Crisis intervention in the residential setting
Karen Isaacson wrote this article while a School Social Worker consulting in a child and youth care program
What is the rationale of crisis intervention or management? According to research and from the writer’s personal experience, those who are able to experience and express appropriate feelings of loss and anxiety are usually able to cope and grow through crisis — whereas those who can not often become fixated at a less adaptive level of managing crisis.
Each child who is placed in the residential home experiences some kind of loss, and with every loss there is an appropriate pattern of mourning or grief, which may include anger, depression or denial. With every loss there can be a gain, which comes from the experiencing of deep emotions. On the one hand, this gain can represent a frightening step forward into new territory for the child. On the other hand, when the child blocks or denies his feelings, these can channel inward to destructive anger or depression, with the care worker (or clinician if necessary) having to later "dig" these feelings out.
By definition a crisis means a loss, threat or challenge. In the present context a crisis can be described as a traumatic or unsettling event. At first the child may try to cope using his customary survival techniques. However, when these skills attemptst diminish his difficulty, he becomes increasingly vulnerable.
The elements of a crisis can be broken down into
a hazardous event
resulting in a physical or emotional reaction and confusion
which can’t be handled in the usual ways
so there is an increased anxiety and fear
and a searching for new ways for coping.
The crisis as a challenge
The Chinese idiogram or picture symbol for "crisis" includes the concept of opportunity for growth, for example, learning more adequate ways of coping. It is here that the element of challenge comes in. The danger is that, because the child is so stressed, he may withdraw, regress or become "ill" and cope in inappropriate and maladaptive ways. Worse, he may come to learn these ways of "coping" and habitually resort to similar methods in future.
Factors both within the individual and in the situation whether or not the child will be able to cope in a constructive manner. Individual factors include the child’s state of health, whether the child has coped constructively or destructively with past crises, whether the child is feeling good about himself at the time of the crisis, and how many crises the child has already experienced.
Situational factors include whether the child has support from others, whether there is someone objective and dispassionate with whom he may talk, whether the crisis occurs for the child individually or in a group of children, and the nature and extent of the crisis.
According to Erikson there are two types of crises, namely life crises which include actual losses such as death of a parent, and maturational (developmental) crises which include symbolic losses such as loss of trust. Erikson believed that children develop through stages and that in each stage the child can become unsettled due to the new and different demands made of him. The child is expected to learn and master certain tasks and skills in order to continue to develop healthily. As child and youth care workers, directors or social workers within a residential setting, some of the crises you are likely to encounter include:
admission of child into the program
feelings related to traumas, conflicts or failures
difficult or sudden separations
death of the child’s parent
theft or critical incidents within the home
weekend incidents or disappointments at home.
Coping with crises
What follows are some guidelines for care workers to assist in being helpful to children in crisis. These are of course only guidelines, not gospel!
Prevention: There are fewer crises when there is a high degree of teamwork and support, a predictable and organised routine and clear role and task definitions for staff. One should try to anticipate problem areas. New staff members should be properly oriented and be prepared for the situations they will be expected to handle. The staff’s training should convey an understanding of the child's needs at critical times. Such training should assist staff members in preparing for and coping with crises.
Attitude: Child care workers’ attitudes are important. They should attempt to view the crisis situation as a challenge and opportunity for learning and growth for themselves as well as for the child, because it is necessary for the care worker also to widen their skills. We know that when care workers feel endangered by a crisis they may unwittingly transmit an attitude of fear or panic to the child. This increases the child’s feelings of vulnerability and insecurity.
Learning from experience: Ideally, supervision provides the child care worker with the opportunity to examine his or her crisis-handling methods together with an experienced worker. Through this process they should be enabled to determine what works for them as individuals and what does not, and what they still need to learn.
Containment: The experience of deep emotion
can be frightening for children as they feel overwhelmed and
less-than-usually in control of themselves. It is often helpful for the
child care worker to separate a child from the stressful situation and
to provide boundaries and structure, for example by taking him to his
room. The purpose here, of course, is to shelter, not to punish.
Containment need not be physical; it can be verbal, for example,
confident words of control or reassurance.
Controlling the situation: At the time of the crisis the child is vulnerable and needs looking after. It may be that the care worker needs to "lend" his or her own controls (temporarily only) to the child.
Acknowledging feelings: The child is usually too emotional at this stage to discuss the crisis rationally. If he wishes to talk, the care worker should listen and help the expression of dominant feelings. This ventilation may be regarded as a release valve, since with the release of emotions the child’s rational powers are able once more to emerge. Often the hardest task for the care worker when the child is expressing deep feelings is to try not to take verbal abuse personally. It is common for the phenomenon of transference to occur amongst children who live in institutions. If, for example, Johnny’s mother has deserted him, in his emotional and irrational state he may view the care worker (particularly if she is female) as "mother", and "transfers" his feelings about his mother onto the care worker because he is unable to communicate these feelings to his real mother. Accusations such as "You don’*t care about me" are very often directed to the child care worker while really meant for the mother.
Putting feelings into words: The care worker can help the child to regain a sense of control by giving him words to describe his feelings. Saying "You must have felt very sad, upset, frustrated, cross achieves a lot. The child is reassured that such a human feeling is common to everyone, and that it is not "bad" to feel like that. Further, the child is offered words (more mature than destructive acting out of feelings) which help to "congeal" the flow of out-of-control feelings.
Outside help: It is acceptable and often appropriate for the care worker who is directly involved in a crisis situation to call in someone who is not emotionally involved to act as a mediator or sounding board.
Don’t add fuel to the fire: It is important for the care worker to recognise the situation as a crisis for the child and not in any way to increase the intensity of the crisis by being critical, attacking or punitive. Child and youth care workers may themselves often feel threatened by unexpected and frightening behaviour in individual children or groups. They can be tempted to want to seize control by shouting, pushing or otherwise raising the level of crisis. Usually an out-of-control child is feeling exceptionally exposed and overwhelmed, and he needs protection and support more than disapproval and abuse.
Space to solve the problem: Having allowed the child to ventilate and having assisted the child to think, the care worker should, at this point, step back and give the child the space and time to think and reflect and internalise what has happened. The child should not be pressurised into solving the problem at this point.
Follow up discussion: If a child is to learn anything from a crisis, it is advisable that later on there should be a "debriefing". Reconstructing and reviewing an event when it is no longer threatening serves to strengthen the child's cognitive processes. It is in this linking of the emotional experience with understanding that real learning and growth comes. It also demonstrates the ongoing concern the care worker has for the child and the fact that things are alright and the world hasn’t fallen apart reduces possible guilt feelings over things said and done, and reinforces the child’s confidence and hope.
Acceptance and empathy: It is important for the care worker to accept the child, his problem and the fact that he cannot cope with the problem at that time.
Care worker’s emotions: It is important for the care worker to be aware of his own emotions because they filter through to the child and affect his own performance. The care worker should use supervision, staff support and outsiders for this if necessary. All care workers have themselves experienced loss and crisis. Reflecting on this enables them to empathise and share feelings. The care worker needs to feel safe and comfortable in the type of work in which there may be many crises. The more anxious the care worker is, the more the child may be seen as threatening and disruptive rather than in need of personal support.
The purpose of crisis intervention is to clear and contain the turmoil so that the child can be safe to think and problem-solve and so learn more constructive coping means. Because crises are time limited, there is a tendency for equilibrium eventually to be restored even without our intervention. But to distance ourselves from crises, and to say "He will get over it", is to forego invaluable opportunities for growth and learning, and this we do to our cost, for the child will not improve.
Golan, N. Treatment in Crisis Situations. The Free Press, New York, 1978.
Fassler, J. Helping Children Cope. The Free Press, New York, 1978.
Erikson, E. Childhood and Society. Norton. New York. 1950