Instruction on self-care while working the crisis line. I intern with SoCal united way 211 as a crisis counselor for the community of suicidal people. ?Need to tie in with page 1
Instruction on self-care while working the crisis line. I intern with SoCal united way 211 as a crisis counselor for the community of suicidal people. Need to tie in with page 14 and add some self care after a call. 1 1/2 page.
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Inland SoCal
Crisis Helpline Counselor Manual
Table of Contents
Policies & Procedures 4
Inland SoCal Crisis Helpline Core Values 5
Suicide Terminology 6
Trauma-informed Care (TIC) Policy 7
Duty to Warn Policy for Inland SoCal Crisis Helpline 8
Mandated Abuse & Neglect Reporting Policy for Inland SoCal Crisis Helpline 9
Imminent Risk Policy for Inland SoCal Crisis Helpline 10
Third-Party Suicide-Related Call Policy for Inland SoCal Crisis Helpline 11
Self-Disclosure Policy for Inland SoCal Crisis Helpline 12
Caller Follow-Up Policy for Inland SoCal Crisis Helpline 13
Debriefing Policy for Inland SoCal Crisis Helpline 14
Mandated Reporting 15
Mandated Abuse Populations 16
California Mandated Reporter 19
Emotional Support 21
Inland SoCal Crisis Helpline: Supporting Our Community 22
Inland SoCal Crisis Helpline’s Four Fundamental Principles 23
Understanding Trauma-Informed Care 24
Emotional Support Skills Utilized on the Crisis Helpline 25
Phases of a Crisis Helpline Call 26
Identifying Protective Factors with Crisis Helpline Callers 27
Strategies to Refrain From Self-Disclosure 28
Crisis Helpline Attitudinal Training Objectives 29
Inland SoCal Crisis Helpline Role Play Feedback Form 30
The Feeling Wheel 32
Vocabulary of Emotions/Feelings 33
Cultural Competence 34
Cultural Identity Worksheet 35
Cultural Competence for Inland SoCal Crisis Helpline Counselors 36
Cultural Competence Self-Assessment Knowledge Checklist 37
Crisis Helpline Exercise for Diverse Populations 39
Riverside County Demographic 48
San Bernardino Demographic 49
Large-Scale Crisis 50
Online Warning Signs of a Suicidal Crisis 51
Responding to Online Signs of Suicidality 52
Attitudes and Behaviors of Culturally Competent Counselors 53
Assessment 55
Suicidality Assessment 56
Assessing suicide risk: Initial Tips for Counselors 57
Active Rescue Guideline 58
Guiding a Third-Party Caller 59
Third-Party Case Vignette 61
Frequent Callers: Who? What? How? 62
National Suicide Prevention Lifeline: Assessment standards 64
Suicide Prevention Referrals for Inland SoCal Crisis Helpline 66
Logistics 67
NICE inContact 68
iCarol 70
Accessing Tele-Interpreter Services for Inland SoCal Crisis Helpline Calls 75
Inland SoCal Crisis Helpline Quiz Databank 76
Policies
&
Procedures
Inland SoCal Crisis Helpline Core Values
1. Crisis Helpline will take all necessary actions to prevent a person from dying by suicide.
2. Crisis Helpline will collaborate with the person to secure individuals’ safety.
3. Crisis Helpline will work with emergency services to ensure the safe, continuous care of the person in imminent risk.
Inland SoCal Crisis Helpline Goals
WE DO NOT!
Provide therapy
Provide advice
Fix people
Save people
WE DO
Provide support
Provide referrals
Offer Hope
Increase Safety
References:: Adapted from National Suicide Prevention Lifeline: Policy for Helping Persons at Imminent Risk of Suicide
Revised by R. Garcia 04.27.21
Suicide Terminology
Suicide:
Death caused by self-directed injurious behavior with an intent to die as a result of the behavior.
Suicide attempt:
A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury.
Suicidal ideation: Thinking about, considering, or planning suicide.
Suicidal self-injurious behavior:
Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Behavior could be with or without suicidal intent
No suicide is “committed” or “successful,” just as a death to cancer isn’t a successful cancer.
References: Crosby AE, Ortega L, Melanson C. Self-directed Violence Surveillance: Uniform Definitions and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2011. Retrieved on March 3, 2021 from https://www.cdc.gov/violenceprevention/pdf/Self-Directed-Violence-a.pdf
Revised by R. Garcia 04.27.21
Trauma-Informed Care (TIC) Policy
I. PURPOSE
To ensure that services and programs support trauma issues and avoid re-traumatization for all persons within Inland SoCal United Way and served by Inland SoCal United Way.
II. POLICY
Inland SoCal United Way staff, volunteers, and stakeholders will create and maintain a safe, calm, and secure environment with supportive care, a system-wide understanding of trauma prevalence and impact, recovery and trauma-specific services, and recovery-focused services.
III. IMPLEMENTATION
All staff and volunteers will receive annual training to appropriately support all peers, clients, and stakeholders with a history of trauma. All supervisors also receive training to make trauma-informed hiring and retention decisions. All training will focus on " The Trauma-Informed Care Four R's": REALIZATION about trauma and how it can affect people, RECOGNIZING the signs of trauma, having a system that can RESPOND to trauma, and RESISTING re-traumatization .
IV. PRINCIPALS
The "Five Guiding Trauma-Informed Principles” guide Inland SoCal United Way. They are safety, choice, collaboration, trustworthiness, and empowerment. These principles ensure that an individual's physical and emotional safety needs are addressed, and providers are trustworthy.
V. DEFINITIONS
Trauma: A survivors' biological response to difficult events. These can include loss, sexual abuse, physical abuse, emotional abuse, intimate partner violence, rape, human trafficking, terrorism, and natural disasters. Trauma can cause short-term or long-term physical symptoms, mental health problems, unhealthy behaviors, and relationship problems.
Trauma-Informed Care: An approach that considers a person's life experiences; "what happened to you" versus "what is wrong with you"? It connects the impacts of an individual's experiences on their overall wellbeing (physical, emotional, and psychological), provide choice, and is client-centered and practiced at the individual patient/client and system levels.
VI. REFERENCES
SAMHSA’s Concept of Trauma and Guidance for a Trauma Informed Approach. HHS Publication No. (SMA) 14- 4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014
Duty to Warn Policy for Inland SoCal Crisis Helpline
Victimology
Victimology is the study of violent crime victims or victimization. Using victimology, helping professionals can identify and warn potential victims of possible harm by violence.
Tarasoff
All helping professionals in the United States have an ethical duty to breach clients’ confidentiality to make notifications for both homicide risk and suicide. Mandated homicide reporting and the duty to warn were established in Tarasoff v. Regents of the University of California (Cal. 1976).
Duty to Warn
The Supreme Court of California held a court ruling which authorized helping professionals have a duty to protect individuals who are being threatened with bodily harm by a client. Crisis Helpline counselors fall under this mandate and MUST breach confidentiality when a caller threatens to harm themselves or another individual.
Mandated Homicide Reporting
If the caller makes a threat on the life of another person or reports a threat on the life of themselves or someone else, the crisis worker has a “duty to warn”. According to Tarasoff Decision (1976), law enforcement MUST be called, the Crisis Helpline Manager must be notified, and the “Threat to Others” form must be completed.
References: Tarasoff v. Regents of the University of California, 131 Cal. Rptr. 14 (Cal. 1976)
Revised by R. Garcia 04.27.21
Mandated Abuse & Neglect Reporting Policy for Inland SoCal Crisis Helpline
Mandated Dependent Adult/Elder Abuse Reporting Procedure
If you suspect the abuse or neglect of a dependent adult or an elder (over 65), you are mandated to make an immediate verbal report by calling the Riverside County Adult Services Hotline at 1-800-491-7123 and submitting the attached written report within 36 hours by mail to DPSS – Adult Services Central Intake Center 4060 County Circle Drive Riverside, CA 92503 or by fax to 1 –951-358-3969. San Bernardino County Elder/Dependent Adult 24-Hour Toll-Free Hotline 1-877-565-202. If an elder or dependent adult is in imminent danger, call 9-1-1 immediately.
Welfare and Institutions Chapter 4.5, Division 8.5, Sections 9381 (a) and Welfare and Institution Code (WIC) Chapter 11, Division 9, Section 15630 (a)
Child Abuse Mandated Reporter Requirements
If you suspect the abuse or neglect of a child (under 18), you are mandated to make an immediate verbal report by calling the Riverside County Child Protective Services at 1-800-442-4918 and submitting the attached written report within 36 hours by mail to Riverside County CPS 23119 Cottonwood Ave. Bld. B Moreno Valley CA 92553 or fax to 951-413-5122. San Bernardino County CPS at 800-827-8724 or 909-384-9233 and submit completed form via fax to: attention: Child Abuse Hotline 909-891-3545 or 909-891-3560. If a child is in imminent danger, call 9-1-1 immediately. Penal Code Section 11165.7
Follow Up with Inland SoCal United Way Crisis Helpline
You must notify the Crisis Helpline Manager immediately if you make an abuse report. A copy of your completed mandated report must be provided to the Crisis Helpline Manager.
Imminent Risk Policy for Inland SoCal Crisis Helpline
Imminent Risk
A caller or third party is determined to be at imminent risk of suicide if the caller or third party has a desire and intent to die and has the capability of carrying through with intent.
Active Engagement
Active engagement on a crisis call is a crisis counselor's ability to use active listening and engagement in a direct discussion about suicide with every caller.
Least Invasive Intervention
Crisis Helpline counselors should use the least invasive intervention and consider involuntary emergency interventions as a last resort. Crisis Helpline counselors must incorporate the caller’s wishes whenever possible into any intervention plan.
Supervisory consultation
A Crisis Helpline counselor may seek support necessary to effectively determine the need for and initiate an active rescue procedure. The Crisis Helpline Manager will provide timely access to supervisory guidance during all hours of crisis center operation. When in doubt, immediately contact the Crisis Helpline Manager.
Active Rescue
An active rescue is a set of actions taken by Crisis Helpline counselors to ensure individuals' safety if imminent risk has been determined. Initiation of active rescue entails a three-way call with police. Crisis Helpline counselors must confirm that crisis services arrived by staying in contact with the caller and authorities. All active rescues require immediate contact with the Crisis Helpline Manager.
References: National Suicide Prevention Lifeline (2010),”Policy for Helping Callers at Imminent Risk of Suicide”: Retrieved on October 16, 2018 from https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/FINAL-IR-BOOKLET-01-20-2011.pdf
Third-Party Suicide-Related Call Policy for Inland SoCal Crisis Helpline
In general, individuals at risk of suicide who do not contact a crisis center are likely in imminent danger. Those at-risk individuals come to our attention in many cases through a third-party caller – someone who cares about the individual experiencing suicidal ideation, desire, or intent.
We can often make the third-party caller an ally and use their contact with the individual at-risk to ensure safety.
Active rescue suggests the crisis counselor must attempt to talk directly to the individual at-risk.
Use active listening skills and assess the situation
Find out the relationship between the third-party caller and at-risk individual
Gather the name and contact information of the third-party caller
Try to obtain the name, contact information and location of the individual at risk
Ask to speak to the at-risk individual one-to-one or on a three-way call
If the at-risk individual is unavailable, educate the third-party caller on ways to intervene
Third-party Anonymity
Be aware that there are times when a third-party caller wants to remain anonymous. This may be because they are domestic violence victims, fear the police, and or wish not to be further involved in the crisis.
References: National Suicide Prevention Lifeline (2010),”Policy for Helping Callers at Imminent Risk of Suicide”: Retrieved on October 16, 2018 from https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/FINAL-IR-BOOKLET-01-20-2011.pdf
American Association of Suicidology (2012), “Organization Accreditation Standards Manual”. Retrieved on October 15, 2018 from https://www.suicidology.org
Revised by R. Garcia 04.27.21
Self-Disclosure Policy for Inland SoCal Crisis Helpline
Counselor self-disclosure should be avoided. A crisis center call should not sound like a two-way conversation with a friend. The crisis counselor should entirely focus on the client—not themselves.
Be aware of the following signs:
· “Getting to know you” questions asked by a caller may cause unproductive role reversal in the emotional support relationship. Ex: “Do you have kids?”
· Shared personal experiences with a caller; avoid sharing personal resolutions as it is inappropriate and can be harmful. Ex: “It worked for me; it could work for you.”
· Sympathy statements demonstrate a lack of empathy. Avoid sharing personal feelings during the call. Ex: “If I were in your shoes, I would be so sad.”
Self-Assessment
If you accidently self-disclose during a call, change the subject back to the caller. After the call, reflect on what caused you to cross this boundary. Maybe the issue presented by the caller was “close to home,” or you are experiencing personal stress. When this happens, reach out to the Crisis Helpline Manager to provide you with support, recommendations, and assistance.
Revised by R. Garcia 04.27.21
Caller Follow-Up Policy for Inland SoCal Crisis Helpline
Follow-Up Procedures:
If a caller is in imminent danger, you will follow the Imminent Risk Policy. At that time, the Crisis Helpline Manager may assign a single follow-up call to you, the Crisis Helpline Manager or another counselor. Once approved and assigned, there should be three documented attempts to contact a caller.
Follow-Up Consent:
Caller’s consent is required to follow up. Ex: " We would like to call you back in a few days and see how you are doing. Would you be open to allowing us to re-contact you soon?”
If the caller says, “yes”, obtain:
1. The caller’s name:
2. The best phone number:
3. Best days and times to call:
4. Is it okay for us to leave a message?
5. Special Instructions: ________________________
Document Unsuccessful/Successful Attempt to Reach the Caller:
There should be documentation of an unsuccessful/successful follow-up call via iCarol
References: National Suicide Prevention Lifeline (2012), “Crisis Center Guidance: Follow-up with Callers and Those Discharged from Emergency Department”. Retrieved on October 15, 2018 from https://suicidepreventionlifeline.org/wp-content/uploads/2016/09/Lifeline-Follow-Up-Guidance1214.pdf
Revised by R. Garcia 04.27.21
Debriefing Policy for Inland SoCal Crisis Helpline
The following calls MUST be reported to a Crisis Helpline Manager for debriefing and follow up:
1. A call that involves emergency services (police, an ambulance, or the fire department).
2. A call that resulted in a mandatory child, elder or disabled adult abuse report.
3. A call in which the counselor was sexually harassed, verbally abused or threatened by a caller.
4. A call in which a third-party was contacted (a parent, a guardian, animal control…).
5. A call that leaves the crisis counselor feeling discomfort, upset or disturbed.
Debriefing: A debriefing meeting will allow the crisis counselor to obtain support and guidance from the Crisis Helpline manager. Also, Helpline weekly debrief meetings are hosted to provide additional support.
Follow-up: May also be utilized to ensure client’s safety.
Nuisance Call Policy
· You have the right to end nuisance calls and prank calls.
· To end an abusive or harassing call, you may either just hang up or you may say, “This is inappropriate. I’m hanging up now.”
Revised by R. Garcia 04.27.21
Mandated
Reporting
Elder Abuse Mandated Reporting
Recognizing the increasing reported instances of abuse of elderly people, the State of California has passed various statutes making such abuse subject to unique criminal and civil liability. Essentially, the laws forbid the lack of care as well as the physical or mental abuse of elderly dependent persons. Violation of such provisions can subject the perpetrator to civil and, more drastically, criminal liability. The definitions are contained in the Welfare and Institutions Code and the criminal penalties in the Penal Code. It is important to note that many of the statutes apply to ANY dependent adults regardless of age. It is also important to note that failure to provide goods or services by a care custodian, itself, may be considered elder abuse.
Welfare and Institution Code Definitions.
15610.23. (a) "Dependent adult" means any person between the ages of 18 and 64 years who resides in this state and who has physical or mental limitations that restrict his or her ability to carry out normal activities or to protect his or her rights, including, but not limited to, persons who have physical or developmental disabilities, or whose physical or mental abilities have diminished because of age.
(b) "Dependent adult" includes any person between the ages of 18 and 64 years who is admitted as an inpatient to a 24-hour health facility, as defined in Sections 1250, 1250.2, and 1250.3 of the Health and Safety Code.
15610.27. "Elder" means any person residing in this state, 65 years of age or older.
15610.07 . "Abuse of an elder or a dependent adult" means either of the following:
(a) Physical abuse, neglect, financial abuse, abandonment, isolation, abduction, or other treatment with resulting physical harm or pain or mental suffering.
(b) The deprivation by a care custodian of goods or services that are necessary to avoid physical harm or mental suffering.
15610.57. (a) "Neglect" means either of the following:
(1) The negligent failure of any person having the care or custody of an elder or a dependent adult to exercise that degree of care that a reasonable person in a like position would exercise.
(2) The negligent failure of an elder or dependent adult to exercise that degree of self-care that a reasonable person in a like position would exercise.
(b) Neglect includes, but is not limited to, all the following:
(1) Failure to assist in personal hygiene, or the provision of food, clothing, or shelter.
(2) Failure to provide medical care for physical and mental health needs. No person shall be deemed neglected or abused for the sole reason that he or she voluntarily relies on treatment by spiritual means through prayer alone in lieu of medical treatment.
(3) Failure to protect from health and safety hazards.
(4) Failure to prevent malnutrition or dehydration.
(5) Failure of an elder or dependent adult to satisfy the needs specified in paragraphs (1) to (4), inclusive, for himself or herself as a result of poor cognitive functioning, mental limitation, substance abuse, or chronic poor health (CDSS 2019).
Both the Courts and the various governmental agencies have held that abuse may be defined in a broad category of actions:
· Phys
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