Crisis Intervention Model

Therapeutic Interventions

Because the patient verbalized her wishes for immediate removal of the respirator and brief interventions, the social worker will utilize the Crisis Intervention model. In the Crisis Intervention model, the social worker must respond quickly to the challenges the clients present and critical decisions must be made by the patient. The Crisis Intervention model also ties in with Solution-Focused Therapy. According to Roberts & Ottens (2005), in order to maximize the social worker’s ability to effectively intervene, they must focus on the here and now, rapidly assessing the patient’s problem and resources, suggest goals and options, develop a working alliance, and build the patient’s strengths (p. 331). It is important

for the social worker and patient to establish rapport and develop a mutual agreement on short-term goals and tasks. For Josephina, her short-term goals are regarding her health/medical issues and preserving her rights to remove herself from the respirator.
The first step of the Crisis Intervention model is to conduct a thorough psychosocial assessment as well as an imminent danger assessment to rule out risk factors.

The social worker will conduct a swift but thorough psychosocial issue to gather the patient’s needs and concerns, environmental stressors, medical needs and medications, use of drugs and/or alcohol, coping mechanisms. It can also be called the triage assessment, assessing the patient’s emotional, behavioral, and cognitive aspects of a crisis (Roberts & Ottens, 2005, p. 334). In assessing lethality, the social worker must discuss with the patient and discover if the patient has ever had any suicidal attempts or thoughts. It is also important to assess the patient’s family members for suicidal ideations as

well.
The second step is to establish rapport and a collaborative relationship between the social worker and the patient by providing the patient with the social worker’s presence of respect, acceptance, genuineness, a nonjudgmental attitude, and good eye contact. The third step is to identify the major problems of the patient. At this time, the patient’s problem is taking herself off the respirator, but her family members disagree with her decision.
The forth step is to explore the patient’s feelings and emotions.

The social worker must allow the patient to express her feelings, venting and explaining her story by utilizing active listening skills such as reflecting feelings, probing, and paraphrasing (Roberts & Ottens, 2005, p. 335). The fifth step is to explore new coping strategies. At this point, the social worker and the patient can discuss housing alternatives and programs for the patient post hospitalization and upon discharge planning. According to Roberts & Ottens (2005), the patient should select the alternatives on their own rather than have the social worker decide (p. 335).

The sixth step is to restore the patient’s functioning by implementing an action plan. In this step, strategies earlier discussed with the patient will become integrated into a treatment plan. Lastly, the seventh step is to plan a follow-up. The social worker should plan for a follow-up with the patient after the initial intervention to secure resolution of the patient’s crisis and evaluate the patient’s status post-crisis (Roberts & Ottens, 2005, p.

336).
Solution-Focused Therapy (SFT) focuses on the solutions rather than the problems. It is more concerned with the future than the past. SFT is addressed within the Crisis Intervention model as well in steps five through seven, focusing on the patient’s future and what they want for their future. The solution for the patient would be in regards to post-hospitalization and discharge planning care.
Grief Therapy can be provided for the patient’s family members and also for the patient (individually or together). The goal is to resolve separation conflicts and for the patient and family members to better adapt to the patient’s death by providing the social support needed and allow them to grieve (Worden, 2009, p. 155). The family and/or the patient may be experiencing anticipatory grief, which occurs when a patient or family is expecting a death. Symptoms may include depression, preparing for the death, adjusting to changes, and extreme concern for the patient that is dying. Grief therapy can be provided for the patient in allowing herself to have control. The patient stated that she is accustomed to being in control, and by allowing herself to choose her own fate and decide on end-of-life decisions, it gives her back the sense of control she missed when she lost the control to breathe on her own. The social worker can also emphasize the patient’s comfort level in bringing closure to her life. Grief therapy can also be provided for the family members before and after the patient’s death for support.
Resources Coordination
First, the social worker will go over the POLST form and ADHC for the patient. The patient can choose to have her family members present during decision-making or not. Next, the social worker will discuss discharge planning and post-hospitalization plans with the patient. During the discussion of discharge planning, the social worker will discuss with the patient if she wishes to have durable medical equipment (oxygen tanks), hospital bed, walker, wheelchair, and/or a bedside commode. If she decides that she wants an oxygen tank, the patient can also apply for the Medical Baseline Allowance, which can provide a deduction in gas/electricity bills.
The patient can then choose to return home or be transferred to a skilled nursing facility. If the patient chose home, she can choose between palliative care and/or home care hospice. Depending on the patient’s housing size (one story or two story), the patient may need to have safety bars constructed within her home. Depending on the patient’s income, she can also apply for In-Home Support Services (IHSS) to explore her eligibility for domestic services and a caregiver. If she is ineligible for IHSS, she can apply for private pay attendant care. If needed, the patient can apply for Meals-On-Wheels for home-delivered meals services and a volunteer for respite care (also known as a caregiver relief). If the patient chose a skilled nursing facility, she can choose between custodial or skilled care. She may also be eligible for Medi-Cal for long-term placement if a skilled nursing facility is chosen.