Walking on Down Virginia Avenue:

Crisis Intervention for I&R”AIRS 31st Annual I&R Training and Education Conference

“Mining for I&R Excellence”Reno, NV

Tuesday June 2, 2009Part 1 – 10:30 AM – NoonPart 2 – 2:15 – 3:45 PM

John PlonskiDatabase/Training CoordinatorCovenant House InternationalPresident NYS AIRSjplonski@covenanthouse.orgVoice: (212) 727-4040Fax: (212) 727-4964

Your Presenter

John has been involved in crisis intervention since 1984. Beginning as an overnight volunteer crisis counselor for six years at Response of Suffolk County. Since 1989 John has worked for the Covenant House Nineline, a national crisis hotline for youth under 21 and their families. Over the years he has served Nineline as a crisis worker, shift supervisor, and is currently Nineline’s Database Coordinator. In this position he oversees the maintenance of the agency’s call entry and referral databases. At present Nineline’s referral database consists of over 30,000 records providing referrals throughout the United States and its territories.

John has presented basic and advanced crisis intervention skills development training for his own and other agencies. His presentations of various topics at training conferences on the state and national level have been well received. He has also developed skills development trainings for individual agencies. John has consulted on several of the AIRS on-line training modules as well as the AIRS/United Way “Managing the Surge: 2-1-1 Volunteer Surge Management Curriculum”. His involvement at the 2-1-1 call center in Monroe, LA following the 2005 Gulf storms lead to his becoming a member of the AIRS/United Way 2-1-1 Disaster Response Team. He has been a volunteer board member of the New York State Alliance of Information and Referral Systems (NYS AIRS) since 2000 and is currently their President.

John can be reached at jplonski@covenanthouse.org or by calling Covenant House International at (212) 727-4040.

Getting To Know YouNow that you know about me and since we are going to be together for a while tell us a bit about yourselves. However, given the size of the group we do ask that you be brief.

•Name…

•Agency…

•I really like…

•I really don’t like…

•I think learning about crisis intervention is...

Ground Rules• Don’t worry about right and wrong.

• Forget about normal…more about that later.

• Take risks…It is the best way to learn and if you follow rules 1 and 2 it is easy to do.

• Ask questions…ask enough questions and maybe they won’t make us do role plays…NOT!!!

• Ask more questions…there may be a prize for the best one.

• Relax…John’s bark is worse than his bite…and his bark isn’t all that impressive anyway.

• Have fun…Yes we are here to learn, but it also a time away from work.

• If John says he’ll get back to something and he dosen’t...remind him…he forgets

What are we going to do today?

The workshop intends to provide I&R workers an understanding of crisis intervention that will enable them to:

• Understand what crisis is and the continuum of crisis • De-escalate and stabilize callers• Enable the caller to talk about and work through their feelings to facilitate assessment, problem-solving, and appropriate referral• Maintain contact with the caller pending referral or rescue• Prepare the caller to follow through with any referrals given

We plan to explain the...

• Reasons for knowing the basics of crisis intervention

• Definition of crisis and the nature of the continuum of crisis as it relates to the normal state and coping

• Basic tenets, elements, and listening skills of client centered crisis intervention

• Basic crisis intervention Model

• Do's and Don'ts of crisis intervention

Wow!! Seems like a lot. Why so much theory? Why? Why? Why? I’m

Stressed!!

We are doing it this way because too often we are taught the “How” without being given a thorough understanding of the “Why”. Once we understand the “Why” it becomes easier to understand and implement the “How”.

Besides, who likes being told, “Do it because we said so!”

I do I&R. Why should I learn about Crisis

Intervention?

Let’s ask the group what they think.

I do I&R. Why should I learn about Crisis

Intervention?

• It is, perhaps the only commonality you have with your Callers.

• To a degree you already do it. You call it Active Listening• People contacting you don’t differentiate between an I&R

Service and a Crisis Service• It facilitates making “contact” with your Callers• It can help you make better referrals to your Callers• It helps your Callers better accept the services of the offered

referrals• AIRS Standards have been amended to require basic crisis

intervention skills (see page 18 of handout).

Ok. If you say so.Where do we start?

As it relates to Crisis Intervention people are a product of three affects. Their:

• Thoughts• Feelings• Behaviors

Let’s begin by talking about assumptions we can make about the person who is not in “Crisis”.

• They are relatively “normal”. • They have basic coping skills.• They have ways to cope with day to day problems.

And?In our “normal” lives what we think, feel, and the way we behave are in a homeostatic balance which is referred to as the “Normal State”. In the normal state there is a homeostatic balance between a person’s thoughts, feelings and behaviors. In the crisis state there is imbalance between a person’s thoughts, feeling and behaviors.

“Homeostatic Balance”? That sounds gnarly to me. And “Normal”? I thought Normal was:

Sorry. If we didn’t throw in some big words we couldn’t

call it a workshop.

OK so instead of using “Homeostatic Balance” and “Normal State” what if we call it

“The Don’t Worry Be Happy State”?

So group…How would you define “Crisis”?

So just what is “crisis”?

• Crisis is: “A state of acute emotional upset in which an individual or group of individuals experience a temporary inability to cope with a given situation by means of usual problem-solving devices.”

Or in other words

• Crisis is: “A period of psychological disequilibrium, experienced as a result of a hazardous event or situation that constitutes a significant problem that can not be remedied by using familiar coping strategies.”

C’mon, that’s mystifying me. In simple

language…what is “crisis” ?

OK in even simpler words.

Crisis is when stuff happens that we can’t control or fix on our own and

we end up feeling crummy and stuck. Oh, that I

understand.

Actually crisis is all about stress.

Stress is a response to a stimulus characterized by heightened physical and psychological arousal response.

Stress is a disruption of the homeostatic balance which may be triggered by alarming experiences, real or imaginary. The body reacts releasing epinephrine (adrenaline), norepinephrine, cortisol and cortisone. This leaves the lower brain functions in control inducing three possible responses to the stressor.

Stressor induces one of three responses

Fight

Flight

Freeze

There are what we will term Autonomic Coping

Defenses.

Autonomic Coping Defenses protect the individual from consciously experiencing

anxiety and engage automatically when the homeostatic balance

Autonomic Coping Defenses include but are

not limited to:

• Avoidance • Delusions • Denial • Displacement • Dissociation • Hallucinations • Intellectualization • Isolation

• Projection • Rationalization • Reaction Formation • Repression • Somatization • Splitting • Suppression

Hmmm...So a crisis is like a problem or an

emergency.

• A problem may create stress and be difficult to solve but we are able to find a solution without outside intervention.

• An emergency is a sudden, pressing necessity, such as when a life is in danger requiring immediate attention by a trained professional. It does not require action by the individual.

Not really...

OK, fine. Now you said something about “problem-solving devices” and “coping strategies”. What’s

that about?

See I’m paying attention.Do I get a prize?

As individuals, when things go wrong, we each have our own ways of problem-solving or coping.

While we may not actually think about it, we have three levels of resources we use to respond to stress and fix stuff. They are:

• Primary Resources

• Secondary Resources

• Tertiary (AKA Adaptive/Maladaptive Resources)

So what are “Primary Resources”?

• Primary Resources include the individual’s own interpersonal, mechanical skills, and experiences that they use daily to negotiate their lives.

• They can include immediate family members and close friends with whom they are comfortable interacting.

• Primary Resources also include the individual’s belief, ethical, and moral systems.

• Can you suggest other Primary Resources?

Hmm...And “Secondary Resources”?

• Secondary Resources are those resources that are less familiar to the individual.

• They may include relatives, clergy, teachers, and school counselors.

• What do you think some other Secondary Resources may be?

Ok so far…Now ”Adaptive/Maladaptive

Resources”?

• Adaptive/Maladaptive Resources are resources the individual turns to when they feel their Primary and Secondary Resources have not been helpful in resolving their situation.

• Adaptive Resources are those that will assist the individual in addressing their needs.

• They might include counseling, calling a hotline, going to a crisis center, substance abuse counseling, or hospitalization.

Maladaptive Resources?

• Maladaptive Resources are what people use to mask the effect of the precipitating crisis and ultimately harm the individual.

• Turning to substance abuse or contemplating suicide would be examples of a Maladaptive Resource as they are inherently damaging to the individual.

• Some other Tertiary Resources?

So how does crisis happen?

•Normal state :-).

•Precipitating event disrupts normal state.

•The person reacts to event using primary and/or secondary coping skills.

•Existing coping skills (primary and secondary) are temporarily ineffective or lost.

•Tertiary resources are called upon.

•Crisis will resolve or not.

•Post-crisis functioning.

So how does all this help me understand Crisis

Intervention and how it

works? Let’s draw a picture. Imagine the line below represents the “Road of Life” (Normal/Homeostatic State). The road is flat and easily negotiated.

Okay…so…?Now, say something upsets the Normal State and “crisis” happens. We get a road like this...

Okay…so…and?Now, if Primary and/or Secondary Resources are used, a bridge is built over the crisis and the road is smooth again….the crisis disappears (is resolved).

Okay…so…and that’s it?

Not really. If Primary and/or Secondary Resources don’t work and Adaptive Resources are used. A new bridge is built to a higher level of coping….the crisis disappears and the ability to face similar crises is enhanced.

What if nothing is done or Maladaptive Resources are

attempted?Then the Caller is trapped in a state of crisis that continues until they opt to use Adaptive Resources. If the decision is made to not attempt Adaptive Coping the crisis becomes chronic.

Which brings us to….

John you said you were not going to do that!

Well I lied…Besides its tradition.

The Chinese Symbol for Crisis consists of

2 glyphs representing Danger

and Opportunity.

The Caller in crisis is in danger of remaining stuck in the crisis but, with effective intervention, has the opportunity to transcend the crisis and develop new levels of functioning and coping.

So it seems crisis is about change. Right?

It is all about change. Changes that happen. Things that can be changed. Things that can’t be changed.

• Crisis is precipitated by life changes.

• Crisis is resolved by changes in how we address the new situation.

• We can not change who or what Caller is physically.

• We can not change the situation or past activities that have created the situation that bought the Caller to us.

• We can help the Caller change how they react to the crisis.

LIFE EVENTS AND WEIGHTED VALUES Event Value Event Value

1. Death of a spouse 100 22. Change in responsibilities at work 29 2. Divorce 73 23. Son or daughter leaving home 29 3. Marital Separation 65 24. Trouble with in-laws 29 4. Jail term 63 25. Outstanding Personal achievements 28 5. Death of a close family member 63 26. Wife begins or stops work 26 6. Personal injury or illness 53 27. Begin or end school 26 7. Marriage 50 28. Change in living conditions 25 8. Fired at work 47 29. Revision of personal habits 24 9. Marital reconciliation 45 30. Trouble with boss 23 10. Retirement 45 31. Change in work hours or conditions 20 11. Change in health of family member

44 32. Change in residence 20

12. Pregnancy 40 33. Change in school 20 13. Sex difficulties 39 34. Change in recreation 19 14. Gain of a new family member 39 35. Change in religious activities 19 15. Business readjustments 39 36. Change in social activities 18 16. Change in financial state 38 37. Loan less than 50,000 17 17. Death of a close friend 37 38. Change in sleeping habits 16 18. Change to different line of work 36 39. Change in # of family get-togethers 15 19. Change in # of arguments with spouse

35 40. Change in eating habits 15

20. Mortgage over $ 50,000 31 41. Vacation 13 21. Foreclosure of mortgage 30 42. Holidays 12

43. Minor violation of laws 11 SCORING

Each event should be considered if it has taken place in the last 12 months. Add values to the right of each item to obtain the total score. Your susceptibility to illness and mental health problems:

Low < 149 Moderate 200-299 Mild 150-200 Major >300 References: Holmes, T.H. & Rahe, R.H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213-218. Horowitz, M., Schaefer, C., Hiroto, D., Wilner, N., and Levin, B.

We can help the Caller to effect change by addressing that which they can control, change, or adapt…their Thoughts, Feelings, and Behaviors.

As we have said in the Normal State there is a homeostatic balance among the three.

In the “Crisis” state there is imbalance.

To help the Caller restore balance among the three parts we engage in the Crisis Intervention Process.

The Good News About Change.

AUTOBIOGRAPHY IN FIVE SHORT CHAPTERS

By Portia Nelson

I I walk, down the street.

There is a deep hole in the sidewalk.I fall in

I am lost.... I am helplessIt isn't my fault.

It takes forever to find a way out. II

 I walk down the same street.There is a deep hole in the sidewalk.

I pretend I don't see it.I fall in again

I can't believe I am in the same place but it isn't my fault.

It still takes a long time to get out.

III I walk down the same streetThere is a deep hole in the

sidewalk.I see it there.'

I still fall in.... it's a habit, my eyes are open.

I know where I am.It is my fault.

I get out immediately. 

IV I walk down the same street.

There is a deep hole in the sidewalk.

I walk around it. 

V I walk down another street.

So what does Crisis Intervention do?

Crisis Intervention is a short-term helping process that focuses on resolving the immediate problem by using personal, social, and environmental resources in an effort to mitigate an individual’s response to the situation precipitating the crisis.

Crisis Intervention is not psychotherapy or a substitute for psychotherapy.

And Crisis Intervention does this how?

Crisis Intervention accomplishes crisis resolutionthrough a focused communication process based on• Three Basic Rules• Four Fundamentals• Seven Active Listening Skills This allows us to create a five step Model to guide the

crisis intervention process..

Just like anything else in life, the Crisis Intervention

Process has rules.

The Three Tenets (ahem, Rules) of Crisis Intervention are:

• The worker and Caller are equals.• The Caller determines the pace of the

interaction and can make their own choices and decisions.

• The worker “mirrors” the Caller through Active Listening

Whoa! The worker and Caller are equals? Isn’t that kind of

radical? Not really. The equality of the two

participants:

• Discounts the concept of the high and mighty, all knowing worker

• Empowers the Caller who is feeling powerless as the result of the their crisis.

• Allows the worker and Caller work together on an equal level.

It helps to facilitate the interaction if we remember that the Caller still has their own resources.

They set the pace and make choices and decisions. How does

anything ever get done? We have phones to answer! What

are you saying!This says that the worker accepts the Caller:

• Is a capable, competent person who knows their life, situation, experiences, and abilities better than anyone else.

• Is best equipped to make the decisions that will affect their lives.

• Best knows the rate at which they can explore and resolve their presenting situation.

In the Model we’ll introduce later you will see that it is direct, focused, and not particularly time consuming

process.

The worker “mirrors” the Client through Active

Listening. Is that like me using my mirror to look

fabulous?

Actually, this is the part of Crisis Intervention you learned about in “The ABC’s of I&R”.

This rule refers to the “reflective” Active Listening techniques used by the worker to help the Client better hear themselves and gain greater objectivity in making the decisions regarding their situation.

Aren’t listening and hearing the same thing?I hear, therefore I listen.

• Hearing is the physical act of perceiving sound by the ear. If you are not hearing-impaired, hearing happens. If that weren’t the case there would be no use for alarm clocks.

• Listening, however, is something you consciously choose to do. Listening requires concentration so that your brain processes meaning from words and sentences. Listening leads to understanding.

• Most people tend to be "hard of listening" rather than "hard of hearing."

Gee! That wasn’t so bad was it. Now for

the four Fundamentals of

Crisis Intervention

• Acceptance• Respect• Empathy• Hope

Acceptance is…?Acceptance is the “non-judgmental” piece of Crisis Intervention we hear so much about.

This fundamental says:

• Regardless of what we think or feel about the Caller we will not judge them, their situation, their actions, or their ability.

• That people, situations, actions, and abilities are things to be acknowledged, not judged.

Respect is...?

Once we accept the need to be non-judgmental we can then embrace the idea of respect. This means:

• We will respect each person's unique individuality and ability.

• The worker will respect the Caller enough to accept that they can resolve the crisis at hand.

Which brings us to empathy.

Ahem…This is important. Please try to remember empathy is not sympathy.Empathy is our attempt to

understand what the Caller is feeling and the

communication of that understanding to the Caller. In this sense, empathy is a “shared” experience.

Sympathy is our attempt to remove the Caller from their feelings so they (we?) will feel better. Sympathy is something we “extend” to them.

When we do the “Poor baby, poor baby” of sympathy we are denying the strength of their feelings.

Hmm…Empathy…Wasn’t that an

original Star Trek episode?

• Empathy is the most powerful fundamental because we seldom, if ever, communicate with others on an empathic level.

• Once a person experiences communication on this level the novelty of the “reflective” experience a bond is produced which permits open interaction and effective problem solving.

The Star Trek episode in question was “The Empath” and was aired 12/6/1968 during the 3rd season of the show.

Then what about “Hope”? “Hope you get over this”,

doesn’t sound too empathic to me.

The fundamental of hope has it’s basis in the concept that each person has, within themselves, the power to:• Change• Survive• Thrive• Regain control of their situation

Worker/Caller Equals - check

Caller Decides – yep, got that Mirroring/Active Listening – can do

Then there’sAcceptance/No Judging – cool

Respect – we like that

Empathy Good/Sympathy Not – OK

Hope – Sounds Good

Gotcha…We’re good to go. What’s next? Bring it on!

Okay! You’re getting there. We are almost finished with the basic

technical stuff. Let’s look at the 7 listening skills then we will have some

real fun. We are going to let you do some of the

talking.Isn’t that exciting?

Rats! Letting us talk…sounds like role-plays to me. Let’s run and hide!

7 Active Listening Skills…Oy! Sounds Like

too many!

• Silence• Encouragment

(Minimal and Standard)

• Reflection

• Paraphrasing• Summarizing• Restatement• Clarification

Don’t worry. As we said, you already do them. The only change is that we are going to try and help you understand why you do them. Chill. This will be a breeze. The Listening Skills are:

Let’s run through them real quick. Then a break!

Silence

Silence is a simple, yet effective, skill to use if we keep in mind that while it is a lack of sound it is also in indication of inner stillness.

• Silence allows the client room to think. • Silence demonstrates respect for the client’s work in the interaction.• Silence passively pressures the Caller to say more.

And more about Silence

Silence lets important points hang in the air for greatest impact. The “Pregnant Pause”. Silence allows the worker to formulate their thoughts into clear and concise messages. Silence expresses feelings.

Can somebody tell us how “silence” expresses feelings?

Encouragement?

Umm…Not exactly.

Encouragement is the skill of getting the Client to elaborate on stated points or feelings. In essence we are “encouraging” them to say more.

• Minimal Encouragers are the nodding head, “Mm-hmm”, “And then”, or the “Go on” we are familiar with.

• Standard Encouragers are statements much like, “What did you do then?”, or “Can we talk some more about."

Psst…For the Jargon Junkies in the group…think “Operant Conditioning”.

Reflection

• Reflection is the verbal interpretation of the verbal and non-verbal expressions of the Caller’s emotions. • It establishes an empathic relationship with the Caller that permits them to feel understood by and connected to the worker. • It also creates an emotional mirror that lets them see an objective view of their situation and their relationship to it.

Psst! This is the biggie do this right and there are big time brownie points from the Big Guy.

Ahem! Reflection sounds real important. Can You tell

us how to do it?

Use a stem statement, such as:

“Sounds like you feel”

Then add a feeling, such as:

“sad”

Then add context, such as:

“that you lost your job after so many years”

You bet. You do it just like this...

• I wonder if….• I'm not sure if I'm with you but...• Correct me if I'm wrong, but......• You appear to be feeling......• Perhaps you're feeling.....• It seems that you....• As I hear it, you......• What you mean...• What I think I'm hearing is.....• Let me see if we are together....• I get the impression that…• The message I'm getting is that....

• You felt that.......• Sometimes you think ...• Tell me ....• Let’s talk about ...• If I'm hearing you correctly......• What we are talking about is....• So, you are feeling.......• So, as you see it, you feel ......• It sounds as though you are saying......• Is it possible you are saying.....• So, from where you sit.......• Right now you're feeling......• You must have felt...

Examples of Stem Statements

Examples of FeelingsA Sense Of Loss Brave Diminished Forced Indecisive Nervous Reliable Thankful

Abominable Bright Disappointed Fortunate Indifferent Neutral Repugnant Threatened

Absorbed Calm Discouraged Free Indignant Nonchalant Resentful Thrilled

Accepting Certain Disgusting Free And Easy Inferior Nosy Reserved Timid

Aching Challenged Disillusioned Frightened Inflamed Offended Restless Tormented

Admiration Cheerful Disinterested Frisky Infuriated Offensive Sad Tortured

Affected Clever Dismayed Frustrated Injured Open Satisfied Touched

Affectionate Close Dissatisfied Fuming Inquisitive Optimistic Scared Tragic

Afflicted Cold Distressed Gay Insensitive Overjoyed Secure Unbelieving

Afraid Comfortable Distrustful Glad Inspired Pained Sensitive Uncertain

Aggressive Comforted Dominated Gleeful Insulting Panic Serene Understanding

Agonized Concerned Doubtful Good Intent Paralyzed Shaky Uneasy

Alarmed Confident Doubtful Great Interested Passionate Shy Unhappy

Alienated Confused Drawn Toward Grief Intrigued Pathetic Skeptical Unique

Alive Considerate Dull Grieved Irritated Peaceful Snoopy Unpleasant

Alone Content Dynamic Guilty Joyous Perplexed Sore Unsure

Amazed Courageous Eager Happy Jubilant Pessimistic Sorrowful Upset

Angry Cowardly Earnest Hardy Keen Pessimistic Spirited Useless

Anguish Cross Easy Hateful Kind Playful Strong Victimized

Animated Crushed Ecstatic Heartbroken Liberated Pleasant Stupefied Vulnerable

Annoyed Curious Elated Helpless Lifeless Pleased Sulky Warm

Anxious Daring Embarrassed Hesitant Lonely Positive Sunny Wary

Anxious Dejected Empty Hesitant Lost Powerless Sure Weary

Appalled Delighted Encouraged Hopeful Lousy Preoccupied Surprised Woeful

Ashamed Depressed Energetic Hostile Love Provocative Suspicious Wonderful

At Ease Deprived Engrossed Humiliated Loved Provoked Sympathetic Worked Up

Attracted Desolate Enraged Hurt Loving Quaking Sympathy Worried

Bad Despair Enthusiastic Important Lucky Quiet Tearful Wronged

Bitter Desperate Excited Impulsive Menaced Reassured Tenacious Zany

Blessed Despicable Fascinated In A Stew Merry Rebellious Tender

Boiling Determined Fatigued In Despair Miserable Receptive Tense

Bold Detestable Fearful Incapable Misgiving Rejected Terrible

Bored Devoted Festive Incensed Mournful Relaxed Terrified

It’s hard to remember all those. Isn’t there an easier way to remember all those

feeling words?

You really don’t have to remember them because you all ready know them. You experience feelings day in and out. It does make it easier though if you think of it as a game…”Connect the Feelings” to get the whole picture of the person’s situation. For example:

Do you remember “Connect the Dots”?

Let’s do a “Connect the Feelings” exercise.

A Few Thoughts About Feelings

• There is no such thing as "controlling" your feelings. However, you can you can control your behaviors and actions.

• All feelings are positive, true, and provide information about what is going on inside you.

• Feelings themselves are non-rational, but they arise for a reason that you have decided is either positive or negative.

• You have a right to your feelings.

• Your feelings will never lie to you; your mind will.

A Few More Thoughts About

Feelings• Your feelings do not make choices for you. They remind you of past choices, which are now translated into emotional responses.

• You "lose touch" with your feelings when you disguise them or cover them up with other emotions you think more appropriate.

• It is possible to have "mixed" or contradictory feelings.

• You can have feelings, as well as thoughts, about your feelings.

How about “Paraphrasing”?

Paraphrasing takes a long, detailed message and feeds it back to the Caller in a condensed version.

Let’s practice by paraphrasing the following:

When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out.

And what about “Summarizing”?

Summarizing refers to verbally collecting all the facts and feelings that the Caller has shared with and concisely restating them.

Let’s practice by summarizing the same scenario:

When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out.

Gotcha! “Restatement”?

Restatement refers to the reflection of a Caller's thinking, meanings, and facts as

they perceive them. We put what they've said into our own words.

Let’s practice using restatement. You know the scenario:

When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out.

Yep! And “Clarification” Dude?

Clarification refers to the search for connections that aren't immediately apparent.

You know the drill. Let’s practice clarification:

When I come back from vacation there is a pile of work that people didn’t do while I was away. Then there is the line of people with problems that need to be solved. Going away doesn’t seem worth all the aggravation but I feel so burnt out.

Okay…7 active listening skills• Silence• Encouragement (Minimal and Standard)

• Reflection• Paraphrasing• Summarizing• Restatement• Clarification Break Time!?!

Almost, but not quite yet! Let’s take a look at what the Active Listening Skills aren’t. Then we will demonstrate how they work.

I dunno…On reflection, it sounds like they are hungry and getting cranky. But let’s take a quick look at what active listening isn’t.

Active Listening Skills are not:

• Asking questions

• Self-disclosure

• Making promises

• Giving advice

• Defining right and wrong

Walking on Down Virginia Avenue: Crisis Intervention for I&R”

AIRS 31st Annual I&R Training and Education Conference“Mining for I&R Excellence”

Reno, NVTuesday June 2, 2009

Part 1 – 10:30 AM – NoonPart 2 – 2:15 – 3:45 PM

John PlonskiDatabase CoordinatorCovenant House NinelinePresident NYS AIRSjplonski@covenanthouse.orgVoice: (212) 727-4040Fax: (212) 989-9098

First a poetic interlude.Listen

When I ask you to listen to meand you start giving advice,you have not done what I asked.

When I ask you to listen to meand you begin to tell me why I shouldn’t feel that way,you are trampling on my feelings.

When I ask you to listen to meand you feel you have to do something to solve my problem,you have failed me, strange as that may seem.

Listen! All I asked was that you listen;not to talk or do – just hear me.

Advice is cheap; ten cents will get both Dear Abbyand Billy Graham in the same newspaper.

And I can do for myself; I’m not helpless.

But, when you accept as a simple fact that I do feel what I feel,no matter how irrational, then I can quite trying to convince you and get about the business of understanding what’s behind this irrational feeling.

And when that’s clear, the answers are obvious and I don’t need advice.

Irrational feelings make sense when we understand what is behind them.

Perhaps that’s why prayer works, sometimes, for some people.Because God is mute, and he doesn’t give adviceor try to fix things.He just listens and let’s you work it out for yourself.

So please, listen and just hear me.And, if you want to talk, wait a minute for your turn;And I’ll listen to you.

A Crisis Intervention Model

• Defining The Problem

• Exploring Goals

• Generating Alternatives

• Planning

• Closure

Why a Model?

· Views a person in terms of their ability to cope, their strengths and problem-solving abilities

· Uses the person's environment and social structure

· Assumes the Caller can make the right choices

· Emphasizes active, direct role of crisis worker

Why a Model? (continued)

· Is active and cognitively oriented

· Worker focuses on assisting the Caller to identify the problem, develop a reasonable goal, generate alternatives, and make a plan.

· Deals with the situation in the present.

· Assists the Caller in identifying and using personal and social resources

Let’s look at each step of the model.

Defining The Problem

• Use silence, listen carefully• Reflect and identify feelings; make contact on a feeling level• Build on feelings and points, using encouragers• Identify the problem. Why is the Caller calling right now?• Track the Caller by restating, paraphrasing, and summarizing• Clarify what is unclear

Exploring Goals

• Determine to what end the effort will be directed• What are the Caller's immediate goals? Today? Tomorrow?• What are the Caller's long-term goals?• Facilitate the Caller to make their own decisions• Remember: The Caller may not want to do what you want them to do• Set some realistic goals for the specific areas you have agreed upon• Be sure that goals can be reached by immediate action

Generating Alternatives

• Acknowledge the Caller's personal strengths• Explore past coping strategies• Identify personal resources: family, friends, loved ones• To whom has the Caller spoken already? What advice was offered?• Have the Caller generate his or her own options, consider alternatives, costs• Offer additional options for consideration• Provide information and referral when needed• Determine the means by which the Caller will reach his or her goals

Planning

• Facilitate the Caller in selecting thebest option(s)• Make the plan manageable. Break it down into steps• Prioritize goals and planned steps• Get the Caller to offer a prognosis. How confident are they in the plan?• Offer your prognosis based on Caller’s confidence• Encourage the Caller to take action; assign tasks• Remind the Caller about available resources• Reinforce the benefits of following up on referrals

Closure

• Summarize the call and plan, emphasizing strengths and progress

• Monitor for dial-tone disclosures

• Avoid farewell party syndrome

• Offer a few words of encouragement

What is the worker’s role in the Model?

• LISTEN Actively!!

• Mobilize resources within and around the Caller.

• Learn your limits and know when to ask for help.

• Recognize that you are not responsible for the outcome…You are responsible for using your intervention skills to the best of your ability.

• Be involved with your agency. Share experience and feedback with staff and supervision.

• Let the Model, not your personal feelings guide you.

Helpful Hints• Take your time…Think about what has

been said and what you plan to say.

• The personal pronoun “I”…avoid.

• Direct questions back to the Caller.

• Involve the Caller in the resolution…don’t problem solve for them.

• Your “Style”

• “Normal”

• Responsibility

• No sermons

• Dare to expand your skills

• Use Parallel Process

Parallel Process is a fancy way of saying, “Go with your gut”.

Okay…Now it is time to practice what we have learned. This will be a ton of fun!

Oh no...I knew it...role plays…and too late to hide!!!

See its not so bad. Homer is practicing already!

Role Play Ground Rules

• Have fun!

• Don’t be afraid to make mistakes. You are learning something new.

• Participate in feedback.

• Track your progress through the Model.

• Vary the Active Listening Skills you use.

Feedback Ground Rules

The person receiving feedback should be in charge.

Corrective feedback should be balanced and address specifics whileoffering alternatives.

The person receiving the feedback should summarize.

Feedback Ground Rules

Feedback should:

•Focus on strengths.

•Be helpful, not harmful.

•Be concrete and specific.

•Be non-judgmental.

•Be focused and precise.

Let’s look at how we are doing in achieving our goals

and review what we have covered.

• Reasons for knowing the basics of crisis intervention…Check!

• Definition of crisis and the nature of the continuum of crisis as it relates to the normal state and coping…Did that!

• Basic tenets, elements, and listening skills of client centered crisis intervention…Yep!

• Basic crisis intervention model…You bet!

• Do's and Don'ts of crisis intervention…Yep!

And so there you have it. Crisis Intervention demystified.

Let’s review.

• People are a product of their thoughts, feelings, and behaviors.

• They are relatively “normal”, have basic coping skills, and have ways to cope with day to day problems.

• A problem may create stress and be difficult to solve but we are able to find a solution without outside intervention.

• An emergency is a sudden, pressing necessity, such as when a life is in danger requiring immediate attention by a trained professional. It does not require action by the individual.

And…?

• Crisis is: “A state of acute emotional upset in which an individual or group of individuals experience a temporary inability to cope with a given situation by means of usual problem-solving devices.” Or more simply: Crisis is when stuff happens that we can’t control or fix on our own and we end up feeling crummy and stuck.

• We have three levels of coping resources which are Primary, Secondary, Adaptive/Maladaptive Resources.

• Crisis Intervention is a short-term helping process that focuses on resolving the immediate problem by using personal, social, and environmental resources.

And…?

The 3 Tenets of Crisis Intervention are: The worker and Caller are equals; The Caller determines the pace of the interaction and can make their own choices and decisions; the worker “mirrors” the Caller through Active Listening.

The 4 Fundamentals of Crisis Intervention are Acceptance, Respect; Empathy; and Hope.

The 7 Active Listening Skills are: Silence; Encouragment; Reflection; Paraphrasing; Summarizing; Restatement; and Clarification

And…?

The Active Listening Skills are not: Asking questions; Self-disclosure; Making promises; Giving advice; Defining right and wrong.

The 5 steps of the Crisis Intervention Model are: Defining The Problem; Exploring Goals; Generating Alternatives; Planning; Closure.

Well that sums it all up. Any questions?

Psst! Just one question. What makes John so cool?

Well, then on behalf of everyone who made this presentation possible we would thank you for your attendance. You were a really great group to work with. Thank you for sharing your time with us.