Download Crisis Intervention Refresher Course

Texas Commission on Law
Enforcement Officer Standards and
Education (TCLEOSE) Course # 3843
PARTICIPANT HANDOUT
TRAINING NOTES
To develop an advanced personal
appraisal of crisis identification
2
Formulate a working definition of a
“crisis”
___________________
____________________
CRISIS
___________+
________________
Class discussion: definition of the term “CRISIS”.
3
Personal identification with crisis
 “A temporary state of upset and
disorganization, characterized by an
inability to cope with a particular
situation using customary methods of
problem solving, and by the potential
for a radically positive or negative
outcome.” Webster
4
Personal identification with crisis
 English word derived from the
Greek “Krinein”
 Chinese term for crisis “Weiji”
5
Critical incidents are:
 Sudden, _________ _______ that
may overwhelm an individual’s
ability to respond resiliently.
 Extreme ________ _________ may
result in traumatic stressors, a
personal crisis, or even Post
Traumatic Stress Disorder (PTSD).
6
“A
crisis occurs when a stressful life
event __________ a person’s ability
to cope effectively in the face of a
perceived challenge or threat.”
(Flannery)
7
“When a person faces an ________ to
important life-long goals that is, for a
time, insurmountable through the
utilization of customary methods of
problem solving, a period of
disorganization ensues, a period of
upset, during which many abortive
attempts at solutions are made.”
(Caplan)
8
Identify behaviors that detect an
individual in crisis
Physical
Emotional
Psychological
9
How do these crisis behaviors differ
if there is a pre-existing mental
health issue?
10
 Initial
Phase-Decision or incident occurs
Initial
Phase
11
 Deliberation
Phase-Responding to Crisis
Deliberation
Phase
12
 Decisive
Phase-Feeling Assigned
Decisive
Phase
13
Survival Arc Summary
Initial Phase-Decision or incident occurs
Deliberation Phase-Responding to Crisis
Decisive Phase-Feeling Assigned
Decisive
Phase
Deliberation
Phase
Initial
Phase
14
Articulate the technique of Crisis
Intervention
Crisis Intervention techniques assist
individuals in returning to a level of
___________ that enables them to
gain some sense of behavioral
control.
15
 The sooner the better
 Intervention by first responders
tends to greatly ______/_______
many crisis symptoms
 A front-line officer has one critical
qualification that a qualified
practitioner does not…they are
there. (Hogan)
16
DO
DO NOT
17
 _____________, an interruption in
crisis escalation behavior,
identification of any risk of harm to
themselves and others
 _________ in the acute signs of
distress
18
 _______ independent functioning
or, if needed, referral to higher level
of care for assessment/evaluation
19
Provide with _____ of ________ and
safety by:
 Allowing them to ventilate
 Validate
 Give honest predictions
 Prepare for situational outcome
20
 Individual is lost
 Individual is out of medications
 Individual is afraid of going to jail
 Individual is hurt or ill
21
22
Implement the Crisis Intervention
Model through a scenario activity
23
A successful ______ intervention model
is comprehensive enough to be
implemented by those with little
training and flexible enough to be used
by those that are trained.
As law enforcement officers crisis
intervention techniques are used to
alleviate immediate ________ only,
followed by a referral to qualified help
as appropriate.
24
 Primary tool is __________
 Ventilation - ______
 Do not _____ _____
25
 Listening is the _______ tool used
by the crisis interviewer.
 Encourage the individual to ____ to
you and share their present feelings.
 A person who feels understood and
_____ about will feel emotionally
safe and be more able to deal with a
crisis situation.
26
 Listening should be non-
__________; judging makes open
communication almost impossible by
making the individual feel defensive.
27
 __ ____ jump to situational solutions
without allowing time for ventilation.
 Ventilation _____ in the reduction of
crisis response behaviors.
28
 __________ crisis feelings through
ventilation to an active listener
creates an atmosphere of
understanding and rapport and helps
both speaker and listener to have a
clearer understanding of the
situation.
29
 The individual is in crisis, because of
their inadequate coping skills and are
not able to handle the crisis at hand.
 They are already feeling out of
_______.
 Don’t compound that feeling by
excluding them from the solution
process.
30
 Do not “call their bluff.” Even if the
individual states they are going to
commit suicide but you feel they are
just looking for attention, not
believing them is too dangerous.
 Do not take the _____.
31
 Do not create a lose-lose situation.
By intensifying feelings of anger and
embarrassment it will only result in
closed communication
32
Identification
________ _____
______ needed addressing
33
33
 Limited to the assistance of
identifying specific problem areas
and what issues need to be addressed
as a result of this identification.
 Nothing else should be assessed as
nothing else is needed to deal with
the immediate crisis.
34
 Some individual’s lives may be very
complex and seem so disorganized
that identifying a specific problem
area in their crisis experience may be
difficult. But by doing so it provides
the individual with evidence that
regaining control is possible
35
Questioning
 Questioning Process
______ _______
List alternatives
Best ________
36
36
 It is helpful to assist the individual
through a questioning process in
order to narrow options (What has
worked for you in the past?) and in
listing alternatives to their problem
area in order to obtain a clearer
picture of what the individual is
willing to do to manage the crisis
situation.
37
 Once alternatives have been
discussed, a joint decision will need
to be made to choose the best
_________ within the available
parameters.
38
 These solutions should be focused
enough that the individual has a
specific course of action; vague or
ambiguous plans like “go home and
talk to your family,” or “make an
appointment for more meds” is too
abstract; concrete statements are
needed for ________.
39
 The simpler the ________, the
quicker an implementation can be
achieved and the individual
experiences feelings of hope.
 Reminder: even though the
intervener can offer solutions, it is
the individual in crisis that must be
willing to act and accept any
consequences associated with the
solution.
40
 Encourage individual to talk to you
 Share their feelings
 Seek to understand if you want to
be understood
 Non-Judgmental
41
 Identification
 _______ _____
 Issues needed addressing
 Questioning Process
 Narrow options
 List alternatives
 ____ ________
42
 Jointly brainstorm possible solutions
to the problem area and how to
present these solutions to an individual
in crisis.
 Each group will then come up with a
plan for finding an appropriate and
specific referral source.
You are looking for resources specific to the problem!
43
 You encounter a man outside the
window of a 10 story building and he
says he is going to jump.
 You encounter a woman from
Moldavia who tells you in broken
English she wants to kill herself.
 You encounter a 14-year old run-a-
way who refuses to give you her
name and address
44
Incorporate the technique of Crisis
Intervention into Officer Safety
45
 Is foremost an _______ ______
Training
 It will ______ in keeping the officer,
community, and mental health
consumer safer in difficult and
potentially volatile situations.
46
The person in a mental health crisis is
usually
• _______,
• _______,
• ________,
• and feeling a lack of _______
47
“The essential difference between
suspect encounter training…and how to
approach the mentally ill is the need to
be non-confrontational…to shift
gears…opposed to the way officers are
routinely expected to control conflict…”
(Police Magazine)
48
 Define
 Assess
 Respond
 Evaluate
49
 A 75-year-old man is found roaming a
busy highway outside an area hospital.
He has just been notified his wife has
died. He is also in the beginning stages
of Alzheimer’s.
50
•
Define
•
Assess
•
Respond
•
Evaluate
51
Knowing that you have taken a Crisis
Intervention class, a friend calls you
from his sister’s home. His sister has
just been badly beaten by her husband,
who has stormed out of the house. The
sister is hysterical and does not know
what to do
52
•
Define
•
Assess
•
Respond
•
Evaluate
53
 A female caller phones the station
and states she is suicidal; her life is
going nowhere and she doesn’t see the
point in living. She mentions at one
point that she has “taken her pills.”
(Pills may not mean overdose; it could
mean daily medications)
54
•
Define
•
Assess
•
Respond
•
Evaluate
55
 You hear honking and brakes
screeching at a busy intersection. A
young boy is hunched in the
intersection cradling a small injured
dog. Upon approaching, a neighbor
tells you that the boy is autistic
56
•
Define
•
Assess
•
Respond
•
Evaluate
57
 A young woman is seated on a park
bench after dark in a dangerous part of
town. She is unresponsive but holding
a crumpled paper in her hand. The
paper is a copy of a blood test stating
that she is HIV positive.
58
•
Define
•
Assess
•
Respond
•
Evaluate
59
Critique intervention techniques for
their proactive abilities
60
_________ Interventions:
Address need’s prior to a problem or
action
________ Intervention:
Already escalated behavior
61
62
63
Apply knowledge of cultural
background to crisis behavior
64
65
Response to individuals in crisis needs
to include an understanding of
_________ within the context of their
cultures.
Thus a crisis intervention model
should take ________ __________
into effect.
66
…but crisis response varies.
Consider:
 How _______ impact’s one’s
perspective of trauma
 Perception or interpretation of a
threat’s meaning
 Cultures nature of expression
67
68
69
 One’s presence can and does mean
more than what you say …..”it is far
more important that they know you
care”.
70
Reinforce through discussion the
term “mental illness”
71
 General Definition
 Professional Definition
 Definition per Texas Health and
Safety Code
 Insanity
 Abnormal vs. Normal Behavior
72
73
 Genetic Factors (Heredity)
 Biological Factors
 Psychological Factors (Trauma)
 Environmental Factors (Stressors)
 Non-Discriminatory
74
75
List common symptoms of mental
disorders
76
________ vary depending on the type
and severity of the ________. Some
general symptoms that might suggest
a mental disorder could include:
77
Confused thinking
Long-lasting sadness or irritability
Extreme highs and lows in mood
Excessive fear, worrying, or anxiety
Social withdrawal
Dramatic changes in sleeping or eating
Strong feelings of anger/frequent outbursts
Delusions or hallucinations
Increasing inability to cope with daily problems and activities
Thoughts of suicide
Denial of obvious problems
Many unexplained physical problems
Abuse of drugs and/or alcohol
Defying authority, missing school/work, stealing, damaging
property
 Hyperactivity
 Other:














78
79

List
80
Compile general categories of the most prominent
mental disorders and the mental illnesses that
populate these categories
81
Most common:
 Depression
 Bipolar Disorder
82
83
Most Common:
 Organic Brain Disorders
 Pain Syndromes
 Drug Withdrawal
84
Most Common:
 Panic Attacks
 Phobias
 Obsessive-Compulsive Disorder
 Post Traumatic Stress Disorder
(PTSD)
85
86
Most Common:
 Alzheimer’s Disease
87
88
Most common:
 Stimulants
 Alcohol
 Heroin
89
90
Most Common:
 Paranoid
 Antisocial
 Borderline
91
92
Categorize common symptoms of
mental illness with a prominent
mental disorder
93
Utilize the list compiled in learning objective 2.2 and
mental disorders/illnesses discussed in learning
objective 2.3 to match symptoms to categories of
disorders/illnesses.

94
Confused thinking
Long-lasting sadness or irritability
Extreme highs and lows in mood
Excessive fear, worrying, or anxiety
Social withdrawal
Dramatic changes in sleeping or eating
 Strong feelings of anger/frequent outbursts
 Delusions or hallucinations
 Increasing inability to cope with daily problems and
activities
 Thoughts of suicide
 Denial of obvious problems






95

Mood Disorder

Psychotic Disorder

Anxiety Disorder

Cognitive Disorder

Substance-Abuse Disorder

Personality Disorder
96
Identify suicidal ideations in mental
illness protocols
97
 _________
 Nature of current ________
 ______ and Degree
 Prior Attempt
98
 ______ vs. ________
 ________ Status
 Chance for _______
 Social __________
99
Outline the four major categories of
psychotropic medications
100
 Anti-psychotic
 Antidepressants
 Mood Stabilizers
 Anti-anxiety Drugs
Old vs. New Medications?
101

Notes
102

NOTES
103

NOTES
104

NOTES
105

NOTES
106
 Uncomfortable
 ______________
 Irreversible
 Tartive __________
107
108
109

nasty _____ ________,

the _______ associated with being mentally ill,
i.e., they don’t want people to know they have a
mental illness.

They start _______ _______ and think they no longer
need the medications

110
A person ___ ___ __________ a
psychoactive medication to a patient who
________ to take the ___________
voluntarily unless the patient is in need of
a medication related to an emergency, or
the patient is under an order authorizing
the administration of the medication
regardless of the patient’s refusal.
111
Develop an increased understanding
of the legal process; evaluation and
techniques for appropriateness of
apprehension
112
113
Analyze the law enforcement
decision-making process utilizing the
concept of “discretion”
114
115
Dependent on:
 __________
 Resources
Major Areas of Disposition:
 Emergency __________ Apprehension
 Informal Disposition
116
117
Texas Health and Safety Code, _____
___, Chapter ____
118
Summarize the legal category’s
directly related to mentally ill
consumers and crisis incident control
119
120
Two prominent cases in the state of Texas have been
_______ ______ who killed her five children by
drowning in June 2001 and ______ ______ who
bludgeoned her three sons with rocks in May 2003.


Results:

Discussion Notes:
121
Around 10:00am on June 20, 2001, Rusty Yates received a startling phone call from his wife, Andrea, whom he had left only an hour
before.

"You need to come home," she said.

Puzzled, he asked, "What's going on?"

She just repeated her statement and then added, "It's time. I did it."

Not entirely sure what she meant but in light of her recent illness, he asked her to explain and she said, "It's the children."

Now a chill shot through him. "Which one?" he asked.

"All of them."

He dropped everything and left his job as a NASA engineer at the Johnson Space Center. When he arrived fifteen minutes later, the
police and ambulances were already at their Houston, Texas home on the corner of Beachcomber and Sea Lark in the Clear Lake
area. Rusty was told he could not go in, so he put his forehead against a brick wall, trying to process the horrifying news, and waited.

Restless for information, he went to a window and on to the back door where he screamed, "How could you do this?" According to
an article in Time, at one point Rusty Yates collapsed into a fetal position on the lawn, pounding the ground as he watched his wife being
led away in handcuffs.

John Cannon, the police spokesperson, described for the media what the team had found.

On a double bed in a back master bedroom, four children were laid out beneath a sheet, clothed and soaking wet. All of them were
dead, with their eyes wide open. In the bathtub, a young boy was submerged amid feces and vomit floating on the surface. He looked to
be the oldest and he was also dead.

In less than an hour that morning, five children had all been drowned, and the responding officers were deeply affected.

The children's thin, bespectacled mother---the woman who had called 911 seeking help---appeared able to talk coherently, but her
frumpy striped shirt and stringy brown hair were soaked. She let the officers in, told them without emotion that she had killed her
children, and sat down while they checked. Detective Ed Mehl thought she seemed focused when he asked her questions. She told him
she was a bad mother and expected to be punished. Then she allowed the police to take her into custody while medical personnel
checked the children for any sign of life. She looked dispassionately at the gathering crowd of curious neighbors as she got into the police
car.

Everyone who entered the Spanish-style home could see the little school desks in one room where the woman apparently homeschooled them. The house was cluttered and dirty, with used dishes sitting around in the kitchen. The bathroom was a mess.

This crime story would unravel in dark and strange ways, with the reasons why a loving mother of five had drowned all of her children
tangled in issues of depression, religious fanaticism, and psychosis. The nation would watch with polarized opinions , as the State of
Texas was forced into a determination about justice that was rooted in glaringly outdated ideas about mental illness.

But in the meantime, Andrea Yates sat in a jail cell and Rusty Yates had to deal with a demanding media that not only wanted a scoop
but also wanted an answer. Why would any mother murder all of her children?

122
No one thought there was something wrong with 39-year-old Deanna Laney on Mother's Day weekend in 2003. That's why they could
not have predicted what she was about to do.

A housewife in New Chapel Hill, Texas who saw herself as a religious sister to Andrea Yates, the housewife who drowned her five
children in 2001, Laney began to see "signs." Her 14-month-old son, Aaron, was playing with a spear. That was the first signal from God
that she was to do something to her children.

She resisted, not certain that she understood. But the signs continued.

The case was broadcast on Court TV, and covered by newspapers, television talk shows nationwide and by Internet Web sites.

When Aaron presented Laney with a rock that day, she later reported that she believed she was supposed to pay attention. This was a
symbol. Later that same day, he squeezed a frog. Then she understood. She was to kill her children, either by stoning them, strangling
them or stabbing them. God had shown her three ways.

Again she told God no, but again she felt pressured to comply. "Each time it was getting worse and worse," she later said, "the way it
had to be done." In other words, the more she resisted, the worse the death would be for her children. She decided that rocks would be
preferable to strangulation, so she found some in preparation.

Laney knew she had to "step out in faith." She had to trust God, and she believed that God would use her brutal deed to do
something great. He had done such things in the Bible. Then when Laney woke up before midnight on May 9, she knew that the time was
at hand. She had already hidden a rock in Aaron's room, so she went there first.

Lifting the rock, she hit Aaron hard on the skull. He began to cry, alerting her husband, Keith. He asked what was wrong and Laney
kept her back to him to prevent him from seeing what she was doing. She assured Keith that everything was okay. But it wasn't
okay. Aaron was still breathing, so she put a pillow over his face until she heard him gurgle. She silently told God that He would have to
finish the job.

Next Laney went after her other two sons. She took Luke, six, outside first in his underwear and smashed his skull by hitting him
repeatedly with a large rock. Then she dragged him by the feet into the shadows so that Joshua, eight, would not see him. She left the
stone, the size of a dinner plate, lying on top of him.

Joshua was next and Laney repeated to him what she had done with Luke, placing them together in a dark area of the yard.

Afterward, she called 911 to report, "I killed my boys."

When the police came, they found Aaron still alive. He was taken away and it eventually became clear that both his vision and motor
skills were severely impaired.

Outside, the police saw Laney standing still in blood-stained clothes. She indicated where she had left the boys and they found the
bodies lying beneath large rocks. Both boys had serious head wounds. Laney was arrested, leaving her bewildered, horrified husband to
wonder what had happened.

123
Appraise the legalities and ethical
considerations of consumer rights
124
 Competency
 Age
 Criminal
 Residency
 Court Orders
 Orders of Protective Custody
125
Illustrate the reasoning of “arresting
to manage”
126
 _______ community tolerance
 Person will continue to _____ problem
 Behavior ___ ______ enough
 Too _________
 __________ for treatment
127
NOTES:
1.
2.
3.
128
 Inadequate _______ between ______
and ______ health system
 Inadequacies in ______ health system
129
Give examples of the types of
mentally ill consumers that are
handled in an informal manner by
law enforcement
130
 Neighborhood Characters
 Troublemakers
 Quiet Consumers
131

NOTES:
132

NOTES
133
134
Compile a list of mental health
referrals/resources in the student’s
community
135
136
137
 Placement difficult
 Criminal Charges
 Cooperation
138
139
Discuss Mental Health
Transformation-Related Legislation
in Texas
140
 Funding awards
 Ultimate Objective
141
Law Enforcement officers are recognized as the
_____ __________ for individuals who are
experiencing a mental health crisis.

NOTES:
142
143