Crisis Intervention with youth is far too vast a topic to do justice to in a short article. There are too many anecdotes, too many rules and laws to remember, too many configurations of teams in so many diverse programs and schools that do this kind of work to really cover it all adequately here. Instead, I will try to give a rough overview of the topic to give the reader a decent framework to begin operating from as he or she approaches this kind of work.
You Must Care
This is hard, often thankless work that most people don’t get fairly compensated for. If you signed up to work with young people who have major emotional and behavioral issues, you have an important job that can be highly stressful at times, and highly rewarding at other times. You will hear, see, and experience things most people have no frame of reference for understanding. You will meet people who have been through a lot of really horrible traumatic circumstances, and who may have committed horrible acts themselves. You have to care about the young people you work with, and you have to put your pride aside and make sure that the right thing happens every time. And you have to accept that the right thing doesn’t always happen every time.
When you are threatened, or even assaulted (being spat on or kicked for example), you have to remember that you have a job to do and people to keep safe. Taking it personal and not learning to cope with stress and emotions will lead to making mistakes, and a split second bad decision can lead to people being injured, property being destroyed, and you being handed your walking papers. Or worse. Lawsuits and jail time are not out of the realm of possibility. If you have become vindictive, careless, or are lying to cover your ass, you are making huge mistakes that can be costly.
My best piece of advice is to align yourself with whomever is a veteran of the program you work in who is ready and willing to show you by example the best way to do the work. I was blessed to be around a lot of people who knew very well how to do their job and I had a lot of support from coworkers and administrators.
Know Your Environment
You need to understand where you work. When you are part of a team you have backup, a closed in environment, and hopefully some consistent plans and strategies for preventing aggressive outbursts and dealing with unsafe situations as they come. You also have state and federal laws (HIPAA is an example), company policies and ethics, and the professional culture of your setting. Are you in a hospital setting? Partial-hospitalization? A behavior unit of a public or private school? A detention facility? You need to understand the setting and the options and limits you have when confronted with crisis. Otherwise, what you do could prove disastrous for you professionally and physically, and may have consequences for your co-workers and the young people you are responsible for.
Next you have to know the physical layout of the place you work in. You need to know where youth are allowed to go, where they aren’t allowed to go, where they like to hide or where stolen items might be stored, etc. You need to know what doors are kept locked at all times, where utility closets are and what is in them, and you need to be aware that objects that are available to be used as weapons may be. In my experience, the vast majority of occasions where a chair was grabbed or a stapler was held it was just a threat, but there have been times where the improvised weapon was used. Keep scissors in drawers if they are not being used, and be mindful of who is using whatever implement to participate in whatever activity.
Know Your Team
This makes or breaks everything. A good team always assumes that a solution is possible, that there is always room to improve, and that supporting each other is absolutely crucial. A good team consists of people who will put quality of work before any ego or recognition, and are always ready to help whenever possible. A good team builds rapport with each other proactively, getting to know each other and probably considers each other to be friends as well as work colleagues. They will listen to and protect each other, and will verbalize regularly that they are available to help in any way possible. Anything less means that “the inmates will run the asylum.” And if that happens, your job will become nearly impossible.
Synergy with team mates means we can communicate with non-verbals, we can predict each others’ intentions and actions, and we can monitor each other and step in and switch-out with someone to make a bad situation calm down. A lack of synergy means that we make decisions that undermine each others’ authority, and can show clients that we are not a unified front. Once that happens, there will be some who exploit the gaps in our cohesion. The manipulators are the ones that exploit these holes the most, and that creates more disunity within a team.
Team building exercises, retreats (we used to have a program wide camping in-service), and simply meeting after work for food and shenanigans can help a team build rapport. Joke, smile, and laugh whenever there is time for it.
Know Your Clients
Your setting may call them clients, consumers, students, or whatever term is most appropriate. In any case, knowing as much as you can about them is very helpful. New intakes are especially tricky if you have never read any of their information, and you have to be ready to deal with a client that behaves in a way that is totally inconsistent with what has been reported. Sometimes the previous staff who worked with a client, or their parent or guardian, has such a bad relationship that all they write is negative, and the client turns out to be genuinely good hearted, polite, and desiring to make positive changes. Other times someone will have completely omitted that the client has a history of sexual predation, a key piece of information that can completely change how he/she is monitored. I had teaching partners who had worked with adolescent sex offenders and were able to spot problem behaviors that were invisible to me at first. I heeded the warnings. It pays to listen even if you don’t always see what someone else is seeing. It probably protected some vulnerable clients.
For small children, crisis episodes tend to be high frequency, low intensity. This means that you may have to deal with lots of instances of verbal and physical aggression, but due to the size of the client, it presents a relatively low amount of danger (Danger is still danger. A 6 year old can still stab me with a pair of scissors). In adolescents, crisis episodes tend to be low frequency, high intensity. This means that the instances of verbal and physical aggression are low compared to very young clients, but are typically much more dangerous and volatile. These kinds of situations are the ones that may result in police intervention and can have a lot of spill-over into and from the community (i.e. gang related issues, neighborhood conflicts, etc.). This is a range of averages, and not any kind of perfect predictor of behavior in an individual young person. Read the files, talk to parents or guardians, and familiarize yourself with different behavioral profiles. A sexual predator has a certain list of personality traits and behaviors to look for. So does a neglected child or one who was beaten severely by an adult. No 2 clients are exactly the same, but you will see variations on themes if you stay with this kind of work long enough.
To understand the type of client that ends up in a program that deals with severe behaviors, whether this is a unit within a school or a residential facility or a youth detention facility, one has to have some background on the causes of the behaviors. The clients I worked with typically had a brutal trauma history, lived in economically depressed areas, and experienced marginalization due to cultural and racial factors.
As a result, the world in their experience was a small place where yelling, cursing, and aggression are cultural capital, and not being able to communicate with at least the threat of violence could and would lead to being bullied, jumped, robbed, and otherwise ridiculed. When we professionals are coming from very different environments than this, it can be difficult to understand the clients we serve. And understanding is key in helping them.
Cultural capital is a big deal. Most of my clients came from inner-city Cleveland, and most were African American. I came from the suburbs and was at least 7 years older than most of them when I started. I had to listen and observe them a lot to get a handle on the slang they used, the body language that told me that a fight was on (pulling up pants was an indicator that a fight-or at least grandstanding like tough guys-was about to happen), or what type of intoxicant they might have used before coming to school that day (this can be key, because what they used may have had some serious physical effects as well as mental.
An assumed increase in blood pressure and heart-rate due to drug use can change how we approach a physically aggressive person. A physical restraint could have dire consequences if a heart is already abnormally pounding out of a client’s chest). You have to piece together a puzzle sometimes. On client looks quizzically at his peer while another laughs at him. Another asks “you gone of that lean, ain’t you?” The client in question seems amped up. Is he high? What is our protocol when we suspect drug use in a client?
As you can start to see, lots of different kinds of knowledge and pieces of the puzzle begin to come together and overlap each other, and you have to gather all of this info in a short amount of time and already have in mind the policies and procedures for handling situations legally and ethically, all the while doing your best to keep everyone as safe as possible.
Other things to be aware of…has the client had neighborhood issues? Domestic abuse issues? A history of sexual or physical abuse? How stable is the current home environment? Has the client and his/her family had to move recently or frequently? Are there siblings or other family members living with the client? Are there any intellectual delays? Is the client currently medicated? What medicines is he/she on? What are the medicines for? And on and on…