Kenneth Sweat, a high school counselor in Clayton, North Carolina, tells Larry E. Thomas with the Thomas Mentor Leadership Academy in the Research Triangle area about an interaction with a student he’d never met before, who had become distressed and angry.
Betty Washington, director of the children and adolescents’ residential facility Pearl’s Angel Care, Inc. in Fayetteville, takes notes of Thomas non-verbal responses – keeping eye contact, nodding, and smiling when it was appropriate.
Their exercise is part of the crisis intervention training sessions provided by UNC Greensboro for professionals from across North Carolina who work with young people at risk of a mental health crisis. Together they learned intervention techniques that can help de-escalate a crisis or prevent one from starting.
Addressing a growing need
Professionals who regularly work with young people know of the rising need for mental health support. In 2021, the U.S. Surgeon General issued an advisory, saying, “Between 2011 and 2015, youth psychiatric visits to emergency departments for depression, anxiety, and behavioral challenges increased by 28 percent.”
He wrote, “Ensuring healthy children and families will take an all-of-society effort, including policy, institutional, and individual changes in how we view and prioritize mental health.”
UNCG’s Center for Youth, Family and Community Partnerships (CYFCP) works within the Office of Research and Engagement to promote interdisciplinary research that addresses community needs. CYFCP Director Christine Murray says, “Our mission is to educate, advocate, and collaborate with individuals and systems to promote the well-being of youth and families. As such, this initiative is in perfect alignment with our overall mission.”
Providers learn from each other
Amy Ali, an instructor with the Crisis Prevention Institute (CPI) led the first summer session on May 17. She discussed the types of behavior these providers may encounter. How can a professional reassure someone who is anxious? How do they give instructions to a person who’s become defensive? What if that person escalates further to a point that puts themselves or others at risk? How do they move forward once the crisis has passed?
Shannon Barr, CYFCP facilitator, says, “I worked in higher education for nine years in direct student support. I’ve thought about the impact it would make for the students that I work with, to know that everybody they interact with has the confidence and comfort to respond to trauma, to crisis situations in a way that they need.”
Ali encouraged the providers to share their experiences from schools, outpatient centers, counseling services, and other places where they work with youth. Other times, she presented a scenario first, and they talked about ways to respond.
Workshops like these give providers their own supportive environment to learn from each other and to hone practices and habits that could empower or even save a young client.
Thinking rationally in unpredictable situations
Throughout the session, several themes repeatedly presented themselves: how to keep thinking rationally when emotions are running high, how the professional’s behavior influences their client, and how to avoid taking a person’s actions personally.
Sweat’s example in the non-verbal exercise is one example; he had no prior interaction with the student; he had no background information to help him understand why the student was berating him.
They discussed non-verbal cues to watch for within themselves and from the person in distress. “When someone gets defensive, they focus on how the words sound and not the words themselves,” Ali said.
In one exercise, using a chart with footprints to visualize one person walking toward another, she asked participants to select how close they’d let that person approach before they felt uncomfortable. The responses were varied, and Ali reminded them that their own personal space limits may not match their client’s.
Positive, patient, and personal
In a series of hypothetical case scenarios where a person had become demanding and made comments that could instigate a fight, participants suggested ways to calm down the situation.
What was not on that list of suggestions, was saying, “Calm down.” Ali said that can be counterproductive.
“We’re trying to be person-centered in our approach,” Ali explained. “I’m not going to say, ‘Stop shouting.’ Instead of focusing on what I don’t want to see, I redirect to the positive outcome – ‘You’re shouting. Please speak quietly. Lower your voice, and then I can address your concerns.’ That helps the person see the positive outcome of a behavioral change.”
The priorities, said Ali, are always the patient or client’s care, wellness, safety, and security.
Upon completion, participants were certified to use the skills provided to keep themselves safe. It is recommended that they be trained annually. CPI also separately offers certification to become an instructor.
These training sessions were funded through a grant from the North Carolina Department of Health and Human Services (NCDHHS) Division of Mental Health, Developmental Disabilities, and Substance Abuse Services.
The courses are scheduled throughout the summer, and additional courses will be scheduled until March 2024, to ensure that as many health care providers – and by extension their patients and clients – as possible can benefit.
Story by Janet Imrick, University Communications
Photography by Sean Norona, University Communications
