Safety Risks in Residential Settings
Risk factors common in residential treatment settings include problematic factors related to the actual facility, such as escape routes, co-ed facilities, lighting issues, wet or slippery floors, locked and unlocked doors, and cleaners and cleaning equipment. It is important to become thoroughly familiar with the work environment, including knowing when things are out of place or not working and how to operate doors and window exits. Other risks include client-related factors – infection, medical crisis, and behaviors harmful to self or others. Facilities that provide services to involuntarily admitted individuals need to be aware of the possibility of a resident leaving without permission, also called “an elopement” or AWOL.
Peer support specialists need to be trained in the various safety protocols that are used in their agency. This includes such procedures as
- Cardio-Pulmonary Resuscitation (CPR)
- Use of “universal precautions”
- Location of emergency equipment
- Follow-through on crisis and medical issues.
Responding to Emergency and Disaster Situations
Peer support specialists also can play a critical role in maintaining safety in emergency and disaster situations. At these times, persons receiving services are especially vulnerable. The stress of an emergency situation may precipitate a relapse or emotional crisis. Helping to maintain calm and restore order are important responsibilities for peer support specialists. In order to prepare for emergencies and disasters, behavioral health agencies conduct fire and disaster drills and practices.
Peer support specialists need to understand and participate in these drills, understand why they are being done, and what their specific roles in these drills are. For emergency drills, it is most important to know the organization’s policy, pay attention during the event, and follow directions. All staff must follow their supervisors’ requests and orders in emergency situations, since the time available for evacuations or other emergency tasks can be short and of great priority. If, for some reason, a peer support specialist is alone in an emergency without the benefit of a supervisor or other staff, they should remember these key guidelines.
- The first and most important task is to try to ensure the safety of the persons receiving services, any other people involved, and other staff.
- Second, stay calm. Getting stressed out or panicky does not help anyone.
- Third, get help as quickly as possible without leaving others in dangerous situations.
Clients who engage in behavioral health treatment have a right to expect that they will receive appropriate support if they have a crisis. Peer support specialists are among the first responders when clients with behavioral health disorders experience a crisis. Crises can include relapse to substance use, emotional decompensation (worsening of symptoms), suicidal or homicidal threats or attempts or physical aggression. Peers provide crisis support by:
- recognizing the early signs of relapse
- implementing coping strategies, including physical and verbal de-escalation
- preventing hospitalization and the use of emergency services when appropriate
- developing of a Wellness Recovery Action Plan (WRAP).
The best way to handle a crisis situation is to prevent it. Crisis prevention also involves early assessment of persons receiving services for their potential for crisis along with the development of appropriate plans of care for managing these behaviors. Strategies aimed at helping persons receiving care to manage their own behavior, such as stress and anger management groups, can also be effective.
Steps in Crisis Intervention
Crisis intervention requires timely and skillful support to help the person receiving services to cope with his/her situation before further physical or emotional deterioration occurs. Peer support specialists may be the first to respond when a person receiving services is in crisis. They must determine the distress level, impairment, and instability of the person in crisis. Use of a structured or systematic model of crisis response helps peer specialists feel confident that they have provided appropriate and sufficient response. The use of a comprehensive model allows for a response that is active and directive enough but does not take problem ownership away from the person receiving services.
In general, the following steps are used in crisis intervention models:
- Assessing the Severity of the Crisis. The first step in crisis intervention is assessing the severity of the problem. If the person in crisis is physically injured, or violent, some immediate steps need to be taken to safeguard this person and those around them. More typically, the person in crisis is confused, anxious, and unsure of what to do next. This is not an immediate medical emergency. There is some time to assess the problem and deal with solutions.
- Forming a Connection. To assist a person in crisis it is necessary to form a human connection or establish rapport with them. Even if the peer support specialist has already created a relationship, it is important to reinforce the connection at the time of crisis. Body language, facial expressions and eye contact will all convey caring and interest. With crisis intervention done by telephone, only the words used, the tone of voice, the speed of speaking, the loudness of the voice, and the inflection used that could convey caring and interest. The initial response to a person in crisis should be a response that demonstrates empathy. This is the communication to the person in crisis that the responder understands the feelings being expressed by the person in crisis.
- Exploring the Problem. The next step in crisis intervention is exploring the problem. In crisis intervention it is important to focus on the immediate situation. The goal of crisis intervention is to help the person through the immediate crisis by restoring the person to his/her previous level of functioning. The tools used to explore the problem in a crisis intervention setting are active listening and paraphrasing.
- Dealing with Feelings and Emotion. In addition to the specific circumstances of the crisis, the feelings generated by the crisis must be examined so that the peer support specialist can view the situation from the client’s perspective. Many people have difficulty expressing their feelings. They may have been taught at an early age to contain their feelings, and that the outward expression of emotion is not to be done. When these individuals are in crisis they may seem unaffected or detached and emotionless about their situation. However, there are some individuals who become overly emotional during a crisis. They may be crying or overwrought to an extent that makes communication nearly impossible.
- Generating Alternative Solutions. After hearing a considerable amount of detail regarding the present crisis and the feelings underlying those facts, the peer support specialist may want to summarize their understanding of the situation, either verbally or in appropriate documentation, to the counseling staff that will discuss alternative possible solutions with the person receiving services.
- Development of an Action Plan. The final step in crisis intervention is the development of an action plan. The action plan is an outline of the steps that will be taken by the person in crisis to resolve the situation. The action plan will be specific, concrete, and in small mutually agreed upon increments. The action plan should be developed by the person in crisis with the assistance of the peer support specialist or other crisis counselor. The action plan must be very specific regarding time. The person in crisis is desperately looking for some relief. To give them hope of moving in a positive direction today, and to see some concrete examples of some resolution by tomorrow will greatly benefit the individual requesting help.
- Planning Follow-Up and Booster Sessions. There should also be a specific follow-up plan. If the action steps run into a snag, if there are unanticipated complications, there needs to be further contact so that the plan can be modified. It is also beneficial to have follow-up to monitor progress on the action plan.
Module 7 Activity: Steps in Crisis Intervention
Instructions: Click the box below to complete the Module 7 Activity: Steps in Crisis Intervention.