4.2 Crisis Cycle

Situations that could trigger a resident

  • Court Appearance
  • Visits
  • Mail
  • Phone Calls
  • Intimidation & Pressure
  • Felony Arrest
  • Lack of Outside Contact
  • Recent Loss
  • Bad News from Home
  • Argument with Peers
  • Therapy Session
  • Recent Suicide in the Unit

Behaviors that could indicate that a resident is in crisis

  • Non-Compliance
  • Picking fights
  • Instigating
  • Rise in Voice Level
  • Hysteria
  • Violence
  • Silence
  • Depression
  • Crying
  • Withdrawal
  • Demanding Attention
  • Preoccupation with Death/Suicide
  • Drug withdrawal
  • Belligerent/Oppositional Behavior

Verbal Stages of Staff Response during crisis

Trigger Stage:

  • Generic Reminders – “There is no talking during…”
  • Specific Reminders – “Resident Garcia, there is no talking…”
  • We cannot control the behavior of another person but we can control our response to that behavior.
  • We can escalate or deescalate a situation by our approach 
  • Give personal space – watch change in behavior 
  • Non-verbal communication – body posture, tone of voice & facial expressions 
  • Be supportive, calm, flexible, validate feelings and plan ahead.

Escalation Stage:

  • If/then statements, also known as limit setting statements - “If you don’t stop talking, then… will happen.”

  • Set limits, offer choices but not too many, consequences and state positives 1st, give them control.
  • Do not get into a power struggle, simple clear instructions, be reasonable 
  • At this stage: challenged behavior, don’t listen, loss of rationality, loss of self-control, reasoning skills, increased blood pressure, adrenaline, name calling, refuse directives, loss of compromise. 

Also consider removing the resident from the group setting

Late Escalation:

  • If they refuse to comply due to an escalating behavior try staff switching.

Crisis:

  • If you are at this stage the resident is in full blown crisis. 
  • Most likely not listening and cannot communicate their needs. 
  • Offer supportive information, clear and concise directives. 
  • Only one staff should be giving these directives

Recovery Stage:

  • Occurs when the crisis is over and the resident begins to calm down 
  • Limit setting instructions are helpful in this stage as well

Post Crisis Resolution:

During this stage, the communication should be supportive and active listening skills are important. The resident should be able to share their perspective on the incident. Then staff and resident should identify the trigger and let the resident formulate a plan, a Post Crisis Resolution. This conversation is also known as the Post Crisis Interview.

  • Maintain supervision to make sure the resident isn’t feeling depressed or suicidal. 
  • Would Sympathy or Empathy be better to apply here?
Crysis cycle: trigger, escalation, crisis, recovery, post-crisis resolution