Use a checklist to assess the need for intervention
Your agency may have a checklist that contains all the information you need to ask the client/caller. Check whether or not your agency has one. In the checklist there may be a series of questions you need to ask and space for you to record the person’s response to the questions.
When you are receiving information from a client, you need to document that information very carefully. Regardless of the format required by your agency, any documentation relating to the recording of initial inquiries/interviews is likely to contain the following information in the example below.
You may be able to think of other information that is given that would need to be documented.
Emergency procedures and crisis management
How are appropriate procedures implemented to prevent escalation of any potential emergency or crisis?
Let’s look at each step in more detail, with examples of how these can be used in workplace situations.
You must make a judgement about whether the situation at hand is a crisis and requires a formal crisis response. For instance, a carer breaking an arm is inconvenient, and of course must be responded to, but it is not a crisis. A client attacking a carer and breaking the carer’s arm is a crisis, and you must make a formal response.
It is important to identify the issues arising from the crisis. Often a crisis creates more than one issue for workers and clients to deal with. Different issues may need different responses. Be clear and calm when dealing with a crisis, as the worker does in the example below.
Case study: Identify crisis issues
Read the case study below.
Joanne works in a residential unit which houses up to ten young people who are unable to live with their families. One morning, she discovers that two fourteen-year-old clients, Renee and Selda, have run away the night before, stealing the work car in the process.
Selda suffers from severe asthma. A quick inspection of her room reveals that her asthma medication has been left behind but all her clothes are gone. Joanne contacts her supervisor and has a lengthy discussion about how the situation can be handled. In the privacy of the office, Joanne telephones people known to Renee and Selda but no one has seen them. Joanne has a quiet chat with each of the residents. One young woman tells Joanne that Renee talked about going interstate to meet up with an ex-boyfriend.
Joanne contacts her supervisor again with an update. She identifies these crisis issues:
- Two young women are missing, whereabouts unknown.
- Selda may have an asthma attack with no medication.
- The work car missing and two young women are probably driving it without the necessary skills or licence.
On her supervisor’s advice, Joanne contacts the police to report the car and the young women as missing. She provides the police with the relevant details. They suggest she continue to contact friends and relatives who might know where to find Renee and Selda.
As in the previous example, sometimes crises require the intervention of authorities and/or emergency services.
Depending on the crisis, you may have a legal responsibility to notify police, ambulance/hospital or the fire brigade. Contacting and using emergency services is dealt with later in this section.
Even if it is not an emergency, your agency may require you to inform your supervisor when a crisis arises. For instance, if the crisis involves a breach of a court order, such as a parent not returning a child from a contact visit, tell your supervisor immediately so that appropriate action can be taken.
Your major priority in any crisis is to make sure people involved, including you, are safe. This means securing them from any immediate physical danger.
Read the case study below.
Margot is a family support worker working with the Patton family. The Patton family was referred to Margot’s agency by the department because of concerns about Mrs Patton’s boyfriend hitting her children. Part of the case plan requires Margot to carry out home visits to monitor how the family are coping.
On one of these visits, Margot enters the house to see Roger, the boyfriend, shaking and slapping four-year-old Jacob. Jacob’s sister, Deanne, is crouching in the corner of the room crying. Margot can see that Deanne has bruising down one side of her face and red marks on her arms. Mrs Patton is in a bedroom, sobbing and rocking.
Roger stops when he sees Margot. He swears at her and storms out the back door. After comforting the children and calming Mrs Patton, Margot takes them back to her agency.
It becomes clear that Mrs Patton is firm about staying in the house with Roger, even if it means her children remain at risk of violence. In consultation with her supervisor, Margot arranges for Jacob and Deanne to go into respite care, while workers look at longer-term options for placement.
In this example, the worker needs to take care of the immediate danger to the children. She would consult with her supervisor, and either she or the supervisor would contact the police and a worker from the Department of Child Safety.
Once you have secured people’s safety, the next step is to ensure supports are available for everyone involved in the crisis. This includes your client, significant others and you. ‘Significant others’ usually refers to people who have involvement with the client now or in the past. A significant other can be a parent, teacher, childcare worker, probation officer, foster carer or social worker.
Support can also be moral and/or emotional, such as arranging for debriefing for people directly involved or for a friend/relative to be with your client during their time of crisis. Talk through available supports with your client, as in the next example.
Read the case study below.
Jemma is a single mother with three young children. She had her third baby a month ago. Jemma has also recently come off a heroin addiction. Her worker, Annie, has helped her with this and supported Jemma during a difficult pregnancy.
Annie finds out that Jemma’s baby died of SIDS on the weekend. Annie has concerns about Jemma and the children’s welfare. Not only is Jemma grieving, but she has the demands of two young children and may be tempted to resort to drugs to block the pain.
Annie contacts Jemma who agrees to see her for a long chat. They talk about how Jemma is coping and what Annie can do to support her. Jemma agrees to allow Annie to contact Jemma’s mother, to see if she can mind the children a couple of days/nights a week. Annie also puts Jemma in touch with a SIDS support group for parents. Annie has been seeing Jemma once a fortnight but they change that to once or twice a week for the short term while Jemma is facing a crisis.
Five main factors affect a decision about the appropriate level of intervention in a crisis. These are:
- your client’s history/your knowledge of them
- the circumstances of the crisis
- your own work role
- statutory obligations
- resources available.
You have to make a judgement based on these factors. Sometimes that judgement has to be made in a split second if you or others are confronted with immediate danger. This is the situation in the next example.
Read the case study below.
Jim works at a youth detention centre. He hears yelling and runs to see one of his clients, Luke, fighting with another young man, Tony. Luke has Tony up against a wall and is punching him around the head. Both boys have blood on their faces. A couple of other boys are standing around, calling out to the ones fighting.
Jim calls out, ‘Stop it. Enough!’ They continue fighting. Jim holds Luke firmly by the arms from behind. Tony falls in a heap, covering his nose with his hands. Luke is still swearing and struggling. Jim pushes Luke to the ground and sits on top of him to restrain and quieten him. He instructs the watching boys to leave the room. Jim keeps repeating, ‘Calm down, Luke, it’s over’, to quieten him until another worker arrives to help him.
In this example, the circumstances of the crisis mean that Jim has to act immediately to secure people’s safety. He is careful not to place himself between the fighting boys and risk his own safety. Jim's priority is to stop the fight in a safe way. In a crisis, you do as much as is needed to secure people’s immediate safety without risking your own.
Some agencies have policies which are ‘No Restraint’ policies. If, in the example above, Jim was working for an agency with such a policy, he would not have been able to ‘hold Luke firmly’, as it would be against agency policy. Under these circumstances, the agency would have clear guidelines for him to follow, e.g. shutting the door on the situation and calling the police.
In other situations you may have a little more time to consider what intervention is needed. You do not have to do this alone. Consult with your supervisor, other workers and your client. Talk to your supervisor or other workers about how they make judgements about the level of intervention needed.
Know the limits of your work role and the resources your agency can provide. Sometimes just contacting emergency services or referring clients to crisis services is an appropriate level of intervention.
It may not be appropriate for emergency services, you or your agency to deal with a particular crisis. That is where crisis services are useful. Your role may be to link people into other services or agencies that can provide an appropriate crisis response. This is what happens in the crisis following.
Read the case study below.
Pedro is thirteen and lives with his grandmother. He has been diagnosed as having a mild manic-depression condition. One afternoon, Pedro’s grandmother calls Rose, Pedro’s case worker, very distressed. She tells Rose that Pedro went out for a walk and has come back acting very strange. He does not seem to hear his grandmother when she talks to him, is mumbling and talking to the air and has a glazed look in his eyes. Pedro’s grandmother wants Rose to do something.
Rose agrees to come and see Pedro. When she goes to his room, she can see his behaviour has changed. He is yelling and swearing, sometimes banging his head on the wall. Rose cannot get Pedro to respond to her. He resists her attempts to lead him out of his room. Pedro’s grandmother is scared Pedro will hurt himself or her.
Rose suspects that Pedro has been using illegal drugs. His behaviour does not seem consistent with his manic-depressive condition. With his grandmother’s consent, Rose contacts the mobile psychiatric care team to come and assess Pedro’s condition and treat him.
Mobile psychiatric care teams are one kind of crisis service. Crisis services offer short-term assistance and support to people experiencing a crisis. Many are specialist services which deal with people experiencing a particular kind of crisis.
Other examples of these include:
- emergency accommodation
- material/financial aid
- respite care
- domestic violence outreach/refuge
- sexual assault counselling/advocacy.
You can probably think of others you or your agency have used. If you do not know what crisis services are available in your area, you need to find out.
When acting in a crisis situation involving a client, it is important that, where possible, you keep people informed about what you are doing. It is important that you set an example by your own behaviour. Remaining calm and in control goes a long way in:
- managing the behaviour of others
- restoring calm
- creating an environment where you can respond appropriately to the crisis.
This means thinking about what you say, how you say it, your body language and what you actually do.
Here are some major considerations when dealing with crisis:
- Crisis intervention requires a more directive approach.
- Don’t get hooked into the crisis and the urgency of the situation – your stress won’t help the client. Don’t add to the pressure!
- Timing is crucial. The earlier you respond to a client in crisis, the better the chances are of working through it effectively.
- Don’t expect the client to make sense. They are in crisis, chances are they won’t! Part of your role is to help them clarify and make sense of their situation.
Remember, a crisis is a short-term condition – it won’t last forever. Focus on working for short term solutions to move on from the crisis, then you can move to more long-term solutions. The aim of crisis intervention is to get the client back to a state of balance of functioning as soon as possible. It is not about exploring issues in depth, or a forum for therapeutic counselling.
Dealing with violence or aggression
- Follow organisational procedures to remain safe.
- Clear the space as much as possible.
- Remove others from the scene.
- Speak to the client in a non-provocative manner.
- Give the person enough personal space.
- Use voice and eye contact to attempt to maintain the balance.
- Use diversion if possible – a change of focus, distraction, or interrupting the client's train of thought.
- Inform other staff as soon as possible.
- Call emergency response teams if needed (including police, ambulance, and mental health response teams.)
It is important in these situations that workers don’t add to the problem by reacting to any personal abuse or being authoritarian or aggressive in the situation.
Some appropriate procedures to prevent escalation of a potential emergency or crisis include:
- Calming skills – speak in a measured, respectful and calm voice. Use soothing terms and repeat your desire to understand the person’s situation. Ask probing questions to identify what they hope to gain and then offer suggestions for more productive ways of achieving the same outcome.
- Managing and containing emotional responses and escalating behaviour. Even if you are feeling stressed and tense, try to appear calm and in control.
- Identifying and dealing with the source of the issue.
- Seeking assistance from other workers, carers, family or services.
Some further aspects that will impact on support work with clients in crisis include:
- legal considerations
- professional considerations (e.g. your role)
- the particular policy approach of the agency in relation to risk assessment and risk management.