Crisis Management Research Paper Example

Crisis Management

What is Crisis?

A crisis is defined as an upset in a steady state, a critical turning point leading to better or worse, a disruption or breakdown in a person’s or family’s normal or usual pattern of functioning (Parad & Parad, 1990).

The US department of Health and Human Services (1994) differentiated between problem, emergency and crisis. A problem may cause some sort of stress and could be hard to solve, however the family or individual is often capable of finding a solution. Therefore any problem that can be resolved by an individual or a family is not a crisis.

An emergency is a sudden, demanding necessity, such as when a life is in danger because of an accident, a suicide attempt, or violence. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to such events. If a situation can wait 24 to 72 hours for a response, without placing an individual or a family in jeopardy, it is a crisis and not an emergency (US Department of Health and Human Services, 1994).

Goals of Crisis Intervention

A focus on limited goals and objectives is essential for crisis intervention. This is particularly true with families in which disorganization and lack of finality leads to- chaos. As Rapoport (1970) proposed, crisis intervention is guided by six primary goals, all aimed at stabilizing and strengthening functioning. These goals are to:

• symptom relieving that cause distress
• restoring optimum pre-crisis levels of functioning
• identify and understand the relevant precipitating event(s)
• identify preventive and remedial measures that help in overcoming the crisis situation
• establish a connection between the family’s current stressful situation and past experiences
• helping the members in developing new ways of perceiving, thinking, and feeling, and adaptive coping responses for future use.

Steps of Crisis Intervention Model

Step 1: Quickly Develop a Constructive Relationship

Step 2: Elicit and Encourage Expression of Painful Feelings and Emotions

Step 3: Discuss the Precipitating Event

Step 4: Assess Strengths and Needs

Step 5: Formulate a Dynamic Explanation

Step 6: Restore Cognitive Functioning

Step 7: Plan and Implement Treatment

Step 8: Terminate

Step 9: Follow-up

(Note: Step 1, 2, and 3 focus on the immediacy and should be followed by the immediate caregiver of the child i.e. staff members. While the rest of the steps of the model should be followed by a professional i.e. a school counselor or a child clinical psychologist).

Elements of Crisis

There are three basic elements of crisis;

1. A Stressful Situation

During a stressful or troublesome situation every individual tend to feel upset, disappointed, or exhausted. There are five types of situations or events that may produce stress and, in turn, contribute to a state of crisis:

• Family Situations. A child abuse investigation, spouse abuse, an unplanned pregnancy, a chronically ill family member, and lack of social supports are examples of family situations that can create crises.
• Economic Situations. Sudden or long term financial problem is often the reason for many family crises, such as loss of employment, a theft of household cash or belongings, medical expenditures, utilities cut off from service, money lost to gambling or drug addiction, and poverty.
• Community Situations. Neighborhood violence, inadequate housing, a lack of community resources, and inadequate educational programs can be the causes of family crises by community.
• Significant Life Events. Events that most view as happy, such as a marriage, the birth of a child, a job promotion, or retirement, can trigger a crisis in a family. Apart from these a child enrolling in school, the behaviors of an adolescent, fights with peers, suicidal attempts and self-harm, a grown child leaving the home, the onset of menopause, or the death of a loved one can also be very stressful life events.
• Natural Elements. Crises are created by disasters such as floods, hurricanes, fires, and earthquakes, or even extended periods of high heat and humidity, or gloomy or excessively cold weather.

        2. Difficulties in Coping

An individual’s or a family’s ability to deal with a crisis situation is influenced by their physical and psychological characteristics which help them adapt to the new situations effectively. Even individuals with better coping strategies can become overwhelmed by stressful events. For example, poor physical health, a low level of personal energy, an overly sensitive temperament, and mistrust of community service providers set the stage for difficulty in coping with a crisis.

Families or individuals who have overcome the stressful situattions in past can overcome the stressful situations in the present as well. With proper level of support, and a focus on the problem-solving process, they often regain composure. For example, one case referred to Child Protection Services involved the neglect of a young child. The child’s mother was depressed about her ex-husband’s threats of a custody fight. Feeling hopeless about a legal battle, the mother began to blame and neglect her child. As a result of crisis intervention, the mother quickly regained hope, secured legal counsel, and realized that she could do something about the threats she has been experiencing. Within a period of 3 weeks, the mother was appropriately parenting her child again and finding joy in life.

     3.Timing of Intervention

Crises usually last for 4 to 6 weeks during which timely solution of a problem is necessary. A quick therapeutic response is likely to prevent a severe breakdown in individual’s relationships and restore adequate functioning. It is at this time that the individual is most likely to accept the intervention. By intervening in a timely manner and by assisting the family or clients in overcoming situational factors which led to the crisis, maintenance is likely to occur within a few weeks.

Initially, the crisis worker may remain with the family or client for several hours, if needed. As the situation progresses or becomes more intense, the crisis worker’s time with the family is adjusted to fit the situation. As termination is approached, fewer hours should be required.

Psychological Effects of Crisis / Child’s Feelings during Crisis

Howard and Parad described some of the anxiety- ridden responses of some people in crisis as which includes upsets in eating, sleeping, dreaming, feeling, thinking, and doing.They believe that the following nine emotional reactions of people in crisis, as discovered by the Benjamin Rush Center for Problems of Living, can help professionals better identify and understand the individuals going through a crisis and help them work with crises situations:

• Bewilderment: Experiencing new and unusual feelings
• Danger: Feelings of tension, fear, and impending doom
• Confusion: Mind is confused and not working well
• Impasse: Feeling stuck; nothing works
• Desperation: Need to do something, but what?
• Apathy: Why try?
• Helplessness: Need someone to help me
• Urgency: Need help right now
• Discomfort: Feeling down, restless, disturbed

Due to the differences in coping abilities, stress-producing situations, and timing of intervention make each crisis unique, individuals in crisis experience some common psychological effects that affect assessment and treatment.

Generally, crisis events produce problems in six broad areas. Such problems are temporary, however, and not indicators of mental illness. A crisis is momentary, as are the temporary responses of the sufferers. Being in crisis is not synonymous with being mentally ill.

1. Disorganized Thinking. People in crisis experience disorganization in their thinking process. They may overlook or ignore important details and distinctions that occur in their environment and may have trouble relating ideas, events, and actions to each other in logical fashion. They sometimes jump from one idea to another in conversation so that they appear confused and their communication becomes hard to follow. Important details may be overlooked in interpreting events, such as a client’s giving extensive information about a house fire, but failing to tell that her brother had three previous charges of arson. Fears and wishes may be confused with reality, manifesting a general feeling of confusion.
2. Preoccupation with Insignificant Activities. In an attempt to deal with disorganized thought processes and anxiety, people in crisis tend to become involved in some unimportant activities, such as worrying that someone will be overwhelmed with bad air by keeping a window open. When the crisis is at its peak, these individuals may need help in focusing on important activities, such as implementing the steps for productively resolving the crisis.
3. Expression of Hostility and Emotional Distancing. Some people in crisis are so upset over their loss of control that they become hostile toward anyone who intervenes in the situation. They resent their need for help, feeling both angry and vulnerable. Other crisis-ridden people react with extreme emotional distancing and passivity, seeming not to be emotionally involved in the situation or concerned with its outcome. For crisis workers, the issue is not how to give directives, but to point out the choices for handling the crisis and to reinforce strengths.

• • While some people are immobilized in crisis situations, others are quite impulsive, taking immediate action in response to the crisis without considering the consequences of their action. Their failure to evaluate the appropriateness of their responses may provoke further crises.
  • Dependence on the crisis worker at a time of crisis is a natural response and may be necessary before an individual can resume independence. During a crisis, perceptions of the crisis worker’s power or authority can have a stabilizing impact on a family or the member. A family in crisis is likely to welcome an objective, skillful, and kind authority who knows how to “get things done.” Offers of help from a concerned, competent crisis worker seem the answer to all the family’s difficulties.

     4. Threat to Identity. Identity is both an inner condition and an- interactional process. When an event, such as a child abuse report, threatens one’s self-concept and family relationships then a crisis may occur. Because usual coping methods fail, one’s sense of personal identity is impaired, causing disequilibrium. One’s previous feelings of competency and worth may seem totally lost.

           To counter a lowered self-perception, a parent in crisis may assume a facade of adequacy or arrogance, claiming that no help is needed. The crisis worker has the opportunity to establish rapport by recognizing strengths that help to restore a sense of goodness or individual worth. The crisis worker cannot accept abuse of a child, but does acknowledge the parent’s and family’s strengths.

Intervention / Some Common Preliminary strategies to use at the time of a Crisis

Some interviewing techniques which can be used to work through client resistance include:

• Active listening and Reflection
• Normalization
• Partialization / Prioritization (breaking into several smaller issues) of problems, when the client presents numerous issues
• Ventilation of feelings (with closure before the interview ends)
• Summarization of client feelings after extended listening
• Acceptance of the client, but not the client’s abusive or neglectful behaviors
• Logical discussion
• Education or information about crisis intervention, forthcoming events, community resources, etc.;
• Setting boundaries and limits on behaviors and contracting on acceptable alternatives;
• Concrete services such as housing, homemaker services, and respite care;
• Firm, but kind, confrontation regarding inconsistencies in the clients’ statements or behaviors; reframing client statements or behaviors to find the positive aspects; and
• Joining client resistance by saying “why should you change?” The crisis worker should not say this regarding acts of abuse or neglect or any criminal behaviors

Note. Aim of the crisis intervention is to provide the psychological first aid which could be given by the staff, teachers and the professional clinicians. However, the first hand intervention is mostly provided by the staff members because of their immediate availability and presence at the time of the crisis.

Initial Defusing

The Initial Defusing is the group process (30-45 minutes) provided immediately after a traumatic event, once the individuals are disengaged from the on-scene operations. The process of the defusing aims to:

• Establish non-threatening social environment
• Allow rapid ventilation of stressful experience
• Equalize access to facts and information
• Restore cognitive processing of event
• Provide information for stress survival
• Affirm value of individuals
• Establish linkages for additional support
• Develop expectancies for the future

Components of Defusing

The defusing components are as follows:

1. Introduction

• Introduce facilitator(s)
• State Purpose
• Invite voluntary participation
• Establish ground rules (not therapy, not investigation)
• When possible assure confidentiality (no notes, recording, etc.)
• Describe process
• Offer additional support

2. Exploration

• Ask individuals to describe what just occurred
• Answer questions of clarification
• Review experiences and reactions
• Assess need for more help
• Reassure participants, as necessary

3. Information

• Accept/summarize their exploration
• Normalize experiences and reactions
• Teach multiple stress survival skills
• Advise diet & nutrition, alcohol/caffeine avoidance
• Pay attention to rest & relationships
• Recommend recreation & exercise

4. Aftermath

• Offer handshake and comment to each participant
• Provide one-on-one follow-up
• Determine whether to proceed with debriefing

Psychological First Aid

1. Self-care and Stress Reduction of the staff before giving Aid.The delivery of psychological first aid following an emergency can be very rewarding for people involved in the emergency response. However, it can also be very problematic and stressful. It is not uncommon for people to feel stressed, distressed, tired, overwhelmed, troubled, or frustrated in the course of their work.

• • Stress is the body’s way of getting energy to operate outside our normal comfort zone. Stress is caused by stressors, these can be internal, such as thoughts or feelings or external, such as poor health, conflict, noise etc.
  • If it is not possible to relax between demands, or there is not enough time to unwind between the problems, the stress builds up. It is not the actual difficulty of the task that causes chronic stress; it may be the sheer quantity or continuity of work

2. Reducing stress. Stress will not resolve spontaneously. People need to take steps to break the cycle of stress. It is important to identify what causes stress for you and put in place some steps to reduce stress. This sort of self-care is especially important if we wish to support others during times of crisis.

• • Think about what has helped you cope in the past and what you can do to stay strong.
  • Try to take time to eat, rest and relax, even for short periods.
  • Try to keep reasonable working hours so you do not become too exhausted.
  • Consider, for example, dividing the workload among helpers, working in shifts during the acute phase of the crisis and taking regular rest periods.
  • People may have many problems after a crisis event. You may feel inadequate or frustrated when you cannot help people with all of their problems. Remember that you are not responsible for solving all of people’s problems. Do what you can to help people help themselves.
  • Check in with fellow helpers to see how they are doing, and have them check in with you. Find ways to support each other.
  • Talk with friends, loved ones or other people you trust for support.

3. Deep breathing and Relaxation Exercise (refer to Stress Management Section)

Psychological First Aid to be given by the staff immediately

World Health Organization (WHO) has devised an action plan for the workers providing psychological first aid to the effected.

Psychological First Aid Action Plan

1. Look

• • Check for safety.
  • Check for people with obvious urgent basic needs.
  • Check for people with serious distress reactions.
  • LISTEN

2. Approach people who may need support

• • Approach people respectfully and according to cultural norms
  • Introduce yourself by name and organization
  • Ask if you can provide help
  • If possible, find a quiet and safe place to talk
  • Help the person feel comfortable

3. Ask about the people’s needs and concerns

• • Address any obvious needs. For example, if a person’s clothing is torn or they need a blanket
  • Always ask for people’s needs and concerns
  • Do not assume you know
  • Find out what is most important to them at this moment
  • Help them work out what their priorities are

4. Listen to people and help them to feel calm

• • Stay close to the person
  • Do not pressure the person to talk
  • Listen in case they want to talk about what happened
  • If they are very distressed help them to feel calm and try to make sure they are not alone

Providing Immediate Psychological First Aid for Children and Young People

The following points are important when using psychological first aid with children and young people.

1. Keep together with loved ones

• • When unaccompanied, link them with a trustworthy child protection network or agency. Do not leave the child unattended.
  • Be wary of offers of help with looking after children from unauthorized strangers.
  • If no child protection agency is available, take steps to find their caregivers or to contact other family who can care for them.

2. Keep safe

• • Protect them from being exposed to any gruesome scenes, like injured people or terrible destruction.
  • Protect them from hearing upsetting stories about the event.
  • Protect them from the media or from people who want to interview them who are not part of the emergency response.

3. Listen, talk and play

• • Be calm, talk softly and be kind.
  • Introduce yourself by name and let them know you are there to help.
  • Find out their name, where they are from, and any information you can in order to help find their caregivers and other family members.
  • Listen to children’s views on their situation.
  • Try to talk with them on their eye level, and use words and explanations they can understand.
  • Support the caregivers in taking care of their own children.
  • If passing time with children, try to involve them in play activities or simple conversation about their interests, according to their age.

Crisis Communication Plan

• Who should speak and who shouldn’t comment
• Materials that need to be produced
• Who should be involved in the process and who shouldn’t
• Who needs to be in the loop and who should be left out both internally and externally
• The organization’s crisis telephone directory with the numbers for reaching critical people 24-7

The five C’s of Crisis Intervention Plan

1. Care
2. Commitment
3. Consistency
4. Coherence
5. Clarity

Selecting a Spokesperson

• Good under pressure
• Can stay on message
• Assertive body language
• Willing to PREPARE / Already has EXPERIENCE
• Can act as point person (reviews All outgoing messages for consistency

Indictor to Provide Additional Support

The defusing process may provide the necessary support to groups or individuals; however it may happen that the defusing will reveal that need for further support. Indicators that additional support may be necessary include:

• Intense emotions, unusual behavior
• Unfinished business
• A sense (sometimes subtle) of incompleteness
• Excessive silence

Intervention Strategies / Techniques Used By the Professionals

Special treatment techniques such as generalization, self-disclosure, storytelling, limit-setting, and instillation of hope are effective in crisis intervention.

1. Generalization

Generalization is one of the effective techniques to use with clients during crisis situations. Because when a crisis worker says, “we all get angry and don’t know how to express it sometimes” then it proves to be more effective than saying that clients get angry and professionals never do.

2. Self-Disclosure and Storytelling

During a crisis situation clients do need positive role models but it would be helpful for them to know that professionals are humans too and they also have to deal with emotions. It should be kept in mind that during a crisis situation, a crisis worker must focus on clients’ needs and priorities and must not vent out his personal frustrations. Similarly telling a story or a narrative that how a crisis worker or someone else had dealt with a similar crisis would prove to be helpful for some clients.

During Self-Disclosure or Story-Telling a crisis worker can test whether self-disclosure is appropriate or not, by clearly asking a question, “Am I doing this for my benefit or is it for the clients’ benefit?”

3. Setting Limits

All models of crisis intervention emphasize respect for the clients’ culture and value systems. Every model also emphasizes the importance of listening closely (for hours) to what the clients are saying. This helps establish rapport but, more importantly, determines what the family is motivated to do. It respects the family’s wishes rather than imposing the crisis worker’s wishes or needs on the family.

In respecting and being accepting of clients, but not their inappropriate behavior, it may be necessary to say specifically that child abuse and neglect are never acceptable. Many clients need that directive because proper family values were not instilled during their childhoods.

Certain clients misinterpret crisis worker acceptance of them as full agreement with their abusive actions. It may be necessary to state frequently that child maltreatment is never an acceptable behavior. If not clarified, clients may assume that the crisis worker approves of such behavior. When encouraging clients to discontinue corporal punishment, for example, it is best to give specific instructions on use of “timeout” for young children, choices and natural consequences for older children, and the need for parents to learn active parenting skills.

4. Instilling Hope

A crisis worker can work at his or her best when he or she beliefs in self, has personal enthusiasm and ability to instill hope during crisis situation. A hopeful and enthusiastic crisis worker can significantly affect the functioning of an individual or family in crisis, because when an individual or family thinks that a crisis worker can predict a positive resolution of a crisis then they also feel confident in their ability to bring change during crisis situation.

While instilling hope a crisis worker and clients collaboratively look for times in past when the clients were able to achieve their goals successfully in similar situations or crisis. Similarly when clients are encouraged to try new ways and solutions rather than being blamed for failures, then hope arises. A crisis worker should use such words like “when” and “will” rather than “if” or “maybe” when discussing plans.

When crisis workers keep their promises and stick to the defined goals then a trustworthy relationship develop with clients and they begin to trust and believe in change. Thus a change occurs, when clients and professionals form a positive “team” that builds on client strengths.

References;

• Gentry, C. E. (1994). Crisis intervention in child abuse and neglect. US Department ofHealth and Human Services, Administration for Children and Families,Administration on Children, Youth, and Families, Children’s Bureau, Office on ChildAbuse and Neglect.
• Parad, H., & Parad, L. G. (Eds.). (1990). Crisis intervention: The practitioner’s sourcebook for brief therapy. Family Service America.
• Rapoport, L. (1970). Crisis Intervention as a Mode of Brief Treatment, in R. W. Roberts andR. H. Nee (Eds.), Theories of Social Casework (pp. 265-371). Chicago: University of Chicago Press.

Appendices

Indicators of Families in Acute Crisis vs. Indicators of Families in Chronic Crisis

Acute Crisis— Parents Fundamentally Able To Cope but Temporarily Overwhelmed	Chronic Crisis— Parents with Continual and Serious Child-Rearing Difficulties
Major crisis or series of crises	Constantly in stressful situation or crisis
History of adequate child care	Little parenting knowledge
Regular employment	Limited education/vocational opportunities and skills
Sufficient income and skills	Poverty
Emotional support from friends and relatives	Extreme social isolation Little support from relatives or community
Average problem-solving abilities	Poor problem-solving skills; blame others
Generally good physical health, minimal use of illegal substances, and essentially no illegal activity	Ill health, substance abuse, drug dealing, legal problems, physical handicap
Adequate education and housing that allow for individual space and organization of belongings	Overcrowded or run down housing, cluttered areas, economically disadvantaged
Intimacy is non-sexualized	Prostitution, sex abuse, abuse between adults
Acceptance of differences of opinion	Social, racial, or cultural discrimination
Family members understand and accept their respective roles	Poorly defined role boundaries in the family
Generally good mental health	Chronic mental illness or character
Likely to be cooperative with genuinely supportive child protection personnel, welcoming offers of help	Distrustful of professional helpers
Likely to regain ability to solve problems themselves when crisis has passed	A new crisis arises, even though there is relief from a previous crisis

*Adapted from Crisis Intervention: A Manual for Child Protective Workers, by R. Borgman, M. Edmunds, and R. MacDicken, U.S. Department of Health, Education and Welfare, National Center on Child Abuse and Neglect, 1979.

Acute Vs. Chronic Crisis in Child Protection Services

Acute Crisis	Chronic Crisis
Major crisis or series of crises	Constantly in stressful situation or crisis
Engagement in Studies and Extra-Curricular Activities	Limited education/vocational opportunities and skills
Sufficient income and skills	Poverty
Emotional support from friends and staff	Extreme social isolation Little support from staff or community
Average problem-solving abilities	Poor problem-solving skills; blame others
Generally good physical health, minimal use of illegal substances, and essentially no illegal activity	Ill health, substance abuse, drug dealing, legal problems, physical handicap
Adequate education and housing that allow for individual space and organization of belongings	Overcrowded or run down housing, cluttered areas, economically disadvantaged
Intimacy is non-sexualized	Prostitution, sex abuse, abuse between adults
Acceptance of differences of opinion	Social, racial, or cultural discrimination
Staff members understand and accept their respective roles	Poorly defined role boundaries in the staff and administration
Generally good mental health	Chronic mental illness or character
Likely to be cooperative with genuinely supportive child protection personnel, welcoming offers of help	Distrustful of professional helpers
Likely to regain ability to solve problems themselves when crisis has passed	A new crisis arises, even though there is relief from a previous crisis