Building the Path to Home

Crisis planning and management

The person you are supporting may have frequent crises and often be involved with crisis services, hospitals and other emergency services. Crises are frightening for the person and those around him or her. Frequent crises can cause the person to lose important supports.

For a person with a developmental (intellectual) disability and a mental health problem, a crisis can also mean the loss of functional abilities. This can happen because of a psychiatric deterioration or changes in physical health, or because separation from familiar surroundings and routines disorients the person. Long hospitalizations resulting from crises can effect a person's functional capacity simply because learned skills fall into disuse and need to be re-learned.

For these people, good planning and co-ordination of support can reduce the frequency of crises and help them resolve more quickly when they do happen. The shorter the crisis, the less the impact on the person. Good planning can also help the group of people supporting the person to weather the storm and to keep going with someone who might otherwise wear them out.

Crisis Prevention and Management Tool
The Crisis Prevention and Management Tool was developed to help family members and services providers:

• gather important information in one place
• communicate the information to all the people in an individual's support network.

The tool:

• helps people supporting the person analyze which behaviours are likely to lead to a crisis, and how they have been successfully managed in the past
• spells out what to do as the behaviour becomes more extreme (this helps ensure a consistent approach)
  
• protects against over-reactions, which can trigger further deterioration
• ensures that the necessary steps are taken to keep the person safe and get him or her the help he or she needs when moving into crisis.

Development of the tool
In September 2005, the Dual Diagnosis Resource Service (DDRS) at the Centre for Addiction and Mental Health (CAMH), the Griffin Community Support Network (GCSN) and the COTA Health Dual Diagnosis Case Management Service collaborated to develop a crisis prevention and management tool. The tool is based on a support planning tool that was developed in Massachusetts by Joan Beasley and the START Program and which was demonstrated there to be effective in helping families and providers collaborate effectively and improve understanding for people with complex needs living in the community. * GCSN, COTA and DDRS have adapted the tool for Canadian circumstances.

Using the tool
The tool includes a Personal Support Plan section in the form of an escalation continuum. This section helps the people supporting the person to know which behaviours are likely to lead to a crisis, how they have been successfully managed in the past and what to do as the behaviour becomes more extreme. This helps the people supporting the person to be consistent in their approach. It protects against overreactions that can trigger further deterioration and it ensures that the necessary steps are taken to keep the person safe and get him or her the help needed when moving into crisis. It also helps the person know what to do as the problem gets worse.

As with the shorter Integrated Support Planning Tool, the Crisis Prevention and Management Tool works best when it is used by the group of people supporting the person and when the planning process starts with a conversation with the person about what works best for him or her. It is also important to update the plan regularly. The nature of crisis is that things often don’t go according to plan. Meeting regularly to review and update the plan can help the group learn from each crisis and ensure that the approaches taken fit for the person.

Think carefully about who should have copies of the plan. With the person’s permission, you can arrange for a copy to be on file with your local crisis services and hospital. You can even arrange for the police to know about it so that a constable responding to a call knows to ask for it when he or she arrives at the door.

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*Beasley, J.B. & Kroll, J. (1999). "Family caregiving part II: Family caregiver-professional collaboration in crisis prevention and intervention planning," in Mental Health Aspects of Developmental Disabilities, 2 (1), 22-26.

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