First published in 1999. This text examines the impasse in the development of alternatives to hospitals, drawing on the experience of both crisis service users and providers, and evidence of the effectiveness of such services. The book concludes that crisis services are preferred by users, are usually more cost effective and often more clinically effective than acute admissions wards. It offers a number of policy suggestions to advance the role of crisis services, including monitoring, evaluation and development centres, or programmes being established on a national basis, and joint training between crisis service and hospitals.
Psychological Crisis Intervention: The SAFER-R Model is designed to provide the reader with a simple set of guidelines for the provision of psychological first aid (PFA). The model of psychological first aid (PFA) for individuals presented in this volume is the SAFER-R model developed by the authors. Arguably it is the most widely used tactical model of crisis intervention in the world with roughly 1 million individuals trained in its operational and derivative guidelines. This model of PFA is not a therapy model nor a substitute for therapy. Rather it is designed to help crisis interventionists stabile and mitigate acute crisis reactions in individuals, as opposed to groups. Guidelines for triage and referrals are also provided. Before plunging into the step-by-step guidelines, a brief history and terminological framework is provided. Lastly, recommendations for addressing specific psychological challenges (suicidal ideation, resistance to seeking professional psychological support, and depression) are provided.
Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources. Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake. Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.
Crisis resolution and home treatment teams respond rapidly to people experiencing mental health crises and offer an alternative to hospital admission. They are an increasingly important component of mental health care and are adopted by many health care systems around the world. This practical and pioneering book describes the evidence for the effectiveness of such teams, the principles underpinning them, how to set up and organise them, how patients should be assessed and what types of care the teams should offer. Other topics covered include integration of crisis teams with in-patient, community residential and day care services, the service users' experiences of crisis teams, and responding to diversity in home treatment. This book is essential reading for all policy makers, service managers and mental health workers interested in establishing or operating crisis resolution and home treatment services, as well as for researchers and students seeking to understand this model.
During a wide-reaching catastrophic public health emergency or disaster, existing surge capacity plans may not be sufficient to enable health care providers to continue to adhere to normal treatment procedures and follow usual standards of care. This is a particular concern for emergencies that may severely strain resources across a large geographic area, such as a pandemic influenza or the detonation of a nuclear device. Under these circumstances, it may be impossible to provide care according to the standards of care used in non-disaster situations, and, under the most extreme circumstances, it may not even be possible to provide basic life sustaining interventions to all patients who need them. Although recent efforts to address these concerns have accomplished a tremendous amount in just a few years, a great deal remains to be done in even the most advanced plan. This workshop summary highlights the extensive work that is already occurring across the nation. Specifically, the book draws attention to existing federal, state, and local policies and protocols for crisis standards of care; discusses current barriers to increased provider and community engagement; relays examples of existing interstate collaborations; and presents workshop participants' ideas, comments, concerns, and potential solutions to some of the most difficult challenges.
Helping Kids in Crisis: Managing Psychiatric Emergencies in Children and Adolescents provides expert guidance to practitioners responding to high-stakes situations, such as children considering or attempting suicide, cutting or injuring themselves purposely, and becoming aggressive or violently destructive. Children experiencing behavioral crises frequently reach critical states in venues that were not designed to respond to or support them -- in school, for example, or at home among their highly stressed and confused families. Professionals who provide services to these children must be able to quickly determine threats to safety and initiate interventions to deescalate behaviors, often with limited resources. The editors and authors have extensive experience at one of the busiest and best regional referral centers for children with psychiatric emergencies, and have deftly translated their expertise into this symptom-based guide to help non-psychiatric clinicians more effectively and compassionately care for this challenging population. The book is designed for ease of use and its structure and features are helpful and supportive: The book is written for practitioners in hospital or community-based settings, including physicians in training, pediatricians who work in office-based or emergency settings, psychologists, social workers, school psychologists, guidance counselors, and school nurses -- professionals for whom child psychiatric resources are few. Clear risk and diagnostic assessment tools allow clinicians working in settings without access to child mental health professionals to think like trained emergency room child psychiatrists--from evaluation to treatment. The content is symptom-focused, enabling readers to swiftly identify the appropriate chapter, with decision trees and easy-to-read tables to use for quick de-escalation and risk assessment. A guide to navigating the educational system, child welfare system, and other systems of care helps clinicians to identify and overcome systems-level barriers to obtain necessary treatment for their patients. Finally, the book provides an extensive review of successful models of emergency psychiatric care from across the country to assist clinicians and hospital administrators in program design. An abundance of case examples of common emergency symptoms or behaviors provides professionals with critical, concrete tools for diagnostic evaluation, risk assessment, decision making, de-escalation, and safety planning. Helping Kids in Crisis: Managing Psychiatric Emergencies in Children and Adolescents is a vital resource for clinicians facing high-risk challenges on the front lines to help them intervene effectively, relieve suffering, and keep their young patients safe.
Catastrophic disasters occurring in 2011 in the United States and worldwide-from the tornado in Joplin, Missouri, to the earthquake and tsunami in Japan, to the earthquake in New Zealand-have demonstrated that even prepared communities can be overwhelmed. In 2009, at the height of the influenza A (H1N1) pandemic, the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services, along with the Department of Veterans Affairs and the National Highway Traffic Safety Administration, asked the Institute of Medicine (IOM) to convene a committee of experts to develop national guidance for use by state and local public health officials and health-sector agencies and institutions in establishing and implementing standards of care that should apply in disaster situations-both naturally occurring and man-made-under conditions of scarce resources. Building on the work of phase one (which is described in IOM's 2009 letter report, Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations), the committee developed detailed templates enumerating the functions and tasks of the key stakeholder groups involved in crisis standards of care (CSC) planning, implementation, and public engagement-state and local governments, emergency medical services (EMS), hospitals and acute care facilities, and out-of-hospital and alternate care systems. Crisis Standards of Care provides a framework for a systems approach to the development and implementation of CSC plans, and addresses the legal issues and the ethical, palliative care, and mental health issues that agencies and organizations at each level of a disaster response should address. Please note: this report is not intended to be a detailed guide to emergency preparedness or disaster response. What is described in this report is an extrapolation of existing incident management practices and principles. Crisis Standards of Care is a seven-volume set: Volume 1 provides an overview; Volume 2 pertains to state and local governments; Volume 3 pertains to emergency medical services; Volume 4 pertains to hospitals and acute care facilities; Volume 5 pertains to out-of-hospital care and alternate care systems; Volume 6 contains a public engagement toolkit; and Volume 7 contains appendixes with additional resources.
Economic shocks pose a threat to health and health system performance by increasing people's need for health care and making access to care more difficult - a situation compounded by cuts in public spending on health and other social services. But these negative effects can be avoided by timely public policy action. While important public policy levers lie outside the health sector, in the hands of those responsible for fiscal policy and social protection, the health system response is critical. This book looks at how health systems in Europe reacted to pressure created by the financial and economic crisis that began in 2008. Drawing on the experience of over 45 countries, the authors:' analyse health system responses to the crisis in three policy areas: public funding for the health system; health coverage; and health service planning, purchasing and delivery 'assess the impact of these responses on health systems and population health' identify policies most likely to sustain the performance of health systems facing financial pressure' explore the political economy of implementing reforms in a crisisThe book is essential reading for anyone who wants to understand the choices available to policy-makers - and the implications of failing to protect health and health-system performance - in the face of economic and other forms of shock.--
The first edition of People in Crisis, published in 1978, established success as a comprehensive and user-friendly text for health and social service professionals. The book and its following incarnations included critical life events and life cycle transition challenges, clearly pointing out the interconnections between such events, stressful developmental changes, and their potential for growth but also danger of suicide and/or violence toward others. This revised edition includes new case examples and expanded coverage of cross-cultural content, including 'commonalities and differences' in origins, manifestations, and crisis responses. The authors illustrate the application of crisis concepts, assessment, and intervention strategies across a wide range of health and mental health settings, as well as at home, school, workplace, and in the community. Each chapter contains a closing summary that includes discussion questions, references, and online data sources for maximum application and learning. Updated chapters discuss new, research-based content on: • workplace violence and abuse • youth violence in schools and higher education settings • the use of psychotropic drugs, including for very young children in the absence of comprehensive assessment • the crisis vulnerability of war veterans and the hazards of 'pathologizing' what should be considered a 'normal' response to the repeated and catastrophic trauma of war • the intersection of socio-political factors with individuals’ psychological healing from catastrophic experiences such as war and natural disaster.
Since the late 1980s the international relief community has seen its resources stressed beyond capacity by humanitarian crises. Covering topics from emergency public health measures to the psychological trauma of relief workers, this volume presents a seasoned assessment of current practice and proposals for improving operational efforts.
