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Home > Crisis Intervention in Child Abuse and Neglect > Crisis Intervention in Child Abuse and Neglect: Crisis Intervention Goals And Steps
Crisis Intervention in Child Abuse and Neglect
User Manual Series (1994)
Crisis Intervention Goals And StepsIntroduction Crisis intervention begins at the first moment of contact with clients.7 Consequently, community coordination in its planning and implementation results in tremendous benefits to families. In a matter of weeks, families may achieve progress that is the equivalent of 1 or 2 years of traditional case management and treatment. In fact, families are most ready to change their nonproductive approaches to problem-solving during a time of crisis. Crisis intervention focuses on one to four goals that are chosen by the family. Intervention is time limited, usually between 4 to 12 weeks, family-centered, and occurs in the family's home much of the time. Concrete services, along with counseling and referral to community resources, are provided by one or more crisis workers. Crisis workers representing some combination of CPS, family preservation, and other crisis workers, are available 24 hours per day, 7 days per week. Using eclectic, solution-focused approaches, they concentrate on family strengths, rather than weaknesses, believing that families have the knowledge and skills to solve their own problems. The major focus is on the here and now, but linkages to the past may be explored in order to break a repetitive cycle of inappropriate problem-solving or self-destructive behaviors. All crisis intervention programs emphasize safety for the children. Concern for the safety of other family members and crisis workers is rapidly evolving as a part of good practice. In addition to the scope and goals of crisis intervention, this chapter considers the following: a nine-stage model of crisis intervention, crisis-intervention teams, crisis as an opportunity to initiate change, and crisis intervention as a planned response. The Scope and 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 perpetuate chaos. Six Goals of Crisis Treatment As proposed by Lydia Rapoport, crisis intervention is guided by six primary goals, all aimed at stabilizing and strengthening family functioning. These goals are to:
Since crisis intervention is time limited, an attempt to achieve too many goals leads to disappointment and feelings of failure. While clients should be encouraged to stretch their resources or abilities, they cannot be expected to go in too many directions or too far beyond their basic abilities. It is better to help clients view life as a "practice field" where they practice repetitively to accomplish a goal, or as a "house" where they put one piece of progress (building block) on top of the other until the goal is achieved. A Nine-Step Crisis Intervention Model The following model incorporates steps from a seven-stage model for crisis intervention.9 This nine-stage model is slightly more comprehensive.10 Step 1: Rapidly Establish a Constructive Relationship In the first step, the emphasis is on crisis worker sincerity, respect, and sensitivity to clients' feelings and circumstances. Crisis workers must listen and observe for long periods of time. As Puyear states in Helping People in Crisis, "Active listening entails listening for the latent, underlying, coded message and then checking to see if you've gotten it correctly."11 Active listening gives clients a chance to develop their own strengths. By assuming that clients are motivated, they are supported in thinking through their solutions, which enhances their self-respect. "The worker," Puyear continues, "must assure that the client feels that something useful has been accomplished in the first session and that there is promise of something useful being accomplished in the next."12 Rapport is enhanced by showing respect and unconditional positive regard for clients. Crisis workers need to start with the assumption that people are basically good.13 Step 2: Elicit and Encourage Expression of Painful Feelings and Emotions Anger, frustration, and feelings related to the current crisis are the focus of intervention rather than issues in the past. Linkages to past crises and repetitive, ineffective responses to problems can be explored at a later time. Step 3: Discuss the Precipitating Event After rapport is established, the focus turns to the family perceptions of the situation, the chain of events leading up to the crisis, and the problem that set off the chain of events. Discussions examine when and how the crisis occurred, the contributing circumstances, and how the family attempted to deal with it. Step 4: Assess Strengths and Needs Family assessment of strengths and needs begins immediately and continues throughout crisis intervention. The crisis worker draws conclusions regarding the family's strengths and needs related to the current crisis and, with the family, evaluates the potential for recovery. Client strengths are tapped to improve self-esteem, while also providing energy and skills for problem-solving. Step 5: Formulate a Dynamic Explanation This step looks for an explanation not of what happened, but why it happened. This is the core of the crisis problem. The meaning of the crisis and its antecedents as seen by the clients are explored. Why do they ascribe that meaning or perceive it as they do? Step 6: Restore Cognitive Functioning In this step, the crisis worker helps the family identify alternatives for resolving the crisis ( i.e., reasonable solutions toward which the family is motivated to work). Step 7: Plan and Implement Treatment The crisis worker assists the family in the formulation of short- and long-term goals, objectives, and action steps based on what the family chooses as priorities. With a concrete plan of action, the family feels less helpless, more in control, allowing members to focus on action steps. Objectives and action steps need to be simple and easy at first, assuring client success. The family members are responsible for action steps or homework, but the crisis worker continues to counsel them, seeks to help find appropriate resources in the community, and becomes the family's advocate. Step 8: Terminate Termination occurs when the family achieves its pre-crisis level of stability. Crisis workers review with the family the precipitating event(s) and response(s) and the newly learned coping skills that can be applied in the future. The crisis worker assures that the family is scheduled for meetings with, and committed to, any necessary, ongoing community services. Step 9: Follow-up Crisis workers arrange for continuing contacts with families and referral sources on predetermined dates or by saying "I'll be contacting you soon to see how you are doing."14 This puts appropriate pressure on families to continue to work on issues in a positive way.15 Crisis Intervention Teams In cases involving child abuse or neglect, there is frequent misunderstanding about the differences among investigation, psychological first aid, and rehabilitative crisis intervention. Each, however, plays a critical role in a team's response to child maltreatment. Ultimately, rehabilitative crisis-intervention skills can significantly enhance investigative or psychological first-aid approaches. Investigation The purpose of the investigation is to determine whether child abuse and neglect exist within a family reported to the CPS agency, to interpret the agency role, to determine whether the family will benefit from further intervention, and to assess whether there is a risk that future maltreatment will occur.16 As noted in an earlier user manual, Child Protection Services: A Guide for Workers, "[investigative] intervention should be timely, limited to required procedures, and terminated when it is determined that continuation is unnecessary or when services are no longer required."17 Whereas emergencies should receive immediate response, nonemergency situations can be contacted within 24 hours, and can usually take place in the child's current residence. On the basis of the CPS investigation and case assessment, crisis workers must decide if the case warrants continued intervention. At this point, crisis workers may need to use crisis-intervention techniques. Removal of the child is not the primary objective, but rather the alternative, if intervention fails and the child cannot be protected in the home. Psychological First Aid Psychological first aid, or helping to reduce anxiety by listening and reassuring the family, is critical to the establishment of rapport. This requires hours of listening on the part of crisis workers. Psychological first aid may also be a one-time intervention offered by neighbors, relatives, churches, or helping agencies that provide money, food, housing, or transportation. Although this support system is extremely important in the overall crisis response, it does not teach clients to problem-solve and, in fact, may leave the clients to struggle with repetitive crises.18 If possible, crisis workers need to persuade community support systems to stay involved with the family after the initial crisis period, going well beyond the psychological first aid stage. Establishment of consistent friendships and other community supports can help avert future crises. Rehabilitative Crisis Intervention As Slaikeu states in Crisis Intervention: A Handbook for Practice and Research, rehabilitative crisis intervention aims to help "the client deal with the impact of the crisis event in all areas of the client's life."19 Through resolution of one crisis, the client can gain skills for facing and solving future problems, rather than developing a repetitive cycle of being "rescued" from similar crises. This does not mean that the primary focus is on all areas of the client's life. Instead, by staying focused and being successful in problem-solving, clients learn skills that are transferable to all areas of their lives and can be used to resolve future crises. Even though the focus is on current problems, many clients come to understand how past, unresolved trauma contributed to maladaptive attempts to solve the present crisis. Overview of Teams Related to CPS Whenever a CPS investigator believes that a child's safety in the home is questionable, and that intensive, in-home intervention services are needed to protect the child from harm, a crisis-intervention team should be called in right away. CPS and specialized teams should always cooperate, not compete, since investigation and treatment are separate, equally important functions.20 The team concept is critical in shaping the philosophy and vision of family preservation or other crisis-intervention programs. The combined knowledge of a multidisciplinary team provides for more accurate assessment and treatment approaches, and more varied use of community resources. Furthermore, there is strength in numbers, meaning that a team provides safety or protection for its members as well as the families that are being helped. The likelihood of violence, or even resistive behaviors, is reduced when a "team" is present. A dysfunctional family system is also more likely to be positively influenced by an intervention system, a team, that demonstrates clear and honest communication, as well as respect, among team members. Team members should have diverse knowledge and skills. Those with highly specialized knowledge, such as child development or substance abuse assessment, may serve as consultants to other team members. When a multidisciplinary crisis team is unavailable, as in small communities, close contact must be maintained between the crisis worker and the supervisor or consultant, who work together as a small team. Specialized, Multidisciplinary Teams Multidisciplinary crisis-intervention teams bring specialized knowledge to a crisis situation. To be effective, each crisis worker plays a distinct role, with a coordinating supervisor providing support and overall direction. Team members may be in a direct service role or that of a consultant to other crisis workers. Preferably, team members represent both sexes and a range of chronological and professional development stages. When more than one team member goes to a home or multidisciplinary interview center, a lead crisis worker needs to be in charge to assure that goals for the visit or interview are accomplished. Some crisis workers excel at using community resources or providing concrete services. Others excel at assessing problems, helping families communicate better, or listening in a way that makes families willing to talk openly. Some crisis workers are especially good at accompanying clients to a well baby clinic, to a physician's office, to prospective employment, or even the grocery store, thereby helping them feel successful in accomplishing a task. Some crisis workers are better at supportive confrontation or placing limits on inappropriate client behaviors. Drawing on each team member's strengths greatly enhances service delivery. Time limits of service, 24-hour availability, and belief that clients have the skills with which to solve their problems are essential. Time-limited service requires advanced planning, specialized knowledge, and specific skills if families are to benefit. The following are areas that any program providing a team approach must address in order to assure the team's effectiveness:
Crisis as an Opportunity to Initiate Change If help is not available when a family is open to new ways of coping, family members may sink deeper into maladaptive patterns such as more violence, heavier substance abuse, deeper withdrawal, or more destructive scapegoating. Under such circumstances, there is increased risk of child abuse and neglect. When individuals and families are highly stressed and anxious about dealing with unfamiliar problems, such as a summons to appear in juvenile court, they may feel overwhelmed, hopeless, and panicked. After attempting to use responses that have worked for them in the past, they are searching for new responses to their dilemma. If, in the past, they have responded to frustration by yelling, accusing, hitting, feeling sick, withdrawing, or crying, it becomes evident to them that these responses are not stopping the CPS or law enforcement investigation. Finding no answer to the situation, while perceiving a threat to their existence, families are open to new ways of processing and resolving their problems. During the resolution of a crisis, individuals and families tend to be particularly amenable to help. Customary defense mechanisms weaken, usual coping patterns prove inadequate, and the ego becomes more open to outside influence and change. A minimal effort at this time can produce a maximum effect; a small amount of help, appropriately focused, can prove more effective than more extensive help at a period of less emotional accessibility.21 If an immediate therapeutic response is made while the family is still experiencing a high level of anxiety or emotional pain, the family is more receptive to intervention. Therefore, the crisis worker must listen closely and determine what the family wants to change. During this emotional, rehabilitative, goal-setting period, crisis workers should:
Crisis Intervention as a Planned Response Since there is a window of opportunity during which families are open to change, effective crisis intervention is timely in its response and diligent in assuring safety for the children and other family members. A helpful, planned response includes:
Presence Until Stress Is Reduced It is important to note that the crisis worker must be present until family stress is reduced and the child is safe. Seldom can only one visit provide such safety. For resolution, most crises require several visits. Certainly this is true in families where there are linkages to unresolved past crises and where the child's safety may be in doubt.23 Some families seem to be crisis prone, always living on the brink of another crisis. At least one author has referred to "exhaustion crisis," in which persons under consistent stress are finally overwhelmed by an additional internal or external stress, and "shock crisis," in which there is no forewarning prior to a sudden change in the social environment.24 Chronically dysfunctional families who are reported for child abuse and neglect could fall into either category. "Stresses become traumatic through repetition."25 Consequently, some families are overwhelmed not only by abuse or neglect but also by repeated inquiries into their abusive or neglectful patterns. These families may need ongoing services for a period of 2 to 5 years, or parental rights may need to be terminated when sadistic and torturous abuse is present.26 It is possible that multiple crises in families as a way of life may be an attempt to avoid emotional pain from the past and to test crisis workers' commitment and trustworthiness. Crisis workers should not promise more than they can deliver in the prescribed time limit, but arrangements for long-term intervention can be part of the crisis-intervention plan. Summary In summary, a family is most likely to accept intervention from "outsiders" during a state of crisis. In contrast to traditional casework, crisis intervention is brief in duration, focused primarily on the "here and now," and supports family members in what they – not the crisis worker – want to change. A skillful crisis worker or crisis-intervention team involves the entire family in the problem-solving process, reinforces the family's abilities and strengths, and conveys a hopeful attitude to the family about problem resolution. Concrete services are provided to lessen pressures in the family and to free the family's energy for setting and achieving goals. Prior to termination of crisis-intervention services, skillful crisis workers make sure the family is linked to the resources it needs in the community and then formalize a plan for follow-up. Many families known to CPS agencies have multiple problems. It is important to remember that crisis workers are not responsible for helping families solve all of their problems. Rather, the task is to help families stabilize and learn to focus and find solutions to a limited number of problems. In that way, families gain a sense of accomplishment and success, encouraging them to move on to solving other issues, either on their own or with the help of resources in the community.
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