Roberts’s Seven-Stage Model for Crisis Intervention

This goes out to all my CISes (those are crisis intervention specialists, if you didn't know).  Most folks think of Roberts as THE crisis guy, and his seven stage model is included in pretty much every crisis intervention manual ever.

• Assess safety & lethality – Begin with a fast yet thorough biopsychosocial assessment.  You want to find out what the supports & stressors are, any medical issues, medications, any current substance use, and coping strategies & resources.  If there is concern about suicidality, you want to find out what the thoughts are, if there is intent & the strength of the intent, whether there is a plan & if the plan is potentially lethal, any history of past attempts, and other specific risk factors (substance abuse, social isolation, losses such as divorce or employment).
• Rapport building – In a crisis, you must do this quickly & it will ideally happen as part of your assessment.  Here, we harken to Rogers’s warmth, genuineness and empathy.  These three skills will go a long way in developing rapport with your client in crisis.
• Problem identification – Find out from the client why things have come to a head.  There is usually a so-called last straw, but you also want to find out what other problems the client is concerned about.  It can also be useful to prioritize the problems in terms of which problems the client wants to work on first.
• Address feelings – Validate, validate, validate!  You want to let the client vent about his or her feelings about the crisis.  This is achieved using active listening skills, like paraphrasing, reflective listening and probing questions.  With caution, you can also challenge maladaptive beliefs.
• Generating alternatives – This is where you come up with a plan.  The clinician and the client (ideally) begin to come up with options that will help improve the current situation.  You can brainstorm about possibilities or ask about what has been helpful in the past as ways to get the client’s input.
• Develop action plan – This is where you shift from a crisis to a resolution.  The client & worker will begin to take the steps negotiated in the previous stage.  This is also where the client will begin to make meaning of the crisis event.
• Follow up – The follow up can take on many forms.  A postcrisis evaluation may look at the client’s current functioning and assess the client’s progress and satisfaction with treatment.  It can also involve phone or in person visits at specific intervals.

Crisis Intervention

Just to keep things interesting, I'm going to start mixing in some posts based on a study guide I created for my clinical practice course final exam.  See, kiddies, it pays to hang on to old study materials!  Today, we'll start with some overview information on crisis intervention.

• What is a crisis?
• Event is perceived as a threat, danger or loss
• Coping strategies are overwhelmed and insufficient
• Person is in a state of disequilibrium
• There is a window of opportunity to intervene
• Opportunity for growth
• What are the types of crises?
• Situational – specific incidents (dumped by boyfriend, fail a test, busted for possession)
• Developmental – developmental tasks produce a crisis. If prior developmental tasks have not been completed successfully, future tasks can produce crises
• Environmental – different from situational crises because they affect groups of people (human disasters, political disasters, economic, natural disasters)
• Existential – escalating inner conflicts related to issues of purpose in life, responsibility, independence, freedom and commitment (teen angst, midlife crisis, spiritual crisis)
• Compound or Transcrisis – crisis reaction due to multiple partially unresolved prior crises
• Dilation-Constriction Continuum Model
• The dilation-constriction continuum assesses a person's affect, behavior & cognitions related to the crisis.
• It can be used to assess where the person is on the continuum of dilation & constriction & try to bring the person back to center if they’re at extremes

	Dilation	Constriction
Affect	Overemotional Worker response: focus on specific feelings, work w/ cognitive material	Holding in feelings Worker response: facilitate emotional expression
Behavior	Excessive behavior, acting out Worker response: reality oriented & problem solving	Paralyzed, immobile, withdrawn Worker response: stimulate movement, help ct do for themselves
Cognition	Disorganized, chaotic, confused Worker response: clarification, specifics, problem identification	Preoccupied w/ solutions, ruminative, obsessive Worker response: id alternatives & workable solutions

Edited to add:  Upon listening to the social work podcast on crisis intervention, I realized that this post is essentially a summary of that podcast.  You can listen to that podcast here: http://socialworkpodcast.blogspot.com/2007/01/crisis-intervention-and-suicide.html Since Jonathan, the host of the social work podcast, is so kind as to include on his blog a properly formatted APA reference, here that is as well. Singer, J. B. (Host). (2007, January 29). Crisis intervention and suicide assessment: Part 1 - history and assessment [Episode 3]. Social Work Podcast. Podcast retrieved October 1, 2011, from http://socialworkpodcast.com/2007/01/crisis-intervention-and-suicide.html