Crisis Management presentation
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How to manage a crisis in instances of suicidality, homicidality & engaging Child Protective Services.
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Crisis Management presentation
- 1. Crisis Management: Suicidality, Homicidality & CPS Dr. SOS Executive Director of Community Wellness at The Mount
- 2. What is a crisis? A condition of instability or danger, as in a social, economic, political, or international affairs leading to a decisive change; a dramatic emotional or circumstantial upheaval in a person’s life (dictionary.com)
- 3. Who determines if a situation is a crisis? The person who experiences it May feel ill-equipped/ill-prepared to manage it
- 4. Crisis we are most concerned about... Suicidal and homicidal threats Child Protective Service concerns
- 5. Ideations vs Declarations Ideations I would be better off dead. I just want to die. Declarations I’m going to kill myself. When I see him, I’m going to kill him.
- 6. Assessing for Suicidality & Homicidality History - previous attempts Intent - how certain is the person that this is something they actually intend to do Plan - has the person devised a specific plan to follow through with their intent to harm Access - does the person have access to materials to follow through with the plan
- 7. So you say you’re going to kill him...& you mean it! Foreseeable victim Name Reasonable Identity Duty to Warn Breach of confidentiality Warn intended victim(s)
- 8. How do we warn? Disclose the limits of confidentiality Inform of duty to warn Determine if other protective services need to be contacted Contact Executive Leadership Document your interactions and responses
- 9. I think she’s suicidal... Willingness to act or motivation to die Reasons for wanting to die Preparation to act Prep and rehearsal behaviors
- 10. I think she’s suicidal... Capability to act Previous attempt or self harm behavior Experience of trauma Barriers to act Reasons for living Faith beliefs
- 11. I think she’s suicidal... Subjective intent What she says Objective intent What she is doing or planning on doing Hopelessness
- 12. Risk Factors Biopsychosocial Mental disorders (mood disorders, anxiety disorders) Alcohol and other substance use disorders Impulsive/aggressive tendencies Physical illness Family history
- 13. Risk Factors Environmental Job/financial loss Relational or social loss Easy access to lethal means Local clusters of suicides (contagious influence)
- 14. Risk Factors Social-cultural Lack of social support Stigma associated with help-seeking behavior Barriers to accessing health care Certain cultural/religious beliefs Exposure to others who have died by suicide
- 15. Risk Factors Demographic American Indian/Alaska Natives; White Male 15 - 24 y.o. Divorced (men)
- 16. He is suicidal...now what? Priority: Keep him safe Remind him of the limits of confidentiality (if applicable) Try to get him to agree to getting help (asap) Do NOT leave him alone
- 17. He is suicidal...now what? Suggest he contact a doctor or go to the hospital immediately Contact a family member or other supportive person who can meet him and take him to the hospital Call the community services board and they can assess and set up supportive resources
- 18. He is suicidal...now what? Call 911 (if needed) Contact Executive Leadership Document your interaction
- 19. Somethings to keep in mind... Most suicidal people want to live Some suicidal people are determined to end their lives We are limited in what we can do We are not personally responsible for what someone else is determined to do Remember the power of PRAYER
- 21. Mandatory Reporters Virginia Law Enforcement Teachers Health/Mental Health Care Social Workers ME or Coroners Child Care Providers Clergy (privilege)
- 22. Privileged Communications Clergy (Virginia) Have the right to maintain confidential communications between professionals and their congregants The requirement to report shall not apply to any regular minister, priest, rabbi, imam, or duly accredited practitioner of any religious organization or denomination usually referred to as a church
- 23. Mandatory Reporters North Carolina Everyone is a mandatory reporter...if you suspect child abuse, you “shall” report
- 24. Reporting Requirements Virginia Can be anonymous (would prefer name) Reporter confidentiality maintained (unless suspected false report) North Carolina Must include name, address, telephone number of reporter Reporter confidentiality maintained
- 25. CPS vs Criminal Report We are only required to report to CPS A CPS issue exists if... Abuse perpetrated by an individual serving in the role as a care giver at the time of the abuse Criminal issue exists if... Abuse perpetrated by a non care-giver
- 26. If you suspect child abuse... Assess the level of danger for the child and do the following in the order most appropriate based on safety concerns for the child Notify parent/guardian Encourage parent/guardian to contact CPS
- 27. If you suspect child abuse... Advise parent/guardian of your mandate to report to CPS If parent/guardian is suspected abuser, determine if environment is safe enough for child to return home - start process of reporting to CPS so they can start investigation
- 28. If you suspect child abuse... If you are concerned the environment is not safe enough for the child to return home and he/she is imminent danger - call 911. Attempt to alert your Ministry Leader or Executive Leadership prior to involving authorities when at all possible Definitely notify Executive Leadership in all cases - especially those involving the authorities
- 29. If you suspect child abuse... Create a detailed report Remember...you are not responsible for determining if abuse occurred or not...you are responsible for reporting suspected abuse and CPS will investigate accordingly
- 30. Helpful information to report to CPS... Name, address, and phone number of child and parent(s)/guardian Child’s birth date or age, gender, race Nature and extent of the abuse or neglect Names and ages of other persons, if known, who reside with the child Persons/alternatives available to the child to provide protection Info regarding the suspected abuser
- 31. National Child Abuse & Neglect Hotlines 7 Days a week/24 hours per day 1.800.552.7096 (VA Child Abuse Hotline) 1.800.442.4453 (National Child Abuse Hotline) 1.800.354.5437 (NC Committee for Prevention of Child Abuse)
Editor's Notes
- The person who is experiencing a situation will determine if it is crisis or not. Something may be a crisis to one person, but not to another The person in a crisis usually feels ill-equipped and ill-prepared to manage the situation without support or assistance.
- While we may experience a number of crisis situations as leaders in ministry, today we will focus on issues related to dealing with suicidal and homicidal threats and CPS related issues
- So we ’ ll start by looking considering the differences between a suicidal/homicidal ideation vs a declaration Ideations - merely thoughts about engaging in the behavior, they may be fleeting and non-specific like “ I would be better off dead. ” or “ I just want to die. ” Declarations - statements that are much more direct and usually more specific than an ideation like “ I ’ m going to kill myself. ” or “ When I see him, I ’ m going to kill him. ”
- If you suspect that someone is homicidal or suicidal you should attempt to make an assessment so you can determine how you can best assist and support them. There are some broad areas of content we consider when we assess for these issues The way a person responds to these assessment components helps us to determine to what degree we need to intervene to assist the individual History - Has the person ever attempted to kill or harm themselves (suicidal) or anyone else (homicidal)? Intent - How certain does the person seem in their intention to actually do something to hurt themselves or someone else? Plan - Has the person come up with a specific plan to follow through with their intent to harm themselves or someone else? Is this plan realistic/reasonable? Access - Does the person have access to the materials they say they will use to hurt themselves or someone else (weapons, medications, etc.) You really want to consider the likelihood that the person would actually do what they are saying they will do and have readily available access to the weapon they would use to do harm. GFM pt who was going to stab himself to death with a pocket knife Sentara pt who was going to take her mother ’ s insulin Summit partner who was going to use his father ’ s gun, which he had immediate access to, to shoot himself Summit adolescent who threatened to kill himself by getting hit by a car - with a history of running into traffic These components serve as indicators regarding the severity of the threat, therefore informing us as to what level of support and what safety mechanisms we need to put into place for that person.
- So someone has just told you they want to kill someone...and they aren ’ t joking...they ’ ve thought it through, they have a plan...what do you do? From a counseling perspective, as a licensed provider, I have what ’ s called a “ duty to warn ” , but in order to effectively warn, I have to have a “ foreseeable victim ” This means I have the name of the intended victim or a reasonable identity of the intended victim (my wife) or a class of victims (my former co-workers, the people in my class). While I am professionally obligated to do this, in our roles as leadership here at The Mount, I believe that we have moral obligation to try to keep our partners safe to the extend that we can...so in that sense I believe that we all are obligated to warn an intended victim if we find ourselves in a situation like this with someone. From a legal standpoint, the Duty to Warn refers to the legal responsibility of a counselor to break confidentiality and warn the intended victim(s) of the threat.
- So if you find yourself in a situation with a partner where this becomes an issue there are a couple of things you need to do. If it ’ s a counseling situation (depending on your role in church leadership), I recommend that you always disclose the limits of confidentiality up front before you start counseling (confidential unless - suspected child/elder abuse, harm to self or others, records court subpoenaed ). Once the person disclose that they intend to hurt someone, let them know you intend to notify their intended victim for the safety of the intended victim, but also for the safety of the partner...before they do something they will regret. Determine if you need to contact the police, the Community Services Board (to assess the mental status of the partner). Let someone one the Executive team know what ’ s going on so we can support you...whether that ’ s me, Bishop or Elder, Min. Marcus or Min. Georges, whomever...they will likely get in touch with me anyway. As soon as you are able to, document your interactions with the partner
- So we are much more likely to be in a situation with someone who is suicidal than someone who is homicidal and we all need to have a general idea of how to manage these situations and how to best determine the level of threat we are dealing with. The basic indicators we reviewed remain the same (history, intent, plan, access). But there are very specific indicators that suggest an increased likelihood of someone committing suicide that we need to be aware of. These indicators build on the 4 components we ’ ve already mentioned. Willingness to act/motivation to die - we assess this by asking very straight-forward questions that will allow the person to reflect on their reasons for wanting to die. Keep the language very simple...you may simply ask the partner “ What are your reasons for wanting to die? ” Preparation to act - is another key element to assess. The difference between ideators and attempters is usually found within this component. Has the person made any kind of preparation to die? This can be assessed by asking questions like: “ Have you prepared for your death in any way (will, letters, finances, etc.)? You can also ask directly if they have rehearsed their suicide.
- Capability to act - If there ’ s been a previous attempt or any kind of self harm behavior it only makes sense that a person would be more capable of engaging in a suicidal act. So asking questions like - “ Have you attempted to commit suicide before? ” and “ Have you ever done anything to intentionally hurt yourself? ” are good assessment inquiries. Experience of trauma - We also need to consider the issue of “ trauma ” . Research suggests that ppl who have experienced trauma as a victim, witness or in a supportive role assisting others involved in trauma (especially physical trauma like death) such as physicians and first responders, have an increased likelihood of suicidality. They think there may be a relationship to the experience of violence and death that make the individual become somewhat desensitized to the experience of death and/or see it as a viable option. So questions such as - “ Have you ever witnessed any trauma or seen someone die? ” become very relevant when assessing this component. Barriers to act - serve as reasons for living. Barriers to act, unlike the other components mentioned, can serve as a protective mechanism that will provide you with valuable information to use to encourage or support the individual in finding more appropriate ways to manage their situation. A direct question like - “ What reasons do you have to live? ” is helpful in quickly assessing this component. In our faith based setting, many people will discuss issues relevant to their faith beliefs and helping them to view their faith and walk with Christ as a valid reason to continue to hone His gift of lief may be helpful to them during this time of distress. But I caution you to avoid being judgmental or critical of where they are emotionally during this crisis. And I encourage you to resist the temptation to take on a “ holier than thou ” faith based superiority complex by “ preaching ” to them about their lack of faith and conviction as this may serve to worsen the crisis situation.
- It ’ s important to look a the persons subjective intent...meaning what she says, as well as pay attention to what she does or is planning on doing, which is the objective intent. These behavioral based cues can provide you with valuable information that will assist you in determining what level of intervention is required. Another important indicator associated with increased suicidality is hopelessness. There has been strong evidence that suggests that once a person becomes hopeless (demonstrated subjectively and objectively) they are at a high risk for following through on a suicide attempt and intervention is required.
- American Indians/Alaska Natives and White Americans are at the highest risk for committing suicide. Males commit suicide at a higher rate than females (4:1), however females make more attempts than males. Males tend to use more lethal methods such as firearms, females tend to use poisons. Suicide is listed as the 10th leading cause of death by the CDC in 2012, however it was noted as the 4th leading cause of death for middle-aged White Americans during 1999-2010 (which was a 40% increase from previous years)- this was suggested in relationship to the recession and mortgage crisis. Suicide is the leading cause of death for individuals ages 15-24 y.o. It accounts for 20% of all deaths in this age group annually. With regard to marital status - there doesn ’ t appear to be much of a difference amongst women, however men who were divorced were 2x more likely to commit suicide than those who were married. Marriage seems to serve as a protective factor for men...not so much for the ladies
- Most suicidal people want desperately to live, but are unable to see alternatives to their problems. But, if someone is intent on committing suicide, there may be little we can (personally) do to prevent this from occurring. Never forget our most valuable asset in intervention...along with doing all of the practical things to help keep partners safe...is the power of PRAYER.
- Everyone take a break as you need to...we are now going to transition to issues related to Child Protective Services.
- Ok...there are a couple of things we have to be mindful when it comes to CPS issues especially as it relates to state requirements because right now we have church facilities located in 2 different states: VA and NC and there are some differences between what the states require when it comes to child protective services reports. There are mandatory reporters and permissive reporters Mandatory reporters are required to report any suspected child abuse issues Permissive reporters are not required to, but are encouraged to do so In VA mandatory reporters include: Law Enforcement Officers, Teachers (other school personnel), Health Care and Mental Health Care Professionals, Social Workers, Medical Examiners or Coroners, and Child Care Providers Clergy in the state of VA are given privilege - meaning they are not required to report and a person can come to them in confidence with child abuse issues
- In NC everyone is a mandatory reporter...including clergy - if you suspect child abuse, according to the state of NC, you “ shall ” report With the exception of attorney-client privilege
- Here are some things to know about the reporting requirements for VA and NC. In VA the reporter can be anonymous, whereas in NC the reporter must provide their name, address and telephone number. Both states attempt to maintain the confidentiality of the reporter, however in VA if there is suspected false reporting, the reporter may be identified.
- So...not every suspected abuse issue will be something that we should report to CPS. Some abuse is considered criminal and would involve the police rather than CPS. CPS reports are limited to abuse that is suspected by someone who was serving in the role as a care-giver of the child at the time the act occurred (ex - Cousin John-John (17 yo) was watching his younger cousin Sarah while his mama and aunt took Big Mama out for her birthday and he molested her - CPS would need to be involved, a babysitter is suspected of molesting the child she was watching (CPS would be involved). Criminal charges need to be filed against offenders who abuse a child, but they are not considered to be the caregiver at the time the abuse occurred (ex - Cousin John-John was visiting with his aunt and little cousin and he snuck off to his little cousin ’ s room while his mama, aunt, and big momma was cooking dinner) this is a criminal issue and we are not required mandatory reporters in this case.
- Name, address, and telephone number of the child and parents and other person responsible for the child's care, if not parent. Child's birth date or age, sex, and race. Nature and extent of the abuse or neglect. Names and ages of other persons, if known, who live with the child and their relationship to the child. Persons/alternatives available to the child to provide protection. Information regarding the suspected abuser if available (name, contact information, relationship to child)
- Child Abuse & Neglect Hotline 7 days a week; 24 hours per day 1.800.552.7096 (VA) 1.800.442.4453 (National Child Abuse Hotline) 1.800.354.5437 (North Carolina Committee for Prevention of Child Abuse) Local Department of Social Services Phone Numbers (use during business hours)
- Please feel free to ask questions, share comments (depending on our time). I ’ ll answer as best I can, and if I don ’ t have the answer...I ’ ll find it out and follow-up with you. Thank you for your attention and I hope this has been helpful! Enjoy your Saturday!