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The Seven-Stage Crisis Intervention Model: A Road Map to Goal Attainment, Problem Solving, and Crisis Resolution

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Abstract

This article explicates a systematic and structured conceptual model for crisis assessment and intervention that facilitates planning for effective brief treatment in outpatient psychiatric clinics, community mental health centers, counseling centers, or crisis intervention settings. Application of Roberts' seven-stage crisis intervention model can facilitate the clinician's effective intervening by emphasizing rapid assessment of the client's problem and resources, collaborating on goal selection and attainment, finding alternative coping methods, developing a working alliance, and building upon the client's strengths. Limitations on treatment time by insurance companies and managed care organizations have made evidence-based crisis intervention a critical necessity for millions of persons presenting to mental health clinics and hospital-based programs in the midst of acute crisis episodes. Having a crisis intervention protocol facilitates treatment planning and intervention. The authors clarify the distinct differences between disaster management and crisis intervention and when each is critically needed. Also, noted is the importance of built-in evaluations, outcome measures, and performance indicators for all crisis intervention services and programs. We are recommending that the Roberts' crisis intervention tool be used for time-limited response to persons in acute crisis.
The Seven-Stage Crisis Intervention Model:
A Systematic Blueprint for Intentional Crisis Response
Allen J. Ottens Albert R. Roberts
Northern Illinois University Rutgers University
DeKalb, Illinois Piscataway, New Jersey
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Abstract
This article explicates a systematic and structured conceptual model for crisis
intervention useful for clients in outpatient psychiatric clinic, counseling center, or crisis
intervention settings. Application of this crisis model can facilitate the clinician’s
effective intervening by emphasizing rapid assessment of the client’s problem and
resources, collaborating on goals and alternative coping methods, developing a working
alliance, and building upon the client’s strengths.
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The Seven-Stage Crisis Intervention Model:
A Systematic Blueprint for Intentional Crisis Response
We live in an era in which crisis-inducing events and acute crisis episodes have
rapidly escalated in prevalence. Each year, millions of people are confronted with crisis-
inducing events that they cannot resolve on their own, and they often turn for help to
crisis units of community mental health centers, psychiatric screening units, outpatient
clinics, hospital emergency rooms, college counseling centers, family counseling
agencies, and domestic violence programs (Roberts, 2005).
This article delineates and discusses a systematic and structured conceptual model
for crisis intervention useful with persons calling or walking into an outpatient
psychiatric clinic, counseling center, or crisis intervention program. A model is a
prototype of the real-life clinical process the crisis clinician/counselor would like to
implement. It serves as guideposts while also facilitating memory retention on alternative
methods and techniques of facilitating the counseling process. A systematic crisis
intervention model is analogous to mapping out a road map as a model of the actual
roads, highways, and directions one will be taking on a trip. Thus, the clinician can
visualize the implications of each proposed crisis intervention guideline and technique in
the model’s process and sequence of events, and make any necessary adjustments before
the program is fully operational. By learning about each component or stage of a model,
the clinician will better understand how each component relates to one another, and
should facilitate goal attainment, problem-solving and crisis resolution.
--You are a crisis consultant to a large fortune 500 corporation, and a volatile
domestic violence situation took place last week at the corporate headquarters office. The
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employee assistance counselor, the director of training, the director of strategic planning,
and the director of disaster planning want you to provide crisis intervention training to all
employee assistance counselors and all corporate security officers.
--you are the new psychiatrist in an inpatient psychiatric unit with 50 patients
diagnosed with co-occurring disorders, over the weekend a patient assaulted the
psychiatric resident you are supervising. The resident wants to be transferred to another
unit of the hospital because he had a nightmare and cold sweats last night. What do you
do now? What types of training should be provided to all residents and mental health
clinicians in order to prevent patient-staff conflict from reaching a crisis point?
--You are the counseling psychologist at a state university assigned to see walk-in
emergency clients. An 18 year old freshman appears one afternoon, and tells you she just
came from her residence hall room and found her boyfriend in bed with her “best friend”
roommate. Now she tells you she is seriously considering taking an overdose of
nonaspirin pain capsules in their presence to “teach them a lesson.” How can crisis
intervention help her to find adaptive coping skills and a more effective problem solving
approach to her predicament?
Crisis clinicians must respond quickly to the challenges posed by clients
presenting in a crisis state. Critical decisions need to be made on behalf of the client.
Clinicians need to be aware that some clients in crisis are making one last heroic effort to
seek help and hence may be highly motivated to try something different. Thus, a time of
crisis seems to be an opportunity to maximize the crisis clinician’s ability to intervene
effectively as long as he or she is focused in the here and now, willing to rapidly assess
the client’s problem and resources, suggest goals and alternative coping methods,
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develop a working alliance, and build upon the client’s strengths. At the start it is
critically important to establish rapport while assessing lethality and determining the
precipitating events/situations. It is then important to identify the primary presenting
problem, and mutually agree on short-term goals and tasks. By its nature, crisis
intervention involves identifying failed coping skills and then helping the client to replace
them with adaptive coping skills.
It is imperative that all mental health clinicians—counseling psychologists,
mental health counselors, clinical psychologists, psychiatrists, psychiatric nurses, social
workers, and crisis hotline workers—be well-versed and knowledgeable in the principles
and practices of crisis intervention. Several million individuals encounter crisis-inducing
events annually, and crisis intervention seems to be the emerging therapeutic method of
choice for most individuals.
Crisis Intervention: The Need for a Model
A crisis has been defined as
“An acute disruption of psychological homeostasis in which one’s usual coping
mechanisms fail and there exists evidence of distress and functional impairment.
The subjective reaction to a stressful life experience that compromises the
individual’s stability and ability to cope or function. The main cause of a crisis is
an intensely stressful, traumatic, or hazardous event, but two other conditions are
also necessary: (1) the individual’s perception of the event as the cause of
considerable upset and/or disruption; and (2) the individual’s inability to resolve
the disruption by previously used coping mechanisms. Crisis also refers to “an
upset in the steady state.” It often has five components: a hazardous or traumatic
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event, a vulnerable state, a precipitating factor, and active crisis state, and the
resolution of the crisis. (Roberts, 2002, p. 516)
Given such a definition, it is imperative that crisis workers have in mind a framework or
blueprint to guide them in responding. In short, a crisis intervention model is needed, and
one is needed for a host of reasons, such as the following:
When confronted by a person in crisis, clinicians need to address that person’s
distress, impairment, and instability by operating in a logical and orderly process
(Greenstone & Leviton, 2002). The crisis worker, often a paraprofessional, is less likely
to exacerbate the crisis with well-intentioned but haphazard responding when trained to
work within the framework of a model. A comprehensive model allows the clinician to
be mindful of maintaining the fine line that allows for a response that is active and
directive enough but does not take problem ownership away from the client. Finally, a
model should suggest steps for how the crisis worker can intentionally meet the client
where he or she is at, assess level of risk, mobilize client resources, and move
strategically to stabilize the crisis and improve functioning.
A number of crisis intervention practice models have been promulgated over the
years (e.g., Collins & Collins, 2005; Greenstone & Leviton, 2002; Jones, 1968).
However, there is one crisis intervention model--building upon and extending the seminal
thinking of Caplan (1964), Golan (1978), and Parad (1965)--the Roberts Seven-Stage
Crisis Intervention Model (R-SSCIM; Roberts, 1991, 1998, 2005), that represents an
elegant example of a stepwise blueprint for crisis responding that has applicability across
a broad spectrum of crisis situation. What follows is an explication of that model.
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Roberts’ Seven Stage Crisis Intervention Model
In conceptualizing the process of crisis intervention, Roberts (1990, 1991, 1995,
2000, 2005) has identified seven stages through which clients typically pass on the road
to crisis stabilization, resolution, and mastery. These stages, listed below, are essential
and overlapping in the process of crisis intervention:
1. plan and conduct a thorough biopsychosocial and lethality/imminent danger
assessment
2. make psychological contact and rapidly establish the relationship
3. identify the major problems, including crisis precipitants
4. encourage an exploration of feelings and emotions
5. generate and explore alternatives
6. restore functioning through implementation of an action plan
7. follow-up
What follows is an explication of that model.
Stage I: Psychosocial and Lethality Assessment
The crisis worker must conduct a swift but thorough biopsychosocial assessment.
At a minimum, this assessment should cover the client’s environmental supports and
stressor, medical needs and medications, current use of drugs and alcohol, and internal
and external coping methods and resources (Eaton & Ertl, 2000). One useful (and rapid)
method for assessing the emotional, cognitive, and behavioral aspects of a crisis reaction
is the Triage Assessment Model (Myer, 2001; Myer, Williams, Ottens, & Schmidt, 1992).
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Assessing lethality, first and foremost, involves ascertaining whether the client
has actually initiated a suicide attempt, such as ingesting a poison or overdose of
medication. If no suicide attempt is in progress, the crisis worker should inquire about the
client’s potential for self-harm. This assessment requires
asking about suicidal thoughts and feelings (e.g., “When you say you can’t take it
anymore, is that an indication you are thinking of hurting yourself?”)
estimating the strength of the client’s psychological intent to inflict deadly harm
(e.g., a hotline caller who suffers from a fatal disease or painful condition may
have strong intent)
gauging the lethality of suicide plan (e.g., does the person in crisis have a plan?
how feasible is the plan? does the person in crisis have a method in mind to carry
out the plan? how lethal is the method?)
inquiring about suicide history
taking into consideration certain risk factors (e.g., is the client socially isolated or
depressed, experiencing a significant loss such as divorce or lay-off?)
With regard to imminent danger, the crisis worker must establish, for example, if
the caller on the hotline is now a target of domestic violence, a violent stalker, or sexual
abuse.
Rather than grilling the client for assessment information, the sensitive clinician
or counselor uses an artful interviewing style that allows this information to emerge as
the client’s story unfolds. A good assessment is likely to have occurred if the clinician
has a solid understanding of the client’s situation and the client, in this process, feels as
though he or she has been heard and understood. Thus, it is quite understandable how in
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the Roberts Model Stage I and Stage II, Rapidly Establish Rapport, are very much
intertwined.
Stage II: Make Psychological Contact and Rapidly Establish Rapport
Rapport is facilitated by the presence of counselor-offered conditions such as
genuineness, respect, and acceptance of the client (Roberts, 2005). This is also the stage
in which the traits, behaviors, or fundamental character strengths of the crisis worker
come to fore in order to instill trust and confidence in the client. Although a host of such
strengths have been identified, some of the most prominent include poise, creativity,
flexibility, resiliency, and optimism (see James & Gilliland, 2005, pp. 14-16).
Stage III: Identify the Major Problems or Crisis Precipitants
Crisis intervention focuses on the client’s current problems, which are often the
ones that precipitated the crisis. As Ewing (1978) pointed out, the crisis worker is
interested in elucidating just what in the client’s life has led her or him to require help at
the present time. Thus, the question asked from a variety of angles is, “Why now?”
Roberts (2005) suggested not only inquiring about the precipitating event (the
proverbial “last straw”) but also prioritizing problems in terms of which to work on first,
a concept referred to as “looking for leverage” (Egan, 2002). In the course of
understanding how the event escalated into a crisis, the clinician gains an evolving
conceptualization of the client’s modal coping style—one that will likely require
modification if the present crisis is to be resolved and future crises prevented. For
example, Ottens & Pinson (2005) in their work with caregivers in crisis has identified a
repetitive coping style—argue with care recipient-acquiesce to care recipient’s demands-
blame self when giving in fails—that can eventually escalate into a crisis.
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Stage IV: Deal with Feelings and Emotions
There are two aspects to Stage IV. The crisis worker strives to allow the client to
express feelings, to cathart, and to explain her or his story about the current crisis
situation. To do this, the crisis worker relies on the familiar “active listening” skills like
paraphrasing, reflecting feelings, and probing (Egan, 2002). Very cautiously, the crisis
worker must eventually work challenging responses into the counseling dialogue.
Challenging responses can include giving information, reframing, interpretations, and
playing “devil’s advocate.” Challenging responses, if appropriately applied, help to
loosen clients’ maladaptive beliefs and to consider other behavioral options. For example,
in our earlier example of the young woman who found boyfriend and roommate locked in
a cheating embrace, the counselor at Stage IV allows the woman to express her feelings
of hurt and jealousy and to tell her story of trust betrayed. The counselor, at a judicious
moment, will wonder out loud whether taking an overdose of acetomeniphen will be the
most effective way of getting her point across.
Stage V: Generate and Explore Alternatives
This stage can often be the most difficult to accomplish in crisis intervention.
Clients in crisis, by definition, lack the equanimity to study the big picture and tend to
doggedly cling to familiar ways of coping even when they are backfiring. However, if
Stage IV has been achieved, the client in crisis has probably worked through enough
feelings to reestablish some emotional balance. Now, clinician and client can begin to put
on the table options, like a no-suicide contract or hospitalization, for ensuring the client’s
safety; or discuss alternatives for finding temporary housing; or consider the pros and
cons of various programs for treating chemical dependency. It is important to keep in
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mind that these alternatives are better when they are generated collaboratively and when
the alternatives selected are “owned” by the client.
The clinician certainly can inquire about what the client has found that works in
similar situations. For example, it frequently happens that relatively recent immigrants or
bicultural clients will experience crises that occur as a result of a cultural clash or
mismatch, as when values or customs of the traditional culture are ignored or violated in
the United States. It may help to consider how the client has coped with or negotiated
other cultural mismatches. If this crisis precipitant is a unique experience, then clinician
and client can brainstorm alternatives—sometimes the more outlandish, the better—that
can be applied to the current event. Solution-focused therapy techniques, such as
“Amplifying Solution Talk” (DeJong & Berg, 1998) can be integrated into Stage IV.
Stage VI: Implement an Action Plan
Here is where strategies become integrated into an empowering treatment plan or
coordinated intervention. Jobes and Berman (1996), who described crisis intervention
with high-risk, suicidal youth, noted the shift that occurs at Stage VI from crisis to
resolution. For these suicidal youth, an action plan can involve several elements:
removing the means—involving parents or significant others in the removal of all
lethal means and safeguarding the environment
negotiating safety—time-limited agreements during which the client will agree to
maintain his or her safety
future linkage—scheduling phone calls, subsequent clinical contacts, events to
look forward to
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decreasing anxiety and sleep loss—if acutely anxious, medication may be
indicated but carefully monitored
decreasing isolation—friends, family, neighbors need to be mobilized to keep
ongoing contact with the youth in crisis
hospitalization—a necessary intervention if risk remains unabated (see Jobes &
Berman, 1996, pp. 76-77)
Obviously, the concrete action plans taken at this stage (e.g., entering a 12-step
treatment program, joining a support group, seeking temporary residence in a
women’s shelter) are critical for restoring the client’s equilibrium. However, there is
another dimension that is essential to Stage VI, as Roberts (2005) indicated, and that
is the cognitive dimension. Thus, recovering from a divorce or death of a child or
drug overdose requires making some meaning out of the crisis event: why did it
happen? What does it mean? What are alternative constructions that could have been
placed on the event? Who was involved? How did actual events conflict with one’s
expectations? What responses (cognitive or behavioral) to the crisis actually made
things worse? Working through the meaning of the event is important for gaining
mastery over the situation and for being able to cope with similar situations in the
future.
Stage VII: Follow-up
Crisis workers should plan for a follow-up contact with the client after the initial
intervention to ensure that the crisis is on its way to being resolved and to evaluate the
postcrisis status of the client. This postcrisis evaluation of the client can include:
physical condition of the client (e.g., sleeping, nutrition, hygiene)
12
cognitive mastery of the precipitating event (does the client have a better
understanding of what happened and why it happened?)
an assessment of overall functioning including, social, spiritual, employment,
academic
satisfaction and progress with on-going treatment (e.g., financial counseling)
any current stressors and how those are being handled
need for possible referrals (e.g., legal, housing, medical)
Follow-up can also include the scheduling of a “booster” session in about a month
after the crisis intervention has been terminated. Treatment gains and potential problems
can be discussed at the booster session. For those counselors working with grieving
clients, it is recommended that a follow-up session be scheduled around the anniversary
date of the deceased’s death (Worden, 2002).
Conclusion
The Roberts Seven Stage Crisis Intervention Model has applicability for the wide
range of crisis workers—counselors, paraprofessionals, clinical social workers, clergy,
psychologists—who are called upon to make rapid assessments and clinical decisions
when faced with a client who is in the midst of a crisis-inducing or traumatic event. If
done properly, crisis intervention can facilitate an earlier resolution of acute stress
disorders or crisis episodes. Not only does this model give the crisis worker an
overarching plan for how to proceed, but the components of the model take into
consideration the what the persons in crisis bring with themselves to every counseling
encounter—their inner strengths and resiliency.
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References
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DeJong, P., & Berg, I. K. (1998). Interviewing for solutions. Pacific Grove, CA:
Brooks/Cole.
Eaton, Y., & Ertl, B. (2000). The comprehensive crisis intervention model of Community
Integration, Inc. Crisis Services. In A. R. Roberts (Ed.), Crisis intervention
handbook: Assessment, treatment, and research (2nd ed.) (pp. 373-387). New
York: Oxford University Press.
Egan, G. (2002). The skilled helper (7th ed.). Belmont, CA: Wadsworth.
Ewing, C. P. (1978). Crisis intervention as psychotherapy. New York: Oxford University
Press,
Golan, N. (1978). Treatment in crisis situations. New York: Free Press.
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Jobes, D. A., & Berman, A. L. (1996). Crisis intervention and time-limited intervention
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"There is plenty in this book to get your teeth into and help us think about how we work with people in mental health crises and how we might best make a difference." Alan Simpson, Professor of Mental Health Nursing, Health Service and Population Research, King's College London, UK "Any one of us could experience a mental health crisis. However, a high-quality interdisciplinary response can be lifesaving and life changing. This book is an important contribution to the literature as it has examples of good practice for all professionals - both on the frontline and in service development." Dr Adrian James, President, Royal College of Psychiatrists, UK "This publication is a valuable and timely resource given the increasing recognition of the impact of mental health needs in a range of different professional settings." Victoria Sweetmore, Acting Discipline Lead for Mental Health and Learning Disability Nursing, University of Derby, UK Interprofessional Perspectives of Mental Health Crisis improves the care of those experiencing a mental health-related crisis by providing insight into the roles different UK statutory services have and the need for collaborative mental health care. For those studying and working in the field of mental health crisis, this vital work will bridge your understanding by offering a cross-discipline perspective of the different services, their role in aiding service users and, the ways we can work more collaboratively together to meet the mental health needs of those requiring care. Throughout, the book: * Promotes understanding of the various roles each of the key services play within the crucial first 24-hours of a mental health crisis and the challenges they face * Fosters interprofessional collaboration to create a whole-system approach to crisis care * Helps professionals to understand good practice and the challenges of other services when aiding a person in crisis * Critically evaluates service provision and ways to improve crisis care * Explores recovery and collaboration with service users experiencing a crisis and their significant others The book is timely and essential in its promotion of high-quality interdisciplinary response and emphasis on integration and collaboration between service providers. Kris Deering is Senior Lecturer in Mental Health Nursing and the module lead of Working with a Person Experiencing a Mental Health Crisis at UWE Bristol, UK. Including working as a senior practitioner for a mental health crisis team, Kris has over 15 years of mental health nursing experience. Jo Williams is Senior Lecturer in Mental Health Nursing at UWE Bristol, UK. Her clinical practice experience includes civilian and military nursing, supporting people living with co-existing mental health and substance misuse issues.
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Introduction Because of their regular contact with students, faculty can find themselves in the position of needing to support student’s emotional needs, a task for which not everyone feels well trained. Statement of the Problem COVID-19 has exacerbated existing mental health concerns and created additional problems related to low levels of motivation, increased loneliness, and heightened levels of stress. Literature Review Fortunately, psychological science can explain the causes of these symptoms as well as offer evidence-based interventions. The literature related to motivation, loneliness, and stress is reviewed with an emphasis placed on common studies or theories that are covered in typical psychology curriculums. Teaching Implications Evidence-based classroom interventions and assignments designed to promote student well-being are discussed. Conclusion Grounding discussions of student’s emotional reactions within the psychological literature may help instructors without a mental health background better support student’s emotional needs, illustrate course concepts, and model the practice of clinical science while helping to promote student well-being.
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The American education system has been significantly disrupted by the COVID-19 pandemic, which led schools to shut down and convert to remote learning environments in spring 2020. However, long before these school closures, school social workers (SSWs) have faced significant practice dilemmas, as they have encountered obstacles to their engagement in best practices. While initial pandemic school closures presented SSWs with a range of uncertain situations, they also provided the possibility to respond to practice demands in different and dynamic ways. This article explores the pandemic's impact upon SSWs’ practice, and how SSWs responded in turn as they quickly adapted their practice during this widespread, ongoing crisis. Informed by crisis theory, previous analyses of SSW practice trends and dilemmas, and a review of traditional social work values and ethics, we conducted three focus groups in July 2020 with SSWs during the pandemic’s early months. From these interviews, we learned that participants’ work was disrupted by dramatic shifts in school and community settings, as well as changes in support needs within their respective school communities. Those disruptions gave way to substantial shifts in practice, which reflect a more prominent role for systemic practice and for traditional social work values in SSW decision-making. These findings offer implications for post-pandemic practice, and practice in other host settings.
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لق ʙأحَ ʙث انʷʱار فʛʽوس ؗʨرونا الʺ ʙʳʱʶتأثʛʽات Ǽالغة الʙʷة في الȄʛʷॼة، وأحʙث اخʱلالاً في نʨاحي الॽʴاة، فاجʚʱبʗ العʨاق ʖالʻفॽʶة والاجʺʱاॽɺة الاهʺʱام Ǽع ʙفʛض العʜل و"الابʱعاد الاجʺʱاعي "على الأفʛاد ال ȑʚشȞل تهʙيʙاً للʴʸة الʻفॽʶة وأد Ȑإلى تغʛʽʽات معॽɾʛة وسلॽؗʨة .وق ʙأج ʗȄʛال ʙارسة الʴالॽة لؔʷف ما أحʙثʱه الʳائʴة م ʧتأثʛʽات ل Ȑʙالأفʛاد . وت ʦجʺع الاسʳʱاǼات إلؔʛʱونॽاً م ʧخلال اسॼʱانة تق ʛȄʛذاتي في الʺʙة ب25 ʧʽأبȄʛل و 17ماي2020. ʨوȃلغ عʙد الʺ1692 ʧʽʰʽʳʱʶم ʧعʙة دول عॽȃʛة وم ʧʽʺॽʁفي Ǽع ʠدول العال ،ʦوشّȞل ʗالإناث % ،63,3وتʛاوح ʗأعʺار %64,8 م ʧالʺʷارؗ ʧʽب23 ʧʽو 50سʻة .وأʣهʛت الʱʻائج في الʺʳال الانفعالي، أن الʺʷارؗ ʧʽقّʙروا ȞʷǼل مʛتفع جʙاً عʺل الʨʢاق ʦالॽʰʢة، والʳهʨد الʺʚʰولة م ʧالأجهʜة الأمॽʻة .وفي الʺʳال الʺعʛفي، ت ʧʽʰأن %85مʻهؗ ʦانʨا ǽعʛفʨن أن الأسॼاب الʺʺʱʴلة الʱي ت ʙȄʜفʛصة الإصاǼة Ǽالفʛʽوس ت: ʧʺʹʱعʙم الʺʴافʤة على الॼʱاع ʙالاجʺʱاعي، ووجʨد أمʛاض مʜمʻة .وفي مʳال الʺʺارسات الʶلॽؗʨة، ت ʧʽʰأن الأفʛاد أصʨʴॼا أك ʛʲوॽɺاً Ǽالʺʺارسات الॽʴʸة لا سʺॽا غʽʶل الʙʽي ،ʧواسʙʵʱام الʺعقʺات .وأما Ǽالॼʶʻة لʺʸادر القل ،Șفق ʙت ّ ʙʸرها الʱفؔǼ ʛʽاحʺʱال إصاǼة أح ʙأفʛاد الأسʛة Ǽالفʛʽوس، تلاه اسʛʺʱار تأثʛʽ الʳائʴة .وأʣهʛت الإناث مȄʨʱʶات أعلى م ʧالʨؗʚر على جʺॽع مقاي ʝॽال ʙارسة، ؗʺا ت ʧʽʰأن العʺ ʛالأك ʛʰارت ȌॼبȄʜادة في الʺʤاه ʛالانفعالॽة والʺʺارسات الʶلॽؗʨة وتʙني في مʷاع ʛالقل. Șوت ʧʽʰأن الاسʳʱاǼات الʶلॽؗʨة ل ȐʙسȞان الʺʙيʻة ت ʙȄʜع ʧسȞان القȄʛة Ǽفارق دال إحʸائॽاً، في ح ʧʽتقار ʗȃالاسʳʱاǼة الʻفॽʶة لʙيه ʦضʺ ʧالʺʳالات الانفعالॽة والʺعॽɾʛة ومʷاع ʛالقل. Șوق ʙأبʛزت ال ʙارسة أن الʺȄʨʱʶات العالॽة م ʧالقل Șالʱي ǽعاني مʻها الأفʛاد تع ʛʰʱأساساً لفه ʦالقʹاǽا الʺʱعلقة ʱʴʸǼه ʦوعافʱʽه ʦالʻفॽʶة والʱغʛʽات اللاحقة في عʨاʡفه ʦومعʛفʱه ʦوسلؗʨه
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To determine how suicide prevention agencies function, an exploratory survey of such facilities in large urban areas of the United States was planned. A list of such agencies was obtained by checking the local telephone directories for each of the 212 Standard Metropolitan Statistical Areas. The 31 suicide prevention agencies thereby identified were mailed a 22-item questionnaire asking about the initial steps they took to avert threatened suicide. Twenty-four agencies replied to the questionnaire. The questionnaires sent to three agencies were returned by the post office because the addresses were unknown. The staffs of two agencies in the New York metropolitan area, who were interviewed in person after their questionnaires were returned, supplied more detailed information. A study of the replies of the agencies revealed that they handled 41,020 calls for help in 1966. Their initial procedures in dealing with persons at risk of suicide fell into a general pattern: When a suicidal person called, the suicide prevention worker of the agency would try to establish rapport, evaluate the client's potential for suicide, and decide upon a course of action. A large proportion of the clients who called the suicide prevention agencies in a crisis were referred for treatment to general hospitals, physicians and psychiatrists in private practice, outpatient clinics, community agencies, clergymen, or other community resources. Sometimes the worker recommended that a client get in touch with nonprofessionals--the police, members of his family, or close friends. The worker would make several followup calls to see if the caller had contacted the designated community resource.
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Considering the prevalence of suicide and other forms of self-injurious behavior, it is ironic that relatively little attention has been paid to the training of mental health workers in suicide intervention. Still less effort has been spent in evaluating the effectiveness of such workers or the agencies in which they serve. We review the evaluation strategies that have been used to assess the process and outcome of suicide intervention, ranging from macroanalyses of the impact of crisis services on suicide rates in the community to microanalyses of the competence of individual suicide interventionists. Particular attention is paid to the Suicide Intervention Response Inventory, a self-administered test of suicide counseling skills whose validity, reliability, and practical utility suggest the benefit of its use in a broader range of research and applied settings. The advantages and disadvantages of each evaluation strategy are discussed, and guidelines are offered for the sophistication of future research and program evaluation efforts.