Crisis Work Research Articles

Affected or Detached? Gendered Emotional Reactions to School Shootings

This article explores whether gendered norms and beliefs about emotions persist, as people relive and recount unexpected incidents of mass violence. The emotional expressions of men and women after two school shootings in Finland are examined and compared, based on qualitative interviews with local residents and crisis workers. Two emotional orientations in relation to school shootings were identified: being affected and being detached. Women were associated more with being emotionally affected and men with being detached. However, there was not always a consensus on how gendered individuals should express emotion in the aftermath of a school shooting.

Psychiatric Problems of Emergency Workers in Nuclear Crisis: An Issue in Industrial Psychiatry

Psychiatric Problems of Emergency Workers in Nuclear Crisis: An Issue in Industrial Psychiatry

Rape Crisis Centers and Programs: “Doing Amazing, Wonderful Things on Peanuts”

Even though the anti-rape movement began more than 30 years ago and there is greater awareness of sexual violence, are rape crisis centers or programs financially secure? Data from interviews with 63 rape crisis workers and volunteers from 6 rape crisis centers or programs located in 4 East Coast states indicate not only that rape crisis centers/programs continue to struggle financially but also that lack of funding continues to present challenges. When rape crisis centers/programs experience reductions in funding, staff positions are eliminated, remaining staff and volunteers are overworked, efforts to recruit and train volunteers are compromised, services for victims are reduced, and education and outreach to the communities become less available. Lack of funding negatively affects rape crisis centers/programs and jeopardizes their future.

Challenges to Doing Sexual Violence Work

ABSTRACT Sexual assault victims experience a number of effects as a result of their victimization. Sexual assault crisis workers are assigned the responsibility of trying to minimize the negative consequences of sexual assault. In their efforts to serve sexual assault victims, it is likely that certain problems make it difficult to adequately help victims. This study considers how 43 sexual assault crisis workers (27 directors of sexual assault crisis centers and 16 workers) define the challenges of serving sexual assault victims. Major challenges reported included a lack of awareness about sexual assault, victim blaming, and a lack of resources. Implications are provided.

The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.

Sexual Assault Crisis Centre Workers' Perceptions of Law Enforcement: Defining the Situation from a Systems Perspective

To date, the literature tends to be rife with research examining individuals' perceptions of the police. Most of this research had focused on how members of the public perceived law enforcement. Missing from this research were two types of studies: (1) those examining how certain types of professionals perceive the problems they have collaborating with law enforcement; and (2) those examining the consequences of those perceptions. This study addressed that void by considering how 44 sexual assault crisis workers described their experiences in collaborating with law enforcement agencies. In the discussion, attention was given to the possible consequences of these perceptions. Implications are provided.

Mental health triage in the ER: a qualitative study

The London Health Sciences Centre found that its emergency room (ER) mental health services were affected by people presenting with problems that did not require psychiatric intervention. Consequently, a second triage using a crisis worker (CW) was introduced in the ER to identify those persons with mental illness (PMI) who presented for social stressors related to housing, finances and legal issues. A qualitative, process evaluation study was conducted to capture experiences and perceptions of the new triage and CW. Qualitative input was obtained from a broad range of stakeholders in three waves of data-gathering over a 25-month period. This method allowed corroboration of findings from informants with varying interests and backgrounds. The data were collected through interviews, focus groups and surveys. The NUD-ist Qualitative Data Analysis Software Program was used to conduct content analyses. Many PMI seeking ER mental health services are presenting with problems related to social stressors and being referred by the second triage to the CW. The introduction of the second triage CW has had a positive effect on ER functioning, the workload of ER staff and the experience of persons presenting at ER. A defined triage process coupled with the use of psychiatric nursing staff may be applicable to ERs within general hospital settings to improve ER functioning, focus support for PMI and further integrate ERs within the community mental health model.

Intimate Violence Among Lesbian Couples

SUMMARY Intimate violence between opposite sex partners has been increasingly acknowledged and empirically studied in recent decades. Findings from both quantitative and qualitative research have resulted in a substantive knowledge base that is widely accepted and applied in treatment. Unfortunately, intimate violence between partners of the same sex has not been adequately addressed. The limited research data that has emerged raises questions not only about the prevalence of the problem, but also the definition of the problem, some differing dynamics as compared to heterosexual couples, the responses of crisis workers, social services, the police, and the courts, and appropriate therapeutic interventions. The authors discuss the above mentioned topics as they apply to intimate violence between female partners. They offer recommendations for clinicians who treat women involved in abusive, intimate relationships, as well as researchers who aim to build much needed knowledge about this neglected issue.

Termination of resuscitation in the prehospital setting for adult patients suffering nontraumatic cardiac arrest

The National Association of EMS Physicians (NAEMSP) supports out-of-hospital termination of resuscitation for adult, nontraumatic cardiac arrest patients who have not responded to full resuscitative efforts. The following factors should be considered in establishing termination of resuscitation protocols: 1) Termination of resuscitation may be considered for any adult patient who suffers sudden cardiac death that is likely to be medical. 2) Unwitnessed cardiac arrest with delayed initiation of cardiopulmonary resuscitation (CPR) beyond 6 minutes and delayed defibrillation beyond 8 minutes has a poor prognosis. 3) In the absence of “do not resuscitate” or advanced directives, a full resuscitative effort including CPR, definitive airway management, medication administration, defibrillation if necessary, and at least 20 minutes of treatment following Advanced Cardiac Life Support (ACLS) guidelines should be performed prior to declaring the patient dead. 4) A patient whose rhythm changes to, or remains in, ventricular fibrillation or ventricular tachycardia should have continued resuscitative efforts. Patients in asystole or pulseless electrical activity should be strongly considered for out-of-hospital termination of resuscitation. 5) Logistic factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public. 6) Online medical direction should be established prior to termination of resuscitation. The decision to terminate efforts should be a consensus between the on-scene paramedic and the online physician. 7) The on-scene providers and family should have access to resources, such as clergy, crisis workers, and social workers. 8) Quality review is necessary to ensure appropriate application of the termination protocol, law enforcement notification, medical examiner or coroner involvement, and family counseling. PREHOSPITAL EMERGENCY CARE 2000;4:190-195

Adolescent Latino Males with Schizophrenia: Mobile Crisis Response

Although schizophrenia has a biological basis, the presentation of symptoms and the understanding of the disorder vary among cultures. Service providers who understand these cultural variations are in a better position to provide effective crisis intervention. When a person with schizophrenia goes into crisis (often synonymous with the acute psychotic phase), the intersection of culture, diagnosis, developmental stage, and social setting can be overwhelming to the crisis worker. Roberts’s Seven-Stage Crisis Intervention Model provides a useful framework within which to provide culturally competent crisis intervention. This article applies Roberts’s model to a case involving an adolescent Latino male who has a diagnosis of schizophrenia. Included is a review of literature on mobile crisis intervention with youth, cultural competence, and schizophrenia. Specific treatment recommendations are made for understanding cultural variations, developmental influences, and service delivery with this population. [Brief Treatment and Crisis Intervention 5:35–55 (2005)]

Modeling crisis decision-making for children in state custody

We studied 1492 children in state custody over a 6-month period to investigate the relationship between children's hospital admissions and the crisis workers' clinical assessment. A 27-item standardized decision-support tool [the Childhood Severity of Psychiatric Illness (CSPI)] was used to evaluate the symptoms, risk factors, functioning, comorbidity, and system characteristics. The CSPI has been shown to have a reliability range from 0.70 to 0.80 using intraclass correlations. Logistic regression was used to calculate age-adjusted odds ratios (AOR) of hospitalization, their 95% confidence intervals, and corresponding P values. The results showed that risk factors, symptoms, functioning, comorbidities, and system characteristics were all associated with hospital admissions. Children with a recent suicide attempt, severe danger to others, or history of running away from home/treatment settings were more likely to be hospitalized (respective AOR=12.7, P<.0001; AOR=32.3, P<.0001; AOR=3.0, P=.001). In addition, hospitalization was inversely associated with caregiver knowledge of children (AOR=0.2, P=.01) and multisystem needs (AOR=0.3, P=.04). The decision to hospitalize children psychiatrically appears to be complex. As predicted, risk behaviors and severe symptoms were independent predictors of children's hospital admissions. Interestingly, the capacity of the caregiver and the children's involvement in multiple systems also predict children's hospital admissions.

Mental health issues of peacekeeping workers.

The end of the Cold War has brought a dramatic change to the international political situation and the role of the United Nations peacekeeping operations (PKO) has drawn increased attention. While many reports on PKO have focused on political or sociologic considerations, the mental health of the peacekeepers themselves has received little attention and psychiatric problems that can have a negative impact on mission success have been largely ignored. Participation in PKO creates a number of stressors and serious psychiatric and/or physical disorders may result. Yet, there is little research on this topic, either domestically or globally, and the methodology for clinical intervention remains in an early stage of development. We have reviewed previous reports to determine how various stressors before, during and after deployment affect the participants. Research in associated fields (e.g. crisis workers and military personnel) are also reviewed and their application to peacekeeping psychiatry is discussed. It must be admitted that the significance of PKO is arguable and each PKO is unique in terms of the nature of its mission and the local situation. Yet, the relationship between the psychiatric status of the personnel and the characteristics of an individual mission has never been studied. At present, no clear consensus regarding a framework for psychiatric intervention exists. Studies that enhance the recognition and significance of peacekeeping psychiatry are likely to improve the efficacy of PKO.

Telephonic response to workers in crisis

Telephonic response to workers in crisis

Teaching Crisis Intervention

ABSTRACT The purpose of this article is to explore ways of aiding students in their learning how to become effective crisis intervention specialists by helping them understand their responses to crisis, and through the development of their professional use of self. New police cadets and human service workers alike bring with them the beliefs and emotions learned from personal histories that may hinder or help their ability to become effective crisis workers. The article helps those who teach crisis intervention to engage students in various experiential exercises that maximize their strengths and minimize their weaknesses.

Evaluating the Use of Psychiatric Hospitalization by Residential Treatment Centers

To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality. This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.

Variations in the clinical presentations of children and adolescents at eight psychiatric hospitals.

Clinical presentations of children and adolescents admitted to eight psychiatric hospitals were examined to determine variation in symptoms and severity of illness. A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI) scale, a reliable measure of psychiatric severity and factors thought to affect decision making about mental health services. The CSPI was completed by mobile crisis workers after interviews with 875 children and adolescents to assess whether hospitalization was appropriate. All the children were wards of the state in Cook County, Illinois, and all were subsequently hospitalized. A factor analysis of the CSPI revealed three distinct factors: caregiver problems, externalizing symptoms, and internalizing symptoms. Children were classified as having mild, moderate, or severe problems or symptoms in the areas covered by the three factors. Chi square analyses revealed that significant variation existed between hospitals in the proportions of children with problems or symptoms in the three factor areas and in the severity of their problems or symptoms. The major finding of variation among the eight hospitals on measures of severity of children's psychiatric illness and caregiver problems empirically supports the importance of adjusting for severity before implementing initiatives to manage performance and outcome across a system of hospitals.

LAYERS OF GRIEF: COUNSELING THE SEROPOSITIVE GAY MALE

Seropositive gay men experience multiple losses in their lives resulting in layers of grief. Models of grief were not developed for people experiencing multiple losses therefore lack the capacity to help crisis workers with this population. Counseling strategies developed specifically for seropostive gay men also may not be adequate because are not crisis oriented. This paper suggests the use of the Tirage assessment Form as a means of assessing the multiple losses experienced by this population. Used in conjunction with models of grief and counseling approaches for seropositive gay men, the Triage Assessment Form helps crisis workers identify and monitor the layers of grief experienced by this population.

T ERMINATION OF R ESUSCITATION IN THE P REHOSPITAL S ETTING FOR A DULT P ATIENTS S UFFERING N ONTRAUMATIC C ARDIAC A RREST

The National Association of EMS Physicians (NAEMSP) supports out-of-hospital termination of resuscitation for adult, nontraumatic cardiac arrest patients who have not responded to full resuscitative efforts. The following factors should be considered in establishing termination of resuscitation protocols: 1) Termination of resuscitation may be considered for any adult patient who suffers sudden cardiac death that is likely to be medical. 2) Unwitnessed cardiac arrest with delayed initiation of cardiopulmonary resuscitation (CPR) beyond 6 minutes and delayed defibrillation beyond 8 minutes has a poor prognosis. 3) In the absence of “do not resuscitate” or advanced directives, a full resuscitative effort including CPR, definitive airway management, medication administration, defibrillation if necessary, and at least 20 minutes of treatment following Advanced Cardiac Life Support (ACLS) guidelines should be performed prior to declaring the patient dead. 4) A patient whose rhythm changes to, or remains in, ventricular fibrillation or ventricular tachycardia should have continued resuscitative efforts. Patients in asystole or pulseless electrical activity should be strongly considered for out-of-hospital termination of resuscitation. 5) Logistic factors should be considered, such as collapse in a public place, family wishes, and safety of the crew and public. 6) Online medical direction should be established prior to termination of resuscitation. The decision to terminate efforts should be a consensus between the on-scene paramedic and the online physician. 7) The on-scene providers and family should have access to resources, such as clergy, crisis workers, and social workers. 8) Quality review is necessary to ensure appropriate application of the termination protocol, law enforcement notification, medical examiner or coroner involvement, and family counseling.

Creating Excellence in Crisis Care: A Guide to Effective Training and Program Designs

Back to table of contents Previous article Next article Book ReviewFull AccessCreating Excellence in Crisis Care: A Guide to Effective Training and Program DesignsJim Mueller, M.S.W.Jim MuellerSearch for more papers by this author, M.S.W.Published Online:1 Nov 1999https://doi.org/10.1176/ps.50.11.1506AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Perhaps more than with other aspects of health care or human service, crisis programs are shaped by their environments. The types of services a particular crisis program provides and the way in which it provides them are strongly influenced by the needs and goals of its funding sources and the organization it is a part of, as well as the characteristics of the community in which it is located. Consequently, the landscape of crisis programs is a confusing one. Domestic violence programs, emergency room psychiatric services, volunteer hotlines, mobile intervention teams, and many other types of programs count themselves among the providers of crisis services.In Creating Excellence in Crisis Care: A Guide to Effective Training and Program Designs, Lee Ann Hoff and Kazimiera Adamowski give an apt description of this current state of affairs and suggest that it argues for the establishment of professional standards in the field of crisis care. The variation among crisis programs partly reflects the fact that these programs are highly responsive to community needs. On the other hand, it can also indicate an unhealthy malleability. Crisis programs can be pushed in the direction of attempting to become all things to all people or shifted toward narrowing their focus in response to a dominant stakeholder and perhaps not providing some services their community really needs. Adding the reality that those who are entering the field from educational institutions often have not had training in crisis care, it is clear that crisis programs are particularly vulnerable to the pushes and pulls of the health care and human service environment.The authors draw on a growing body of professional literature in the field of crisis care, as well as on their own considerable experience as educators and practitioners, to propose standards for training crisis workers and operating crisis programs. In doing so, they have produced a highly practical book and an extremely valuable resource for anyone responsible for management of a crisis service or education and training related to crisis care.The authors include a detailed outline of a training curriculum along with specific suggestions about how to implement it. They describe a knowledge base, a set of attitudes, and particular skills, which are applicable to the full range of crisis programs and could serve as a general standard in the field. Equally specific are their proposals for the operation of crisis programs. They offer guidelines about organizational structure, service elements, and program management and evaluation. As with the proposed training curriculum, these guidelines are general enough to be applicable to the broad spectrum of crisis programs, and they are meant to serve as a standard against which programs can measure themselves.Throughout the book the authors use case examples that illustrate their points wonderfully. They also include a comprehensive bibliography and, true to the spirit of crisis work, a listing of persons and organizations to contact for further information and material.Creating Excellence in Crisis Care is truly an excellent book. It not only is a fine how-to manual for crisis training and program development, but it also represents a welcome step in the direction of establishing more widely recognized standards in the field of crisis care.Mr. Mueller is director of the Westfield (Mass.) Crisis Intervention Program.by Lee Ann Hoff and Kazimiera Adamowski; San Francisco, Jossey-Bass, 1998, 272 pages, $34.95 FiguresReferencesCited byDetailsCited ByNone Volume 50Issue 11 November 1999Pages 1506-1506 Metrics History Published online 1 November 1999 Published in print 1 November 1999

The Economic Crisis and Migrant Workers in Japan

The employment situation in Japan continues to deteriorate, and it will take some time before recovery starts. The current economic crisis has had little negative impact on the inflow of migrant workers, both legal and illegal. The declines recorded in recent years are due more to stricter control of illegal migration in Japan and in a few sending countries. The crisis, however, has reduced the earnings of some groups of migrant workers. Illegal workers are more vulnerable because they are not protected from abuse as much as legitimate workers, nor do they usually come out to seek official services offered. More serious international efforts are required to curb the illegal flow of workers. An aggressive labor export policy may work against workers' welfare especially at the time of crisis in host economies.