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Article Excerpt
The expectation that police officers can address every need in every situation is daunting and unrealistic. Recognizing this, some police departments have instituted special training or used other resources to better serve the needs of citizens. One example is an on-scene crisis counseling unit comprised of volunteer mental health professionals who respond to calls with police officers. These counselors provide mental health services that police officers cannot. This article explains the usefulness of this type of program, and crisis counseling in general, for both officers and victims as they deal with crises like domestic violence, homicide, suicide, and sexual assault. The study examines survey results from victims and police officers about the impact of this intervention. The data support the helpfulness of the program. Implications and recommendations for further research are included.
INTRODUCTION
A typical call for the on-scene crisis counseling unit (the Crisis Team) with the local police department in a Texas city, population over 200,000, is the following: At 1:00 a.m. police officers are dispatched because a young woman called 911 screaming that her mother had just shot herself in her living room. When officers knock on the front door, no one answers, so they ask the dispatcher to call the residence and ask the young woman to open the door. When called, the young woman states she is too frightened to leave her room. At this point, one of the officers asks the dispatcher to page the Crisis Team.
After officers ease the young woman out of her house through her bedroom window, the Crisis Team volunteer helps her calm down by asking simple questions about what transpired. The young woman reports her estranged mother had asked to visit her for the holidays. During the visit, her mother shot herself in the head as she watched.
Over the course of the next hour, the volunteer counsels with her and answers her questions about what the officers are doing in her house and what will happen to her mother's body. The volunteer helps the young woman make a plan for where she will stay, who to call for support, and what she will say to her boss about work. She decides to stay with some friends but needs some items retrieved from her home. The Crisis Team member coordinates with the investigating officers and goes into the living room, steps over the body of the mother, finds her suitcase, meets her in her bedroom, and helps her pack. Before she leaves the home, plans are made for a follow-up call from the Crisis Team volunteer for support.
LITERATURE REVIEW
The importance of the field of crisis intervention is increasing. Recent experiences like the September 11th terrorist attacks and Hurricane Katrina and the increased visibility of home, school, and community violence are the most obvious types of crisis that require psychotherapeutic attention on both personal and community levels (Brown & Rainer, 2006). It is clear that events like terrorist attacks, natural disasters, wars, suicides, large-scale riots, and homicides--and the posttrauma stress symptoms associated with them--present mental health counselors with unique challenges (Dingman, 1995; Dingman & Ginter, 1995).
One approach to helping people in situations like these is crisis intervention (Swanson & Carbon, 1989); it provides emotional aid to victims with specific attention to the circumstances of the presenting problem. Crisis intervention also seeks to mitigate the impact of the stress on the victim (Dykeman, 2005).
The literature about crisis intervention is primarily concerned with reducing anxiety and posttraumatic stress symptoms through critical incident stress debriefing (CISD). CISD is a group crisis intervention technique designed by Mitchell (1983) to ease the acute symptoms of distress associated with psychological crisis and trauma (Everly, Flannery, & Eyler, 2002). CISD was originally a way to allow emergency services personnel who had been exposed to traumatic events to emotionally process the event. Later, CISD was expanded to treat civilian victims of trauma (Pennebaker, 2001). A number of studies produced evidence to support the use of CISD in preventing posttraumatic stress disorder (PTSD) (Campfield & Hills, 2001; Everly & Boyle, 1999; Stapleton, Lating, Kirkhart, & Everly, 2006); other studies concluded that CISD was not effective and may even have adverse effects (Emmerik, van Kamphuis, Hulsbosch, & Emmelkamp, 2002; Gist & Devilly, 2002; Harris, Baloglu, & Stacks, 2002; Raphael, 2000; Small, Lumley, Donohue, Potter, & Waldenstrom, 2000; Wessely, Rose, & Bisson, 1999).
Research on CISD is useful but limited because it mainly deals with group debriefing provided several days to weeks after the traumatic event (Rauch, Hembree, & Foa, 2001). Therefore, it becomes necessary to consider other modes of crisis intervention. Many studies strongly support immediate, acute intervention after traumatic events (Bisson, McFarlane, & Rose, 2000; Everly, Flannery, Eyler, & Mitchell, 2001). For example, Everly et al. (2001) proposed that psychological support is more effective if it occurs quickly at or near the location of the crisis. Similarly, Stein and Eisen (1996) found that early short-term crisis intervention for members of the general population helps prevent the development of PTSD and restore balance. Campfield and Hills (2001) also suggested that early crisis debriefing designed so as to help victims through a normal recovery process helps prevent PTSD. Studies of victims of sexual assault (Marotta, 2000; Resnik, Aciemo, Holmes, Kilpatrick, & Jager, 1999) and armed holdups (Manton & Talbot, 1990; Talbot, 1990) also demonstrated a decrease in PTSD symptoms when psychological intervention occurred quickly.
In some research the findings related to psychological intervention after trauma are inconclusive. Rose and Bisson (1998) reviewed six randomized control trials, all focused on individual debriefing after a variety of traumatic events. Two of the studies yielded evidence that supported the use of debriefing, two demonstrated no effect, and two offered evidence of negative effects. A few studies (Gard & Ruzek, 2006; Litz, Gray, Bryant, & Adler, 2002; McNally, Bryant, & Elhers, 2003) that looked at interventions immediately after crisis have provided evidence that debriefing does not prevent the development of PTSD. Despite the inconclusive and negative findings, an accepted protocol is that psychological intervention should be provided immediately after a trauma and in combination with medical assistance (Burges, 1987; Raphael, 1986; Talbot, 1990).
Psychological first aid (PFA) has been proposed as the main alternative to immediate individual crisis intervention in the hours and even days after a traumatic event. According to Gard and Ruzek (2006) and Ruzek, Brymer, Jacobs, Layne, Vemberg, and Watson (2007), PFA is designed to meet the immediate practical needs of survivors. Elements of PFA are making contact and engaging in conversation with the victim in a helpful manner, providing immediate and continuing safety, stabilizing and calming, gathering information, addressing immediate needs and concerns, connecting with social support systems, providing information on coping, and...
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