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Crisis intervention model

Six-step model

Front-line shelter staff will need to address the level of distress and impairment of women in crisis by responding in a logical and orderly manner. Training in the use of a standardized model for intervening in crisis situations can help the counselor to be aware of the elements of an effective response to crisis, and to intervene in a way that appropriately supports a woman through the crisis which assists her to maintain ownership of the problem and be empowered toward self-determination (Roberts, 2002 as cited in Alberta Council of Women's Shelters, 2009).

A six-step model for crisis intervention is one framework that shelters may implement to respond to crisis. The model focuses on listening, interpreting and responding in a systematic manner to assist a woman or girl return to her pre-crisis psychological state to the extent possible. Emphasis is placed on the importance of listening and assessment throughout each step, with the first three steps focusing specifically on these activities rather than on taking action. At any point, emerging safety considerations that present risk of the woman being hurt or killed should be addressed immediately.

The model involves the following steps:

  1. Defining the problem to understand the issue from the [woman's] point of view. This requires using core listening skills of empathy, genuineness and acceptance.
  2. Ensuring [the woman's] safety. It is necessary to continually keep [the woman's] safety at the forefront of all interventions. This means constantly assessing the possibility of physical and psychological danger to the [woman] as well as to others. Assessing and ensuring safety are a continuous part of the crisis intervention process.
  3. Providing support, by communicating care for the [woman], and giving emotional as well as instrumental and informational supports.

Acting strategies are used in steps 4, 5, and 6. Ideally, these steps are [implemented] in a collaborative manner, but if the [woman] is unable to participate, it may be necessary to become more directive in helping [her] mobilize her coping skills. Listening skills are an important part of these steps, and the counsellor will mainly function in nondirective, collaborative, or directive ways, depending on the assessment of the woman.

4.   Examining alternatives, which may be based on three possible perspectives: a) supporting the [woman] to assess [her] situational resources, or those people known to [her] in the present or past who might care about what happens to [her]; b) helping the [woman] identify coping mechanisms or actions, behaviours, or environmental resources that she might use to help her get through the present crisis; and c) assisting the [woman] to examine her thinking patterns and if possible, find ways to reframe her situation in order to alter her view of the problem, which can decrease her anxiety level.

5.   Making a plan led by the woman, which is very detailed and outlines the persons, groups and other referral resources that can be contacted for immediate support. Provide coping mechanisms and action steps that are concrete and positive for the woman to do in the present. It is important that planning is done in collaboration with the [woman] as much as possible, to ensure she feels a sense of ownership of the plan. It is important that she does not feel robbed of her power, independence, or self-respect. The most important issues in planning are the woman’s sense of control and autonomy. Planning is about getting through the short-term in order to achieve some sense of equilibrium and stability.

6.   Obtaining commitment. Control and autonomy are important to the final step of the process, which involves asking the [woman] to verbally summarize the plan. In some incidents where lethality is involved, the commitment may be written down and signed by both individuals. The goal is to enable the [woman] to commit to the plan, and to take definite positive steps toward re-establishing a pre-crisis state of functioning. The commitments made by the [woman] need to be voluntary and realistic. A plan that has been developed only by staff will be ineffective (adapted excerpt from James, R. 2008. Six-step model of crisis intervention. In Crisis intervention strategies. (6th ed). Thomson.  Belmont, CA: as cited in Alberta Council of Women's Shelters, 2009).

(based on Alberta Council of Women's Shelters, 2009. Sheltering Practices: Module 6 - Crisis Intervention)

 

Psychological support

Increasingly promoted in place of methods which involve debriefing during crisis, Psychological support (referred in some places as “first aid”) is a response option which focuses on:

  • providing practical care and support, which does not intrude;
  • assessing needs and concerns;
  • helping people to address basic needs (for example, food and water, information);
  • listening to people, but not pressuring them to talk;
  • comforting people and helping them to feel calm;
  • helping people connect to information, services and social supports;
  • protecting people from further harm.

The approach is ordered around three principles: look (to ensure the situation is safe, identify individuals who have emergency needs or might be in crisis); listen (by approaching and seeking to understand a woman or girl’s concerns, if she chooses to share them, and helping her feel calm); and link (women with relevant information, resources, support to address their basic needs).

Individuals should have training and orientation on psychological first aid before implementing the approach, although they do not need to be professional counselors to implement the method. This makes it a particularly relevant method of response in low-resource settings (WHO, War Trauma and World Vision, 2011).

Tools:

Psychological first aid: Guide for field workers (World Health Organization, War Trauma Foundation and World Vision International, 2011). Available in English.

Anthology Of Resources: Psychological First Aid For Low And Middle Income Countries Project 2009-2010 (War Trauma Foundation and World Vision International, 2011). Available in English.

IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (Inter-Agency Standing Committee - IASC, 2007). Available in English.

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