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Culturally Competent and Trauma-Informed Crisis Ma ...
Presentation and Q&A
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Hello and welcome. I'm Shereen Khan, Vice President of Operations and Strategy at Thresholds, Illinois' oldest and largest provider of community mental health services and also social work expert for SMI Advisor. I am pleased that you are joining us for today's SMI Advisor webinar, Culturally Competent and Trauma-Informed Crisis Management. Next slide. SMI Advisor, also known as the Clinical Support System for Serious Mental Illness, is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Next slide. Today's webinar has been designated for one AMA PRA Category 1 Credit for Physicians, one Continuing Education Credit for Psychologists, one Continuing Education for Social Workers. Credit for participating in today's webinar will be available until April 3, 2023. Next slide. Slides from the presentation today are available in the handout area, which is found in the lower portion of your control panel. You can select the link there to download the PDF. And next slide. And please do submit your questions throughout the presentation by typing them into the question area, which is also found in that lower portion of your control panel. We will reserve 10 minutes at the end of the presentation for Q&A. I also want to call to your attention the chat function, which is there. There might be times throughout the presentation today where we ask you to participate via chat. So that is found right under questions and handouts. Next slide. Now I would like to introduce you to the faculty for today's webinar, Jason Phillips. Jason is a trusted licensed clinical social worker that provides evidence-based treatment to foster success for your mental health and wellness. He has extensive experience in various settings, including community mental health, grief and loss, college counseling, psychiatric inpatient units, veterans, and active duty soldiers. His areas of expertise include trauma, anxiety, depression, grief, loss, and life transition. Jason, thank you so much for leading today's webinar and I'll turn it over to you. Wow. Thank you. Thank you. I'm so excited to be here with you all this afternoon. As we kind of proceed, I want to let you all know that as far as disclosures, I have no disclosures, no financial obligations. And now we'll just get right into our learning objectives for this webinar. So throughout the webinar, upon completion, you will be able to, one, define and recognize a mental health crisis, as well as evaluate potential triggers and signs. You will also be able to identify and incorporate evidence-based tools and resources for managing distress and coping with crisis reactions, meaning the skills and the tools that we'll be sharing with you won't be just things that we've heard that have worked or that we've tried once or twice, but these will be actually evidence-based practices that have been studied and researched. And finally, we're going to make sure that you are able to differentiate between culturally competent strategies to manage crises different from those that are unhelpful. So as we proceed, again, we'll have the, you know, you'll be able to define and understand a mental health crisis, recognize signs and triggers of a mental health crisis. We'll go through evidence-based tools. Then we'll go into the role of trauma and crisis reactions. We'll take into cultural considerations and crisis management. And then finally, we'll wrap up with the Q&A. So before we begin, I just want to say that the last few years have been extremely difficult and unsettling for most of us. Many of your clients, loved ones, or even yourself may feel that you've been in a constant state of crises. I know I have, especially what's been going on with recent events. So throughout this presentation, we'll explore what a mental health crisis is, you know, and identify the necessary tools to deal with the crises in the short-term and long-term. So as we think about defining and understanding a mental health crisis, if you all don't mind, please share with us in a few words, what do you consider to be a mental health crisis? And then as you all are chatting or typing away in the chat, I'll kind of start with the more clinical definition, which is a crisis can occur in any situation in which you are having thoughts of self-harm, putting yourself in danger, or when you're not functioning at the highest, at your highest level. So in other words, a mental health crisis is a short-term, highly distressing situation with the potential to have a negative outcome, prompting an urgent need to act often in unhelpful ways. So Jason, people are putting in the questions that the way they define a mental health crisis is a situation where you feel like you have no control that leads to an inability to function with everyday tasks. There's a few people who have mentioned it impacts daily functioning, when people have exhausted their coping mechanism to manage that stress. And yeah, a few people said when coping skills run out and everyday tasks or interactions become too much to handle, and then you have feelings where you have no control, you can't function or thoughts of self-harm. So lots of great responses to what a mental health crisis is. Thank you. Thank you, Shereen. And I want to say that all of you all are correct. When you're experiencing a mental health crisis, it's not for us as clinicians to decide whether or not it's a crisis or not, it's for you to be able to have the language to identify when you are in a crisis situation. And as we think about defining a mental health crisis, the first example that comes to mind is when I was an intern at the VA, I was working in the substance abuse clinic. And if any of you all have worked in substance abuse, you know that the primary treatment for substance abuse is group care. However, I was working with an individual, a veteran providing one-on-one support. And I remember vividly, there was a Monday, he came in for our appointment, and he said, hey, I'm not in a good place. I think I need to be admitted. And during that time, I recognized that this was a crisis. He had relapsed. He had been sober for about four to six months, but over the weekend, he relapsed on crack cocaine and he also had been using alcohol as well, having fights with his wife. He had not been home in a few days, appeared very disheveled, very dysregulated. And in that moment, I had to assess what was the next best thing for this veteran so that we could mitigate whatever crises had already transpired and then get him the best appropriate care. And I'm sharing with you all this story because we had to act fast and there was a huge potential for a negative outcome if I interacted with him in an unhelpful way. And as we proceed, we'll talk about what some of those unhelpful ways look like. So what are the features and form of a mental health crisis? So under a dialectical behavioral therapy framework, or DBT, crises involves three distinct features. The first feature is crisis involves extremely stressful situations that can lead to negative outcomes. For example, a crisis could be failing an exam that you needed to pass in order to be able to move ahead in your grad program or reaching your credit card limit and not having any money left over to pay your bills for the month. So having to drop out of school and not being able to pay your bills both have the potential to have very negative consequences. So in the example that I shared with you earlier, this gentleman had spent all of his money, he had marital discord, so this situation had the potential to have an even worse outcome. Second, crises are typically short term but intense. Crises occur in the present moment and feel highly dysregulated and overwhelming to deal with for a short but intense period of time. This time can range from a few seconds, minutes, or even hours. So I'm sharing this with you all so you think about the crises, it can go from, again, seconds to minutes to hours. So we want to intervene with the best approach possible to manage the crises. Finally, there's going to be pressure to resolve the situation. So when faced with a crisis, you might feel compelled to act on a strong urge, such as to drop out of school after failing an important test, or to hurt yourself to shift the focus of your pain. In other cases, the feeling may be so overwhelming that it paralyzes you from acting. So instead, you might shut down and avoid the situation. How many of us have been faced with a situation and instead of doing something, we did nothing and we tried to avoid it, and that just led to an even worse outcome? So for an example, if you avoid opening up the recent exam results because you're thinking, okay, I just, I don't want to look at the test, I don't think I did well, and I can't face what that test score is going to show, you may be really afraid of the outcome. So because of that, you numb yourself or you distract yourself. In any of these cases, the outcome as far as whatever the grade is, is still the same, but we're trying to avoid the pressure and resolve that situation. So crises can be categorized in three different ways. One is situational, experiencing a life event like getting fired from your job, becoming homeless, or experiencing a natural disaster. In my situation that I described, there was marital discord, there was a relapse. Or it can be emotional. And during the emotional category, you could be experiencing depression or suicidal urges. And last category is existential, where now we feel conflicted regarding our life purpose or direction. When we look at these different categories, think about the situations that you've been involved in, or maybe your clients have been involved with. I know personally, when I was working with a client who had recently been laid off, had gone through marital discord, the wife was having an affair, so that led to a divorce, and they had a parent who was facing a terminal illness. All of these situations led to what could have been a crisis. And this person was experiencing depression, but they were hiding it, trying to avoid being forthcoming with their feelings. And of course, because this person was middle-aged, or I'll say mid-30s, I don't know if that's middle age, but they were feeling like, hey, I'm not sure where my life is going now. So when you combine all of these three categories, you can only imagine what that person is feeling and how they can resolve the crisis. And even so, they don't want to face it, because for a lot of us, going through those things can be very embarrassing and very hard to be transparent about. So now I want to talk about the spectrum of a crisis, because not every crisis situation is going to lead to suicidal thoughts or putting yourself at risk of harming yourself or others. So on one spectrum, we have, we're stressed out, and this happens, right? You know, something goes on in your day-to-day life, and it upsets you. It starts to, you start to develop stressful feelings about that situation. Then next we move into the overwhelm category. Now the stress is starting to last a little longer, and the feelings may be more intense. Now if you don't manage the stress when it's at its lower level, and then it bleeds over to feeling now overwhelmed, for a very long period of time, or even depending on the circumstances, this could lead to suicidal thoughts or self-injury or self-injurious behaviors. So rather than viewing the crises as black and white, whether we're in a crisis or not, I like to encourage you to think about the crises as a spectrum. So when we look at stress, according to Renee Brown in her book, The Atlas of the Heart, we evaluate our environmental demand as beyond our ability to cope successfully. We feel stress when our environment is unpredictable, uncontrollable, or leads us to feeling overloaded. In this stage, physiological symptoms of stress start to elevate. For instance, you could have increased heart rate, shallow breathing, rapid breathing, and the mind begins to further interpret these symptoms as catastrophic, which can compound one's feelings of pressure and sense of an inability to cope. So when you hear people say, just take a deep breath, a lot of times that feels or could sound really cliche. However, in reality, taking a deep breath or being mindful of your breathing really does help you to manage your thoughts and feelings that you're having in that moment. And when we move to feeling overwhelmed, that's a more extreme level of stress. So people who are overwhelmed feel a level of cognitive intensity that is almost debilitating and leads to significantly impaired functioning. So when someone is overwhelmed, being asked the question, how can I help you? And what do you need from me can feel impossible to answer for the individual due to the degree of cognitive intensity. Think about when you're working with someone and you ask them, what do you need or how can I be of service? They don't know because in that moment, it feels like it's all too much. Things or feelings are all consuming. And then lastly, when you're at risk of suicide, when someone feels excruciating pain to the point of feeling a sense of defeat and complete inability to cope, this often results in looking for ways to escape the pain, such as urges to harm oneself, having suicidal thoughts or urges to harm others. Again, I want us to be mindful of these different categories so we know how to intervene and also to reflect back to our patients or our clients, asking them or helping them identify what stage they're in. Now, crises, signs and symptoms. This is important because when crises happens, a lot of times we feel like they appear out of the blue. We don't know how it transpired and we feel like, how do we get here and land in this situation? So they can present in various different ways and there's signs that we can look for to intervene sooner than later. So some of these warning signs would be changes in sleep or appetite. And what this looks like is either not sleeping enough or sleeping too much. Often when I'm working with individuals and they let me know that they can't sleep, I'm aware that, yes, they want sleep, they need sleep, the body needs sleep to better regulate their body. However, there's typically something else going on underneath the sleep problems that are preventing them from relaxing at night. And once we can identify what else is going on, it helps to then calm them down and improve their sleep. Also, overeating or under eating. So the changes in our appetite is a clear indication that something else is going on as well, because we're either overwhelmed with our day to day taskings that we feel like we can't slow down to eat or because of the mental state that we're in, we don't want to eat. We don't have an appetite. So these are some key indicators that we want to be aware of. Next, having a loss of interest in previously enjoyable activities. People will say, I don't enjoy this anymore or this isn't fun for me anymore. And when someone says that, or even if you notice this in yourself, it's very important to peel back the layers and ask what is going on behind my lack of desire to engage in some of these activities and behaviors that really used to bring me joy. Next, withdrawal from relationships and other protective factors like our hobbies. Again, when you are isolating and you don't want to be around others, it's another clear sign that something else is going on and we want to lean forward and look into that. Next, neglecting our daily responsibilities or personal hygiene. How many of us have ever worked with a client and they start to tell you, hey, I'm not really looking forward to waking up anymore or I don't get dressed anymore. Or you may even notice that in them, that their physical appearance is starting to change. These are subtle indicators that something else is going on and there could be a crisis that we want to further address. And then lastly, there's a significant decline in mood or mental state. So when I share with you all my client, he definitely appeared really, one, disheveled, but two, very agitated in the moment. So next, we're looking at the crises and how they present in three different ways. So one, from a cognitive standpoint, emotional standpoint, and behavioral. If one doesn't feel equipped to adequately deal with the crises, they may also experience destructive and dangerous urges that will make the situation worse. So for example, individuals in crises might try to cope with their overwhelming feelings by abusing drugs or alcohol to avoid thinking about the situation or experience thoughts of harm and suicide if they feel hopeless that the situation can or cannot be improved. So pay very close attention to irrational thinking, illogical thinking, paranoia, catastrophizing. When people are making very broad generalizations and feeling like I don't see a way out, pay attention to the language that they're using. Are they still having forward thinking? Are they thinking about the future or is the language they're using more have a negative tone behind it and feel like they don't see a light at the end of the tunnel? Next, when we look at the emotional category, when the person has difficulty communicating their emotions, this is a sign of a crisis. They're saying, I don't know what's wrong, but I know I'm not right. And we're gonna talk about trauma-informed care. However, I wanna say this now, when someone articulates to you that they don't know what they're feeling or they don't know how to feel, this is our job to explore more and provide a safe environment for them to be okay not knowing how or what they feel or not knowing how to articulate it. What we don't want to do is say, are you feeling like this? Or put words in their mouth because then it can feel disheartening and that we're being dismissive of their emotions. And then lastly, the behavioral changes, impulsive behavior, substance misuse, avoidance, and thoughts of self-harm. All of these are indicators that someone is experiencing a crisis. Now, what triggers a mental health crisis? A trigger is defined as a stimulus such as a person, place, situation, or a thing that contributes to an unwanted emotional or behavioral response. Oftentimes, triggers can be linked to a previous wound and traumatic events. Something that a lot of us may hear often is that, will I ever not be triggered? How often will I be triggered because of something that's happened to me? And being triggered is uncomfortable and triggers are unique to each and every one of us, even if we've experienced the same situation. So the first step to dealing with one's trigger is becoming aware of them. So as you help your client understand this is a trigger or this leads to triggers, then they'll feel more in control so that they can manage these triggers in the future. Some triggers will be unavoidable. However, if when the trigger happens or when we are triggered, if we can better manage it, then they'll feel more in control of their situation. Triggers can impact physical sensations since the body becomes more alert to the environment and attempts to prepare for the perceived threat. So it's important to give yourself the space to decompress as the physical sensations lessen over time. So what are some examples of external triggers? Receiving bad news that catches us off guard. I was sharing the example of someone who had the unfortunate news that they will be laid off and then they found out their spouse was having an affair and then to find out that their parent is terminally ill. All of these are significant signs of external triggers. So going through relationship trauma, we don't know what's gonna happen as far as, you know, what does my life now look like? Or if there's a sudden death or loss of a loved one. So when these things happen and if you're under stress for a long period of time, someone can reach their breaking point and then it starts to impact their relationships with people and their resources. Stress also comes from shame and uncertainty around you because you're not sure, who can I go to for help? Or if I do open up to receive help, will I be looked down upon or will I be talked about? Is this a confidential space? Now we're talking about external triggers now, but here are some signs of internal triggers as well. And I'm gonna pause for a second because internal triggers can be even more difficult to manage for us as clinicians and then even more so for the person because it's easier to hide from the internal triggers. So if there's intense physical or emotional sensations, you or your client may avoid because, hey, if I don't show up or if I'm not around, then nobody will really know what I'm thinking inside. Feeling exhausted and a sense of anguish from constant overthinking and rumination of events. This stands out because if we don't communicate the feelings of exhaustion or how we're overthinking, it can be really difficult to manage this. And then changes in our sleep routine. And I wanna add an avoidance because all of these relate to us not being communicative about what we're experiencing. So moving forward, we're gonna talk about evidence-based tools for crisis management. As we've talked about now, how to define and identify and recognize a crisis, what do you, or how do we mitigate this? How do we manage it? So coping with crisis. Inaction or ignoring the problem does not usually help and or lead to improvement. How many of us at times have felt, well, let me just ignore this problem. Let me let it go away and hopefully it will be over. I can't see you and I know you all know I can't see you, but if you can put it in the chat, if you can relate to ignoring or avoidance, I will say that I think a lot of us tend to do this until we can't anymore. And this is how we go from being stressed to overwhelmed to possibly thoughts of suicide or hurting ourselves or others. Because we recognize that avoidance just doesn't work. So in this moment, we want to establish a crisis plan that helps guard us against panic in the moment and fosters problem solving. If you're creating safety plans with your patients or you're walking them through, how to identify triggers, but then also how do you identify safe resources? This will help you because now when those same feelings arise, you'll know what to do. I was working with someone just last week where they were having thoughts of hurting themselves and as opposed to needing to present to the hospital for a higher level of care, they were able to call a loved one and reach out to their support system. And then we could unpack this in our next session. Also normalizing the experience of crisis in life helps with preparation and expectation. When you normalize that this is not just unique to you or you help your client realize that this is not their problem, it takes a lot of load off so that now they feel safe enough to unpack the trauma behind the crises or to verbalize the other thoughts that they're having which you may or may not be aware of. So just normalizing it lets you know that, hey, we're in this together. Maybe I didn't experience what you did, but I'm definitely here to support you and not judge you. Lastly, tangible reminders in the environment to signal what might be happening can foster action and change when in a crisis. So we want to be able to, again, identify the triggers, the signs, the symptoms. Surviving a crisis means getting through a distressing situation without making it worse for yourself. So this means preventing yourself from engaging in impulsive and harmful behaviors and taking some time to react intentionally instead. And I put emphasis on intentionally because when we're acting intentionally, now we're thinking, what can I do that will lead to me feeling better and not worse? Or what can I do that will help to resolve the situation? And in just doing that, we're not acting impulsively. We're responding as opposed to reacting. Remember, you are not a problem, and this is not your fault. Though you may have had a role, blame results in added pressure and pulls us out of problem-solving mode. This is key because when we start to blame ourselves, blame others, or blame just surrounding pieces of the situation, our focus and energy is on them or that person or on us. And that blame leads to more negative self-talk. There's no reason to be ashamed when experiencing a crisis. When I described the situation earlier as my client who experienced a layoff, marital discord, parents becoming ill, that could be any one of us. So let's take the shame out of thinking you did this or you caused this when the reality is this could be you and I at any given moment. Life is very, very unpredictable. Now, moving towards more concrete tools and strategies for managing crisis reactions. First, take time to react intentionally instead of engaging in impulsive behaviors. This derives from the DBT framework as well because when you can be more mindful of how you're responding, then it prepares you so that you can, again, respond and not react. What's even better to take it a step further is when you have a list of go-to behaviors that will help you so in the moment, you're not trying to think of what can I do on the spot. Next, we want to explore the pros and cons of harmful crisis behaviors that we may typically engage in. Now, you may be thinking, okay, why would we go through the pros and cons? Because this could seem very apparent. Okay, I don't wanna do this or I should do that. However, when we list out the pros and cons, and I like to do it on both sides. So the pros and cons of doing this and the pros and cons of responding this way, it helps us tease out, oh, wow, this is an option. This is an option. And we can also point out what are some of our go-to behaviors, whether that's been helpful or not, so that now we can intentionally not engage in those unhelpful behaviors in the future. So let's list the pros and cons of what could happen. This also is helpful because if someone just wants to take away the pain, by listing out what are the pros of responding in this way, it may help your client realize, oh, this won't really help me alleviate the pain. Maybe short-term, it helps me avoid more. And it seems like this is a good option, but long-term, I'm setting myself up to endure more pain, or my family and loved ones will endure more pain. And when we can kind of conceptualize this, then we say, okay, you know what? This is not gonna be helpful. Next, changing our body chemistry from a state of high emotional arousal to a calmer resting body state. This can look like something very simple as splashing water on your face, or taking a cold shower, or engaging in exercise. All of these things can help to change how you're feeling internally, or physiologically, and also emotionally. Number four, having a distraction. And I would add, having a distraction that is healthy for you, because sometimes you just need a break, or your client may just need a break. And if you can help them think about what can give you some time to step away from how you're feeling, and do something to take your mind off things, quote unquote, but in a healthy, supportive type of way. Next, self-soothe. So using the five senses to ground yourself in the present moment. The exercise that comes to mind, it's actually a fun one. So if we were in person, you know, we can have a bunch of candy out. We could feel what the candy feels like. We can look at the candy, look at the texture of it, the color. We can eat the candy. We can do all of this, because one, it's gonna make us kind of slow down and be in the present moment. Then also we get to eat candy at the same time. So I think that's a win-win. So I've always loved that exercise when thinking about using my five senses to ground ourselves. And then lastly, replacing negative events and situations with more positive or neutral ones. What can be helpful for this is having a plan or having things on your calendar, because now you're not having to think in the moment, what will I do tomorrow? Or what will I do this weekend? Or what will I do with this situation? You have something to look forward to. And sometimes it's just that one meeting or one event that's gonna help you or your client to kind of get to that next day. Learning, so more evidence-based tools for managing crisis reactions. We want to learn how to tolerate distress as a key component of crisis management. So with the goal of learning to tolerate distress tolerance is learning how to survive crises without making them worse. Refraining from engaging in harmful or dangerous behaviors. What this looks like is a graph What this looks like is being able to manage those emotions. So a crucial component of working through a crisis learns how to effectively tolerate distress. And when we do that, we're able to make it through a crisis without worsening the situation for ourselves. And we can move towards accepting reality as it is. There are some situations that we will not be able to change. If you've just lost a loved one, there, you know, unfortunately, there's no way that you can bring that loved one back. Or if you've been laid off, there may not be an opportunity for you to get that specific job back. However, how can we accept the reality? How can we accept the truth of this? And in doing so, how can we not make this about us as an individual, but just about the circumstances that we're in? And then lastly, learning how to become free. So this means being at peace with your life, regardless of your specific circumstances. So as I share with you all, the individual who was laid off, going through marital discord, and had a parent diagnosed with a terminal illness. With crisis management and also other therapeutic resources, their mantra now is to be more peaceful, to accept life as it is, to be more positive. They've moved on, and thankfully they have a healthy relationship, newborn child. And because of all of these things, they're looking at life as more half full than not. So we have to be mindful of how much emphasis we place on some external stimuli that could change. Next, dealing with the aftermath. And it's important for us to educate our clients on what they may experience after a crisis situation. After a crisis situation, things may not always be really chipper and cheery, particularly if you have had a suicide attempt or maybe a hospitalization. So this is the opportunity to now validate their feelings and discuss what they are feeling so that they know that, okay, I hear you and I understand that now there's some things that you're experiencing that we may wanna unpack and explore. So the first being shame. When you are blaming yourself or you're feeling shame because of the crisis that happened, that's gonna be counterproductive in helping you or your client move forward past the situation. Also, you may have uncertainty about who can I share this experience with? Who should we share that, hey, I've been having some thoughts of hurting myself or I was off of work for quite a while because I was receiving behavioral health care. As you just allow them the space to acknowledge that they're having these feelings, that in itself can be very, very validating. Next, if they're experiencing sadness, fear, all of these are very normal behaviors or normal thoughts to have because there could be fear of what if this happens again? There could be fear from their caregivers or their parents, what if this happens again? And these conversations we have to be able to have whole space for them so that they can feel safe sharing these things. There could also be confusion about what to expect. Who's going to help me? Who's going to be there for me? And who's going to have my best interests as we unpack some of these feelings? So what I would say, as you help your clients deal with the aftermath, encourage them to journal what they're thinking, what they're feeling. Encourage them to give themselves grace. Don't feel like they have to figure this all out in the first, you know, over the first day or right after. Help them to identify language that they want to share with others. So meaning, it's not just enough to say, tell people what you feel okay with. That may be a little bit vague. So if you can help them, maybe even role play, how would you share with me, if I'm your best friend, how would you share with me what you've just experienced? And they may not have the words for it right off the top of their head. However, this is the time for us to intervene and we can help them script language where they feel like they're not oversharing or overexplaining to anyone about their mental health and their mental health status. Because if we can give them the tools to have that language, then they'll feel more comfortable integrating and socializing again without thinking, how do I show up? Or how do I manage when people ask me certain questions? All right. So now what is the role of trauma in crisis reactions? Because whether we've acknowledged it or not, there's a significant role that trauma plays in when we are experiencing a crisis. So trauma is unique. Each individual has their own risk factors and experiences. So for crisis intervention responders, displaying curiosity rather than assumptions is a key component of supporting folks through crisis. Having a sound understanding of trauma and related anxiety disorders is therefore a crucial precursor to crisis intervention. We don't want to just assume how our client is feeling. We don't want to assume what's traumatic or what's not traumatic for them. When we do that, we're taking away some of their autonomy and their feelings. So there may be a time where they need to unpack this with the counselor because the impact of trauma has started to set in and they're not sure how to process it. So put yourself in a position of providing great support and helping to remain proactive to managing trauma responses. What is the role of trauma in crisis reactions? Acute anxiety and trauma reactions are mostly related to perceived threats in the environment. So for women, women are 16% more to develop anxiety after a trauma. And then for as far as race-based trauma, people of color are more likely to experience mental health concerns and have less access to support. So there are some of us who are predisposed to experiencing crisis or we've had unfortunate experiences because of what's going on. Now we see it a lot in the media, in the news where because of race relations and historical trauma, cultural trauma, this is impacting how we respond to a crisis situation. We have some of the risk factors up here. Oh, go ahead. I'm sorry. No, it's okay. I just want to give you a time check. In about 10 minutes, we'll need to wrap up the content for sure. So just to give you that heads up, we have 10 more minutes maximum. Thanks. Okay, perfect. Thank you. We have the risk factors there. We talked about anxiety and how that could be related to trauma and trauma reactions or crisis reactions. And then there's race-based traumatic stress. So research reported on the Association for Behavioral and Cognitive Therapy's race-based traumatic stress fact sheet indicates that at least 63% of Black Americans, 47% of Latinx Americans, 6% of Asian Americans, 5% of American Indians or Alaska Natives, and 4% of multiracial individuals have experienced at least one racially charged trauma in their lifetimes. Now, this is significant when we think about how we respond to traumatic stress. When you think about how you are providing the best care for the individuals that you serve, you want to take into context what their previous experiences have been. As far as a trauma-informed crisis response, trauma events do not exist in a vacuum like other social phenomena. They should be understood within the social and cultural context in which they occur. So what does that mean for us as healthcare providers? Trauma-informed care is not a specific EBT, but rather it's an overarching lens to mental health care. Trauma-informed care takes into account and centers safety, trust, peer support, collaboration, choice, and intersectionality. When these factors are considered, this can encourage a greater level of curiosity, care, and non-judgmental treatment. Taking on this stance can foster an environment of emotional safety for the individual experiencing the crisis. When we're providing crisis care to be trauma-informed, it means that we're not the expert of what our clients have experienced. We want to have a safe space for them to share. And you do this by asking questions, being very cultural humility, not just being culturally competent. While cultural competence is an important consideration in working with diverse populations who are experiencing crises and other mental health concerns, we would like to emphasize the importance of cultural humility in these cases. Cultural competence focuses on the expertise of the healthcare provider, whereas cultural humility sees the provider as a learner and positions the client or service seeker as the expert of their own experiences. Often, we're hearing culturally become culturally competent, and almost I can feel like it seems like a buzzword, but we really want to be practicing cultural humility. And that means we humble ourselves and we acknowledge that our client is the expert. So what are the competencies of multicultural care? Awareness, knowledge, and skills. So having these three components prioritized allows there to be more awareness of how the role of the treating professional can impact or enhance the experience of crisis response interventions. So be aware of your own biases. Make sure, again, we're not the expert. The knowledge comes from our client. And then we have the appropriate culturally intervention strategies and techniques to best support them. So cultural considerations. You want to consider how crises are viewed by the person experiencing the crises and the one intervening to support the person, how a trigger is interpreted, and the meaning assigned to that trigger. So in summary, we want to hold space for our client and not feel like we need to be the one telling them what the crisis is or is not. And just in sake of time, I want to say that kind of go through the next slide. Assumptions made by professionals can create significant barriers to culturally responsive crisis responses. So everyone, when we think that everyone benefits from linear thinking about the events, that can be problematic. Interpretations are best provided by using abstract words, giving cause and effect explanations. And lastly, the crisis responder has a sound awareness and understanding of their own cultural assumptions and biases. So it's important for us to create safety when we're responding to crisis situations. That places immediate, it puts the person who's experiencing the crises, it puts them at ease that we're trying to learn from them. We're trying to provide them with resources and not just tools and interventions that are not culturally appropriate. Community-based healing and supports. Taking a harm reduction approach, crisis responders should work with individuals experiencing crises to access culturally safe and responsive resources that do not lean on police or first line responders as the first line of action. So this looks like involving support to the individuals for a warm line, mobile crisis team, and community or social networks. And now this slide goes over police involvement. We understand that police involvement will be necessary at times. However, we want this to, in most situations, be the last resort as we intervene to de-escalate. So the crisis response framework, I'm going to kind of fly through these next slides. So in summary, our first line of response should be a trained mental health professional. Secondly, we want to have a crisis responder assess for imminent risk or harm to the client or others. If there is a high level of risk, we should escalate to the following for further support. So emergency contact, hospital, mobile crisis teams. And then if those steps are not accessible, a non-emergent line and then an emergent line. And follow up with client plus emergency contact as appropriate and necessary. So in summary today, we've discussed what a mental health crisis is, signs and triggers of a mental health crisis, evidence-based tools for managing distress and crisis reactions, the role of trauma and crisis reactions, and cultural considerations in crisis management. Thank you. All right. Thank you so much, Jason, for such an interesting presentation. Before we shift into Q&A, which might just be one Q, but that's okay, I want to take a moment and let you know that SMI Advisor is accessible from your mobile device. So you can use the SMI Advisor app to access resources, education, and upcoming events, complete mental health rating scales, and even submit questions directly to our team of SMI experts. So download the app now at smiadvisor.org. So one question that I would like to pose is, you know, as we talked about managing crises, clinicians, you know, are obviously managing and hear and see a lot of stress. So how do we as clinicians work to avoid burnout or compassion fatigue since we are regularly dealing with people who are in crisis and might be experiencing our own life stressors? Yeah, great question. I would say, I like to use the self-care acronym, and the care stands for, the C is communicate. Communicate what you need to your peers, to your, you know, if you have staff, if you have a boss, but communicate what you need and what you can and cannot do. So this looks like setting healthy boundaries. Then A, for taking assessment, and this is you really asking yourself those same tough questions that you often ask the people that you serve. R, to avoid burnout, I want you to recharge. For some of us that may mean taking a breather, resting, or for some that may mean taking a vacation where you're out and active, being active, but I want you to recharge. And then E, execute. So make sure that whatever you choose, that you actually implement these activities and you don't just think about avoiding burnout, but you do something to actually not have burnout. Great. We're getting requests for you to do a two-hour webinar next time, so you have more time. I have another question though. So, you know, we talked today mainly about people who are in an acute state of crisis. Do you have any suggestions on how to manage people who might be in kind of a continual state of crisis or feel like they're in that crisis all the time? So kind of are people who are chronically in a crisis state? Yeah, great question. I would say for those people who feel like there's always a crisis, I would look at what are some of the driving thoughts or beliefs that they have about how their life should look or the demands on themselves that continuously put them in a crisis situation. So how come every month seems to be the same scenario? What's the story that you're telling yourself that you have to show up or that you have to respond? And, you know, as you allow them space to unpack that, what are some things that they have in their control to change? And this looks like not judging them, but allowing them to articulate areas where they could move some things around or shift their perspective on their situation. Great. I actually think too, you know, you mentioned DBT quite a bit. I think that's a really good evidence-based practice to help people who are in that state of crisis, which is typically an emotional regulation response or dysregulation. Okay, so we do have time for one more question. You also manage the aftermath or you mentioned the aftermath, right? So after a crisis, post-crisis, do you have any suggestions on how we can both help clients re-enter into their relationships and their routine? And then how do we as clinicians re-enter back into, you know, we have a major crisis, then we leave the office and we have to go cook dinner for the kids, for example. So any thoughts on how to manage the aftermath for both us and for the client? Yeah, so I'll start with the client first. Really helping them to normalize what they've experienced. And again, I can't say enough that the more that they can not feel like this is because of them and they have a safe space, whether that's you, whether it's their friend, their partner, but really helping the client identify who do they feel comfortable sharing this with? Or are they journaling out what this means for them? Because then we can hear the language that they're sharing as they say, well, because I was impatient or because I had an attempt, this means that for me. And there we can find the holes to help them kind of navigate that language better. And then for us as clinicians, we also need to have safe spaces where we can debrief and also articulate to those around us, whether that's our support system, whether that's our partners, whomever that I need to, I've had a long day and I can't just keep this all in. So, but if we work, like some of us work in crisis centers, so we experience crisis all day, every day. If that's you, if that's your position, I would encourage you to have some type of practice that you implement on a daily basis. So it's a part of your routine after you get off of work. So you're already, you know, if your stress is here at five o'clock, you're doing something every day to bring it down a little bit so that you're not going home with this same amount of stress. Great. Thank you so much. So I know we weren't able to get to everyone's questions, but we do have opportunities for you to get those questions answered at a later time. So if there were any topics covered in this webinar that you would like to discuss with your colleagues in the mental health field, you can post a question or comment on SMI advisors webinar round table topics discussion board. This is an easy way to network and share ideas with other clinicians who participated in this webinar. If you do have questions about this webinar or any other topic related to evidence-based care for SMI, you can get an answer within one business day from one of our SMI advisor national experts. This service is available to all mental health clinicians, peer support specialists, administrators, and anyone else in the mental health field who works with individuals who have SMI and is completely free and confidential consultation service. SMI advisor is just one of many SAMHSA initiatives that are designed to help clinicians implement evidence-based care. We'd encourage you to explore the resources available on the mental health addiction and prevention TTCs, as well as the national center of excellence for eating disorders and the suicide prevention resource center. These initiatives cover a broad range of topics from school-based mental health through the opioid epidemic. To claim credit for participating in today's webinar, you'll need to have met the requisite attendance threshold for your profession. Verification of attendance may take up to five minutes, and then you'll be able to select next to advance and complete the program evaluation before claiming your credit. Please join us next week on February 10th as Dr. Nasir Ghami presents fallacies and truths of psychopharmacology focused on lithium. Again, this free webinar will be February 10th at 12 p.m. Eastern, and that's a Friday. Thank you so much for joining us, and thank you so much to Jason. Until next time, take care everybody. you
Video Summary
In the video, Shireen Khan, Vice President of Operations and Strategy at Thresholds, introduces the SMI Advisor webinar on Culturally Competent and Trauma-Informed Crisis Management. The webinar is designed to help mental health clinicians implement evidence-based care for individuals with serious mental illness. Today's webinar has been designated for one AMA PRA Category 1 credit for physicians, one Continuing Education credit for psychologists, and one Continuing Education credit for social workers. The webinar will cover topics such as defining and recognizing a mental health crisis, identifying triggers and signs, incorporating evidence-based tools and resources for managing distress and coping with crisis reactions, understanding the role of trauma in crisis reactions, and considering cultural factors in crisis management. The webinar emphasizes the importance of trauma-informed care and cultural humility. It provides strategies for managing crises, including intentional responses, pros and cons assessment, changing body chemistry, distraction, and self-soothing. It also discusses the aftermath of a crisis, including the importance of validation and support, and the need for self-care to avoid burnout and compassion fatigue. The webinar encourages clinicians to communicate, assess, recharge, and execute self-care strategies. It concludes by discussing the role of trauma in crisis reactions and the importance of trauma-informed care in crisis management.
Keywords
Thresholds
webinar
Culturally Competent
Trauma-Informed Crisis Management
evidence-based care
mental health crisis
trauma
cultural factors
self-care strategies
compassion fatigue
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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