Standards for Canadian organizations

2020 Edition

Crisis Response and Information Services (CA-CRI) 4: Crisis Intervention Services

The organization responds immediately and appropriately to individuals in crisis situations.
2020 Edition

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Purpose

Crisis Response and Information Services operate as part of the community's crisis response system to provide immediate, dependable responses and reliable information to promote safety and stability for the individual in crisis.
1
All elements or requirements outlined in the standard are evident in practice, as indicated by full implementation of the practices outlined in the Practice Standards.
2
Practices are basically sound but there is room for improvement, as noted in the ratings for the Practice Standards; e.g.,
  • Minor inconsistencies and not yet fully developed practices are noted; however, these do not significantly impact service quality; or
  • Procedures need strengthening; or
  • With few exceptions, procedures are understood by staff and are being used; or
  • For the most part, established timeframes are met; or
  • Proper documentation is the norm and any issues with individual staff members are being addressed through performance evaluations and training; or
  • Active client participation occurs to a considerable extent.
3
Practice requires significant improvement, as noted in the ratings for the Practice Standards. Service quality or program functioning may be compromised; e.g.,
  • Procedures and/or case record documentation need significant strengthening; or
  • Procedures are not well-understood or used appropriately; or
  • Timeframes are often missed; or
  • Several client records are missing important information; or
  • Client participation is inconsistent. 
4
Implementation of the standard is minimal or there is no evidence of implementation at all, as noted in the ratings for the Practice Standards; e.g.,
  • No written procedures, or procedures are clearly inadequate or not being used; or 
  • Documentation is routinely incomplete and/or missing.      
Self-Study EvidenceOn-Site EvidenceOn-Site Activities
  • Action planning procedures
  • Safety planning procedures
  • Treatment and referral procedures
  • Supervisory review procedures
  • Community resource and referral list
  • Interviews may include:
    1. Program director
    2. Relevant personnel
    3. Persons served
  • Review case records

CA-CRI 4.01

Crisis intervention personnel respond immediately and:
  1. provide intervention and stabilization;
  2. work with the person to develop an action plan;
  3. work with the person to develop a safety plan, as needed, once it has been determined that no immediate emergency intervention is required;
  4. never utilize “no suicide contracts” or “no-harm contracts;"
  5. refer or connect individuals with appropriate resources; and
  6. follow up with each person within 24 hours, when appropriate.

Interpretation

A safety plan includes a prioritized written list of coping strategies and sources of support that individuals who have been deemed to be at high risk for suicide can use. Individuals can implement these strategies before or during a suicidal crisis in order to prevent a suicide attempt or possibly death. Components of a safety plan can include: recognition of warning signs, internal coping strategies, socialization strategies for distraction and support, family and social contacts for assistance, professional and agency contacts, and lethal means restriction.

Interpretation

No-suicide contracts are based on a verbal or written agreement by the service recipient to not engage in self-harm or suicidal acts during a specific timeframe. Research does not support this practice or show that these agreements are effective at preventing suicides, nor have they been found to provide protection against malpractice lawsuits.

Interpretation

In cases of individuals at risk for suicide, every effort should be made to follow up within 24 hours after the initial contact.
Examples: Follow-up can be by telephone, non-identifiable postcards, emails, or text messages. Contacts can be brief, tailored to the individual’s needs, and focused on continued assessment of risk.

Fundamental Practice

CA-CRI 4.02

Written procedures address the provision of treatment and referral when individuals are at risk of imminent harm, including situations involving victims of violence, individuals at risk for suicide, medical crises, and other emergencies.

Interpretation

When an individual calling a crisis hotline is considered to be at imminent risk for suicide, staff should have a written procedure directing them to: (1) practice “active engagement” to promote the caller’s collaboration in securing his/her own safety, (2) use the least invasive intervention and consider involuntary emergency interventions as a last resort, and (3) initiate “active rescue” (i.e., immediately dispatching emergency rescue interventions with or without the callers consent) if the caller remains unwilling and/or unable to take action on their own behalf. 

CA-CRI 4.03

Supervisory personnel review service interventions within 24 hours.