Family crisis intervention in social services

This article advocates the use of family therapy in crisis intervention. It relies upon the literature on crisis intervention, on family therapy literature, and on ten years experience of working in a social services area office, in which social workers are often required to respond alone to many different kinds of crises. Two typical referrals demanding crisis intervention and the responses to them are described.     

Police perspectives on responding to mentally ill people in crisis: perceptions of program effectiveness

In this study, we sampled sworn police officers from three law enforcement agencies (n=452), each of which had different system responses to mentally ill people in crisis. One department relies on field assistance from a mobile mental health crisis team, a second has a team of officers specially trained in crisis intervention and management of mentally ill people in crisis, and a third has a team of in-house social workers to assist in responding to calls. Calls involving mentally ill people in crisis appear to be frequent and are perceived by most of the officers to pose a significant problem for the department; however, most officers reported feeling well prepared to handle these calls. Generally, officers from the jurisdiction with a specialized team of officers rated their program as being highly effective in meeting the needs of mentally ill people in crisis, keeping mentally ill people out of jail, minimizing the amount of time officers spend on these calls, and maintaining community safety. Officers from departments relying on a mobile crisis unit (MCU) and on police-based social workers both rated their programs as being moderately effective on each of these dimensions except for minimizing officer time on these calls where the MCU had significantly lower ratings. © 1998 John Wiley & Sons, Ltd.     

Multi-agency family systems

The term 'multi-agency' family is preferred to 'disorganized' family. Multi-agency family systems present special problems of the relationships (a) within the family, (b) between family and professional network, (c) among members of the professional network and (d) between family, network and treatment centre to whom the family is referred. Pressures on the family and professional workers can create a locked system which prevents natural development of the family or effective problem solving by the workers. A systems approach to such problems is presented which includes consultation to the family/professional network system.     

COVID-19 Pandemic: Applying a Multisystemic Lens

The COVID-19 pandemic has a pervasive effect on all aspects of family life. We can distinguish the collective societal and community effects of the global pandemic and the risk and disease impact for individuals and families. This paper draws on Rolland’s Family Systems-Illness (FSI) model to describe some of the unique challenges through a multisystemic lens. Highlighting the pattern of psychosocial issues of COVID-19 over time, discussion emphasizes the evolving interplay of larger systems public health pandemic challenges and mitigation strategies with individual and family processes. The paper addresses issues of coping with myriad Covid-19 uncertainties in the initial crisis wave and evolving phases of the pandemic in the context of individual and family development, pre-existing illness or disability, and racial and socio-economic disparities. The discussion offers recommendations for timely family oriented consultation and psychoeducation, and for healthcare clinician self-care.     

Evaluation of Crisis Intervention Programs and Personnel: A Summary and Critique*

ABSTRACT: Many of the suicide prevention centers that developed throughout the country during the last decade have evolved into general crisis intervention services. At the same time, they have stimulated the development of a wide variety of agencies that utilize nonprofessional volunteers who, primarily through telephone contact, provide helping services to people in crisis. This paper presents a critique of three particular problem areas relating to the use of volunteer personnel, along with a summary of research aimed at providing new technologies for their solution. Methods have been developed for rating on-the-job performance of crisis intervention workers, based upon criteria that are thought to have general application to crisis intervention centers. Efforts to describe personality characteristics of volunteers are reported, along with suggestions for the direction of additional investigations. Finally, the issue of assessing the outcome of crisis intervention cases is summarized. A four-phase conceptualization of the crisis intervention process is proposed, and appropriate measures of outcome at each point in the process are suggested. The overall significance of this type of research is discussed in terms of the need for standards by which to evaluate crisis intervention services.     

State of mind assessments

This paper describes state of mind assessments as undertaken by child psychotherapists. It considers the similarities and differences with an assessment for an ongoing child psychotherapy treatment intervention and is described here as a ‘package’ that is offered to the family, child and young person and also the referring colleague. It is suggested that the consultative aspect has more weight in a state of mind assessment. The stages of the assessment are outlined and include the initial consultation with the referring colleague, a meeting with parents, three sessions with a child or young person and feeding back to parents with further consultation to the referring colleague. The meaning of the request at any particular time is explored and influences the stance and the approach to the assessment by the therapist. A summary of a case example illustrates the different stages outlined here. The thinking and approach described may be particularly useful to trainees and those starting out as child psychotherapists in child and adolescent mental health services.     

The direct support workforce in community supports to individuals with developmental disabilities: issues, implications, and promising practices

Difficulties in finding, keeping, and ensuring the competence of the direct support workforce in community developmental disability services has long been a challenge for individuals, families, providers, and policy makers. Direct support staff recruitment, retention, and competence are widely reported as one of the most significant barriers to the sustainability, growth, and quality of community services for people with developmental disabilities (ANCOR [2001] State of the states report. Alexandria, VA: ANCOR; Colorado Department of Human Services, [2000] Response to Footnote 106 of the FY 2001 appropriations long bill: Capacity of the community services systems for persons with developmental disabilities in Colorado; Hewitt [2000] Dynamics of the workforce crisis. Presentation at the NASDDDS Fall meeting. Alexandria, VA). While long in existence, these challenges are ones of growing concern because the number of people demanding community services is increasing and the population of people from which to recruit workers is declining (Office of the Assistant Secretary for Planning and Evaluation [2006] The supply of direct support professionals serving individuals with intellectual disabilities and other developmental disabilities: Report to Congress. Washington, DC: Office of Disability, Aging and Long-Term Care Policy, ASPE, U.S. Department of Health and Human Services). As the service system moves towards consumer direction, managed care, and more noncategorical service delivery systems, the difficulties of providing for an adequate and well-prepared workforce to support people with developmental disabilities becomes more complex and multifaceted. The solutions to those challenges are also more complex. This article reviews the literature regarding the complexity of the direct support workforce crisis, the effects of this crisis on various stakeholder groups, promising practices designed to address the challenges, and the related practice and policy implications.     

Family-Based Intervention with High-Risk Infants and Their Families

A model of family-based intervention for high-risk infants hospitalized in the neonatal intensive care unit and their families is presented. The theoretical underpinnings, principles, and nature of the intervention are described. The adaptation of the model from a clinical–research demonstration project to a clinical consultation service is highlighted, with particular emphasis on the practical application of the model. Domains of the intervention include infant behavior, family organization and functioning, caregiving environment, and home discharge/community resources. Three case illustrations are provided to demonstrate the breadth of the intervention and how it can be individualized based upon the presentation of the infant and family.     

Structural family therapy with Mexican-American family systems

Characteristics of traditional Mexican-American families with consequent family rules that affect these family systems are discussed along with selected clinical cases. The specific cases discussed involve: (1) interactions with family of origin in intercultural marriages, (2) intracultural differences in levels of acculturation and traditional family rules, and (3) extended family impact in response to severe life crisis. The development of therapeutic processes from structural and strategic family therapy approaches, which reflect appreciation for cultural differences and strengths, is suggested.This material was presented at the annual meeting of the Texas Association for Marriage and Family Therapy, January, 1994, San Antonio, TX.     

Crisis intervention and the prevention of institutionalization: An interrupted time series analysis

In the context of the community mental health movement in Illinois, the evolution and development of a crisis intervention program aimed at avoiding state hospitalization and bringing more appropriate and efficacious resources to bear on the difficulties of the individual and/or family is described. This intervention program is characterized by a more active-seeking style of delivering mental health services. With the novel application of interrupted time series analysis to both the targeted and matched nonequivalent control communities the efficacy of this more active intervention in reducing the number of state hospital administrations diagnosed as "mentally ill" is highlighted. The cost/benefit to the taxpayer is also discussed.     

A hospital-based crisis service for adolescents: a program description

In the past three decades there has been rapid growth in crisis intervention services. This article describes the development of a hospital-based crisis service for adolescents. This Crisis/Assessment Unit (CAU) has met a community need for a responsive program for adolescents in acute psychiatric crises. The development of the CAU is described and critiqued. In addition, a typical case admitted for crisis services is presented.     

Intregrating family therapy into in-patient paediatric settings: a model

This paper describes the integration of structural family therapy and systemic consultation into an in-patient paediatric unit. Two case examples illustrate the approach used. It is concluded that six stages are involved in the successful integration of a systemic approach: planning and convening an initial staff meeting, developing a structural hypothesis, enlisting hierarchical support in the ward system, holding the family meeting, reconvening the professional team and disengaging the family and ward system.     

The role of network therapy in the treatment of relational disorders: Cults and folie a deux

This article discusses the successful outcome of a network intervention in a case of cult-involvement andfolie a deux. The intervention, specifically designed to help a family in which one member had become involved with an individual who claimed to be the Messiah—an involvement that entailed the exclusion and alienation of all other family members—used a team of network specialists and consisted of a pre-network planning meeting, the network meeting itself which included approximately 70 persons over four hours, and several follow-up meetings with network subgroups.     

Combating Foster Care Drift: An Ecosystemic Treatment Model For Neglect Cases

The neglect of children may take many forms, but always represents the diminished capacity of the entire system of which the children are a living part. Child, parent, family, neighborhood, and community variables mutually influence one another. Once children are removed from a home, these same individual, relational, and contextual factors may result in foster placements of indefinite term and goals. Families are not reunited nor are the children legally freed to be placed in permanent homes. Because of the multiplicity of transacting influences there needs to be a stage-wise, systemic approach to remediation. This begins with crisis intervention and life stabilization. Later it includes more traditional family therapy work. However, the marital and family therapist contributes substantially at each stage.     

The child parent drop-in center: Community based primary prevention

A community supported child-parent drop-in program that provides services to families with few financial resources or to those who may not seek help from other service agencies is described. Services are provided free or at a minimal cost. The family oriented program provides short-term, respite care for children from birth to kindergarten age, educational programs and social opportunities for parents, short-term crisis counseling, referral to other community resources, and volunteer opportunities and training. Three centers are housed in facilities that donate the space. The centers recruit, train and actively involve parents, students, senior citizens and other volunteers to work in the program. Service groups and businesses aid in fund-raising and human service agencies provide consultation, act as referral resources and help with program operation. Each center is individualized to meet the needs of the community it serves.     

Effective crisis intervention

Crisis intervention techniques in a community-based setting, including factors of immediacy of response, location, prior identification and flexibility of service, are examined. Using a community-based program which has received and dealt with 231 crisis situations over a 2-year period as a model, this study shows crisis intervention techniques to be viable and valuable in the identification of problems in the family and individual. Families which request service due to a crisis must be dealt with differently from those who seek service through traditional channels. Preventive intervention is employed to reduce the onset of more serious personality disturbance and family decomposition. Using Caplan's phases of crisis as a guide, most families dealt with in the model program showed signs of reduced conflict and a greater willingness to seek more traditional types of services.     

Increasing intervention implementation in general education following consultation: a comparison of two follow-up strategies

This study examined two strategies for increasing the accuracy with which general education teachers implemented a peer tutoring intervention for reading comprehension. The intervention was implemented for 5 elementary school students who had been referred for consultation services. Initial implementation of the intervention by the teachers was variable, and the data exhibited a downward trend. When consultants held brief daily meetings with the teachers to discuss the intervention, implementation improved for 2 of 5 participants. Four of the teachers implemented the intervention at levels substantially above baseline during the performance feedback condition, whereas implementation for 1 teacher increased following discussion of an upcoming follow-up meeting with the principal. Student reading comprehension scores improved markedly during the peer tutoring intervention. Three students maintained these gains 4 weeks after the intervention ended. The implications of these findings for the maintenance of accurate treatment implementation in applied settings are discussed.     

Crisis Reactions of College Freshmen As a Function of Family Support Systems

This study explored the relationship between family support system availability and crisis reactions of entering freshman college students. Self-report measures, including distance from home, anticipated weekend visits with family, and number of family relatives residing in the college community, were investigated in relation to the crisis variable. The availability of the student's family was inversely correlated with his or her crisis score. This article emphasizes the need for primary group support and discusses implications for intervention.     

A community meeting protocol for assault prevention

Assaultive behavior by patients is a serious problem throughout healthcare facilities. Currently, wide variability exists in the approaches used to deal with assaultive behavior. The immediate objective of this study was to perform a consensus validation of the community meeting as a prevention and intervention measure for assault. The community meeting is a regular meeting of all staff and patients for communication, ward management, or psychiatric treatment. A delphi survey, with three iterations, was used to operationalize the collection of judgments and achieve convergence of opinion from expert respondents. A protocol for a Violence Prevention Community Meeting (VPCM) was established.     

A comparison of performance feedback procedures on teachers' treatment implementation integrity and students' inappropriate behavior in special education classrooms

This study examined the extent to which treatment integrity of 4 special education teachers was affected by goal setting, performance feedback regarding student or teacher performance, and a meeting cancellation contingency. Teachers were trained to implement function-based treatment packages to address student problem behavior. In one condition, teachers set a goal for student behavior and received daily written feedback about student performance. In a second condition, teachers received daily written feedback about student performance as well as their own accuracy in implementing the intervention and would be able to avoid meeting with a consultant to practice missed steps by implementing the intervention with 100% integrity. This latter package increased treatment integrity the most above baseline levels. Higher levels of treatment integrity were significantly correlated with lower levels of student problem behavior for 3 of the 4 teacher-student dyads. Three of the 4 teachers also rated both feedback procedures as highly acceptable. Implications for increasing and maintaining treatment integrity by teachers via a consultation model are discussed.