization. Those most likely to be hospitalized were young, homeless, and experiencing acute problems; they were referred by psychiatric hospitals, the legal system, or other treatment facilities; they showed signs of substance abuse, had no income, and were severely mentally disabled. Results indicate that community-based mobile crisis services resulted in a lower rate of hospitalization than hospital-based interventions. Consumer characteristics were also associated with the risk of hospitalization.

Characteristics of staff victims of patient assault: ten year analysis of the Assaulted Staff Action Program (ASAP).

Patient assaults on staff have been a continuing risk for inpatient and community-based psychiatric healthcare providers. This study presents a ten-year analysis of the characteristics of staff victims of patient assaults in one public mental health system of care, a period which included the transition to managed care initiatives within this system. Assault data was gathered within the context of the Assaulted Staff Action Program (ASAP), a voluntary, system-wide, peer-help, crisis intervention program that is designed to assist employees with the psychological sequelae of these patient events. In general, the findings were consistent with previously reported inpatient and community studies. Less experienced, less formally trained employees remain at high risk. The impact of managed care initiatives was found in community residences where younger female staff were most at risk. The implications of the findings and possible risk management strategies are discussed.

Managed care: Public-sector managed behavioral health care: VI. The Iowa approach to profit and community reinvestment.

T public’s nightmare image of for-profit public-sector managed care is one of an opportunistic, financially driven company siphoning public money away from needy citizens to line the pockets of greedy investors and lavishly paid executives. A recent nationwide survey asked a random sample of adults if they were “worried that your health plan would be more concerned about saving money than about [providing] the best treatment for you if you are sick” (1). Sixty-one percent of respondents who were enrolled in “heavy managed care” said they were somewhat or very worried, compared with only 34 percent of those in “traditional” plans. Backlash against managed care is substantial enough to be the subject of an entire 400-page issue of the Journal of Health Politics, Policy, and Law (2). Since 1995 Iowa has addressed these fears head-on through the evolving design of its Medicaid behavioral health program. This column, which is the sixth in a series on public-sector managed behavioral health care and the second focusing on Iowa (3), addresses the lessons other states can learn from Iowa’s strategy of capping profits and mandating community reinvestment.

The Assaulted Staff Action Program (ASAP) and declines in rates of assault: mixed replicated findings.

The Assaulted Staff Action Program (ASAP) is a crisis intervention program that has been associated with providing both needed support for employee victims of patient assault and declines in rates of assaults in traditional state hospital and community mental health settings. This study examined the possible role of ASAP and declines in rates of assault in three community-based services impacted by privatization and managed care approaches: community residences, an acute care rural community mental health center, and an urban intermediate/extended care facility. ASAP was associated with a statistically significant decline in the rate of assault in the intermediate/extended care facility. The community residence program was not a true test because of structural issues associated with managed care. The community mental health center appeared to be a true failed replication. The extended care facility's decline in the rate of assault was interrupted by the aftermath of one serious clinical incident during one month and then continued to decline. The implications are discussed.

Efficacy of crisis intervention.

This study assesses the efficacy of the treatment approach implemented in the Bern Crisis Intervention Program, where particular emphasis is placed on the remediation of suicide ideation and suicidal behavior, and depression, fear, and phobia are generally considered to be contributing factors. Four questionnaires addressing psychopathology, emotional well-being, social anxiety, and personality were administered prior to and after the treatment of 51 patients over a period of 2 to 3 weeks. The reduction of symptoms contributing to suicidal ideation and behavior was interpreted as indirect evidence of an antisuicidal effect of the program. Significant improvements were found in the psychopathology ratings, with depression and anxiety showing the largest reductions. The impact on personality and social phobia, however, was only moderate, and on average patients still exhibited symptoms after attending the program. This residual symptomatology points to the necessity of introducing a two-step therapy approach of intensive intervention targeted at the precipitating causes of the crisis, augmented by long-term therapy to treat underlying problems.

Acute Residential Treatment: Adapting Our Expertise for Managed Care

ABSTRACT As the application of managed care principles has spread through our country's health delivery system, hospitals have struggled to survive. Now the same managed care principles are starting to be introduced into the child welfare world, precipitating much anxiety. Providers of residential treatment certainly have reason to be concerned. With a focus on reducing costs, “managed care poses risks especially for children with the most intensive service needs, who require comprehensive, long-term and often expensive treatment”–the very children served by residential treatment centers (Emenhiser et al., 1995). To meet the needs of these children and their families, as well as to ensure their own financial viability, residential treatment centers need to adapt their programs and practices to respond to the new demands of a managed care environment. To exemplify one way we can do this, this paper examines Germaine Lawrence's acute residential treatment program–a short-term crisis intervention program–which blends the core skills of residential treatment with the demands of managed care organizations to provide an effective service for children and families.

A crisis intervention program. Staff go the extra mile for client improvement.

1. Community mental health centers are faced with clients with dual and triple diagnoses who do not respond to traditional treatment. 2. A crisis team, with its inherent flexibility, may be able to engage multi-need clients and enable them to become connected to the Community mental health center. 3. Although these clients will continue to require inpatient services, provision of crisis team services can shorten inpatient length of stay. Plans to transition clients to more comprehensive services are necessary.

Crisis intervention: program evaluation.

Crisis intervention is based upon crisis theory and is defined as a short-term active mode of therapy that focuses on solving the client's immediate problem and reestablishing psychological equilibrium. The crisis intervention program was the first phase in the development of a broader mental health program with advancement decisions being based upon evaluation results of this initial phase. An evaluation methodology using the Stufflebeam Goal-Stakeholder Model (1980) was designed and implemented. A satisfaction survey was conducted to develop a database relative to the program's process. The Mental Health Category Measure, and the Crisis Call Outcome Rating Scale were used to capture outcome data. Analysis of the qualitative and quantitative data indicate that stakeholders are satisfied with the program. outcome data demonstrates that the program produces the intended outcomes. Triangulation, a method of comparing the qualitative and quantitative findings revealed consistency, and thus provides confidence in the accuracy of the findings.

Confrontations with reality: crisis intervention services for traumatized families after a school bus accident in Norway.

In August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a "confronting" support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.

Confrontations with reality: Crisis intervention services for traumatized families after a school bus accident in Norway

AbstractIn August 1988 a Swedish schoolbus with 23 children and 11 adult passengers crashed into a tunnel wall in Norway. Twelve children and four parents died, 18 of the passengers survived. The victims' relatives (parents, spouses, siblings, and others) were transported to Norway and given a “confronting” support program at the University hospital in Bergen. The crisis intervention program is described: how the relatives were helped to confront and actively cope with some of the stressful situations from which traumatized families very often are protected. One year later 42 of the relatives answered a questionnaire evaluating the confronting support program that was offered during their stay in Norway. A majority of the respondents did not regret their participation in the program. The answers indicate that passivity and helplessness can be counteracted through a combination of confrontation with reality and emotional support.

Around-the-clock mobile psychiatric crisis intervention: Another effective alternative to psychiatric hospitalization

This retrospective study evaluates the effect of the addition of a mobile psychiatrist to a 24-hour crisis intervention team, on the number of admissions, to the local state and private hospitals, of residents of the team's catchment area. During the Program period, the psychiatrist was available at the site of the crisis to provide immediate psychiatric treatment. The number of admissions to the hospitals during the Program period was then compared to those of the corresponding periods of the two previous years and of the year after, by means of a time series statistical analysis. When the on-site services of a psychiatrist were added to the mobile crisis intervention program a sharp decrease in state hospital admissions took place, without any increase in private hospital admissions. This decrease was followed by a definite rebound, after the on-site services of the psychiatrist were terminated, and throughout the following year.