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Home > Crisis Intervention in Child Abuse and Neglect > Crisis Intervention in Child Abuse and Neglect: Understanding Crisis
Crisis Intervention in Child Abuse and Neglect
User Manual Series (1994)
Understanding CrisisIntroduction Family crises are not unusual events in the field of child protection. A child's disclosure of sexual molestation, the birth of a drug-addicted infant, the discovery of a teenager's dependence on drugs, a parent's arrest for violent behavior, the threat of a family's eviction from public housing, or a parent overwhelmed with the needs of a child illustrate just some of the crises experienced by families. Although the state of crisis is short lived, generally lasting 4 to 6 weeks, it is a period of heightened family vulnerability and imbalance that requires a carefully planned response. This section provides an overview of crisis, its definition, elements, and phases. In addition, the feelings and psychological effects typically experienced by family members in crisis are presented to increase awareness of the ramifications of crisis. Definition of Crisis "A crisis," as defined in Crisis Intervention Book 2: The Practitioner's Sourcebook for Brief Therapy, "is 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. The upset, or disequilibrium, is usually acute in the sense that it is of recent origin."1 A crisis constitutes circumstances or situations which cannot be resolved by one's customary problem-solving resources. A crisis is different from a problem or an emergency. While a problem may create stress and be difficult to solve, the family or individual is capable of finding a solution. Consequently, a problem that can be resolved by an individual or a family is not a crisis. An emergency is a sudden, pressing necessity, such as when a life is in danger because of an accident, a suicide attempt, or family violence. It requires immediate attention by law enforcement, CPS, or other professionals trained to respond to life-threatening 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. Elements of Crises The three basic elements of a crisis – a stressful situation, difficulty in coping, and the timing of intervention – interact and make each crisis unique. Stress-Producing Situations Everyone experiences times then they feel upset, disappointed, or exhausted. When such feelings are combined with certain life events or situations, they often lead to mounting tension and stress. There are five types of situations or events that may produce stress and, in turn, contribute to a state of crisis:
Difficulties in Coping An individual's or a family's ability to deal with a crisis situation is influenced by their physical and behavioral characteristics and their attitudes and beliefs. Even families with generally happy lives and networks of support 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 that have problem-solved well in the past will be quick to benefit from crisis intervention. With encouragement, support, and a focus on the problem-solving process, they will soon regain their coping skills and stabilize. For example, one case referred to CPS 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 "stand up to the threats." Within a period of 3 weeks, the mother was appropriately parenting her child again and finding joy in life. Parents with Chronic Coping Problems Many families in the CPS system do not have experience in solving problems well. Rather, they seem to have continual difficulties in several areas of their life. Indicators distinguishing the two types of families – those in acute crisis and those in chronic crisis – are presented in exhibit I. It is not the task of crisis workers (also known as crisis interveners) to "cure" every dysfunction within "chronic crisis" families. Instead, it is more critical to focus on one to four specific stresses which created the immediate crisis. If a family can learn to focus on and find solutions to a limited number of crisis-producing problems, then the family members will have learned how to problem solve, and they will feel more in control of their destiny. As one client said, "Until you taught me to focus on one thing at a time, I felt like I was a bad person because I couldn't fix everything. Now I see that I was just running from one problem to another and not fixing anything." People with chronic coping difficulties tend to be constantly in stressful situations and must cope with several major problems which occur simultaneously, e.g., unemployment, inability to pay bills, problems with the landlord, marital disharmony, and neighborhood complaints about their children or the appearance of the yard.2 Any new stress, such as the utilities being disconnected, may be "the straw that breaks the back" of these families. Instead of being supportive to each other, family members try to place blame. Arguments or violence between the adults may lead to child abuse or neglect or vice versa. Substance abuse, adolescent gang activity, or a runaway or pregnant teenager may indicate that the family has chronic coping problems. Once families learn to problem-solve, they have new hope for the future, giving them the energy to address some of the antecedents to the current crisis. Again, crisis workers must focus on restoring stability and teaching families how to solve problems, rather than solving the problems for them. When crisis workers assist families in solving a crisis, the families are also helped to avoid future crises. Many of these families, however, need to be referred to mental health or substance abuse counselors for resolution of past emotional traumas, such as childhood sexual abuse or for treatment of addictions, depression, and other emotional disorders. Timing of Intervention As stated previously, crises typically last 4 to 6 weeks during which time problem-solving is critical. A timely, therapeutic response is likely to prevent a severe breakdown in family relationships and restore adequate functioning. It is at this time that the family is most open to intervention. By intervening in a timely manner and by assisting the family in overcoming situational factors which led to the crisis, stabilization is likely to occur within a few weeks. Initially, the crisis worker may remain with the family 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. Throughout the process, the crisis worker should be available at all times. The Phases of Crisis When individuals or families face certain levels of stress or combinations of stress, crises occur. These crises are likely to have a sequence, or series of phases, as described below. Although presented as seven distinct phases, the phases of crisis may overlap or intertwine. The following configuration of crisis phases is adapted and expanded from the four interlocking phases found in Crisis Intervention Book 2: The Practitioner's Sourcebook for Brief Therapy.3
Client Feelings During Crisis Howard and Libbie Parad describe the anxiety-ridden responses of people in crisis as including "...upsets in eating, sleeping, dreaming, lovemaking, 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 understand and work with crises:
Psychological Effects of Crisis While 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. Forming a working relationship with the parents, when responding to a crisis caused by child maltreatment or when dealing with parents in any other child-rearing crisis situation, requires anticipation of these effects. Generally, crisis events produce problems in six broad areas as described below. Such problems are temporary, however, and not indicators of mental illness. A crisis is transient, as are the temporary responses of the family members. Anyone can have a crisis. Therefore, being in crisis is not synonymous with being mentally ill. Disorganized Thinking People in crisis experience a 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 may jump from one idea to another in conversation so that communication is confusing and hard to follow. They may not notice or may have forgotten exactly what happened, or who did what to whom. 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. Some people in crisis develop one-track minds, repeating the same words, ideas, and behaviors which "worked" in the past, but are inappropriate in the current situation. These people may seem unable to move on to new ideas, actions, or behavior necessary to solve the current crisis. Preoccupation with Insignificant Activities In an attempt to combat disorganized thought processes and anxiety, people in crisis tend to become very involved in insignificant or unimportant activities, such as worrying that someone will be overwhelmed with bad air by keeping a window open. At the peak of crisis, then, these individuals may need considerable help in focusing on important activities, such as implementing the steps for productively resolving the crisis. 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. Impulsiveness 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, thus making an already complex situation even more difficult to resolve. Dependence Dependence on the crisis worker at a time of crisis is a natural response and may be necessary before an individual can resume independence. In cases of child abuse and neglect, protection of the children may require the crisis worker to do for the parents what most other parents do for themselves. For example, the crisis worker may need to call a creditor or the utility company or help parents in structuring the basics of child care. During a crisis, perceptions of the crisis worker's power or authority can have a stabilizing impact on a family. 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. After a brief period of dependency, most families are able to resume independent functioning. For some families in crisis, however, dependency may linger. The need to have someone else in charge makes these families particularly susceptible to influence from others, rendering them more vulnerable. In their need to find solutions, they may not be able to discriminate between what is beneficial for them and what could be harmful or, in the absence of a competent crisis worker, to whom they should listen.5 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, a crisis occurs. Because usual coping methods fail, one's sense of personal identity is impaired, causing disequilibrium.6 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. Or, the parent may withdraw from offers of help. In either case, it is important to remember that the parent in crisis is probably very frightened, rather than "resistant" or "unmotivated." 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. Summary During a state of crisis, individuals and families are usually quite receptive to intervention. The anxiety produced by the crisis, coupled with the realization that past coping and problem-solving strategies are not working, spurs motivation to learn new strategies. If help is not available during this critical period of openness to change, the individual and family may become totally immobilized or resort to destructive or maladaptive behaviors. Therefore, it is critical that CPS caseworkers quickly identify crisis situations. In identifying a crisis situation, it is important to consider its contributing elements: What specific situations or events are creating the most stress for the individual and the family? What difficulties in coping are evident? At what point in time is intervention occurring? The phase of the crisis must also be considered. Feelings and behaviors that on the surface appear bizarre, may be, in fact, characteristic of the crisis phase. Correct interpretation of the crisis phase is essential to appropriate intervention. For instance, clients whose crises are chronic or multiple may require referrals to follow-up clinicians who can further address underlying issues. Finally, it is important to be aware of the feelings people typically experience during a state of crisis. A crisis can have a devastating impact on one's senses and psychological functioning. However, that impact is often short lived when interpreted and dealt with correctly.
This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information Gateway. |
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