Tuesday, September 23, 2014

Crisis Response

1.    Provide both an objective (from a source e.g. dictionary, textbook) and subjective definition (in your own words) for the following terms: "crisis" and "precipitating event." (minimum 50 words each, excluding the objective definitions)
Crisis:  a difficult or dangerous situation that needs serious attention (Merriam-Webster.com).  A crisis is any sort of challenging event that causes an intense emotional or mental reaction for a person or group of people who are involved with the event. These occurrences can vary greatly in both cause and reaction, as does the severity, but they all create situations that need to be addressed and resolved in some way. 
Precipitating event:  a perceived loss or traumatic experience that produces intense anxiety and dependence on problem-solving skills (Crisis Center of Birmingham).  Essentially, a precipitating event is the perceived cause of a problematic situation for a person.  “If there is no resolution and the tension builds to a peak, then a precipitating factor may touch off the crisis” (Kennedy and Charles 389).  This issue may be a single event or it can be a combination of multiple events that have built up to a breaking point for someone.  The precipitating event is not something that is always easy to determine, especially if it is a situation or circumstance that has developed over a longer period of time.

2.    Describe at least three different categories of emergency situations and provide a clear example of each. Please ensure you include a source citation. (minimum 50 words each).
There are three primary types of emergency situations that can lead to a crisis in the lives of people.  These three categories are: intrapersonal, somatic complaints, and interpersonal (Kennedy and Charles 392).  Each of these types of emergency situations has unique factors that can lead to issues for some people.
a.     Intrapersonal – Intrapersonal emergency situations involve crises that are developed based upon internal issues for that person.  The most obvious example of this type of emergency situation would be severe depression or anxiety.   This type of crisis may be caused by the loss of a loved one, loss of a job, or various other situations that can cause emotional reactions within a person.
b.    Somatic Complaints – Somatic complaints are physical symptoms perceived by persons that seem to have no medical cause.  These types of situations are physical manifestations of depression or anxiety. Somatic complaints can appear as anything from headaches and stomach pain to conversion disorder which causes hearing or vision loss.  It can also manifest as hypochondria, which is a disease in which a person who frequently believes they have a serious illness when there is nothing physically wrong with them.
c.     Interpersonal – Interpersonal emergency situations are situations where there are “significant outside players” (Kennedy and Charles 392) that cause a person anxiety.  People outside of the victim cause this anxiety, frequently because the effected person is concerned with the actions and behaviors of the other person or people.   This is seen most commonly in situations where someone is abused or bullied such as a victim of spousal abuse. 
3.    Describe at least five possible events or situations that may cause an individual to experience a crisis in his or her life. (minimum 100 words).
There seems to be a nearly infinite number of situations and events that can cause someone to experience a crisis in their life but here are a few examples of possible triggers:
a.     The loss of a loved one (Caruso, Suicide Causes).  Everyone deals with grief differently, but for some people the loss of a loved one can cause significant anxiety and stress.  They may have trouble accepting that the person is gone and may not be able to adapt to life where their loved one is no longer around.
b.     The loss of a home (Caruso, Suicide Causes).  Home is a place where people are supposed to feel safe so if someone loses their house, either through natural disaster such as a tornado or fire, or through a financial loss such as foreclosure, it can be very traumatic. 
c.      The loss of financial stability (Caruso, Suicide Causes).  We live in a society where finances are very important and stressful in every adult life.  When someone loses their job this can lead to them experiencing other issues and can definitely lead to a crisis. 
d.     Personal identification issues (Illinois Department of Public Health).  As humans we are typically our own worst critics.  Someone who is having issues with their gender or sexuality may face feelings of discomfort, depression, and self-doubt.  These feelings may cause other issues for them, including a crisis of identity.  
e.     Situations of abuse (Caruso, Suicide Causes).  Someone who is experiencing any sort of abuse, including bullying, sexual harassment, or spousal abuse may find himself or herself in a situation where they no longer know how to cope with the problem.  This can also lead to a crisis where they feel helpless and lost without guidance on how to remedy the situation.
4.    Discuss how an individual's ability to appropriately cope and/or problem solve may be affected by crisis and explain the process you would use to assist this individual. (100 words)
When a person experiences a crisis they often feel lost and confused.  Frequently their view of the world around them changes and they no longer understand how to properly function in order to cope with situations.  This type of confusion can definitely make it difficult for someone to resolve problems without help and can definitely stop people from using appropriate coping mechanisms (Kennedy and Charles 394).  In these types of situations people are often faced with difficult decisions to make, which can lead to a deeper feeling of bewilderment and make it even more difficult to cope with a crisis.
In these types of circumstances it is important to understand that everyone reacts to crises differently. One of the most important parts of intervening in a crisis is understanding this and being able to assess the situation to see if the coping that is happening is appropriate to the situation (Dass-Brailford 97).  You also have to keep an open mind to be able to listen to the person and help them resolve issues they may be facing. However, it is also important to be able to recognize when a person is not reacting to a crisis in a way that is healthy, and to be willing to make referrals to a professional if they need more help than you can give.  It is very important to be able to know your own limits while also providing support to the person in need.
5.    List and discuss at least five suicide warning signs. Explain how you would respond if you were assisting an individual exhibiting one or more of these signs. (minimum 50 words each warning sign and minimum 100 words for response).
Just as there is a huge difference in how people may react to a crisis, there are also many different ways that someone may display suicide warning signs.  Here are a few signs that are present in people who contemplate or attempt suicide that I found on suicide.org:
a.     Feeling helpless or hopeless.  Everyone has times in their life where they feel sad.  However, if someone consistently appears to feel hopeless or helpless, or frequently appears to be sad or depressed they may be experiencing intense feelings of depression.   Untreated depression is the number one cause for suicide (Caruso, Suicide Warning Signs), so it is important to recognize when someone is suffering from something more than the normal “blues” we all experience.
b.     Changes in personality (American Association of Suicidology).  Someone who is contemplating suicide may often behave in ways that are not typical for them. A straight-A student may fail multiple tests or quit studying all together.  Someone who is very personable may act very withdrawn or anti-social.  They may also experience extreme mood swings, including periods of rage and anger, that seem to be unprovoked or an overreaction to small issues.
c.      Acting impulsively (Melinda Smith).  Someone who is thinking about suicide may also begin to act impulsively and behave recklessly without considering long-term consequences of their actions. These behaviors may include the abuse of drugs and alcohol as well as other irresponsible habits. This type of warning sign may be harder to see in someone who is naturally a thrill seeker, but may be much more obvious in someone who usually plays by the rules.
d.     Changes in diet or sleep (Caruso, Suicide Warning Signs).  Depression frequently effects both diet and sleep habits of people who suffer from it.  This is frequently true in people who go untreated for a long period of time.  Both of these changes can occur in either excess or deficiency.  Someone may begin eating too much, or they may starve themselves.  The same extremes can be seen with sleep.  They may sleep much more than needed, or they may suffer from insomnia where they go without sleep frequently.
e.     Losing interest in activities (Caruso, Suicide Warning Signs).  Someone who has been passionate about activities and suddenly seems to lose interest in those things may be suffering from depression or contemplating suicide.  They made decide to no longer participate in something they have been actively involved with for a long time.  They may also give away their favorite possessions to people. 
Responding to people who are experiencing these types of warning signs can be very tricky.  You want to be able to comfort the person and make them know they are cared for, but you also want to make sure that they get the help they need. The first thing you need to do is make an assessment as to how serious the person is contemplating suicide.  If I felt that the person was contemplating suicide as a serious option I would definitely call 911 to get emergency help for the person.  However, as the severity of things decline, so should the responses.  If someone is depressed, recommending that they seek help while also offering to be someone who is there to talk to them and listen to them could be helpful.  Giving them tools such as suicide hotlines and organizations that may help them address their personal problems.  It is also important to understand my own limits and to know where I need to draw boundaries and understand when professional help is necessary. 
6.    Choose four of the seven common misconceptions about suicide from the list below and discuss why each is a misconception. (minimum 50 words each)
a.              People who talk about suicide won't really do it.
Many people who attempt or commit suicide have talked about it with someone before they act. Talking about suicide is a call for help and should always be approached seriously.  Often they are in pain and reaching out for help because they don’t know how else to cope (helpguide.org).  Don’t be afraid to talk to someone about how they are feeling and guide them to get help.
b.              Anyone who tries to kill himself/herself must be crazy.
People who attempt suicide are not just crazy.  They may suffer from mental illness, or they simply may be feeling overwhelmed in their life and see no other way out. Someone who attempts suicide may be dealing with grief, depression, despair, or any other sort of emotional pain but this does not necessarily mean they are suffering from mental illness (helpguide.org).
c.               People who commit suicide always leave notes.
            Few people commit suicide without first letting someone else know how they feel.  However, statistics show that discussing the act beforehand does not mean that they will leave a note if they decide to attempt to take their own life. In fact, a study by Canadian researcher Dr. A. Leenaars estimates that only 12 to 37% leave notes (Distress Centre Oakville).
d.              After a person has attempted suicide, it is unlikely he/she will try again.
            80% of the people who die from suicide have made at least one previous attempt (Tennessee Suicide Prevention Network). This statistic alone speaks volumes.  People who have reached a point in their life when suicide is an option are not instantly healed if they have made the attempt and survived.  They still need treatment, support, and healing.

7.             Discuss why an individual in crisis might seek an ADF clergy person for help and explain whether or not you feel this is an appropriate function for ADF clergy, why or why not? (minimum 200 words)
            We live in a society where we have been taught that clergy is a place to turn for guidance, assistance, and confidential communication.  Many modern religions use their clergy to provide counseling and therapy for individuals and groups.  Some churches even require counseling sessions with a member of clergy before they will perform certain rites for their members.  This standard in our culture makes it so people often look to clergy for guidance and help with personal issues.  If someone is a member of ADF, or lives in a place with very few Pagan clergy options, they may choose to approach an ADF clergy member to try to help them work through their crisis.
            Approaching an ADF clergy member is something that people may do for numerous reasons.  First, ADF clergy are trained in a way that very few other Pagan clergy will be.  They are expected to do research into not only our own spiritual path, but also the path of many different Indo-European cultures.  We are expected to have at least some knowledge on numerous things, including magical workings, rituals, liturgy, ethics, and divination.  This gives us a diverse set of tools in which they can draw upon to work with someone in need. 
            Another reason that someone may approach clergy from ADF is our work with re-establishing order within our rituals.  The ADF Core Order of Ritual is based around the idea of establishing a Sacred Space in which we (re)create the cosmos and bring chaos back into order.  This tool alone may be very useful for someone who feels that his or her life is out of control.  It gives ADF clergy a tool that they can teach others to use in order to help balance their own life. 
            I think that assisting people in crises is something that is important for ADF clergy to do.  The Pagan community does not have many clergy options, and many of those who are legal clergy have little or no training in how to help people in these types of situations.  Being able to help people in the community in this way is very important.  However, it is also important that clergy know their own personal limitations, as well as the legal limitations for clergy in their area.  Reporting laws should also be reviewed and followed any time you are dealing with allegations of abuse or illegal actions.
8.             Discuss an example of a crisis situation to which you have responded (this may be a crisis you have personally experienced or an experience in which you tried to help someone else in crisis). Reflect upon your response to the crisis in your example, and explain what you found effective, as well as how you could have improved your response to this situation. (minimum 200 words)
            Crisis is something that I am more familiar with than I would like to admit.  I’ve found myself dealing with crisis situations throughout my life, which gives me a vast experience to draw upon.  However, one situation that sticks out in my mind the most would be the loss of one of my closest friends.
            When I was 18 years old, I received a phone call from my best friend to tell me that his younger brother had passed away.  The boy was only 16 years old and had been killed unexpectedly in a car accident, so the family was devastated.  My friend and his brother had been a part of my life since I was in elementary school, so the loss was very hard for me.  We grew up like family, so it felt like I was losing a member of my own family.  They lived 8 hours away, but I knew that I needed to be there to help support his family and take care of the things they couldn’t manage on their own.  I showed up and was there to comfort the family, and help make decisions that they couldn’t yet face.  I spent hours with my best friend, sharing memories of his brother, letting him cry, and providing comfort the best I could.  I cooked meals for the family, cleaned up messes left by other visitors, and helped pick photos for the funeral slide show.  After the funeral, I returned home but I continued to check in with the family, talk to them, and visit them as much as possible so they knew I was always there. 
            Overall, I think my approach was decent and appreciated, especially considering that I was only 18 years old myself.  The family was extremely grateful for my help and I know it meant a lot to have a group of people to help, love, and support them during their crisis.  However, I also know that I was grieving as well at the time, so I’m sure there were times where my pain made me less than productive in the situation.  This crisis was one that was near to my heart, so I don’t think my grief was inappropriate, but I do think that handling a situation without that grief involved would make it easier for both sides.
9.             Discuss how the skills required of ADF clergy in ritual, especially those which involve mitigating chaos and generating order, might relate to those necessary for appropriately responding to an emergency situation (minimum 100 words).
Before I started this course I had never really considered how mitigating chaos could be effective for emergency response, but it absolutely makes sense. Creating order in ritual is something that we do by establishing a Sacred Center and connecting the cosmos. Within ADF, the establishment and reinforcement of order is one of the main functions of a ritual (Fickett-Wilbar). We strive to find balance and align ourselves within the world during ritual.  Individual crises are typically caused by chaotic or unexpected events in someone’s life.  By learning how to effectively find balance in the chaos and bring order to situations that may otherwise seem haphazard could be a useful tool in working with someone who is experiencing a crisis.  It may also be helpful to the person responding because they then have the knowledge to balance himself or herself in the midst of the chaos the other person is experiencing so they don’t also become overwhelmed by the situation.
10.          Compile and submit a list of mainstream resources providing crisis services available in your locality. Additionally, explore your locality for a hotline number to access emergency services and discuss the results of your search. (Please provide the following information for each resource listed a) name of resource b) contact information c) how to make a referral d) hours of operation e) specific service[s] provided by the resource). (no minimum word count)
Researching resources for these different types of crisis has definitely made me grateful for the Internet.   There are numerous options for both local and online resources, but finding legitimate local organizations does take some time.  However, I was pleasantly surprised at how many 24-hour hotlines we have available in Omaha.  My own concern is that there isn’t any sort of “generic” hotline and each one is typically dedicated to a specific need.  The list below is definitely not all of the options available, but does cover some of the most popular options in my area.
a.              Suicidal Thoughts
                                    Boys Town Hotline
                                    24 Hours/Day – 7 Days/Week – 365 Days/Year

                                    Lasting Hope Recovery Center
                                    24 Hours/Day – 7 Days/Week – 365 Days/Year
·      Care for patients experiencing mental illness and multi-occurring substance abuse disorders.
·      Law enforcement has a psychiatric "home-base" for people experiencing a crisis because of their mental illness.
·      Family support.
·      Provides treatment to adults with emergency psychiatric concerns and follow-up care

Referral Process:  Call the Assessment Center at (402) 717-HOPE (4673) or 1-800-523-7294.

b.              Mental Illness
                                    Alegent Creighton Mental Health Services
                                    Inpatient & Outpatient Services with misc. hours
·      Child, Adolescent, Adult, and Senior Care
·      Inpatient Services
·      Outpatient Clinics
·      Partial Hospitalization
·      Home Care

Referral Process:  Call the Assessment Center at (402) 717-HOPE (4673) or 1-800-523-7294.

                                    Douglas County Community Mental Health Center
                                    Monday through Friday, 8am-5pm
·      Adult Care
·      Inpatient Services
·      Intensive Care Unit
·      Outpatient Program
·      Day Treatment Program
·      Mental Health Diversion Program
Referral Process:  Call 402-444-7930 to speak to someone who will help you to determine if you meet criteria and will assist you in scheduling an appointment.

c.               Substance Abuse (addiction)
                                    Addiction & Recovery Services
                                    Hours: By Appointment
·      Substance Abuse Counseling & Addiction Therapy
·      Alcohol/Drug Evaluations
·      Family Consults & Intervention Planning
·      Co-Dependency Treatment

Referral Process:  Call (402)510-1754 to schedule an appointment.

                                    Heartland Family Services
                                    (402) 553-3000                  
                                    Hours: Vary by location
·      Outpatient intensive substance abuse treatment
·      Community Substance Abuse Prevention Coalitions
·      Substance abuse & gambling evaluations
·      Problem Gambling Treatment
o   24-Hour Crisis Line: (866)3225-1407
·      Adolescent Substance Abuse Treatment
o   Individual & Family Therapy
o   Relapse Prevention Groups
o   Adolescent Education Group
o   Support Groups
·      Adult Substance Abuse Treatment
o   Outpatient Treatment
o   Residential Substance Abuse Treatment
o   Transition skills for incarcerated women.

Referral Process:  Call (402)552-7400 to schedule an appointment

d.              Financial Issues
                                    Omaha Housing Authority – Family Self Sufficiency
                                    Hours: 8am-5pm
·      Help Gain Employment
·      Skill Training
·      Housing Assistance
·      Case management & Advocacy

Referral Process:  Complete the Pre-Application Process form online to see if you qualify. 

e.               Homelessness (lack of shelter, food, clothing, other basic needs)
                                    Siena/Francis House
                                    Hours: 24 Hours/Day – 7 Days/Week – 365 Days/Year
·      Women & Children’s Shelter
·      Men’s Shelter
·      Homeless Veteran Assistance
·      Food & Clothing
·      Employment Training & Education
·      Health Care Clinic
·      Supportive Apartments

Referral Process:  Walk-Ins welcome.  Shelter check-in after 4:30pm. 

                                    Stephen Center
                                    (402) 731-0238
                                    Hours: 24 Hours/Day – 7 Days/Week – 365 Days/Year
·      Emergency Shelters
·      Transitional Living
·      Thrift Store
·      Substance Abuse Treatment Center

Referral Process:  Walk-Ins welcome.  Shelter check-in after 4pm. 

                                    Food Bank for the Heartland
                                    Hours: 7:30am to 4:30pm.  Mobile Pantry hours vary
·      Kids Café
·      Backpack Program
·      Mobile Pantry
·      SNAP

Referral Process:  Call 211 to contact the United Way for information

f.               Suspected Abuse of the Individual's Child(ren)
                                    NE Dept. of Health & Human Services –
                                                Division of Children & Family Services
                                    Abuse & Neglect Hotline:  (800)652-1999
                                    Hours: 24 Hours/Day
·      Ensure abused, neglected, dependent or delinquent populations are:
o   Safe from harm
o   In a permanent, healthy environment
o   With a stable family
o   Helped to heal from harmful events
·      Juvenile delinquent services
·      Truancy management

Referral Process:  Call the Abuse & Neglect Hotline (800)652-1999.  For emergency assistance call 911.

g.              Criminal Victimization (victims of theft, sexual assault, etc.)
                                    For emergencies, call 911
                                    Friendship Home
                                    Hours: Shelter 24/7, Office 8am to 5pm
·      Emergency Hotline 24/7
·      Pre-Shelter Services such as counseling
·      Confidential Shelter offering food, clothing, and shelter
·      Case management & advocacy
·      Support Groups
·      Economic Self Sufficiency
·      Children Services
·      Education & Outreach

Referral Process:  Call the hotline to access shelter information

                                    Douglas County – Victim Assistance Division
                                    Hours: VINE Services 24/7, Office Hours 8am-5pm
·      Supportive Listening
·      Victim Compensation
·      Cell Phone Program
·      Case Status Information
·      Victim Assistance with Court Cases
·      Agency Referral
·      Victim Information & Notification Everyday

Referral Process:  Email or call the department for services

h.              Grief (resulting from death, terminal illness, divorce or other loss)
                                    Alegent Bereavement Support
                                    Hours: Hours vary by service
·      Grief Support
·      Weekly meetings
·      Monthly lunch
Referral Process:  Call (402)898-8000 and request a bereavement counselor

                                    Parents of Suicide Together (POST)
                                    (402) 556-7307
                                    Hours: Meetings Tuesday @ 7pm, Saturdays @12:30pm
·      Individual Counseling
·      Support Groups
·      Educational Resources
Referral Process:  Call (402)556-7307 for information

                                    Centering Corporation
                                    (402) 556-7307
                                    Hours: 9am to 4pm
·      Quarterly magazine
·      Education & resources for bereaved
·      Workshops
·      Cards, books, and DVDs
Referral Process:  Call (402)556-7307 for information


American Association of Suicidology. Know the Warning Signs of Suicide. 2014. September 2014 <http://www.suicidology.org/resources/warning-signs>.

Caruso, Kevin. Suicide Causes. September 2014 <http://www.suicide.org/suicide-causes.html>.

—. Suicide Warning Signs. August 2014 <http://www.suicide.org/suicide-warning-signs.html>.

Crisis Center of Birmingham. What is Crisis? 5 January 2012. August 2014 <http://www.crisiscenterbham.com/images/pdfs/3-Crisis_Intervention.pdf>.

Dass-Brailford, Priscilla. A Practical Approach to Trauma. Sage Publications, 2007.

Distress Centre Oakville. Suicide Myths & Facts. 2014. 2014 <http://www.distresscentreoakville.com/suicide-myths-facts.php>.

Fickett-Wilbar, David. Cosmos, Chaos, and the ADF Priest. September 2014 <https://www.adf.org/articles/cosmology/cosmos-and-chaos.html>.

helpguide.org. Suicide Prevention. August 2014 <http://www.helpguide.org/mental/suicide_prevention.htm>.

Illinois Department of Public Health. Sexual Orientation, Gender Identity, and Youth Suicide. March 2011. September 2014 <http://www.idph.state.il.us/about/chronic/Suicide_Sexual_Orientation_in_Youth.pdf>.

Kennedy, Eugene and Sara C. Charles. On Becoming a Counselor. The Crossroad Publishing Company, 2001.

Melinda Smith, M.A., Jeanne Segal, Ph.D., and Lawrence Robinson. Suicide Prevention. July 2014. <http://www.helpguide.org/mental/suicide_prevention.htm>.

Merriam-Webster.com. "Crisis". August 2014 <http://www.merriam-webster.com/dictionary/crisis>.

Tennessee Suicide Prevention Network. tspn.org. 2013. August 2014 <http://tspn.org/myths-about-suicide>.

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