Crisis Intervention Skills
- Explain the concept of a crisis and its characteristics.
- Identify factors that can contribute to a crisis in patients.
- Name the four main types of crisis patients may experience.
- Identify warning signs of crisis in your patients.
- Describe how CHWs work with the care team to handle crises.
You are not alone in this
Sometimes CHWs face situations requiring immediate action to prevent harm to the patient or others. Dealing with a crisis is stressful — especially when safety is at risk.
This lesson is a brief overview. Your employers will provide more detailed training on crisis intervention.
A scenario
The sun is just rising, and you receive an urgent call. A family in your community is in turmoil. The father, a patient you've been working with, recently lost his job. His drinking and violent outbursts are adding fuel to the fire. Last night, he punched a hole in the wall, frightening the children. They're on the brink of losing their home. The mother confides in you, expressing her fear that if he doesn't secure a new job soon, his aggression might escalate toward her.
So, what do you do? How do you respond? As a CHW, you're often the first line of defense.
What is a crisis?
A crisis occurs when someone is going through a difficult time and their usual ways of dealing with problems no longer work. It's a stressful situation that requires immediate help to manage.
Factors that contribute to a crisis
Factors that contribute to a crisis
Which statement best describes when a difficult situation becomes a crisis?
Four types of crises CHWs may encounter
The four main crisis types
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Recognizing a mental health crisis
Actions, feelings, and behaviors that may lead to harm — to self, others, or daily functioning, or that make it hard to take care of oneself or function in the community.
7 NAMI warning signs of a mental health crisis
Inability to Perform Daily Tasks
Struggles with basic self-care: bathing, dressing, eating.
Emotional signs to watch for
Self-injury and suicide
Self-injury
Self-injury (Mayo Clinic) is purposely hurting one's own body, such as cutting or burning. It is usually not life-threatening — rather a harmful way to cope with deep emotional pain and find temporary relief. It is usually done alone in a controlled or ritualistic manner.
Examples of self-injury
- Biting, scratching, or cutting the skin
- Carving words or symbols into the skin
- Burning the skin with matches, lighters, cigarettes, or candles
- Burning the skin with heated sharp objects
- Hitting oneself, punching, or banging the head
- Piercing or inserting objects under the skin
Suicide warning signs
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When patients threaten others
These are direct threats — or behavior with a high likelihood of causing another person harm. Recognizing that a patient might pose a threat to someone else is complex and is not the CHW's responsibility alone. Involve the care team.
Easiest indicator
If your patient says — directly or indirectly — that they want to harm somebody.
Other things to watch for
- History of mental illness, substance abuse, or interpersonal violence (as victim or perpetrator)
- Anxiety symptoms along with aggression, agitation, or desperation
- Problems controlling impulsive actions or feeling superior to others
Older adult and dependent adult abuse
This includes physical, emotional, or sexual harm — plus financial exploitation and neglect. The abuser is usually the person directly responsible for the adult's care.
In California: older adults are those aged 65+, and dependent adults are individuals aged 18-64 who are disabled. When these adults are unable to care for themselves or are victims of abuse, county Adult Protective Services (APS) must be notified to investigate and respond.
8 types of abuse recognized by California APS
California APS — 8 types of abuse
How to navigate a crisis
Before initiating a conversation, ask yourself
- Is the person in immediate danger of hurting themselves, others, or property?
- Do you need emergency assistance?
- Do you have time to call another member of the care team or your supervisor for guidance or support?
A person in crisis can't always clearly communicate. They may find it difficult to understand others. Empathize. Stay calm.
The 4 steps of navigating a crisis
Step 1: Discuss Signs of Crisis with the Patient
- ✦Don't hesitate to talk about what you've noticed
- ✦Mention specific signs that worry you
- ✦Use observable behavior, not judgments
"I've noticed you've been talking about having trouble sleeping." · "It's clear you've been crying a lot lately. Can we talk about what's going on?"
Empathy phrases
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Before initiating a conversation with a patient who may be in crisis, which questions should you ask yourself? Select all that apply.
Match each crisis type with its description.
🌟 Lesson takeaways
Crisis intervention is one of the most serious situations CHWs encounter, and a good foundational knowledge of the signs is essential. We covered four major crisis types: mental health crisis; self-injury and suicide; threat of harm to others; and older / dependent adult abuse. CHWs are not responsible for solving a crisis — but you should know how to recognize and respond to one, how to communicate with patients in crisis, and how to gather enough information to determine a course of action. Always refer to your organization's protocols, and always partner with the care team. If you or someone you're with is in crisis, dial or text 988.
At the end of this module, you'll join a live discussion with your cohort and an instructor. Great work — we'll see you there!