Advanced Crisis Line Training

Introduction

A few years ago when I was working for Distress Centre Durham (DCD), I undertook a project to develop a new advanced training curriculum for telephone responder. Currently the Basic Training is 16 hours of in-class, plus another 16 hours of supervised phone shifts where a responder demonstrates that they have the active listening, empathy, suicide and crisis intervention skills we need for them to be on the phones independently.

After about 3 months or 50 hours they are required to undertake an Advanced Training session. This session helps consolidate some of the learning, revisit some of the classroom skills and then to build some additional skills going forward.

This training was turned into a PowerPoint that I won’t share because it contains some copyrighted Distress Centre Durham material – but you can read below for information that you could use as the foundation of your own advanced crisis line training. I’ve since made some updates so this training goes beyond the original that I developed for DCD.

Session Information

The length of the session was usually about 3 hours. The content covered was as follows:

  • Introduction
  • Burnout and Stress Management
  • Handling Difficult Calls
  • Advanced Suicide Intervention
  • Advanced Crisis Intervention
  • Discussion of Difficult Situations
  • Conclusion

Five Step Limit Setting Process

For more information on this limit-setting process, you can see my article Setting Limits and Boundaries with Callers. Briefly, the five steps are:

  1. Identify the inappropriate behaviour
  2. Identify what correct behaviour is
  3. Indicate the consequences for failing to change behaviour
  4. Give the caller an opportunity to change their behaviour
  5. Follow through on consequences (e.g. hanging up) if behaviour does not change

Active Listening Process (ALP)

For more information on the active listening process, you can see my article Active Listening Process on Crisis Lines. As a quick reminder, the different skills in the ALP include:

  • Voice Tone
  • Pace
  • Setting the Climate
  • Open Ended Questions
  • Close Ended Questions
  • Empathy Statements
  • Clarifying
  • Paraphrasing
  • Summarizing
  • Referrals
  • Winding Up

Burnout and Stress Management

What is Burnout?

Burnout is a “state of physical, emotional, or spiritual exhaustion.” It occurs when we give too much of ourselves for too long and don’t take appropriate steps to recover. Symptoms of burnout can include:

  • Becoming cynical or critical of callers
  • Being irritable or impatient
  • Feeling responsible for the outcome of calls
  • Having unexplained headaches or other physical complaints

An example of a situation I knew a responder was feeling burned out was when they took a 20 minute call with a regular caller who was dealing with relationship issues. While their on-the-phone work was good, when the call was over, they were very upset that the caller was not in crisis and just wanted to bounce ideas off the responder.

This responder felt like their time was being wasted by this caller, when we could be taking crisis calls instead. It’s clear that responder cared a lot for our callers – but they were not treating all of our callers like they were important to us. For this reason, we had a discussion about how our service is preventative and designed to both provide emotional support and crisis intervention. The responder took a leave of absence and when they returned several weeks later they were recharged and ready to support all of our callers.

Emotions on the Helpline

We can experience a range of emotions on the helpline. Some of these are positive and some of these are negative.

Positive Helpline Emotions

  • Excited
  • Grateful
  • Happiness
  • Hopeful
  • Meaningful
  • Optimistic

Negative Helpline Emotions

  • Anger
  • Frustration
  • Guilt
  • Confusion
  • Physical fatigue
  • Nightmares
  • Intrusive thoughts

What Causes Burnout?

There are a number of causes of burnout. These include working too many hours on the helpline – feeling like you’re a martyr or you always have to be there. Having your expectations set too high and expecting clients to change or improve (they call us because we’re a source of support that don’t ask them to change.)

Being isolated or having a lack of social support can increase burnout, as can a failure to debrief either with peers or supervisors after your calls. Feeling disconnected from the day-to-day events and other things happening at the crisis line can also cause increase your fatigue and burnout.

Overall, if you feel ineffective in your work you’ll be at greater risk for burnout.

Preventing Burnout

To prevent burnout, it’s important that you always debrief after tough calls. You can talk to your peer in the call room, you can talk to your supervisor. You can work fewer shifts or even take a Leave of Absence away from the Centre for a while, to recharge. Adjusting your personal life so you have a better work/life balance, and coming to Team Meetings and other social events can help you.

Finally, stress management techniques and having a strong support network will help you prevent burnout.

Relaxation and Stress Management Techniques

  • Bubble Bath
  • Hot Shower
  • Meditation
  • Physical Exercise
  • Sleep
  • Yoga
  • Others…?

Handling Difficult Calls

There are a range of difficult callers that responders can be confronted with. These include individuals with significant mental health issues, “chronic” or repeat callers who are calling for social maintenance reasons and sexual fantasizers or abusive callers who are trying to misuse the service.

Seriously Mentally Ill Callers

These individuals have significant struggles or may be actively in a mental health crisis. They might speak very quickly and not let you get a word in edge-wise, or they may be very impatient. Winding up the call be difficult and these calls can make you feel ineffective or frustrated.

Remember to keep an open mind, and remember why we support these callers. They often have few resources other than us that are non-judgemental and empathic. Let the caller vent their fears, anxieties and frustrations, but always remember the Active Listening Process (ALP).

If a caller is having delusions, we must not feed into those delusions but instead empathize with the underlying emotion. Rather than saying “Yes, there could be vans outside your house monitoring your thoughts”, say something like, “That would be really scary if it were happening.”

Social Maintenance Callers

These individuals are calling because they’re lonely. While our service provides support to them we must make sure that they do not monopolize the lines, or push boundaries in trying to collect personal information on our callers.

We will use our 5-Step Limit Setting Process if the caller wants identifying information, and try to engage the caller openly in things that they can do, or that you and them can talk about, to reduce their loneliness. When the call starts going in circles (they’re repeating themselves and not moving on to anything new), we can begin to wind up the call.

They should call us back tomorrow if they’d like to speak again, and you can discuss with staff the setting of a time limit or other restrictions.

Sexual Fantasizer Callers

These can be some of the most frustrating calls for us to deal with, because they make us question what we’re doing on the helpline. These callers are often difficult to determine as sexual fantasizers at first – they drag it out as long as possible.

When we begin to suspect that we’re speaking with a sexual fantasizer, we must remind them to stick to the discussion of the emotions of their problem. For example, sometimes we get legitimate callers who want to talk about cross-dressing, sexual orientation, or sexual fetishes. If these callers are genuine, they will prefer to speak about the emotions of those elements and how they impact those around them, rather than discussing the specific activities of cross-dressing, having sex with men, or engaging in a sexual fetish.

You might feel angry or used when the call ends if you don’t figure it out early enough. You’ll need to make sure that you debrief and put your stress management techniques into practice.

Angry or Abusive Callers

These callers are those who are calling to take emotions out on you. This can be challenging and is not an appropriate use of our service. Using your Five Step Limit Setting Process, you’ll need to let the caller know that you are here to listen if they are upset but that they cannot direct language at you.

If they would like to make a complaint, they should call the office line. Set the boundary, and if they continue then you’ll end the call. And make sure you follow through!

Suicide/Crisis Intervention

Suicide intervention is the process of assessing and intervening with someone who is at high-risk of suicide. Once you’ve done some risk assessments on the phone you’ll have a better sense of how to weave these questions into your exploration of the caller’s issues.

By starting each suicide assessment with “Have you done anything tonight to kill yourself or end your life?” you’ll be able to move smoothly into the safety planning questions. Your goal is to make sure that you have a sense of whether the caller will be safe tonight. If they will, you don’t have to worry. If they won’t, you can begin building a safety plan or support network collaboratively with the caller to make sure they will be safe.

You’ll want to conduct a suicide risk assessment:

  • Any time you suspect a caller is suicidal
  • When they tell you they’re having suicidal thoughts
  • Even if the person denies current suicidal thoughts

In an emergency, when the caller has already taken steps to end their life, you must:

  1. Change your voice tone. Become assertive, to let that caller know that they need to cooperate with you so you can get them help
  2. Collect their location, and other identifying information
  3. Tell them to unlock their door, open the door if they can, so that emergency personnel can reach them
  4. Debrief after the call with your supervisor

Example of Suicide Intervention

  • Caller explains they have self-injured today
  • Responder assesses suicide risk, they come up medium on the CPR or DCIB Suicide Risk Assessment
  • Responder explores coping strategies but they say there’s nothing they can do, they’ve tried it all and they can’t guarantee their own safety
  • Responder arranges for a taxi to take them to hospital or mental health crisis bed

Discussion of Difficult Situations

During the discussion of difficult situations, responders would talk about situations that they personally found challenging – whether or not they were covered on the above. A group discussion would help responders get a better sense of how their peers would handle those situations, and the facilitators would share their own thoughts. This helped to increase the confidence of the responders in dealing with those situations in the future.

Conclusion

We would wrap the session by thanking everyone for coming out and presenting them with an Advanced Training certificate. Completion of both Basic and Advanced Training was required for a responder to be considered a Certified Volunteer Helpline Worker.

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Deliberate Practice in Social Work

Introduction

Every field has people who are clearly at the top of their game, people who are in the middle or average, and people who shouldn’t be in the profession or who perform very poorly. And everyone wants to be part of that star-performer, top 10% group. Do we know how to get there? Surprisingly, yes. There is a lot of research on “supershrinks” (those rated in the top 10%) and how they differ from other therapists. The outcome of that research applies equally well no matter what role you have.

What it boils down to is that the best therapists, social workers, and clinicians actively practice the basics, and try to get as good as they can. The worst rated therapists, spend far less time on their own professional development.

Chow et. al. (2015) examined a variety of elements to discover what were related to therapeutic outcome. Consistent with what we’re taught in school (that therapeutic modality is responsible for very little change), Chow and colleagues found no relationship between gender, caseload, age, degree, and other elements affected outcome.

What they did find is that the highest performing therapists spent the most amount of time working on their clinical skills. The top performers spent an average of 7 hours a week engaged in deliberate practice. The lowest performing therapists spent around 20 minutes a week engaged in this same kind of work.

Deliberate Practice

Deliberate practice (Ericsson, Krampe & Tesch-Romer, 1993) is a term coined by Psychologist K. Anders Ericsson. He has spent his career studying experts, and found deliberate practice capable of explaining prodigies in music, sports, and even medicine. Malcolm Gladwell’s pop-psych book Outliers: The Story of Success made the case that individuals we see as different simply get more opportunities to practice their skills. Unfortunately he missed the “practice” in deliberate practice, and what most people took away from the book was that you needed 10,000 hours of practice – no matter good or bad, and this is obviously not the case.

Applying Deliberate Practice to Social Work

As a social worker or other clinician, it’s important to make sure that you practice the basics:

  • Read books on basic counselling techniques like Intentional Interviewing and Counseling
  • Video or audiotape yourself (with client consent) and discuss clips in supervision
  • Complete training courses in your chosen therapeutic modality and continue to expand

In addition to engaging in this practice, you must perform outcome based measurement. This involves empirical tools to assess your client’s progress throughout counselling or therapy. By doing this kind of assessment, you can begin to understand what elements are working in your sessions and which ones are not.

Scott D. Miller, the expert in supershrinks, has developed the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). These are standardized rating scales that clinicians can use to track their client’s outcome over time. You can read more by Scott D. Miller in this presentation.

Daryl Chow (who co-authored that study above about supershrinks spending 7 hours a week on deliberate practice) also authored his thesis (Chow, 2014) on the same topic. During that thesis, he wrote that “compared with their peers, therapists’ self assessment of effectiveness was not correlated with actual outcomes, in spite of the use of outcome measures in their clinical practice.” Essentially, we don’t know when we’re doing well or not doing well, and it’s important to use rating scales and continuing to take feedback in order to improve.

References

Chow, D.L., Miller, S.D., Seidel, J.A., Kane, R.T., Thornton, J.A. & Andrews, W.P. (2015)  The role of deliberate practice in the development of highly effective psychotherapists. Psychotherapy. 52(3):337-45. doi: 10.1037/pst0000015

Ericsson, K.A., Krampe, R.T., & Tesch-Romer, C. (1993) The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychological Review. 100(3). 363-406.
Cite this article as: MacDonald, D.K., (2018), "Deliberate Practice in Social Work," retrieved on May 27, 2019 from http://dustinkmacdonald.com/deliberate-practice-social-work/.
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Suicide to Hope Workshop Review

Introduction

Today I had the opportunity to attend the Suicide to Hope Workshop offered by LivingWorks. This course is a complete overhaul of the suicideCare Workshop that was previously offered by LivingWorks. The seminar takes 8 hours, and includes a participant workshop (like ASIST) and also some handouts that can be used with clients. The purpose of Suicide to Hope is to provide long-term suicide prevention work after the suicide crisis is over and immediate safety is secured.

Pathway to Hope

The key to the Suicide to Hope model is the Pathway to Hope or PaTH. There are three phases (Understanding, Planning and Implementing) and six tasks. These six tasks are:

  1. Explore Stuckness
  2. Describe Issues
  3. Formulate Goals
  4. Develop Plan
  5. Monitor Work
  6. Review Process

The purpose of the workshop involves understanding how to do this, moving through each phase. In contrast to the old suicideCare workshop, Suicide To Hope is much more concrete. The goal is to identify the “stuckness” – the elements that an individual was having trouble moving through in order to reduce their suicidality going forward.

Workshop Structure

Prior to attending the workshop some pre-reading on the theoretical and empirical underpinnings of the worksheet. Once the workshop starts, registration is completed and participants are directed to a Helper Qualities worksheet. This sheet contains 20 values like “Belief in suicide recovery”, “Courage to face the pain” and “Tolerance for risk.” These qualities are looked at throughout the workshop.

Next is a review of the workshop and the five principles of hope creation. These five principles are ways in which a client can experience growth and recovery. They include:

  1. Suicide
  2. Safety First
  3. Respect
  4. Self-Growth
  5. Take Care

Essentially these principles mean that the experience of surviving suicidal thoughts or suicide attempts may represent an opportunity for growth. Ensuring a client’s safety will ensure they’re in the right frame to begin recovery and growth work. Respect for the client is key to building a strong helping relationship with them. Self-growth refers to “walking the talk”, and being able to be true to yourself. The final principle involves being careful to apply the model and not oversimplifying or forgetting client’s uniqueness.

The Three Phases are reviewed, and video illustrations are included throughout. These include some short clips demonstrating individuals who are safe but still suicidal, followed by clips of their recovery and a 25 minute single-take demo to really cement the learning.

A short roleplay experience in a triad helps individuals become more comfortable with the variety of tools that are provided (such as the questions to ask and the worksheets that are available.)

The ABCs of Safety

One of the really useful elements is a sheet titled “The ABCs of Safety”, which is an excerpt from the Suicide to Hope Planning Tool provided to workshop participants. This includes some checkboxes under the headings “I am ready to start R&G work”, “I know how to keep myself safe while doing R&G work” and “I know how we will work together.” These elements ensure that clients entering into recovery work have a safety plan and understand informed consent elements related to the treatment or service provision they will be receiving.

Conclusion

I found the Suicide to Hope workshop a vast improvement over the old version. The materials would be extremely useful for case managers, counsellors, psychologists, social workers, therapists and other professionals that are providing support to individuals struggling with suicide.

To learn more about Suicide to Hope you can read about it on LivingWorks’ website or find available training opportunities here.

Cite this article as: MacDonald, D.K., (2017), "Suicide to Hope Workshop Review," retrieved on May 27, 2019 from http://dustinkmacdonald.com/suicide-hope-workshop-review/.
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Ultimate Guide to Starting a Crisis Line

Introduction

Following up on my previous post Starting a Crisis Line or Hotline, I had some reader commentary asking about some more specific nuts and bolts for someone who is passionate and interested in starting a crisis line, hotline or helpline but doesn’t really know where to begin. Obviously, while it is best to bring in experienced individuals sometimes they simply aren’t available. For the purpose of this guide, I will describe the steps to create a fictional crisis line, the Southeast Iowa Crisis Center (SEICC), or “Seek.”

Throughout this article, I use “crisis line”, “helpline” and other terms interchangeably, except in the section “Deciding on Type of Service Provided” where I distinguish between the two.

Staffing a Steering Committee

The first step will be to decide on and form a Steering Committee. This will be a group of individuals who will be responsible for helping to bring your vision of a crisis line to life. Too few people and you may feel overwhelmed. Too many and you risk decision paralysis – not being able to make decisions because of too many disagreements. Perhaps 4-6 people is the optimal size for a Steering Committee.

If (or when) you form a nonprofit, you’ll need a Board of Directors. The members of your Steering Committee often make a suitable Board. Their tasks will include all of the items discussed below.

Choosing a Population and Coverage Area

You likely know this information before you begin, but it’s important to clearly define your population and coverage (or catchment) area as you work on your crisis line. You might choose to create your crisis line based on a specific age range (such as the Kids Help Phone for those 0-25), subject area (like the Rape, Abuse and Incest National Network [RAINN]), geographic region (like Tennessee Statewide Mental Health Crisis Line) or job status such as the Veterans Crisis Line.

Some funders will only fund certain populations or programs but it’s important that you not get into the business of chasing funding by going against your mission – this could lead to you losing your nonprofit status or losing trust among your supporters.

Identifying Mission and Vision

The next step to starting a nonprofit or a new product is to define what you wish to create. An organization’s mission statement is short and punchy, describing what they do. This can be a tagline or slogan, but doesn’t have to be. Distress Centre Durham‘s mission statement is “Helping people in distress to cope.”

Vision is more long-term and describes an outcome. An example vision statement for Habitat for Humanity is “A world where everyone has a decent place to live.” You don’t necessarily have to publicize your visioning statement but your mission and vision will determine whether activities that you pursue are within your organization’s purview.

SEICC’s mission will be “Keeping Iowans safe with 24/7 emotional support”, while the vision will be “Nobody suffers alone.”

Parkinson’s Law of Triviality

There is a concept in management called Parkinson’s Law of Triviality. Essentially it states that organizations spend disproportionate amounts of time on easy-to-grasp issues while neglecting more important but more difficult ones. This is an important trap to avoid when considering things like your organization’s logo, or other elements that are pretty minor in the grand scheme of things.

Picking a Staffing Model

At this stage, you have identified a group of individuals that are going to help you build your crisis line. You’ve also decided on a mission and a vision. You need to decide whether you will use a model of volunteers supported by paid staff, a blended model, or all paid staff. There are pros and cons to each approach.

Volunteers, Staff Supported

Advantages of the volunteers-supported-by-staff model include it is easy to start and individuals can self-select as one or the other (either applying for a staff position in administration or a volunteer position providing direct service.) One downside to this model is that initially your administrative staff will probably have to cover shifts on the helpline until you all get experienced, and that it can be hard to ensure 100% coverage if your service gets popular.

Blended Model

A blended model involves a mix of paid staff and volunteers. This is a more common model in the United States than in Canada, which tends to use purely volunteers. The advantages are that you can attract a more credentialed staff who might hold multiple roles (e.g. a helpline manager might be responsible for 20 hours of helpline work and 20 hours of administration.)

The downsides are that this can make your volunteers uncomfortable, and increase the expenses you need to get your crisis line off the ground.

All Paid Staff

Using all paid staff is an emerging crisis line model. Some helplines like the Veteran’s Crisis Line have used this model for many years. With this model, you can ensure 100% coverage (because your staff are paid to be in the chair), but this will be very expensive. Although research shows that paying crisis line workers does not diminish their importance, it may make it harder for your callers to trust that they’re really interested in listening.

This can also increase the rate of burnout because paid workers are providing many more hours of support each week or month versus a volunteer.

Deciding on Type of Support Provided

It’s important to decide if you’re going to be a distress line, a crisis line, or both. Some organizations will break their services into two distinct phone numbers and lines, with specific caller concerns, while many others (like Distress Centre Durham) will provide all forms of support.

Despite the use of the name “distress line” or “crisis line”, an organization may take all types of calls. You’ll need to read the explanation of the service provided before making a decision about whether or not an agency really does limit or parcel out their support.

Distress Line

A distress line focuses on individuals who are struggling and need to talk to someone but who can still cope. Someone in distress can still think about potential solutions to their problem, is not struggling with high-risk suicide thoughts, and does not need safety planning.

Crisis Line

A crisis line provides support to individuals who are struggling with high-risk suicide, crisis situations (where they can’t think of what to do), or who are otherwise unsafe. Many crisis lines have access to mobile crisis units, may call ambulances to take callers to hospitals or otherwise access more intensive support.

Hours of Operation

Deciding on the hours of operations for a crisis line is an important element. Many crisis lines started as 4-hours a day, 7 days a week operations before moving to 12 or 24 hours. Other organizations started immediately with 24 hours.

Staffing Volume

You’ll need to calculate the amount of staff you need for your crisis line (whether paid or unpaid) once you’ve decided on your hours of operation. One way to do this is the Erlang C formulas that are used to staff call centres (which you can fill with dummy data based on crisis lines in other regions.)

If you’re paying your staff, this will be easier. It might be easier to start small and then build up as your service gets more well known and well supported.

Choosing a Location

Choosing a location for a new crisis line (or any nonprofit really) will depend most commonly on your finances. Many organizations get cheap or free space in an organization like a church starting off, before moving to an office. If you’re really tight on space you might even be able to set up in a large office in someone’s home.

The keys to choosing a location will include availability, security, convenience, and price. While price is obvious, I’ll speak about the others.

One advantage of a stand-alone building is you have 24/7 access to it. If you’re in another type of location you may find it difficult or impossible to access after-hours, which can complicate things. Security is also a factor, in that if you’re not advertising your crisis line location it shouldn’t be obvious where you’re located. While a far-away location might seem to be ideal for security, it complicates accessibility (distance travelled) for your volunteers and limits convenience.

Forming a Nonprofit (or not)

Choosing whether to incorporate is a challenging decision to make. Incorporation provides you with benefits like protection of your assets, tax exempt status (once you’re registered as a charity) and the ability to pursue formal funding. The downsides are that it takes work to form and maintain the nonprofit status.

Finding Sources of Funding

Initial sources of funding may come from your Steering Committee but eventually you’ll need to explore outside sources. When your crisis line has operated for 1-2 years you’ll likely be eligible to apply for formal funding grants such as those at the local, state and federal levels.

Other sources include corporate sponsorship, fundraising events and direct donations.

Developing Policies and Procedures

Policies and procedures are important for ensuring that your volunteers respond in a consistent way. Examples of policies and procedures that you may wish to develop:

  • Call Trace and Intervention
  • Callers as Volunteers
  • Confidentiality
  • Recruitment (Criminal Record Check)
  • Victims of Abuse (Reporting Child Abuse)

Call Trace and Intervention

A Call Trace and Intervention policy will describe under what circumstances you will initiate call trace (to try and find an individual’s address or other identifying information) and under what circumstances you will call police/911 for Active Rescue. Some crisis lines will never initiate Active Rescue, for instance the UK Samaritans, unless the caller requests it. Many crisis lines will always err on the side of caution.

Call Trace will depend on the technology available to your crisis line but may include use of 411 (for non-blocked numbers) or contacting 911 directly to pass available information to them.

Helplines will often describe their intervention policy on the lines as something to the effect of, “We only intervene in cases of imminent homicide, suicide, or disclose of child abuse.”

Callers as Volunteers

Callers to your helpline will usually result in the creation of a call report or other record of that conversation. If you recruit volunteers from the same area that you take calls from, it’s possible that someone who has previously called your line may become a volunteer – and therefore be able to read their call report.

For that reason, you may require that volunteers to your helpline must have not used your service in the amount of time that records are retained. For instance, at Distress Centre Durham call reports are retained for one year so volunteers must not have used the service in that time in order to be eligible.

Confidentiality

Confidentiality is at the core of emotional support. Creating a safe environment is key to helping callers discuss their issues openly. Confidentiality means that volunteers who disclose information about callers outside of the crisis line or make contact with them outside of the line can be dismissed.

Examples of violations of confidentiality:

  • Talking about callers to your friends or family
  • Posting information about callers on social media
  • Giving information from the crisis line to another agency without that caller’s permission

It’s important to establish a very high degree of confidentiality or else callers will quickly lose trust in the helpline.

Data Destruction

A data destruction policy includes information on when and how you’ll destroy data that you’ve collected, such as via call reports or caller profiles. The most important element is to include a timeline for how frequently you’ll destroy data – such as on a quarterly basis for data that is more than 12 months old.

Recruitment (Criminal Record Check)

A Criminal Record Check (CRC), known by other names like a Police Record Check (PRC) or a Disclosure and Barring Service (DBS) Check describes a person’s record of criminal offenses. Many jursidictions include an option specifically for crimes against vulnerable individuals like children or seniors.

Many crisis lines will limit their volunteers only to those who have no criminal record, while some will allow – with approval – individuals who have certain types of non-violent offenses from many years ago.

Victims of Abuse

Nonprofit organizations are often legally required to report abuse, like child abuse or elder abuse. A policy explaining this will help callers better understand when they disclose child abuse, what the volunteer will do. In many crisis lines this means calling Child Protective Services (CPS) or a similar agency (like Children’s Aid Society in Ontario.)

You may also wish to include a statement about how your helpline takes a non-judgemental stance on abuse – not encouraging individuals to leave unless they’re ready to leave on their own.

Volunteers in Counselling or Therapy

Helpline work can be demanding and burnout can be a challenge. For this reason, it’s important to know when your volunteers are undergoing counselling or therapy. One way in which to do this is to have volunteers self-identify if they are receiving counselling or therapy and then giving them a letter to give to their therapist. That clinician will simply sign asserting that the work will not be harmful, and that can be filed away.

Volunteer Recruitment

Recruiting volunteers will depend on your local community. In some communities, United Way may operate a volunteer board online that you can submit your crisis line to. Universities or colleges may allow you to post flyers or distribute information to the students.

A good training class will be between 5 and 20 individuals, but recruiting throughout the year will be important for ensuring consistent service delivery.

Volunteer Screening

Screening involves determining if individuals possess the appropriate attitudes to be successful in helpline training. The American Association of Suicidology Crisis Center Certification identifies these attitudinal outcomes that individuals should experience by the conclusion of training:

  • Acceptance of persons different from oneself, and a non-judgmental response toward sensitive issues (e.g. not discussing suicidal ideation or abortion with a client in terms of its moral rightness or wrongness)
  • Balanced and realistic attitude toward self in the helper role (e.g. not expecting to “save” all potential suicides by one’s own single effort, or to solve all the problems of the distressed person)
  • A realistic and humane approach to death, dying, self-destructive behavior and other human issues
  • Coming to terms with one’s own feelings about death and dying insofar as these feelings might deter one from helping others.

Volunteer screening may include an application form that asks questions about the caller like:

  • Are there situations or topics (such as abuse or abortion) that may place you in a moral or ethical dillema?
  • What are your beliefs on suicide?
  • How do you feel you would talk to someone who is different from yourself?

The screening process does not have to rule out anyone yet, but may be helpful for prepping you on the interview.

Volunteer Interviewing

See also: Interviewing on a Suicide Hotline

The process of the volunteer interview will be to collect more information on the potential volunteer to make sure there is compatibility with your service. For instance, some individuals may only want to work with children or may not want to work with suicide – and your desires for your line may not align with that.

The interview is also an opportunity to see how someone is on the phone, and to help answer more of their questions about what the process looks like.

Volunteer Training

See also: Crisis Hotline Training Curriculum

Volunteer training is the process of teaching a volunteer the core skills that they need to be prepared for the helpline. Rather than reproducing material I’ve written about elsewhere, see the link above. From there you can find posts across my blog that will be useful for building a training program.

Training should run approximately 40 hours, with at least 24 hours of classroom training and 16 hours of supervised “on the phone” training being mentored by a shift supervisor or experienced volunteer before the newly trained volunteer is able to take shifts on their own.

You may find it helpful to bring on a therapist or counsellor to help you develop your initial helpline curriculum, or use a crisis line trainer from an area near you that doesn’t overlap with your catchment area.

Identifying Caller Issues

Caller Issues are the specific issues prevalent in your community that may lead you to develop training modules on them to prepare your volunteers. One example is in college towns where concerns over sexual assault or alcohol and drug abuse may be more prevalent.

The easiest way to do this is with effective helpline management software (see the next section.) With a detailed call report you will be able to pull statistics on exactly what your callers are discussing and this will help you fine-tune your training. Generally, the core elements of emotional support and crisis intervention will be exactly the same.

Helpline Management Software

In order to run a helpline you’ll need some form of helpline management software. I recommend iCarol, which my crisis line has used for several years. iCarol provides all the features you’d expect online helpline software to provide:

  • Shift Calendar so volunteers can sign up for shifts
  • Call Reports so volunteers can record details about their conversations
  • Chatboard for facilitating communication between staff and volunteers
  • Events Calendar
  • News

And a variety of other features, all designed with confidential helplines in mind.

Outcomes Measurement and Evaluation

See also: Methods of Evaluating Helplines and Hotlines

Outcomes Measurement and Evaluation describes the things that you will need to do in order to prove that your helpline is effective. One way in which to do this starts with your Basic Training program. Have your volunteers complete a pre and post training survey that includes questions about the perceived value of the training, their ability to display empathy and their understanding of crisis and suicide risk assessment. You’ll see their scores increase, demonstrating the knowledge transfer.

Another way to evaluate a Basic Training program is with a tool like the Suicide Intervention Response Inventory, which has volunteers rate how effective a series of statements are in providing emotional support. Their scores will change throughout training, indicating their increased skill.

On the phone calls themselves, your call reports can include space for Outcomes Measurement. This can include things like, “Callers says they feel better”, “Decreased distress and anxiety”, “Reduced isolation and loneliness.” These outcomes can be used to show what changes your callers experience throughout the call.

Joining Professional Associations

Finally you may wish to join professional associations like the Association of Crisis Workers or Crisis Lines in your area, or other professional groups that provide support to nonprofits. This will help you network, fundraise and attract volunteers to your organization.

Conclusion

As you can see, a lot goes into developing a crisis line – but it is not unmanageable. If you’ve decided to launch a crisis line, let me know in the comments! And please continue to ask questions if you’d like.

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Counselling and Therapy Credentials

Introduction

I’m about a year (8 courses in fact) away from wrapping up my Bachelor of Professional Arts in Human Services from Athabasca University. This has led me to explore potential graduate schools on my path to becoming a therapist in the future. One thing I’ve discovered is that there’s a lot of confusion around different credentials and what they entitle one to do.

This post is focused on Social Work, Psychology, and Counselling, with an added bonus of identifying distance learning schools where individuals may take these programs.

College Diplomas

College diplomas include 2-year Associates degrees in the United States and Colleges of Applied Arts and Technology CAAT) diplomas in Canada. Examples include:

  • Associates in Human Services
  • Associates in Social Work
  • Social Service Worker, an online version is available through Durham College
  • Community Service Worker

These are entry-level credentials to give you the basic skills to work in the social services. Some of these credentials, such as the Social Service Worker diploma, allow you registration into a professional college (e.g. the Ontario College of Social Workers and Social Service Workers) but most do not.

These programs provide training and experience in assessment (such as suicide risk assessment) and provide training in basic counselling skills but do not prepare students to diagnose or provide therapy.

Job titles for college diploma holders may be:

  • Intake Worker
  • Case Manager
  • Program Manager
  • Shelter Worker

Bachelor’s Degrees

Bachelor’s degrees are the 4-year degree most common in the US and Canada. A 4-year degree may be in Human Services, Psychology, or another discipline. If you earn a Bachelor of Social Work (BSW) you are usually eligible for registration with the appropriate Board of Social Work or College of Social Work. On the other hand, a credential in Psychology or Human Services will not entitle one to registration.

Job titles for Bachelor’s degree holders will be similar to college diploma holders, with the added component that Bachelor of Social Work holders are entitled to the protected job title “Social Worker.” Bachelor’s holders with training may perform assessments and other tasks.

Online programs include Athabasca University’s Bachelor of Professional Arts in Human Services, or Liberty University’s Bachelor of Science in Social Work program.

Bachelor of Professional Arts in Human Services

This is the program I’m completing at the moment. Because I completed a Social Service Worker (SSW) diploma from Durham College (see above), I received 2 years/20 courses of transfer credit towards the 4 year degree, requiring 20 courses to finish.

These courses can be completed online, with no specific semester start and end dates. Instead, if you pay your courses yourself you have 6 months in which to complete them; if you are receiving financial aid (such as through the Ontario Student Assistance Program) you have 13 weeks in which to complete each course.

The fee (approximately $600 CAD for a student in Alberta, $800 CAD for a student elsewhere in Canada and $1000 CAD for a student outside Canada) includes all the course materials including textbooks shipped to you to complete the course. This makes it a very economical option for a Bachelor’s degree.

Examples of courses in the BPA Human Services that are required:

  • Social Work and Human Services
  • Ideology and Policy Evolution
  • Critical Reflection for Practice
  • Professional Ethics
  • Practice and Policy in the Human Services

Master’s Degrees

Here’s where it starts to get complicated. There are a number of Master’s degrees that one may use to enter the counselling or therapy professions. These include a Master of Arts in Counselling Psychology, Master of Counselling, Master of Education in Counselling Psychology, Master of Education in School Psychology, Master of Social Work.

Master of Arts (MA) in Counselling Psychology

The MA in Counselling Psychology may be a practice degree, allowing one to register as a Licensed Mental Health Counsellor (LMHC) or it may be a step on to a PhD or PsyD in Clinical Psychology. Individuals may qualify for registration as Psychological Associates or in Alberta as Psychologists.

Examples of online programs includes Yorkville University‘s program, which is based out of New Brunswick.

Master of Counselling (MC)

The Master of Counselling degree is offered by Athabasca and provides similar training as other counselling degrees such as degrees in Counselling Psychology or other. Athabasca offers specializations in Art Therapy, Counselling Psychology and School Counselling.

Examples of courses taken in the MC degree include:

  • Models of Counselling and Client Change
  • Intervening to Faciliate Client Change
  • Devleoping a Working Alliance
  • Professional Ethics
  • Assessment Processes

This program qualifies for registration with the Alberta College of Psychologists.

Master of Education (MEd) in Counselling Psychology

The Master of Education (MEd) degree in Counselling Psychology is offered through a school’s Faculty of Education rather than a Faculty of Social Work or Faculty of Psychology. One example is University of Toronto’s MEd. This program is designed as a terminal degree to train counsellors and therapists. Courses in this program include:

  • Theories and Techniques of Counselling
  • Critical Multicultural Practice: Diversity Issues in Counselling
  • Group Work in Counselling
  • Ethical Issues in Professional Practice in Psychology
  • Career Counselling and Development: Transitions in Adulthood

Because these programs are in the Faculty of Education they are more likely to cover school counselling and be designed to train counsellors or therapists that work with students and young adults. One example of an online program is the University of Massachusetts–Boston’s MEd in School Counselling.

Master of Social Work (MSW)

The Master of Social Work is the terminal degree for Social Work practice in Canada and the United States. These programs are either one year (for individuals who have already completed a BSW) or two year (for individuals who have not completed a BSW.) These programs qualify for registration with organizations like the Ontario College of Social Workers and Social Service Workers (OCSWSSW) in Canada or a State’s Board of Social Work in the US.

MSW degrees can be focused on macro (community) social work, or micro (individual) social work. Macro social workers are employed in community development, program design, administration and other areas while micro, individual or clinical social workers are employed as counsellors, therapists and other clinical mental health professionals.

An example 2-year online MSW program is that available from the University of North Dakota. Courses in that program include:

  • Human Behavior in the Social Environment I
  • Generalist Practice with Individuals and Families
  • Generalist Practice with Communities and Organizations
  • Social Policy
  • Generalist Research Methods and Analysis

Doctorate Degrees

Doctoral degrees prepare individuals for advanced clinical practice in the fields of Psychology and Social Work. Doctorares usually involve a component of research and practice. Some degrees not listed here (such as the PhD in Social Work) have no practice component and are designed chiefly to train researchers.

Doctorate of Philosophy (PhD) in Clinical / Counselling Psychology

The PhD in Clinical Psychology or PhD in Counselling Psychology are designed to train professional Psychologists. These programs are usually 5-7 years in duration and involve the completion of a PhD dissertation, a book-length research project. In addition to learning these fundamental research skills, Psychologists also learn how to administer and interpret psychological assessments like IQ tests and how to deliver therapy.

These programs are among the most competitive to get into, often admitting 5-10 candidates among the 100+ that apply for admission.

The differences between Clinical Psychology and Counselling Psychology are minor, but Clinical Psychology tends to focus on individuals with more psychopathology than Counselling Psychology.

Examples of courses in the PhD in Clinical Psychology at Ryerson University:

  • Ethical Professional Issues in Clinical Psychology
  • Systems of Psychotherapy
  • Cognitive Neuroscience
  • Community Psychology
  • Mood Disorders

Doctorate of Psychology (PsyD)

The PsyD is a newer program than the PhD, emerging to meet needs of individuals who primarily want to practice therapy and assessment rather than work as scientists or researchers. PsyD programs are offered by a larger variety of educational venues, such as by professional schools of Psychology (like the Chicago School of Professional Psychology) rather than a university.

The PsyD involves learning to utilize research rather than produce it. Because students in a PhD program are creating researcher, they are “paid” to do so, by having their tuition subsidized (often free), and by being given a living stipend, while PsyD students more commonly have to “pay their way” through their program, upwards of $100,000.

Otherwise, PsyD and PhD graduates learn the same skills and are eligible for licensure in the same way – as long as their programs are accredited by the American Psychological Association (APA). Although there are online PsyD programs such as those offered by Walden University and Capella University these are not eligible for APA accreditation and therefore are unlikely to result in licensure.

Examples of courses available in the Chicago School of Professional Psychology’s PsyD program:

  • Biological Bases of Behavior
  • Health and Dysfunction
  • Cognitive Assessment
  • Cognitive Behavioral Theory and Therapy
  • Personality Assessment

Doctorate of Social Work (DSW)

The Doctorate of Social Work is the newest doctorate program. This program is similar to the PsyD in that it is a practice degree rather than a research degree. One example of a DSW is that offered by Tulane University in Louisiana. This program is available online but has significant tuition attached to it, up to $70,000.

Reflecting the existing education of their students (all of whom have an MSW or similar degree accredited by the CSWE) these programs are shorter than a PhD would be, often running 3 years versus the 5-7 years for a PhD or the 5 years for a PsyD.

Examples of courses in the Tulane DSW:

  • Historical Approaches to Social Welfare
  • Social Work Theory, Practice Models & Methods
  • Applied Social Statistics
  • Measuring Social Phenomena: Social and Economic Problems
  • Advanced Clinical Project Seminar

The goal of the DSW program is to train practitioners who are experts in policy analysis, program design and development or implementation of specific therapies.

Cite this article as: MacDonald, D.K., (2017), "Counselling and Therapy Credentials," retrieved on May 27, 2019 from http://dustinkmacdonald.com/counselling-therapy-credentials/.
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