Crisis Responses And Procedures

CRISIS RESPONSES AND PROCEDURES TRAINING MANUAL PSYCHOLOGICAL COUNSELING By Donald S. Graham, Ed.D. , Director at CSU, Chico

This manual is intended to aid in the periodic training and updating of all counselors, interns, and staff, including student help, in the Psychological Counseling Office. These guidelines are provided to give all parties an opportunity to prepare for crisis situations in advance and to increase the likelihood that your response to difficult or stressful encounters will be helpful to the client and effective in obtaining the support that is needed to deal with the situation. Although it is not common to encounter someone who is dangerous in the Center, it is common to encounter those who are under significant stress and are not coping well. In any instance where you are dealing with a person in distress it is necessary to be sensitive to how the interaction is going and be alert to cues that you may need the support of others in the Center to help deal with the situation. This manual is primarily focused on helping you deal with situations that might hold the potential of hostile or violent behavior. This includes verbal hostility and threats as well as physical acting out toward people or inanimate objects. WHO MIGHT BE ASKING FOR SERVICES OR SUPPORT?

 students may be seeking services or may be brought/sent against their will  parents often are upset, fearful, or angry around situations/conflicts with their child, or may be angry and upset with faculty, staff or students who are having a conflict with their child.  faculty & staff most often call concerned about how to deal with a student or how to get a student into counseling. They are generally served by the Faculty and Staff Assistance Program but in a crisis we will see any member of the University. Faculty or staff who insist upon being seen should speak to the Director or a counselor.  others may not have clear connection with the University but are seeking services or wanting something they believe we can give them.

Intense Interactions and Potentially Violent Situations

Basic Assumptions:  Signals such as increasing anger or hostility, confused thoughts and speech, or physical agitation should raise red flags for staff as well as students and should not be minimized.  When you feel like you are dealing with something that is beyond your ability or you feel you need support in dealing with a person on the phone or in person, it is okay to turn to others and ask for help. Trust your gut, don’t lose your temper, don’t make things worse  You should deal with difficult situations or people as best you can, but be aware of when your attempts to help are only leading to greater frustration.  Others need to know when you are dealing with such a situation. Do not keep it to yourself.  At the front desk you can simply say “Rita (or Marilyn) would you give us a hand here.”  Judging when to seek help from a counselor: Students will generally refer problem people to regular clerical staff if they are available. Clerical staff will usually judge when to get a counselor.  If Marilyn or Rita is not available, look for the Director or a counselor. You can just say something like “Let me see if I can get one of the counselors to help us on this.” OFFICE CRISIS RESPONSES AND PROCEDURES (OCRAP!)

IF THE CLIENT IS: GENERAL GUIDELINES

Tearful, crying Crying generally indicates the person is upset, but not necessarily in crisis. Ask the person to complete paperwork if they haven't done so May wish to use Self-D room for some privacy if person is breaking down.

Anxious, tense, fearful Be calm, understanding and reassuring. May want to use Self-D room in order to create feeling of safety.

Confused thoughts Listen respectfully and try to understand. But do not pretend to understand or speech, Out of what you do not understand. Do not agree w/ person's confused perceptions, touch w/ reality thoughts, or hallucinations. A counselor should see the person before he/she Not making sense leaves. If the person is a non-student, let the counselor know that.

Agitated and frustrated, Paraphrase what they have said to be clear that you understand them. not getting what they Acknowledge their emotions if they say how they are feeling. want from you Expressing empathy can be useful. Don't get frustrated. Be mindful you are seen as the person with power. If things are escalating seek some help.

Angry, hostile, and Remain calm, keep a safe distance. Explain the limits of the service or demanding situation. Be aware of whether they have a specific target for anger or if you are now the focus of the anger. Seek some support from others up front and judge whether Director or other counselor should be summoned.

Person is losing control This situation is very rare, but should it happen, do not hesitate to push the going into rage, making alarm button to summon the police. Notify the Director immediately. serious threats, or If someone can get to a separate office to call and give police more info, that becoming physically Is desirable. If you can warn others, do so and leave the area ASAP. violent Use of the Self Development Center as a private space It is sometimes helpful to give the person a private space to wait in if they are amenable to that. Do not enter the room before them.

In what situation should I consider contacting University Police? In situations where there have been clear threats toward persons present When it becomes clear to you that there is immediate danger. When a counselor or other staff directs you to call either by a verbal request or by a code word (orange).

What if I see someone else having a tough time dealing with a disturbed individual? Pay attention, watch body language, consider your options. Is it a situation you might handle more effectively or does the staff member just need some relief? Should you go get a member of the counseling staff to intervene? Is it serious enough you would consider calling University Police?

What if I hear some loud voices in a counseling office and I think there may be a problem? Use your judgment. Buzz them on the phone to check on how the counselor is doing

What should I write down, if anything? If someone clearly acts out of line, is frightening, or out of touch with reality, it is best to document it. Do not make things worse by asking the disturbed person for information in order to document and don’t do it while interacting with the person. If you know the name, note it and note the description, time, and any threat if mentioned. If it is a phone conversation, note what you could tell from the voice as well as time, threat, etc.

Closing the office at noon or 5:00pm Make sure no one is still in a session and left alone. Call in to remind them of the time if they are still not out on the hour Ask if someone needs to stay. No one should be left alone without their expressed consent. COUNSELORS/INTERNS

 Counselors are encouraged to consider the physical layout of their offices with respect to improving your exit.  Counselors should end sessions before 12 noon and before 5:00pm. If not, they may expect to be buzzed by the front desk. However, there is no guarantee that in all cases the staff will know that a counselor is still in session and they could close without realizing you are still with a client. It is best to end by closing times.  Items such as pepper spray are a personal choice. There are pros and cons for its use.  Levels of concern/alarm 1. I don’t feel quite right about this situation and want others to be aware I may want assistance. 2. I need assistance/intervention by others in the Center now. 3. Buzz University Police and get me help immediately!

Strategies  Get up and leave  Calling the front desk and using code words (see below)  Push the panic button  Yell for help

CODE WORDS? The Center’s code for needing help is the word ORANGE. If someone mentions they need the ORANGE FILE, or the ORANGE FOLDER, or whatever, it is a signal that they want some support from other counselors and/or the police. If you hear them say that on the phone, ask them.... “Are you in danger?” “Do you want police?” “Does the client have a weapon?”

SIGNAL LIGHTS/BUZZERS The Center is currently installing a security system.

CALLING THE POLICE When you call the police what do you say?  Identify yourself and the office and where you are (Meriam Library 141)  What are you asking for? What level of urgency is it? 1. Level 1: We just want them to be aware that something COULD be brewing here and we might be calling for an officer 2. Level 2: We are going to need an officer for support (transport of a voluntary hospitalization, or a situation in which we are having some difficulty and we can predict that we will probably need help) 3. We need an officer immediately for a situation that is already dangerous or rapidly headed that way.  What will they want to know? 1. If anyone is in immediate danger 2. In what way is it a dangerous situation? Weapons involved? 3. May want a description of the person in question (did you notice enough to be able to give a good description?)

What you may also want to request: Perhaps it is a voluntary hospitalization (most frequently) and we desire:  Plain clothes officer if available  bring car to the back door

HOSPITALIZATION

Voluntary Counselor should ask another counselor for support in this process (clerical staff can help you get another counselor) Contacting the hospital to facilitate the referral What the police officer may need to know to facilitate the process

Involuntary Warning police officer of the involuntary situation and need for 5150 Consulting with other counselors for assessment Documentation

DEBRIEFING PROCESS  Who needs it? Anyone who has had an intense emotional interaction.  When should it happen? ASAP  Who should be involved? Depends on the situation. Counseling staff should probably help decide this.