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Adverse Childhood Experiences (ACEs)

Adverse childhood experiences (ACEs) can have a tremendous impact on future violence victimization and perpetration, and lifelong health and opportunity. CDC works to understand ACEs and prevent them

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Break Down the Problem

Identifying the Nature of the Crisis and Therapeutic Interaction

Identify the precipitating event

Identify cognitions

Identify subjective  distress

Identify impairments in functions: behaviorally, socially, academically, occupationally

Ethical checks: suicide, homicide, organic issues, psychosis, substance abuse, child abuse, elder abuse

Therapeutic interaction statements: educational, empowerment, validation, reframes

Commitment to Action

Coping Strategies

Explore what client wants to do now to cope

Explore what client has tried in the past to cope

Explore other things client can do to cope

Offer alternative strategies for coping:

Support groups

Twelve-step groups

Marital or family therapy

Lawyer

Doctor

Bibliotherapy

Reel therapy

Assertion training

Stress management

Shelters or other agencies

Secure commitment and follow-up

Kanel, K. (2014). A guide to crisis intervention. Cengage Learning.

Ivey, A.E., Gluckstern, N.B., & Ivey, M.B. (1997). Basic attending skills, 3rd edition. Microtraining Associates.

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The ABCD Model of Crisis Intervention

Crisis intervention helps resolve the immediate crisis and helps restore the victim to a sense of normalcy or level of functioning equal to or higher than prior to the crisis. ______________________________________________________________________________________

Achieve Contact — Provide safety and security, restore power and control. • Introduce yourself, name, role, purpose.
• Assure the victim of emotional and physical safety.
• Ask victim how s/he would like to be addressed (if not known to caregiver).

• As appropriate, collect information regarding residency, health conditions, family member contact, any support systems or friends.
• Use discernment to learn if s/he is taking or needing medication.
• Identify the victim’s feelings, reactions and perceptions.

Possible questions and comments: “You are safe now.” “I am sorry that it happened.” “Are you ready to...?” “Are you able to...?” “Are you ready to give a description now?” “Do you mind if I sit here?” “May I speak with you now?” “Is this all right with you?”

Boil Down the Problem — Allow for reactions and interaction as well as ventilation and validation by telling story; determine most pressing problem and help to restore dignity.
• Ask victim to briefly describe what has just happened.
• Encourage the victim to talk about the present (here and now).

• Avoid criticism of the actions of the victim.
• Ask what the most pressing problem is.
• Review and clarify what you heard as that primary and most immediate problem.
• Ask if the victim has ever experienced a similar situation or crisis in the past.
• Ask how it was handled. Consider how the victim can regain control and authority.
• Review what you heard as the primary problem.
• Transition to “coping with the problem.”
Possible questions/comments (if true and appropriate): “You did the right thing.” “You did nothing wrong.”

Cope With the Problem — Help predict and prepare for the future, explore resources and suggest realistic options, accept a “new normal” or “new reality.” What does the victim want to happen?
• Review what is the most important need — the bottom line.
• Explore what the victim feels is the best solution.

• Help the victim formulate a plan of action: needed resources, specific actions and timeline. • Reaffirm the future and talk in hopeful terms.
• Arrange follow-up contact or visit with the victim.
• Follow through!

Determine the Meaning of the Event — Assist in offering opportunities for restoration and hope, and to find meaning in the traumatic event.
• Assist in allowing the victim/survivor to accept the reality and to experience the pain of the loss.
• Reassure the victim that s/he is not alone in suffering or in having fears.

• Assist in accepting a new normal and new reality, and the understanding or appreciation of beliefs and assumptions about our world.
• Allow questions about faith, God, spiritual issues. Address issues of forgiveness and anger. Determine how the trauma fits into the victim’s life.

• It may take some time for the victim to determine the meaning of the event.
• Help the victim/survivor withdraw emotional energy from the loss and reinvest it in other relationships and other
aspects of life. ABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCDABCD

Association of Traumatic Stress Specialists
“Recognizing Standards Of Excellence In Response, Treatment & Services” PO Box 2747 • Georgetown TX USA • 78627
512-868-3677 • 512-868-3678 fax • admin@atss-hq.com • www.atss-hq.com
©2002 ATSS • Reprint permissible providing acknowledgment is given to ATSS and authors.

Supported by the SC Department of Public Safety through Grant #1W0225.
The ABCD Model of Crisis Intervention was created by Romaine Edwards and Warren Jones;
revisions by David Lowenberg, Paul Forgach, Carol Hacker, PhD, Jayne Crisp, CTS, CVAS, Paul Hamilton, MDiv.

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Achieve a Relationship: Developing and Maintaining Rapport

Attending Behavior

Eye contact

Warmth

Body posture

Vocal style

Verbal following

Overall empathy

Questioning

Open-ended

Close-ended

Paraphrasing

Restating in own words

Clarifying

A close-ended question that serves to clarify what the client just said

Reflection

Painful feelings

Positive feelings

Ambivalent feelings

Nonverbal feelings

Summarization

Tying together precipitating event, subjective distress, and cognitive elements

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According to Swan (2017) "Crises are acute, time-limited events experienced as overwhelming emotional reactions to one’s perception of an event and are experienced by people of all ages, cultures, and socioeconomic conditions and may or may not be related to a specific mental disorder" (p. 1).  Swan (2017) described four types of crises:

1. Maturational Crises - predictable transitions experienced by individuals moving from one stage of human development to another (i.e., marriage, adolescence, midlife).

2. Situational Crises - sudden and unexpected events that threaten physical, social, and psychological aspects of an individual. (i.e., injury, death, divorce, violence).

3. Adventitious or Social Crises - rare and unexpected events of disaster such as floods, fires, riots, etc. Social crises may include acts of terrorism, assault, and rape.

4. Mental Illness Crises - individuals who are living with a mental illness who face non-life threatening situations or stressors that may become overly difficult to deal with. This type of crises can lead to risks of self harm or harm to others, substance abuse, and psychotic behaviors

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Stockholm syndrome is a psychological response that people often associate with infamous kidnappings and hostage situations. A person with Stockholm syndrome develops positive associations with their captors or abusers

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Human trafficking involves the use of force, fraud, or coercion to obtain some type of labor or commercial sex act.

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Human trafficking involves the use of force, fraud, or coercion to obtain some type of labor or commercial sex act.

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Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. 

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Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. 

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression

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Schizoaffective disorder is a chronic mental health condition characterized primarily by symptoms of schizophrenia, such as hallucinations or delusions, and symptoms of a mood disorder, such as mania and depression

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Traumatic events—such as an accident, assault, military combat or natural disaster. People with PTSD will have chronic symptoms of re-living the trauma over and over. ( Hypervigilance)

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Eating disorders such as Bulimia Nervosa, binge eating disorder and anorexia nervosa. 

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Eating disorders such as Bulimia Nervosa, binge eating disorder and anorexia nervosa. 

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The emotional symptoms of anorexia include irritability, social withdrawal, lack of mood or emotion, not able to understand the seriousness of the situation, fear of eating in public and obsessions with food and exercise.

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Obsessive-compulsive disorder (OCD) is characterized by repetitive, unwanted, intrusive thoughts (obsessions) and irrational, excessive urges to do certain actions (compulsions) (washing your hands over and over till your skin starts to peel)

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Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity.  ( It is no longer called ADD !!)

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Psychosis is characterized as disruptions to a person’s thoughts and perceptions that make it difficult for them to recognize what is real and what isn’t.  (symptom of Schizophrenia!!)

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Schizophrenia is a serious mental illness that affects how a person thinks, feels, and behaves. People with schizophrenia may seem like they have lost touch with reality,

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Bipolar disorder is a mental illness that causes dramatic shifts in a person’s mood, energy and ability to think clearly. People with bipolar experience high and low moods.

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 Anxiety- feelings of intense fear and distress become overwhelming and prevent us from doing everyday activities, an anxiety disorder may be the cause.

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 Anxiety- feelings of intense fear and distress become overwhelming and prevent us from doing everyday activities, an anxiety disorder may be the cause.