PREPaRE Model for School Crisis Intervention

Introduction

When we normally think of crisis intervention, we think of adults responding to events in their personal life. Of course, people young and old can require crisis intervention, and not just from events in their personal life. School violence, natural disasters and other elements can require crisis intervention.

Werner (2015) noted that the tow most important activities school counsellors can do to prepare for crisis events are to develop a comprehensive crisis plan and to practice it regularly. The goal of the PREPaRE Curriculum is to train mental health worker, school psychologists and other administrators, educators and clinicians to develop such a crisis plan, to build a crisis team to execute that plan and to understand the tasks of crisis intervention in the aftermath of a crisis.

School Crisis Intervention

Most school counsellors receive little or no crisis intervention training and therefore enter the field feeling unprepared to handle tasks that become assigned to them in the aftermath of a crisis. (Allen, et. al., 2002) Training like the PREPaRE Model and other programs can help bridge this gap.

Knox & Roberts (2005) performed a comprehensive literature review on school crisis intervention and specifically crisis intervention teams. They found that there was a need for well-thought out crisis intervention programs and plans before crises occur, and that there were similarities in the literature about how experts believed response to a crisis should be structured.

They recommended school crisis intervention be split into three phases:

Primary Interventions

Primary prevention activities are those that are provided to all students in order to promote safety and health. These could be “conflict resolution, gun safety and safe driving courses, alcohol and drug awareness programs, teenage parenting resources, and suicide prevention programs.” (Knox & Roberts, 2005; p.94)

Secondary Interventions

Secondary prevention activities focus on individuals in the aftermath of a crisis in order to limit its impact. This can include physical measures like moving students, debriefing and immediate crisis intervention in the aftermath, and notifying parents and the media.

Tertiary Interventions

Tertiary interventions include long-term counselling and psychotherapy that extends after the crisis period ends and the school environment returns to normal.

PREPaRE Framework

  • Prevent and Prepare for psychological trauma
  • Reaffirm physical health, perceptions of security and safety
  • Evaluate psychological trauma risk
  • Provide interventions and Respond to psychological needs
  • Examine the effectiveness of crisis prevention and intervention

The PREPare Model is structured around two workshops. The first (1-day) workshop is provided for all school staff to teach them how the crisis team and crisis intervention works, while the second (2-day) workshop is designed specifically for crisis team members.

PREPaRE Curriculum

The following information comes from Nickerson et. al. (2014):

Crisis Prevention and Preparedness (1-day workshop for all staff)

  • Identify four characteristics of a crisis event.
  • Identify the key concepts associated with the PREPaRE acronym.
  • Describe the four activities of the school crisis team.
  • Understand the importance of hierarchical crisis team structure and response.
  • Identify the five major functions of the Incident Command System (ICS).
  • Identify strategies for communicating with school boards creating or sustaining teams.
  • Identify three concepts related to crime prevention through environmental design.
  • Identify guiding principles in crisis plan development.
  • Identify essential components of crisis plans.
  • Identify key concepts from the workshop that their crisis team needs to learn or address to be adequately prepared for crisis situations

Crisis Intervention and Recovery (2-day workshop for crisis intervention staff)

  • Report improved attitudes toward, and readiness to provide, school crisis intervention.
  • Identify the variables that determine the traumatizing potential of a crisis event.
  • Identify the range of school crisis interventions indicated by the PREPaRE acronym.
  • Indicate how school crisis interventions fit into the larger school crisis response.
  • Specify the critical factors in evaluating psychological trauma risk after a crisis event.
  • Match psychological trauma risk to a range of appropriate school crisis interventions.

Elements of a Crisis Team

A crisis team should be in place before a crisis occurs so that they can immediately get to work after a crisis occurs. Knox & Roberts (2005) recommend that the team be comprised of 4-8 multidisciplinary members (e.g. Principal, counsellor, nurse, etc.)

Responding to a Crisis

Brock (2006) indicates a variety of responses for each level of the framework that are available to the mental health professional facilitating a crisis intervention. These items assume that a crisis has already occurred.

Reaffirm physical health, perceptions of security and safety

  • Meet physical needs like shelter and water
  • Provide a sense of safety by removing individuals from the site of a crisis
  • Remove or restrict access to dangerous objects or crisis site (remove sharps, put up barriers, etc.)

Evaluate psychological trauma risk

  • Evaluate exposure to crisis and note reactions (physical, behavioural, cognitive)
  • Examine internal and external resources (within the school and local community agencies)
  • Refer clients to psychotherapy where possible

Provide interventions and Respond to psychological needs

  • Re-establish social support systems. This can involve
  • Provide psycho-education: Empower survivors and their caregivers
  • Provide immediate crisis intervention
  • Provide/Refer for longer term crisis intervention

Evaluation of the PREPaRE Curriculum

Brock et. al. (2011) performed the initial evaluation of the program and found that participants significantly improved on their skills related to crisis prevention, crisis intervention and displayed high general satisfaction with the workshops. When Nickerson et. al. (2014) evaluated the PREPaRE after making changes they found that these benefits continued to be demonstrated in follow-ups, proving the efficacy of the program.

Training in the PREPaRE Model

Brock (2006) publishes the content of the PREPaRE workshop online, where they can be accessed in order to help individuals build their crisis intervention skills. Additionally, workshops can be accessed through the National Association for School Psychologists (NASP).

References

Allen, M., Burt, K., Bryan, E., Carter, D., Orsi, R, & Durkan, L.(2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6, 96-102

Brock, S.E. (2006) “Crisis Intervention Training”, Workshop PDF. Accessed on November 19, 2016 from www.csus.edu/indiv/b/brocks/workshops/district/smfcsd.12.06.pdf

Brock, S. E., Nickerson, A. B., Reeves, M. A., Savage, T. A., & Woitaszewski, S. A. (2011). Development, Evaluation, and Future Directions of the PREPaRE School Crisis Prevention and Intervention Training Curriculum. Journal Of School Violence10(1), 34-52. doi:10.1080/15388220.2010.519268

Knox, K., & Roberts, A. (2005). Crisis intervention and crisis team models in schools. Children & Schools27(2), 93-100.

Nickerson, A. B., Serwacki, M. L., Brock, S. E., Savage, T. A., Woitaszewski, S. A., & Louvar Reeves, M. A. (2014). PROGRAM EVALUATION OF THE PREPaRE SCHOOL CRISIS PREVENTION AND INTERVENTION TRAINING CURRICULUM. Psychology In The Schools51(5), 466-479. doi:10.1002/pits.21757

Cite this article as: MacDonald, D.K., (2016), "PREPaRE Model for School Crisis Intervention," retrieved on September 26, 2018 from http://dustinkmacdonald.com/prepare-model-school-crisis-intervention/.
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Spousal Assault Risk Assessment (SARA)

Introduction to Spousal Assault Risk Assessment

The Spousal Assault Risk Assessment (SARA) by Kropp, Hart, Webster & Eaves (1995) is used to assess the risk of intimate partner violence. Their tool recognizes that intimate partner violence may occur without regard to gender (male on female, female on male, female on female, male on male, and any other combination including trans and non-binary individuals), marital status (married and commonlaw individuals may engage in intimate partner violence), and does not necessarily require physical injury.

What follows is a brief summary of how to administer and score the SARA. More comprehensive information can be found in the manual itself. The SARA may be administered by minimally trained individuals up to Forensic Psychologists and Psychiatrists.

The SARA is comprised of 20 items that to provide a framework of historic, static and dynamic risk factors that have been shown to increase risk.

Information Required Prior to Assessment

All available sources of information should be consulted before completing the SARA.  This should include:

  • Interviews with both the accused/perpetrator and the victim/survivor(s) with a goal of collecting the SARA items
  • Standard measures for substance abuse (drugs and alcohol), personality, and IQ if available; the SARA manual recommends the Michigan Alcoholism Screening Test (MAST) by Seltzer (1971) for alcohol, and the Drug Abuse Screening Test (Skinner, 1982) for drugs, and the Personality Assessment Inventory by Morey (1991) for personality
  • Police reports, court documents, criminal records, etc.
  • Interviews with relatives or children who may have been exposed to abuse
  • Interview with probation officers

Coding

All items in the SARA are scored based on a 3-point scale:

  • 0 = Absent
  • 1 = Subthreshold
  • 2 = Present

If there is not enough to code an item, it should be excluded, not coded as absent. For instance, if there is no information to confirm or deny a current substance abuse issue, this should be left blank and noted, not assumed to be absent.

Critical Items

Some items are considered critical items – if these are present then it is enough to assume that potential/actual victims are at risk. These items are coded on a 2-point scale:

  • 0 = Absent
  • 1 = Present

These items are chosen as critical items based on the evaluator’s judgement.

Summarizing Risk

The result of a risk assessment will usually address two issues:

  1. Is there risk to the partner?
  2. Is there risk to children/non-spouse/others?

This summary is coded on a 3-point scale,

  • 1 = Low
  • 2 = Moderate
  • 3 = High

Communicating Risk

Writing a risk assessment is outside the scope of this article but you may see the original guide for more detailed information or my blog post about documenting suicide risk assessments for more information.

Assessment Items and Risk Management

For more detailed rating criteria please consult the original guide. The coding has been omitted from this table in appreciation for the original author’s copyright.

Item Name Coding Risk Management Strategies
1 – Past Assault of Family Members Intensive supervision or monitoring
2 – Past Assault of Strangers or Acquaintances Intensive supervision or monitoring
3 – Past Violation of Conditional Release or Community Supervision Intensive supervision or monitoring
4 – Recent Relationship Problems Interpersonal treatment (individual or group)

Legal advice or dispute resolution

Vocational counselling

5 – Recent Employment Problems Interpersonal treatment (individual or group)

Vocational counselling

6 – Victim of and/or Witness to Family Violence as a Child or Adolescent None given in guide;Interpersonal treatment (individual or group)
7 – Recent Substance Abuse/Dependence  Court-ordered abstinence, drug testing

Alcohol/drug treatment

8 – Recent Suicidal or Homicidal Ideation/Intent Crisis counselling

Hospitalization

Psychotropic medication

Court-ordered weapons restrictions

9 – Recent Psychotic or Manic Symptoms Crisis counselling

Hospitalization

Psychotropic medication

Court-ordered weapons restrictions

10 – Personality Disorder with Anger, Impulsivity or Behavioural Instability Intensive supervision

Long-term individual therapy

Group treatment

Psycho-education

11 – Past Physical Assault None given in guide;

Intensive supervision or monitoring

12 – Past Sexual Assaut/Sexual Jealousy None given in guide;

Intensive supervision or monitoring

Long-term individual therapy

13 – Past Use of Weapons and/or Credible Threats of Death None given in guide;

Court-ordered weapons restrictions

14 – Recent Escalation in Frequency or Severity of Assault None given in guide;
15 – Past Violations of “No Contact” Orders Intensive supervision or monitoring
16 – Extreme Minimization or Denial of Spousal Assault History Intensive supervision

Long-term individual therapy

Group treatment

Psycho-education

17 – Attitudes That Condone or Support Spousal Assault Intensive supervision

Long-term individual therapy

Group treatment

Psycho-education

18 – Severe and/or Sexual Assault None given in guide; long-term individual therapy
19 – Use of Weapons and/or Credible Threats of Death None given in guide; long-term individual therapy

Court-ordered weapons restrictions

 

20 – Violation of “No Contact” order Intensive supervision or monitoring

Other Considerations

The SARA manual indicates a number of other risk factors which may be factored into the assessment at the expert judgement of the evaluator. Examples of these include:

  • Current emotional crisis
  • History of torturing or disfiguring intimate partners
  • Victim or witness of political persecution, torture, or violence
  • Sexual sadism
  • Easy access to firearms
  • Stalking
  • Recent loss of social support network

Bibliography

Kropp, PR., Hart, S.D., Webster, C.D. & Eaves, D. (1995) Manual for the Spousal Assault Risk Assessment Guide, 2nd ed., The British Columbia Institute Against Family Violence.

Morey, L.C. (1991) Personality Assessment Inventory Professional Manual. Odessa, FL: Psychological Assessment Resources, Inc.

Selzer, M. (1971) The Michigan Alcoholism Screening Test: The quest for a new diagnostic instrument. American Journal of Psychiatry, 127. 1653-1658.

Skinner, H.A. (1982) The Drug Abuse Screening Test. Addictive Behaviour. 7, 363-371.



Cite this article as: MacDonald, D.K., (2016), "Spousal Assault Risk Assessment (SARA)," retrieved on September 26, 2018 from http://dustinkmacdonald.com/spousal-assault-risk-assessment-sara-guide/.

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Starting a Crisis Line or Hotline

Introduction

Update: May 22, 2017 Please see Ultimate Guide to Starting a Crisis Line for a much more comprehensive treatment of this same topic!

Do you want to start your own suicide hotline, crisis line or helpline? This is an extremely ambitious and admirable goal and I admire you for thinking about your community! Thousands of suicide lines listen to millions of people across the globe every year, preventing thousands of suicides and making the world a better place.

While some areas have lots of crisis lines and supports in place, other communities have a complete lack of them. Especially outside of North America, crisis lines can cost money to call, or may not even exist at all.

Most crisis lines are started by volunteers like yourself, who took the task upon them for the good of their communities. Eventually most lines receive some form of funding, but in the beginning they’re often run out of churches and with volunteer labour.

A few of the things you’ll need to start your own crisis line include:

  • Office space
  • Phone Service
  • Helpline Software / Computers
  • Crisis Line Training
  • Hotline Evaluation

Office Space / Phone Service

These may seem daunting, but they’re not as complicated as they may initially seem. Office space, for instance, is often donated by churches or other community groups for fledgling non-profits. All you really need is an area for taking calls, and an area for performing administrative work. This can be in a single room to start, and could be someone’s house.

Phone service can be expensive, but using VoIP services can help reduce the cost and improve the accessibility to your volunteers. Something to keep in mind is the possibility of doing call forwarding. What this means is that if your volunteers are at home, the calls can be forward to their home or cell phone and they can answer them from there.

Helpline Software / Computers

Initially your helplines can use paper call reports to record information, later switching to a database, or if you can afford it you can subscribe to an online web-based software like iCarol that will give you much more freedom and flexibility.

It may be helpful to get in touch with local crisis lines in your area (or in larger cities) to learn about the way they code calls. This will help you to understand the basics, before you create your own call report that uniquely captures your population.

Crisis Line Training

Crisis line training is probably the most difficult element to starting a crisis line. Working with a neighbouring crisis line to undergo their training is helpful. Additionally, a lot of crisis lines have local mental health professionals work as clinical supervisors until the organization has enough institutional expertise to provide their own.

Tools that can be used to assess crisis line volunteers include the Suicide Intervention Response Inventory (SIRI) or the Crisis Center Discrimination Index (CIDI). Suicide risk assessments are also an important element of starting a crisis line because you’ll need to respond in an effective and reliable method for determining a caller’s suicide risk.

Some suicide risk assessment tools. include the CPR Model (Current Risk, Previous Exposure, Resources), the DCIB (Desire, Capability, Intent, Buffers) Model and the NGASR (Nurse’s Global Assessment of Suicide Risk.)

Helpline Evaluation

Evaluating your hotline is an important element of operating it. If you ever want to receive funding, you need to show that your line is actually beneficial.

This can be as simple as establishing standards for your volunteers (e.g. all volunteers will undertake a 40 hour training session, all volunteers will fill out detailed call reports with outcomes measures, etc.) or as complex as having a silent monitoring system to allow supervisors to listen to calls or research where callers are contacted afterwards to find out their experiences.

Cite this article as: MacDonald, D.K., (2016), "Starting a Crisis Line or Hotline," retrieved on September 26, 2018 from http://dustinkmacdonald.com/starting-crisis-line-hotline/.

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Active Listening on Crisis Lines

The core of emotional support, which is the service provided on crisis lines, is called active listening. Active listening is a special type of listening, distinct from the regular listening we do everyday.

Active listening should also be separated from the work that counsellors and therapists do, which is called professional listening. While therapists and counsellors certainly use active listening, they also use additional advanced skills not covered here (such as interpretation and challenging.)

Active listening is made up of a number of individual skills that include:

  • Demonstrating attending behaviour
  • Using empathy statements
  • Paraphrasing
  • Reflecting
  • Summarizing

These are reviewed below.

Although active listening skills may seem like common sense, it takes conscious practice to develop use of these skills to be second nature. As is often said about this topic, it’s common for people to “wait to talk” instead of truly listening. They’re not hearing the emotions under the content, they’re just waiting for a pause to jump in with their next sentence.

Attending Behaviour

Attending behaviour refers to your non-verbal behaviours used to show that you’re listening. This includes things like eye contact, where your body is pointed, your posture, and so on. The acronym SOLER is one that is used to summarize attending behaviour. It is important to keep in mind that attending behaviour is culture-specific, and this is written with Western cultures in mind.

Other cultures may have different standards for what is considered attending behaviour. For instance, eye contact is often rude and intrusive in Asian cultures, while in North America it is rude to not maintain eye contact.

SOLER is not relevant to crisis lines (because you’re working over the telephone) but is still covered here because occasional in-person clients may occur in some organizations.

SOLER

  • S – Sit Squarely
  • O – Open Posture
  • L – Learn Towards the Client
  • E – Eye Contact
  • R – Relax

Sit squarely refers to your body positioning, which is to point your body towards client so that they know you’re listening, rather than pointing your body away from the person you’re speaking to.

Open posture refers to keeping your arms and legs open. Crossed arms or legs put together are considered closed body language and are off-putting to clients. Instead, keep your legs apart (though not enough that it could appear unprofessional) and keep your arms at your sides or in your lap rather than closed.

Lean towards the client sounds like what it says – to show interest when a client is speaking, lean towards them rather than leaning back which communicates disinterest.

Eye contact, as well, is important for showing interest and building rapport in western cultures. Keep in mind that some other cultures may place different value on eye contact and so it’s important to know the culture you’re working with.

Relax – Relax! No need to be tense, your discomfort may be interpreted by your client as disliking them, so make sure to take a deep breath, be honest with your client if something bothers you, and always keep the lines of communication open.

Empathy Statements

Empathy statements are the core of emotional support. These are feeling words that allow you to communicate that you have an idea what another person is going through. Empathy is defined as “the ability to understand and share the feelings of another”, which is different from sympathy, which is “feelings of pity and sorrow for someone else’s misfortune.”

With empathy, you are highlighting feelings as if you are experiencing them yourself. Examples of empathy statements are:

  • That sounds really scary
  • You must be feeling so frustrated
  • If I were you in shoes I would be devastated

Empathy statements may initially sound un-genuine or forced, but with practice they will get second nature. You may find it helpful to look at a list of feeling words to develop your skills. For additional practice please see my article Empathy Statements in Helpline Work.

Paraphrasing

Paraphrasing is defined as “express[ing] the meaning of (the writer or speaker or something written or spoken) using different words, especially to achieve greater clarity.” In the emotional support context, paraphrasing means to restate the content that a person has said.

An example of this would be, if someone tells you that their dog died. An example of a paraphrase would be “You lost your pet.” Paraphrasing is used to ensure you’ve heard the content that a person has said while they speak to you.

Reflecting

Reflection is similar to paraphrasing but the goal is to reflect the emotion underlining the statement that a person has said. This is quite a bit different than paraphrasing. For instance, if we return to our example of someone telling you that their dog died, the paraphrase was “You lost your pet.” The reflection would be, “You’re feeling really alone right now.”

A reflection highlights an emotion, and is used frequently to check in to make sure that your empathy statements are on point.

Summarizing

Summarizing is similar to paraphrasing or reflecting but it is a longer statement used to sum up several minutes of conversation. Many counsellors use summaries to open their sessions by reviewing the previous week’s conversations, and periodically throughout their sessions.

An example of a summarize that could apply to our dog-grief conversation would be like follows: “So, from what we’ve been discussing, you lost your dog last month and it’s weighing really heavily on you. You feel alone because your house is empty and you don’t know how to cope.” This highlights some emotional items (feeling alone, weighing really heavily on them) and some content items (dog lost last month, empty house.)

Silence

Silence is an important element in active listening and is often overlooked. Silence can be used to help a person process what has just been discussed – it is not necessary, nor desirable to fill every moment of a conversation with words. Sometimes just sitting with someone and being witness to their pain is helpful.

Advanced Active Listening Training

If you’re interested in developing your active listening skills you may want to join a crisis line, or consider taking an Introduction to Counselling course at a local college or university to build your theoretical skills and practice roleplaying with others.

As well, please my article on Building Communication Skills and on Improving Your Helpline Work.



Cite this article as: MacDonald, D.K., (2016), "Active Listening on Crisis Lines," retrieved on September 26, 2018 from http://dustinkmacdonald.com/active-listening-on-crisis-lines/.

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What Makes a Good Crisis Line Volunteer

So, you want to become a crisis line, or suicide hotline volunteer. Congratulations! Not a lot of people feel like they’re able to do this work. It’s very difficult to spend hours alone in the middle of the night listening to someone talk about their depression, or about feeling suicidal, relationship issues, or all the other things that brought them to call in.

This article reviews some of the qualities required to be a good crisis line volunteer and also some of the steps that someone joining a crisis line might need to go through before they begin.

Becoming a crisis line volunteer isn’t an easy process. Most crisis lines require a minimum of 40 hours of training, passing a reference check, being able to display empathy and handle crisis situations, and learning how to perform suicide risk assessments and interventions.

Additionally, after you’ve passed the training you usually have to complete a period of on-the-phone apprenticeship which can add another 8-20 hours to the time that it takes to be fully trained. This is because the standard in which crisis line volunteers are expected to perform is very high.

There are some elements you should consider before deciding to become a hotline volunteer:

  • Can you work well under pressure?
  • Can you be empathetic to other people?
  • Can you resist the urge to fix people’s problems?
  • Are you a team player?
  • Do you have good mental health yourself?

Some of these are obvious: crisis lines can be stressful when you’ve got people in intense situations who need a calm person to listen to. If you can’t empathize with people who are in distress – and communicate that – people won’t feel like you truly understand. And having good mental health is important to ensuring you aren’t negatively affected by your work.

On the other hand, some of these items are less obvious. Often people feel like crisis lines help people by giving them advice. This is in fact not the case; providing advice to people to solve their problems promotes dependance.

Let’s say you tell someone to break up with their boyfriend because he’s treating her badly. She breaks up with him but then decides she really wants to be with him. He refuses to take her back. You’ll be blamed! This can also cause legal issues; people in professional fields have been sued for giving bad advice, and crisis lines are not immune to the impacts of their decisions.

Of course, being a team player is important. Crisis lines are often comprised of large groups of volunteers, or a mix of paid and volunteer staff. Learning to get along with a variety of diverse people is an important skill. Don’t underestimate the benefits that enjoying your coworkers and being able to make friends with them.

To review, in order to become a crisis line volunteer you’ll probably have to go through several or more of the following steps:

  • Information Night
  • Submit Application
  • Interview
  • Reference Check
  • Complete Training
  • Complete apprenticeship on the phone lines

Additionally, you will likely to complete additional in-service trainings and be supervised. If it’s something you’re interested in however, you can gain a lot of great benefits including boosting your resume, learning new skills, networking and meeting people and getting into graduate school.



Cite this article as: MacDonald, D.K., (2016), "What Makes a Good Crisis Line Volunteer," retrieved on September 26, 2018 from http://dustinkmacdonald.com/makes-good-crisis-line-volunteer/.

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