Crisis Intervention
Topic #2: Crisis Intervention & Workplace Violence Prevention
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There are three types of crisis interventions that I will perform at Lxxxx Bxxxxx
Sxxxx (LBS). My site supervisor, Michelle, talked me through what I will do in each of the
types and explained what my sites specific protocols are as well as what my responsibilities
will be in each of the types. The three types of crisis interventions are for suicidality,
homicidality and suspected or self-reported child abuse.
When a client reports suicidal ideation, wanting to kill themselves, I will listen
empathetically and use reflective listening. The first thing I will say is something like,
“Thank you for feeling comfortable enough with me to tell me.” or “That sounds like a lot to
be going through.” Then I will begin a suicide assessment right there in session. LBS’s
protocol is to complete a suicide assessment which is a form with a set of specific
questions, I have included it as page 5 of this paper. If the suicide assessment yields high
risk I will say, “This is quite significant for us to handle alone, I’m going to call Michelle to
help us both figure out a way to help you.” I am to immediately telephone my site
supervisor, if she is not available I am to telephone the front desk and inform them to have
my site supervisor come to my room. I am not to leave the client alone. My site supervisor
or another counselor will come to my office.
When my site supervisor arrives, I will transition the client to Michelle. I will stay in
the room and Michelle will take over. From my assessment and Michelle’s assessing the
client, she will determine whether to Baker Act and the route of the Baker Act or to safety
plan with the client. She said that she or another counselor would take the client to a
receiving facility or call 911, or call the mobile crisis unit. Afterwards I will write my case
note documenting the client’s responses to each of the assessment questions. Michelle
would also write a case note.
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If the suicide assessment yields low risk I will use some of the above reflective
statements or “Sounds like you’ve got a lot of thoughts and feelings about this.” In that
session, I will work with the client to maintain existing coping strategies and develop
additional ones and to reinforce any future events the client is looking forward. I will
reinforce the client’s ability to recognize warning signs of increased risk. I will reinforce
the client’s support network. I asked Michelle about using a no-suicide contract, she said
there is no evidence that they work and there is evidence that they do not work. I was
encouraged to call Michelle into session any time. If I do not call Michelle into session for a
client with low risk, I am to inform Michelle immediately after the session. If at any time
during the session it moves to a high risk, I am to follow the above high risk protocol. My
case note will include the client’s responses to each of the assessment questions. In either
high or low risk, a call will be made by me to the client the next day per LBS protocol.
When a client reports homicidal ideation, wanting to kill someone, I will listen
empathetically and use reflective listening. The first thing I will say is, “That’s a lot of anger
you have towards that person.” or “Those are strong powerful emotions.” LBS does not
have a specific homicidal assessment. Michelle said it would be similar to the suicide
assessment just replacing killing yourself with killing insert name of the target. I would
have to adapt the suicide assessment on the spot with the client. I will be adapting it within
two weeks then Michelle wants to review it with me.
If my homicidal assessment yields high risk the protocol is similar to the above with
bringing Michelle into the session. I will stay and Michelle will take over. From my
assessment and Michelle’s assessing the client, she will determine whether to Baker Act
and the route of the Baker Act. She said that she or another counselor would take the client
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to a receiving facility or call 911, or call the mobile crisis unit. She and I would determine
whether and how to warn the intended victim. Afterwards I will write my case note to
include documenting the facts of the session and the client’s responses to each of the
assessment questions I asked. Michelle would also write a case note.
If the homicidal assessment yields low risk I will work with the client to maintain
coping strategies and explore their feelings being evoked by the person they have
expressed wanting to kill. For example, “This person has a strong impact on your feelings.”
I will reinforce the client’s ability to recognize the difference between thinking and acting
on their thoughts, “From what I’m hearing you say, you have strong thoughts but know you
won’t do it.”. If I do not call Michelle into session for a client with low risk, I am to inform
Michelle immediately after the session. My case note will include the client’s responses to
my assessment questions. In either high or low risk, a call will be made to the client the
next day per LBS protocol.
If child abuse is suspected by me, I must be able to state facts of why I suspect it
when I call the abuse hotline. I will go to Michelle to review why I suspect child abuse then
I will call the abuse hotline with Michelle. I will eventually be providing counseling with
less immediate supervision towards the end of my practicum and internship experience.
Michelle said she expects me to call her or another counselor into a session if I my
assessment indicates any harm to the client or others. By the end of my practicum and
internship experience, she said I will be more independent. That is something I cannot
envision yet, but when it happens I will feel accomplished.
When a child client reports abuse in session, I am to make sure I have as much of the
information as possible to call the abuse hotline. The basic information includes who was
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involved, what occurred, when and where it occurred, the extent of any injuries sustained,
and what the client said happened, and any other pertinent information. I will probably
use a similar statement as above with the client or “I’m glad you told me, it must have been
difficult.” or “You have some big feelings right now. I’m going to get us some help because
this is bigger than both of us.” At which time I’ll call for Michelle or another counselor to
join us, never leaving the client alone. Outside of child’s hearing us, Michelle will review
what I have been told by the client and I will make the abuse hotline call with Michelle.
After I will write a case note documenting the session and Michelle will also write a case
note.
I administered the suicide assessment to another staff member before Michelle and I
met to talk about it. Michelle gave me a copy of Chapter 39 of the Florida Statutes as well as
two articles about child abuse to read before we met to talk about what to do. I asked how
clients would react to her or another counselor coming into a session. She said the clients
will know I am an intern and I will be a co-counselor for the first few sessions. Therefor the
clients will know her or other counselors.
My concern that a client may become upset or frustrated or shut down if asked
direct questions was lessened as Michelle reinforced that I will still be using basic
counseling skills empathy, reflective listening and open body language not just a line of
direct questioning. Administering the suicide assessment to another staff member, helped
practice wording, empathy statements, reflective listening and body language. She also
reminded me that the limits to confidentiality are part of the client intake paperwork. I am
a more prepared now that I know if it were to happen, I understand the protocols and
Michelle’s expectations.