Crisis Response and Management Training from the Doorway Project

Homelessness is in itself a crisis and can contribute to other crises. Our clients often live in a state of crisis, trauma, and emergency. As such, there may be times when crisis (conflict and mental health emergencies) arises. When this happens, we need to be effective responders. Your team is most effective if you react methodologically by separating into primary, secondary, and tertiary responders to maintain the safety of the clients and the space:

Primary Responder(s): Addresses the parties in crisis (conflict, mental health emergency, etc), attempting to de-escalate the client and move them to a more calm, secluded area. There should be one primary responder per client in crisis, to devote attention and energy to their de-escalation. This is typically staff and experienced volunteers, so please defer to your agency’s protocol here.

Secondary Responder(s): Supports the primary responder by ensuring emergency response is initiated, materials are provided, and all positions are covered. This might include: getting other staff, clearing a path to exits, gathering resources, delegating other tasks, or calling the police* as staff dictate.

*Calling Police is not a decision that is made lightly given the criminalization of homelessness, violence against people of color and other marginalized populations, etc. This decision should come from directors, program managers, and preceptors. Your staff might request that police be called if assault occurs or a weapon is brandished. The call can always be canceled.

Tertiary Responder(s): Engages with people in the surrounding space to ensure that other parties remain disengaged from the conflict and don’t get pulled into an escalation. This is vital to maintaining the safety of the entire space during a crisis. These folks should also continue with their typical tasks, working to maintain a typical flow of the space.

CONFLICT RESPONSE

In such a high trauma, high intensity environment, posturing and the threat of violence are often used to resolve conflict. Understanding that conflict does not arise out of nowhere, but follows a cycle of conflict, can help us to understand how and when to intervene. Understanding how to respond verbally and physically can help us become effective de-escalators.

Cycle of Conflict: Conflict often follows a cycle of instability, emergence, escalation, manifestation, and de-escalation. The severity and behavior at each stage varies, but generally follows this cycle:

• Latent Conflict & Unstable Peace: Differential power, resources, interests, and values all have the potential to spark conflict if and when a triggering event occurs.
• Conflict Emergence: Some triggering event marks the emergence of conflict.
• Conflict Escalation: The conflict becomes more dangerous as people become more upset, but the conflict has not manifested yet.
• Conflict Manifest: The conflict is realized in some type of harmful behavior or interaction between the parties.
• Conflict Aftermath: The manifestation concludes, the parties separate, and the resolution begins.

Responses to Conflict: We have the capacity to intervene at each point in the cycle of conflict. When responding, we must be aware of our physical responses to conflict, our body language, our position in the space, and our verbal responses to behavior.

Physiological Responses & Survival Mode: When we observe or participate in conflict, it is natural for our bodies to enter survival mode  faster than our rational minds can react. This alters the way that we approach and respond to situations. Understanding and being aware of possible responses helps us notice them in ourselves and our clients:

Survival Mode (Fight, Flight, Freeze, Flinch, Faint): when we are under stress or a perceived threat, our bodies quickly enter survival mode (fight, flight, freeze, flinch, faint), where physical functioning is heightened and cognitive function is simplified.

• Physically: increased heart rate, decreased digestion relate as blood is devoted to major muscles, tension builds in major muscle groups
  • Fight: The immediate instinct is to fight whatever the perceived threat is. It is difficult to resist the urge to become more aggressive or to disengage.
  • Flight: The immediate instinct is to remove yourself from the situation, rather than engage. It is difficult and uncomfortable to engage.
  • Freeze: The immediate response is to freeze completely, reducing capacity to respond dynamically.
  • Flinch: The immediate response is a physical flinching, often reactive and impulsive. It is difficult for others to read this body language.
  • Faint: The immediate response is feeling faint or dizzy, which is difficult to navigate in the intense situation.
• Cognitively: tunnel vision, reduced facial recognition capacity, dizziness and lightheadedness… This switch from rational to survival thinking can make our reactions more impulsive, more aggressive, and less thorough. It is important to resist this when de-escalating conflict.

VERBAL RESPONSE

Non-Verbal Communication: present the type of calm body positioning you want to see reflected, engage on an equal level, and maintain soothing, calm movements.

Verbal communication (Empathetic & Calming):

• Lead with Compassion. Conflict ultimately stems from some place of hurt or triggering. Leading with compassion can make people reflect your calm.
• Validate & Recognize Emotions (without validating behavior): when someone is extremely upset, validate their emotions (I see you feel angry, but I can’t understand you when you’re yelling) until they feel validated… This does not include validating the behaviors.
• Present Options: once we have validated this person, explore options for removing them from the triggering situation (moving to a different space, presenting consequences for behavior, providing other options for resolution)
• Allow for Choice: recognize that they have choice within this situation, but the consequences are on them (You can either come talk to me now or you can go outside)

Other Resources:

        Conflict Response: https://www.youtube.com/watch?v=pOi0kKhPyX8

        Toolbox:

MENTAL HEALTH EMERGENCIES

The methods used for responding to folks who are battling complex traumas, mental health crises, or severe drug use differ from those used for people who are simply engaging in conflict (although these sometimes intersect). Responses involve heightened levels of empathetic listening and validating safety… Unless you are a mental health professional, you are likely not adequately trained to walk people through this, so the following pertain to immediate responses, rather than ongoing support procedures.

Responding to Mental Health Crisis: The legal language of “imminent danger to oneself or others” is used to determine whether someone should be involuntarily committed. Many of the situations you might encounter may not be dangerous in this way, but will include intense feelings, behaviors, or anxieties. The following are guidelines for responding:

• Ensure & Establish Safety:

• • • Respect Personal Space
    • Approach calmly, immediately ensure that the person feels as safe as possible
    • Remove triggers or respond creatively to their needs
    • Minimize potentially harmful interventions whenever possible
      

• Engage Verbally & Intervene Empathetically:

• • • Be concise (repeat your simple message until it is heard)
    • Identify wants & feelings (approach from a person-centered, trauma informed standpoint, attempting to understand the person and the situation).
      • “I really want to know what you’re upset about, even if I can’t provide what you need, so that we can work on it together”
    • Agree wherever possible (truth, principle, odds, or agree to disagree)

• Provide Options & Control:

• • Establish limits and boundaries
  • Present options and include the person in decision making

Specifics: If you wish to learn how to specifically respond to folks in different states of crisis, please use the following resources:

• • Suicidal Ideation
    • https://suicidepreventionlifeline.org/
    • http://www.intheforefront.org/
  • Severe Mental Illnesses (Bipolar Disorder, Schizophrenia, Major Depressive Disorder): Core Responses
    • Psychosis (Internal Stimuli)

Harm Reduction & Drug Use: Some folks experiencing homelessness might be using substances to cope with various traumas. Harm reduction is the practice of acknowledging that drug use will happen and attempts to prevent harms associated with drug use. This harm reduction can result in many practices, including safe consumption spaces, permitting folks to access services regardless of drug use, and providing support despite drug use. People who are using may present in similar ways to that of a mental health crisis.

• More Resources:
  • New Horizons Mental Health Training

SECONDARY TRAUMA & SELF CARE

Working in high intensity settings can expose you to secondary trauma, the emotional duress from hearing others speak of or walking others through their first hand trauma. It is often accompanied by various emotional, physical, and mental symptoms that can result in burnout, compassion fatigue, or worsening mental health if not addressed. Self care (intentionally taking time for yourself and setting boundaries around your work) can help to mitigate the effects of secondary trauma.

• • Drowning in Empathy
  • Beyond the Cliff
  • Managing Compassion Fatigue