EAP OnStar by yurtgc548


									EAP OnStar

EAPA Conference
      Challenges of Telephonic
• No visual cues: Body language, physical
  state, environment, location
• Remote Locations: friend’s house,
  workplace, cell phone, traveling in a
• Indirect knowledge of community
  resources and crisis responders
    Unique Characteristics of a
    Telephonic Crisis Response
• Crisis is immediate and acute
• Counselor can’t control the caller’s
• Caller can quickly disengaged.
• Caller could be more open and less
  guarded due to the immediacy or urgency
  of the event or just the opposite.
  Important Concepts to Consider
      While Working the Call
• Widening the options (overcoming client’s
  tunnel vision)
• Clarify difference between wanting to die
  and not wanting to live
• Draw from past experience; reference past
  work with similar situations
• Use of Self: Providing self disclosure on
  how call impacts clinician
   Working the Call Continued
• Alignment with the caller
• Understand the function of the crisis and
  how the crisis works for the caller
• Emotional black mail situations
              Risk Assessment
• Need to quickly assess level of physical risk to caller and
  others that may be located near the caller.
• Need to constantly re-evaluate the variables as the
  situation changes.
• What is caller’s level of intoxication and what type(s) of
• If weapons are on scene what kind are they and what is
  the level of lethality?
• What is the caller’s location? Out in public? In a crowded
  work place? Moving vehicle? Alone?
• What is the availability of emergency services? What if
  the person is not easily accessible?
           Nuts and Bolts
• Gather complete demographics especially
  phone number critical
• Understand Caller’s physical environment
• Is the Caller alone? Are others near by?
• Attain clear information for emergency
• Can you call trace? What’s your policy?
        Nuts and Bolts cont.
• Supervisor or coworker support for the
  counselor working the call.
• Accessing local resources
• Identifying collateral contacts
• Advocating for intervention with crisis
  response, insurance/managed care,
  hospital, police
• Safety contracting
       Information for Emergency
• Introduce yourself and your role in the situation
• Describe current status and reason for concern- Plan,
  method, means, intent, etc.
• Is there a presence of any weapons? Where are they
• Emotional description of caller- cooperative, agitated,
  intoxicated, sedated, resistant, dysphoric, manic, etc.
• If under the influence of drugs or alcohol- What drug?
  How much? When last used? Any prescription
  medicines (including names and amount used)?
          Information for Emergency
            Responders continued
•   Physical description of the caller- race, age, gender, height, weight,
    clothes they are wearing, if they have access to a vehicle, vehicle
•   Where are they located? (be as specific as possible)- address,
    apartment number, what room, color of the house, vehicle parked in
    front, etc.
•   Who else is there? Where are they located? Are they aware of the
    situation? Any children?
•   Are there any animals/pets at the location? Are they restrained or
•   Is the caller aware that Emergency Responders are coming?
•   What is the anticipated level of cooperation when they arrive?
     Other Considerations for
    counselors working the call
• Should the caller be told that emergency
  responders are coming?
• What about “suicide by cop”?
  – This is a real and present risk
  – If suspected, focus on method, means, access to
    means, and previous thoughts and attempts.
  – Do not introduce this concept directly but speak
    directly about it if the caller brings it up.
• Are Critical Incident Teams (CIT’s) available?
  (Police specialist who are trained to respond to
  psychiatric conditions)
• Follow up with Emergency responders
                     Local Resources
•   Mobile Crisis
     – Not always in all areas.
     – Can do home visit and evaluation.

•   Psychiatric Facilities
     – Preferred referral for psychiatric emergencies
     – Can get from local resources or health insurance (must ask for specifically)
•   ER
    - Do not always have psych units/client needs to be transferred
    - Can have long wait times/increased chance client will leave if unescorted

•   Suicide Hotline
     – Can help facilitate connection to local tx and/or assist with services in area and
     – Does not transfer liability of case.

•   DV Hotline
    - Can connect to local resources
    - Provides myriad or services i.e. legal, counseling
          Local Resources cont.
• Workplace crisis response (security /safety)
   – Work site may have security/crisis response team
• Family/friends
   – Helpful to assist/connect client to services
   – Can provide support/motivation
• Community Support/faith community
   – Another possible support/motivation base
• Behavioral health network
  - EAP must advocate and make requests that are most
  appropriate for client
  - Need to speak to a clinician
•   Ambulance
     – Can be costly and unnecessary
     – Last resort
•   Police
    -Response and /or effectiveness can vary
•   Taxi
    -Can be used when client is alone and motivated-last option
    -Can be used when client is under influence-last option
•   Family/friends
     – Best possible option-for reasons above
•   Caller
     – Sometimes only option if client refuses assistance and other options are
       not viable or necessary. i.e. urgent but not emergent situation
                   Safety Planning
•   Mobilize internal team to manage situation, i.e., one person with
    caller, one working with external personnel, one searching for
•   Assign one person to manage the team and assign duties.
•   Based on caller’s location and environment determine circle of
    impact and begin mobilizing external resources if possible.
•   Gather as many details of the situation as possible should
    emergency services or company personnel need to be contacted.
    Have them readily available.
•   Attempt to collect any demographic information for external
    resources such as family members, company contacts or security
•   Be prepared to reach out to external resources but work with caller
    as much as possible. E.g., seek permission to involve family,
    company contacts or security personnel.
           Follow through
• Confirm client connected with resources
• What is your policy for follow up after
  confidentiality has been broken
• Staff debriefing Self care
      Breaking Down Barriers to
• Managing participants resistance: Pacing
  your assessment, intervention, overall call
• Safety Planning
• Advocating through resources: managed
  care, community resources, crisis
  responders, key workplace personnel and
  family members
Dual Client Relationship Concerns
• Workplace safety concerns
• Competing priorities
• Working through job jeopardy or prior
  performance issues
• Anticipatory job action concerns

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