Crisis Intervention Protocols for Licensing Exams
Crisis intervention is heavily tested on all counseling and social work licensing exams. This cheat sheet covers crisis assessment, suicide risk evaluation, safety planning, and de-escalation techniques.
Definition of a Crisis
A crisis occurs when a person's usual coping mechanisms are overwhelmed by a stressful event, resulting in emotional disequilibrium. Key characteristics: it is time-limited (typically 4 to 6 weeks), the person perceives the event as threatening, usual problem-solving methods are insufficient, and the person experiences increased vulnerability but also potential for growth.
Crisis Intervention Models
| Model | Key Steps | Exam Notes |
|---|
| Roberts' Seven-Stage Model | 1. Plan and conduct a thorough assessment 2. Establish rapport and therapeutic relationship 3. Identify the major problem(s) 4. Deal with feelings and emotions 5. Generate and explore alternatives 6. Develop and formulate an action plan 7. Follow up | Most commonly tested crisis model; emphasizes assessment first, then rapport |
| James and Gilliland Six-Step Model | 1. Define the problem 2. Ensure client safety 3. Provide support 4. Examine alternatives 5. Make plans 6. Obtain commitment | Steps 1 to 3 are "listening" (nondirective); steps 4 to 6 are "acting" (directive) |
| ABC Model (Kanel) | A: Develop and maintain rapport (Achieving contact) B: Identify the problem (Boiling it down) C: Coping (explore current coping, develop new strategies) | Simple three-step framework; useful for brief crisis contacts |
Suicide Risk Assessment
| Risk Factor Category | Specific Factors |
|---|
| Demographic | Male gender, older adults (75+), White and Native American populations, LGBTQ+ youth |
| Clinical | Previous suicide attempt (strongest predictor), depression, hopelessness, psychotic symptoms, substance use, recent psychiatric hospitalization |
| Situational | Recent loss (relationship, job, financial), social isolation, access to lethal means, recent discharge from inpatient care, legal problems |
| Protective Factors | Social support, reasons for living, children in the home, religious/spiritual beliefs, therapeutic engagement, restricted access to means |
Assessing Suicidal Ideation: Key Questions
- "Are you having thoughts of harming yourself or ending your life?"
- "Do you have a specific plan?" (method, time, place)
- "Do you have access to [the identified means]?"
- "Have you made any preparations?" (giving away possessions, writing notes, putting affairs in order)
- "Have you attempted suicide before?" (number of attempts, methods, lethality)
- "What is keeping you safe right now?" (protective factors)
- "On a scale of 1 to 10, how likely are you to act on these thoughts?"
Safety Planning (Stanley and Brown Model)
- Warning Signs: Internal cues that a crisis may be developing (thoughts, images, moods, situations)
- Internal Coping Strategies: Things the client can do alone to take their mind off the crisis (relaxation, physical activity, distraction)
- Social Contacts for Distraction: People and social settings that provide distraction and support
- People to Contact During Crisis: Family members, friends, or professionals who can help
- Professional and Agency Contacts: Therapist, crisis hotline (988 Suicide and Crisis Lifeline), emergency services (911)
- Making the Environment Safe: Reducing access to lethal means (firearms, medications, sharp objects)
Mandatory Reporting Requirements
| Situation | Requirement | Key Details |
|---|
| Child Abuse/Neglect | Mandatory in all states | Report to Child Protective Services (CPS); based on reasonable suspicion, not proof; failure to report can result in criminal charges and loss of license |
| Elder Abuse | Mandatory in most states | Report to Adult Protective Services (APS); includes physical, emotional, financial abuse and neglect |
| Danger to Others | Duty to warn/protect (varies by state) | Tarasoff ruling; when client poses imminent threat to identifiable victim; may require warning victim, notifying police, or involuntary commitment |
| Danger to Self | Duty to protect | May break confidentiality to hospitalize client involuntarily if at imminent risk |
De-escalation Techniques
- Speak in a calm, low, steady voice
- Maintain a non-threatening posture (open body language, hands visible)
- Respect personal space (at least arm's length)
- Listen actively without interrupting
- Validate the person's feelings without agreeing with harmful behavior
- Avoid power struggles and confrontation
- Offer choices when possible to restore sense of control
- Set clear, simple limits on dangerous behavior
- Remove audience if possible
- Ensure your own safety first: never position yourself between the person and the exit
Exam Tips for Crisis Questions
- Safety is always the first priority; assess for lethality before processing emotions
- Ask about suicidal ideation directly; asking does not increase risk
- The strongest predictor of future suicide is a previous attempt
- "No-harm contracts" are NOT evidence-based and are NOT a substitute for proper risk assessment and safety planning
- Always document your assessment, interventions, and rationale
- Know your state's involuntary commitment criteria (typically: danger to self, danger to others, or gravely disabled)