Crisis Intervention- Analysis and Application

Introduction

The Community Mental Health Act of 1963 was signed into law by President John F. Kennedy in response to the questionable practices of mental health institutions.   The new law helped people suffering from mental illlness who were institutinalized in hospitals move back into their communities during treatment. It allowed for more effective psychotropic medications and treatments to be utilized and made community based care easily available for individuals suffering with mental illness.  (National Council for Behavioral Health, 2013) According to the National Alliance of Mental Heath or NAMI (2013) approximately 61.5 million Americans experience a mental illness each year.  NAMI continues to report nearly 18.1 percent of American adults live with anxiety disorders, such as PTSD, OCD, or generalized anxiety and phobias.  Post traumatic stress disorder is very common and is the root of most crisis situations, such as substance abuse and suicide.  (James & Gilliland, 2013)  This paper will focus on a case in which crisis intervention is utlized and the client displays signs of PTSD.  The paper will provide a plan of action, interpret the crisis and identify the appropriate theory that identifies the crisis.  Futhermore, the paper will use a model of assessment, intervention, and treatment and will discuss the substance abuse of the client’s family and how it affects her directly.  Lastly, the paper will consider ethical issues that may arise during the course of the crisis intervention with the client and other parties involved.

PTSD

The MayoClinic (2015) has defined Post Traumatic Stress Disorder (PTSD) as a “mental health condition that’s triggered by a terrifying event; either experiencing it or witnessing it.”  Individuals who experience a traumatic event and suffer from PTSD may have difficulty coping for months or even years and the trauma will interfere with basic functioning.  Post-traumatic stress disorder is very disruptive causing the client to relieve the trauma over and over again.  Without proper coping techniques the client will attempt to avoid situations that remind them of the event and force them into nonresponsive or psychotic state when triggered.  The client may also become easily agitated, quick to anger, display extreme states of arousal, or suffer from hallucinations or reoccurring nightmares.  The Diagnostic and Statistical Manual of Mental Disorders provides specific standard criteria that should be used when classifying and diagnosing mental disorders.  (The National Center of PTSD, 2015)  When diagnosing a client the clinician should be aware of specific symptoms and behaviors such as reckless or destructive behavior which is identified in Criteria E.  Clinicians conclude that children are more at risk of suffering PTSD after being exposed to a traumatic experience, such as abuse, or witnessing interpersonal violence.  Our client, Cassandra displays behaviors that are thought to be symptoms of PTSD.  As the clinician discovers more about Cassandra’s past, it is learned that she witnessed her mother be victimized both physically and sexually by her father and grandfather and she may have been a victim of such abuse as well.  Dues to these experiences as a child, Cassandra is highly at risk for Post-Traumatic Stress Disorder.   The clinician must also identify intrusive recollections the client may be experiencing from the traumatic event.  The individual must show signs of experiencing recurrent thoughts, dreams, and flashbacks that are causing the stress.  Cassandra is a high rated candidate for Post-Traumatic Stress Disorder and has been experiencing reoccurring nightmares about her father that are causing adverse reactions such as night sweats and curling up into a ball.  Criterion C involved avoidance of associated trauma, people, and activities.  Cassandra is displaying acts of avoidance as she smiles when talking about her negative experience.  She is disassociated and displays flattened emotional response to the negative experience she shares.  PTSD symptoms must be present for an extended length of time and in this case, Cassandra has received a series of psychiatric treatments that date back to when she was a young girl. She also received psychiatric care when she attempted suicide.  The chronic stress that she suffers stems from the experiences she witnessed as a child and has caused significant duress in her personal life.  Cassandra has lost the ability to cope and continues on an emotional rollercoaster, repeating a series of emotional responses that lead back to its origin.  James & Gilliland (2013) allude that the client must effectively work through the crisis in order to avoid the rollercoaster of emotions that is prevalent in victims.

 

Assessment/Theory/Intervention

Prior to working with Cassandra the crisis worker or clinician will need to collect as much information as possible about the client.  When using the biopsychosocial method of assessment the crisis worker will gather any information that identifies the client, current psychiatric symptoms, treatment history, list of medications, and medical concerns.  It would be beneficial to determine family history including physical, sexual, and substance abuse, personal relationships, and legal or criminal history. The psychoanalytic theory gives us a better sense of Cassandra’s crisis.  This theory suggests the early childhood fixation that Cassandra has on the abuse her mother endured is causing her inert reaction to possible triggers.  A better understanding of the crisis can be achieved by reaching her unconscious troughts and the emotional experiences.  As the clinician work’s through the trauma with Cassandra it is important to maintain client safety and the safety of those around her.  The clinician will intially want to connect with Cassandra and identify any threats to safety for all parties involved.  Although, Cassandra has attempted suicide in the past and has voiced her curiosity with killing someone, there is no immediate threats as she is in the custody of law enforcement.  Once safety has been considered it will be imperative for the clinican to define the problem and establish intial support.  These are the first three steps to Gilliland’s Six Step Method of Crisis Intervention. In the final steps the clinician will work to form coping mechanisms, implement an action plan, and plan a followup session with the client.  The clinician may also utilize the Cognitive method.  This method of crisis intervention focuses on the root problem and the negative thinking that surrounds it. (James & Gilliland, 2013) The clinician will focus on changing the emotions and thoughts that Cassandra houses in response to men and physical touch.  This method is used to rewire Cassandra’s way of thinking and will help return her to a pre-crisis psychological state.  In the current state Cassandra appears to be disconnected and uncertain of the events that have occurred as she continually requests to see her boyfriend and asks if she is going to jail.  She is unaware that she has been in a brutal fight with her boyfriend and that law enforcement believes she murdered him.  She houses a lot of negative emotions due to the overwhelming number of brutal attacks physically and sexually she was forced to witness her mother endure, and expresses her desire to kill someone in her family as payback.  When her boyfriend touched her in a physical manner she correlated the touch with the abuse and responded in a way she had hoped her mother would have when her father and grandfather abused her.  Through the cognitive method the clinician will work through the trauma and rewire Cassandra’s thoughts to understand good and bad touch.  During the assessment it is determined that Cassandra is suffering from Chronic Post Traumatic Stress Disorder with the initial trauma occurring when she was a young girl.  She has links to substance abuse, violence, and factors that can be correlated with problems in personal relationships.

Plan of Action

Together Cassandra and the clinician develop short term goals that are designed to help her cope through the triggered trauma.  Cassandra will remain in the hospital for a 72 hour observation period that will allow her to be observed for any indicated suicidal thoughts and to undergo medical evaluation.  This medical evaluation will help determine any underlying mental illness.  Once discharged she will be released into police custody to face any charges that are due her for the murder of her boyfriend.  Cassandra will be monitored for any repeat suicide ideations.  Cassandra will continue treatments and individual counseling while she is in jail.

 

Alcohol and Chemical Dependency

Cassandra informed the crisis worker that her father was an alcoholic and her brother was addicted to heroin.  James & Gilliland (2013) suggest a correlation between chemical dependency and shared genetic traits.  These genetic traits increase the risk of antisocial personality, ADHD, and forms of conduct disorder.  Studies conducted in mice and rats determine a direct correlation of the genetic influence on substance abuse.  (Browman, Crabbe, & Li, 2000)  In this case, the inherited risk affected Cassandra and her brother differently.  Cassandra developed antisocial personality traits, where as her brother inherited the risk of being addicted to an illegal substance.  The exposure of violence and substance addiction caused the onset of Cassandra’s Post Traumatic Stress Disorder as an adult.  Cassandra is currently experiencing nightmares and is having trouble sleeping at night.   The lack of sleep is a symptom of PTSD in adults and can cause the individual to hallucinate, become irritable, and violent.  As discussed in an earlier portion of this paper, the cognitive method would be effective in processing the trauma she has experienced and help develop coping methods that will enable her to work through any future triggered events.  Assisting Cassandra in anxiety management and Eye Movement Desensitization would be effective treatments for the Post Traumatic Stress Disorder she currently suffers from.

Ethical Dilemmas

Clinicians and case workers must adhere to a strict rule of confidentiality.  They have a legal obligation to protect the client’s privacy and the right of confidentiality through privileged communication.  (James & Gilliland, 2013) The presence of outside parties during the crisis intervention interview can be considered an ethical dilemma in this case.  During the interview, law enforcement officers were present in the room, stood over the patient and listened to every personal detail that was shared.  These officers refused to leave because Cassandra was in their custody.  This is a direct violation of the client’s rights to confidentiality and is a breach of the HIPAA Security Rule.  The Office for Civil Rights enforces the HIPAA Privacy Rule.  The HIPAA rule is enforced to protect the privacy of an individual’s identifying heath record.  (U.S. Department of Health and Human Services, 2015)  Legally, anything that she shares with the crisis worker cannot be used in a court room, and should be considered private.  Prior to initiating the interview the clinician should have requested the officers to leave the room and stand outside the door.  There was no immediate danger to the client or the crisis worker, therefore there was no need for law enforcement officers to monitor Cassandra.

Conclusion

            Post-Traumatic Stress Disorder is prevalent in many individuals suffering from a crisis experience.  As James & Gilliland (2013) have expressed children that witness or experience a traumatic event are more likely to develop a case of PTSD as an adult.  Cassandra suffered symptoms of Chronic PTSD that stemmed from a series of abusive events that she witnessed and experienced as a young girl.  As she grew up she had trouble coping with this crisis and attempted suicide several times.  In a triggered event she attacked her boyfriend and brutally murdered him.  Through methods of intervention the clinician was able to work through the crisis and help Cassandra identify coping mechanisms that enabled her to maintain a pre-crisis psychological state.  With continued treatment and counseling Cassandra will have the ability to overcome the PTSD.  Traumatic events can change how our bodies and minds respond to triggered stressors.  The role of the crisis intervention worker is to aid the mentally ill in working through a crisis and enable them to deal with their struggles so that they can effectively live in society.

 

References:

Community Mental Health Act. (2013, February 25). Retrieved August 11, 2015, from http://www.thenationalcouncil.org/about/national-mental-health-association/overview/community-mental-health-act/

Mental Illness Facts and Numbers. (2013). Retrieved August 11, 2015, from http://www2.nami.org/factsheets/mentalillness_factsheet.pdf

James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from https://online.vitalsource.com/#/books/9781285404714/pages/56707132

http://www.ptsd.va.gov/professional/PTSD-overview/diagnostic_criteria_dsm-5.asp

Post-traumatic stress disorder (PTSD). (2015). Retrieved August 11, 2015, from http://www.mayoclinic.org/diseases-conditions/post-traumatic-stress-disorder/basics/definition/con-20022540

DSM-5 Diagnostic Criteria for PTSD Released. (2015). Retrieved August 11, 2015, from http://www.ptsd.va.gov/professional/PTSD-overview/diagnostic_criteria_dsm-5.asp

Browman, K., Crabbe, J., & Li, T. (2000). Genetic Strategies in Preclinical Substance Abuse Research. Retrieved August 6, 2015, from http://www.acnp.org/g4/gn401000077/ch.html

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Development of Crisis Intervention

Introduction

In the last decade public schools and universities have been the target for school shootings and massacres, resulting in the loss of innocent children and educational staff.  James & Gilliand (2013) believe the students held responsible for the massacres share similar root problems including being at risk and being a bully or have been bullied themselves.  Crisis such as these are critical and need immediate response by law enforcement and crisis intervention teams. This paper will review the Virginia Tech shooting that took place in 2007 and discuss how crisis intervention has changed since this event in history.  Furthermore, this paper will describe four stages in the development of crisis intervention and illustrate four ways crisis intervention has made an impact in our society.

 

The Event Details  

The Virginia Tech shooting took place on the morning of April 16, 2007 and is considered the deadliest shooting rampage in the United States.  The shooter was 23 year old Seung-Hui Cho, an Asian student from South Korea who years earlier was evaluated at a local mental facility for making suicide remarks to his roommate.   Cho killed 32 people on the Virginia Polytechnic Institute and State University campus in Blacksburg, Virginia, before taking his own life.  This tragedy is responsible for change in crisis intervention and how schools and law enforcement respond to such events.  After the event a panel referred to as the Virginia Tech Review Panel appointed by the governor was challenged to examine the shooting, the effectiveness of the response team, and determine if the event could have been prevented.  Governor Kaine selected the persons for this panel based on their personal expertise in law enforcement, security, emergency care, mental health, and victim’s services in an effort to prevent future violence on campuses.  Crisis intervention takes place from the beginning of the event and continues until the critical incident is over; it is for this reason school officials, communities, and law enforcement must have an effective response plan in place.  (James & Gilliland, 2013)

The panel reviewed many key elements that led to the mass shootings.  Cho was considered mentally unstable.  As a child and through his early adult years, Seung-Hui Cho exhibited signs of suicidal and homicidal intentions.  He underwent psychiatric treatment and counseling for depression.  There were several incidents that occurred during Cho’s junior year at Virginia Tech that were considered warnings to his mental instability that were ignored. (Panel, 2007)  Under Federal law Cho should not have been eligible to purchase a firearm, but because Virginia law did not require clients like Cho who were under going out patient therapies to be reported to the federal database, Cho slipped through the cracks.  That morning the Asian student used a Walther P-22 pistol he purchased online and a nine millimeter Glock with 50 rounds of ammunition to carry out the shootings.  The first call to 911 came in at 7:15 a.m. after two students were shot and killed in West Ambler Johnston Hall, a dormitory that housed 895 students.  The panel (2007) reported “the Virginia Tech and Blacksburg police departments responded quickly to the report of shootings at West Ambler Johnston residence hall, as did the Virginia Tech and Blacksburg rescue squads and that they were well coordinated.”  Students were not evacuated at this time, nor did the campus notify students and staff throughout the campus of the imminent threat, and law enforcement officials reported that the shooter left campus. Cho had indeed left campus for a short time to mail a package at the Blacksburg Post office.  The package was addressed to NBC which included videos and an 1800 word manifesto that declared he wanted to “even the score against individuals who oppressed him.”  (Panel, 2007)   More than two and a half hours after the firsts shooting, 31 others including staff, students, and the gunman were shot and killed in Norris Hall, where the doors were chained. Many others were injured from jumping out of windows as the shooter entered the classroom. Clearly the victims were in a state of panic and many more students were unaware of the occurrences and were going about their regular routines.  School officials were slow to inform students of the shootings and it wasn’t until 10 am more than two hours after the first round of shootings that a mass email was sent out.

Seung Hui Cho had a history of mental illness that dated back to when he was merely nine months old.  The panel (2007) released private details about Cho’s medical history, in the report it was discovered that he suffered from an aversion to touch at the early of age and was socially inadequate. Seung Hui Cho was extremely quiet and his social isolation worsened when his parents moved the family to the United States of America.  The public school Cho attended as a child took notice of his abrasive shyness and by the time he was in middle school he was labeled a selective mutism and prescribed antidepressants for his suicidal intentions.  James & Gilliland (2013) would classify Cho as an Estranged Violent Juvenile Offender or EVJO, as he remains separated from his peers and harbors an immense amount of enmity towards his professors and fellow students.

 

Crisis Intervention

Crisis intervention during an event of such magnitude as the Virginia Tech shootings must be planned for ahead of time.  Virginia Tech had policies in place, but did not follow the protocol during the shooting.   According to the Hauser & O’Connor (2007) it had been over 41 years since the last shooting massacre when Charles Whitman shot and killed 16 people before being gunned down by police at the University of Texas.  When creating a crisis intervention plan there are four steps that are crucial to the development.  The steps to developing a crisis intervention plan include: prevention and intervention, preparedness, response, and recovery.  “Knowing how to respond quickly and efficiently in a crisis is critical to ensuring the safety of our schools and students. The midst of a crisis is not the time to start figuring out who ought to do what. At that moment, everyone involved from top to bottom should know the drill and know each other.” (Spellings,2009)  During the first step of intervention and prevention the school focuses on what it can to reduce or eliminate life threatening risks on campus.  Setting policies in place, prevention programs, and initiate steps that improve student culture and awareness on campus are ways in which the school and community can prevent crisis situations on campus.  Universities can practice communication and lockdown procedures in the event of a shooter or other on campus threat.   To prevent such events from occurring administration can encourage students to participate in programs that help identify harmful behaviors and troubled students or anti-bullying programs.  Ensuring all school staff is familiar with the layout of the campus and all entry points of the buildings will be helpful if students need to be evacuated to ensure safety during a crisis situation, such as the Virginia Tech shootings.  Preparedness focuses on the process of planning for the worst case scenario, such as a school intruder, or in this event an unpredictable student turning on his classmates and shooting to kill.   Having a well-developed plan will reduce injury and save lives.  Delegating specific roles for individuals during a crisis and working closely with city and county emergency planners and response team during the planning stage will be useful.  The university should collect equipment that will be vital to the response of the emergency team such as: radios, first aid kits, and contact information for families of staff and students.  Plans should be developed for where students will be evacuated during a crisis and how to move them off campus if there is such a need.  The response is the steps the staff and emergency responders will take during a crisis.  It is critical to decide how to respond immediately when experiencing a crisis.  The delegated individual will need to contact emergency personnel and follow through with communicated the plan of action to students and staff, established code words are used, and lock down or evacuation is executed.  Emergency responders provide first aid to injured persons and the lines of communication are open to deliver messages to students, staff, family members, emergency response teams, and the media.  The recovery phase consists of restoring the students, teachers and the learning environment after the crisis.  During this stage the buildings are repaired, students are counseled, families are informed, and stress management and emotional support is offered in order to recover the state of the campus to a safe learning environment.  Crisis management is a process in which all phases are tested, reviewed, and revised to ensure effective intervention.  They are continuously updated after experience, research, and ever changing trends.

 

How Crisis Intervention Improvements Have Impacted Society

The impact of the shootings on the Virginia Tech campus forced the world to realize that we need to be prepared and protect our kids from the growing number of mental illness patients that are living among us in our communities.  Citizens are more aware of how to respond to the needs of unstable individuals and how to read the warning signs.  Since the shootings at Virginia Tech new policies that ensure students and staff are aware of safety risks and prevention methods are in affect.  Universities restrict firearms and weapons to resource officers and patrols, which are visible and remain present on University campuses.  Universities are utilizing surveillance cameras on and around campus and many school are utilizing automated card access for classrooms and buildings to keep intruders from entering.  Since the shootings other college campuses have formed panels much like the panel of specialists at Virginia Tech to ensure protection and safety of all persons on campus.

Conclusion

Virginia Tech staff, teachers, and administration should have recognized the signs that led Cho to brutally shoot and kill so many people on the morning of April 16, 2007.  Unfortunately, the response team wasn’t prepared to intervene properly during the event.  Tragedies like this one, have been used to develop and change current crisis intervention plans and ensure that all staff is aware of the procedures.  Ensuring the safety of all individuals is a key focus when developing crisis intervention plans.

References:

James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from https://online.vitalsource.com/#/books/9781285404714/pages/56707132

 

Mass Shootings at Virginia Tech – Report of the Review Panel. (2007, April 16). Retrieved August 2, 2015, from https://governor.virginia.gov/media/3772/fullreport.pdf

 

Hauser, C., & O’connor, A. (2007, April 16). Virginia Tech Shooting Leaves 33 Dead. Retrieved August 2, 2015, from http://www.nytimes.com/2007/04/16/us/16cnd-shooting.html?pagewanted=all&_r=1&

 

Spellings, M. (2009, April 20). Crisis Intervention Plans. Retrieved August 3, 2015, from http://blackhawkemg.org/10230-Educational_Institutions

 

PTSD

“PTSD is a whole-body tragedy, an integral human event of enormous proportions with massive repercussions.”  (Banitt, 2012) Post Traumatic Stress Disorder has been known to occur when an individual is exposed to a life threatening event such as rape, domestic violence, child abuse, natural disaster, terrorist attack, or combat exposure.   PTSD has affected thousands of people including children and can be difficult to diagnose.  Military personnel working in combat situations are particularly at risk.  According to statistics collected by the Nebraska Department of Veterans Affairs (2007) nearly 30 percent of men and women who have spent time in war zones will experience PTSD.    In this paper we will discuss causations of PTSD, treatments available, and future research possibilities.

The causes of PTSD are not well known or understood and not everyone who is faced with a violent event will result with PTSD.  The disorder is brought on by the trauma, and the causes are correlated with the brain and the underlying risk factors that may have been present prior to the traumatic experience.  Any traumatic event can trigger post-traumatic stress disorder.  Fear conditioning of the brain can also cause an individual to display symptoms of PTSD.  “Fear conditioning is where the person learns to predict traumas and the predicted traumas cause parts of the brain to activate.”  (Bryant, 2011) It is possible for some people to carry predisposed risk factors that can result in PTSD, such as exposure to trauma as a child, depression, family history of PTSD, and gender.  According to the Nebraska Department of Veterans Affairs (2007) women are twice as likely as men to develop signs of PTSD.  Many factors come into play when an individual suffers from this disorder.  The risk factors as reported by the National Institute of Mental Health (2014) include:

  • Experiencing long term trauma
  • Seeing people hurt or killed
  • Having little or no social support after a traumatic event
  • Dealing with added stress after the experience

Suffering from post-traumatic stress disorder can disrupt an individual’s life and negatively affect one’s performance at work, personal relationships, and their health.

Once diagnosed with post-traumatic stress disorder it is imperative to receive the proper treatment in order to gain control of your life.  Your doctor may suggest undergoing psychotherapy treatments paired with medication.  Psychotherapy helps patients to address the suffered symptoms and teach individuals how to cope with their PTSD symptoms.   There are three types of psychotherapy; also referred to as talk therapy that are used to treat PTSD in children and adults alike.  Cognitive therapy is considered the most effective form of psychotherapy.  It addresses ways of thinking that may be inhibiting the individual from coping and causes the symptoms to worsen.   During therapy the therapist will guide the client to identify thoughts that cause the individual to feel afraid or upset and replace them with more affirming emotions.  Exposure therapy allows the client to face their individual fears in a safe environment.  Techniques used during exposure therapy include repeatedly talking about the trauma event and a virtual reality program that allow the client to re-enter the scene of the traumatizing event.  Another form of therapy that has brought up a lot of controversy is eye movement desensitization and reprocessing.  James & Gilliland (2013) describe this technique as a basic way of recreating the scene or expressed emotions from the scene of the traumatic event while the client follows the therapist’s finger with their eyes as it is moved back and forth with rapid motion.  These forms of therapy are often combined with medications that help reduce depression and anxiety and can help improve sleep and concentration.

According to researchers, medicinal marijuana may be an effective drug to remedy symptoms of PTSD such as; flashbacks, insomnia, anxiety, and depression.  Monteiro (2014) a news reporter for The Arbitrage Magazine reports a study by Suzanne Sisely that is awaiting governmental approval that can change treatment of PTSD in the future.  Through this study she will follow the effects of marijuana on Veterans suffering from the illness.  “Participants of the study will smoke or vaporize the marijuana in different amounts, specifically five different amounts, ranging from a simple placebo to twelve percent.”  (Monteiro, 2014) Currently there are only six states that list PTSD as an illness that qualifies to be treated with cannabis.  With approval of the DEA Sisely is hoping to change that for PTSD sufferers.

PTSD has shown to be a very complex illness to diagnose.  Individuals that suffer from PTSD may suffer months even years of repeat trauma without the proper treatment.   “Trauma destroys the fabric of time. In normal time you move from one moment to the next, sunrise to sunset, birth to death. After trauma, you may move in circles, find yourself being sucked backwards into an eddy or bouncing like a rubber ball from now to then to back again. … In the traumatic universe the basic laws of matter are suspended.”  (Morris, 2015)

Through therapy and medications a licensed physician can guide the individual through the traumatic event and emotions and define coping strategies to work through the effects of PTSD.

References:

Banitt, S. (2012). The trauma tool kit: Healing PTSD from the inside out. Wheaton, Ill.: Quest Books.

Post Traumatic Stress Disorder.(2007). Retrieved July 5, 2015, from The Nebraska Department of Veterans Affairs http://www.ptsd.ne.gov/what-is-ptsd.html

Post-Traumatic Stress Disorder (PTSD). (2014, September 12). Retrieved July 4, 2015, from http://www.nimh.nih.gov/health/publications/post-traumatic-stress-disorder-ptsd/index.shtml

Bryant, R. (2011, September 1). Post-traumatic stress disorder vs traumatic brain injury. Retrieved July 5, 2015.

Monteiro, M. (2014). Marijuana as a Treatment for PTSD? A Future Study Could Prove This. Retrieved July 4, 2015.

Morris, D. (2015). The evil hours: A biography of post-traumatic stress disorder.

James, R. & Gilliland, B. (2014). Crisis Intervention Strategies. Cengage Learning Inc. Obtained from https://online.vitalsource.com/#/books/9781285404714/pages/56707132

Crisis Intervention: Suicide

“On a worldwide basis, about one million people kill themselves each year, which is the equivalent of one person every 40 seconds.”  (James & Gilliland, 2013) This growing epidemic is defined by The American Psychological Association (2015) as the act of killing yourself, most often as a result of depression or mental illness.  As Cain (2014) reports, suicide in South Korea has developed at lightning speed and is considered to be the fourth leading cause of death.  In the United States, suicide accounts for about two percent of all deaths, and is considered to be the tenth leading cause of death in America. This paper will compare the suicide rates, factors leading to suicide, and the treatment options available in the countries of South Korea and The United States of America.

Over recent years, the number of suicides in South Korea have increased significantly.  In a recent article, published by the Journal of Child Psychology and Psychiatry reports an increase in South Korea between 2000 and 2009 from 4.2 to 6.9 per 100,000 adolescent males, and from 3.3 to 6.2 per 100,000 adolescent females, whereas the United States showed no change from 2000 through 2008 and remained steady at 7.6 per 100,000 adolescent males and 6.7 per adolescent females.   (Park, Cho, Kim, Kim, Yoo, & Hong, 2013)  The methods of choice for suicide also vary between the two countries.  Jumping is the most common method for suicide in South Korea by both adolescent males and females.  Adolescents in the United States choose more lethal forms of suicide, such as firearms a chosen method by adolescent males and hanging a popular method among adolescent females.  Officials in South Korea believe the media is a strong influence, inspiring adolescents to “copycat” suicide methods that are seen in movies and reported on news television.  In the United States, politicians are blaming gun laws and state that guns are too easily accessed by teens, contributing to plans conjured to end one’s life and a sea of problems.

The reasons for suicide can be complex.  Policing agencies and mental health professionals continue to follow the patterns of teens in both countries in an effort to understand why young people are tragically taking their own lives.  There is not one single cause for suicide, but there can be a plethora of reasons such as: the pressure to excel, bullying, family problems, and financial difficulty; as shared by teens that have considered suicide or have successfully carried out the act and left notes for survivors.  Students studying in South Korea are pressured to excel academically and reflect perfect grades.  The expectations forced on young people in this country can smother and suffocate them, extracting the joy out of their individual lives.  (Voices of Youth, 2011)  Bullying is also a problem that leads South Korean students to suicide.  In a world where perfection is expected on a daily basis and failure is shunned upon there is a high level of competition among the students.  When an individual does not meet the expectations he/she becomes a victim of bullying.  School violence occurs in areas in which security cameras cannot be placed, such as restrooms, and blind spots in the classrooms and often goes unreported until it is too late.  Suicide among teens in America is caused by several factors.  Depression is the leading cause of suicide in young people in the United States, affecting nearly eight million teens in North America.  Being a teen in today’s world can be confusing and often difficult to make decisions or cope with insecurities.  Everyday problems and pressures can become overwhelming and stressful.  Teens that lack coping skills can become desperate and take their own life.  Lesbian and homosexuality is another contributing factor to teen suicide in the United States.  American teens who choice to be lesbian, gay, or transgender are often bullied and rejected.  As if being a teen wasn’t confusing enough, the rejection isolates the individual and leads to suicide.

Treatment options in South Korea are very limited.  The Korean culture discourages people from seeking help for psychological issues.  The country places emphasis on correcting issues within the community and mental health facilities focus on treating patients with a mental illness.  Public school officials are in the process of designing an anti-bullying campaign that will be implemented in the near future.  The United States focuses on managing and treating teens that are considered high risk.  Case management has been effective in reducing emergency room visits, whereas treatment has proven to be more effective long term.  Teens may also undergo therapy to work through the underlying issues.  Individual therapy focuses on the teen and allows the individual to work through feelings and emotions that have led them to believe suicide is the only answer to end their emotional pain.  Family therapy is another option that is commonly used and allows the family to actively support the teen, as they learn how to cope with the problem together.  In extreme cases the teen is hospitalized and monitored in a secure facility to ensure safety.  (National Institute of Mental Health, 2009)

Suicide affects millions of teens every year, worldwide.  This epidemic is extremely complex and several factors can lead an adolescent to take their own life.  Treatment is highly effective and provides teens with the help and coping strategies that prevent re attempts.  South Korea, is a struggling country and is in the process of establishing facilities that are equipped to help patients that do not suffer from mental illness.  Suicide is a permanent solution to a temporary problem and can be prevented by educating our young people and providing them with the support they need to work through the problem.

References:

James, R. & Gilliland, K. (2013). Crisis Intervention Strategies (7th ed). Cengage Learning Inc. Obtained from https://online.vitalsource.com/#/books/9781285404714/pages/56707132

American Psychological Association  (2015).  Suicide Retrieved July 19, 2015, from http://www.apa.org/topics/suicide/index.aspx

Cain, G. (2014, March 15). Why South Koreans are killing themselves in droves. Retrieved July 18, 2015, from http://www.salon.com/2014/03/15/why_is_suicide_so_popular_in_south_korea_partner/

Park, S., Cho, S., Kim, B., Kim, J., Yoo, H. J., & Hong, J. P. (2014). Increased use of lethal methods and annual increase of suicide rates in Korean adolescents: comparison with adolescents in the United States. Journal Of Child Psychology And Psychiatry, And Allied Disciplines, 55(3), 258-263. doi:10.1111/jcpp.12148

Student Suicides in South Korea. (2011). Retrieved July 21, 2015, from http://www.voicesofyouth.org/posts/student-suicides-in-south-korea

Investigative Plan for Robbery

The act of taking an individual’s’ money or property with the intent to permanently or temporarily deprive the individual of such articles, while using force, violence, assault, or instilling fear is considered robbery in the state of Florida.  (Florida Statute 812.13)  Since 1994 policing agencies in the state of Florida have seen a rapid decrease in the number of robbery crimes committed.  The Florida Department of Law Enforcement (2015) reported a significant decrease of 59 percent in violent crimes from 1994-2014.  Furthermore, the FDLE (2015) reported 21,576 robberies in 2014 compared to 45,263 robberies in 1994.  Recently there has been an increase in the number of daytime robberies in the area and law enforcement has very limited information about each robbery.  As a hired consultant I will be drawing up an investigative plan to address the crimes.

 

Investigative Steps

            The investigation of crime encompasses the collection of information and evidence for identifying, apprehending, and convicting suspected offenders.  (Osterburg &Ward, 2010)  As we analyze patterns and trends in crime, the investigator must follow specific investigative steps that can be utilized to identify the source and how to approach the deviant acts.  The following investigative steps will be implemented when addressing the robberies in City X.  The steps are:

  1. Review police reports from all jurisdictions
  2. Re-interview witnesses identified in police reports
  3. Review forensic evidence collected from the crime scenes
  4. Review video collected from surveillance cameras captured from the crime scenes.
  5. Review tactical analysis from policing agencies that are within the city’s jurisdictions to identify similarities of all reported bank robberies.
  6. Synthesize the data for review and organize by specific characterized detail such as the recorded time of day, location of robbery, and the MO of the criminal.
  7. Utilizing crime mapping resources and map the offenses.
  8. Reach out to other agencies in the area to request additional manpower. Make a determination based on responses.
  9. Collect data from policing agencies in the surrounding cities to decipher any increases in robbery in their areas.
  10. Review zones, population changes, and new or sold businesses that could be contributing to the rise in robberies.

By effectively utilizing the investigative steps the investigator has the ability to reconstruct the past and prepare their cognitive mind in order to perceive the clues or hints to work through the investigation.  (Osterburg &Ward, 2010)  The investigative steps will also lead to developing strategical plans that will allow the agency to effectively utilize available resources.

Technological Assistance

            Law Enforcement personnel increasingly rely on technology to perform everyday duties not limited to investigative purposes.  During the investigation process used technology identifies and characterizes biological data and processes digital evidence.  During the investigation of the robberies in city X investigators will utilize new tools brought on by technological advances that go beyond a keyboard and computer screen.  Investigators will utilize footage collected from surveillance and traffic cameras from the crime scenes in order to collect and compare details that lead to a description of the suspects in the crimes and identify any similarities.  Traffic cameras have been highly effective in solving crimes and assisting authorities in identifying criminals, vehicles, and track the whereabouts of suspects. (Territo, 2013)  During the investigation process it will be vital to collect fingerprints and other forensic evidence that can be analyzed. Crime scene analysts will collect fingerprints from the crime scenes using a vapor wand or laser.  Once analyzed the fingerprints are uploaded to the Combined DNA Information system or CODIS to be shared with other agencies.  Investigators can assess this database to view forensic evidence collected by other agencies in an effort to decipher a connection or pattern in the crimes.  Crime mapping is another tool that will provide analysts with data supporting the relationship of the crime in city X with surrounding areas.  By imputing linear data provided analysts can utilize the Geographical Information Software or GIS and create complex mapping data.

Analyzing the Pattern of Robbery Activity

           

            In an effort to analyze the pattern of robbery crimes in city X. investigators can utilize the SARA method.  “SARA is a relatively straightforward process that involves scanning your area of responsibility for problems, conducting a reasonably in-depth analysis of the source of the problem and resources available to assist with the problem’s solution, designing and implementing a response to the problem, and assessing the effectiveness of your solution.  (Foster, 2005)   In the case or the robberies in city X investigators will follow the steps of the SARA method.  The first step is identifying the problem, in this case the increase in robberies in the area and gathering raw data.  The data will be collected from police reports and tactical reports of city X and surrounding jurisdictions.  The policing agency will need to examine statistical data and police reports for the area and go back at least five years to decipher how much of a change has been experienced involving the specific crime.

Synthesizing Data

            As the analyst is working the case data will need to be synthesized and data not relevant to the case needs to be removed in order to look at the fine details of the robberies.   During this process the investigator will review the police reports and conduct interviews with any witnesses listed in the robbery reports, forensic evidence will be reviewed and reexamined to ensure nothing was missed, footage from surveillance and traffic cameras will be reviewed in an effort to collect details that may have been missed during the initial analysis.  Statistics will be reviewed to determine and manage the percentage of change in robbery crimes.  Analysts can arrange data from all robbery reports and sort them by jurisdiction, type of robbery, time of day, and MO to make it easier to separate the data needed for the case.  This data will aide analysts in determining a solution to the robberies.  Investigators can easily connect the crimes of city X and surrounding cities as the data shows an increase in robberies along a common highway that runs through all of the cities.  Collected data reflects rapid growth in the city and population has tripled within the last five years.  Robberies have mostly been reported at gas stations along the highway and occur during nonpeak hours between 10:00am and 2:00pm when traffic is slow and civilians are at work.  Analysts conclude it would be highly effective to increase patrol in these areas and maintain police presence throughout the surrounding communities in an effort to mitigate criminal activity and bring some order to the city.

 

Investigative Units

            To effectively implement the strategical plan cooperation between several investigative units is needed.  The investigative units that will be utilized include: the investigative division of the policing agency in city X and surrounding jurisdictions, crime analysis team, forensics team, street cops and patrol officers in all jurisdictions, detectives, and squads that are specifically trained to handle robbery investigations.  The policing agencies of the cities affected by the rise in robberies may also consider hiring additional patrol officers in order to control the criminal activity.

Supplies, Equipment, and Funding

            The investigative plan requires the use of specific equipment in order to complete the evaluation of the identified problem.  Analysts will need access to computers and crime mapping software such as GIS software, database software such as CODIS and an internal database for police reports.  Crime scene technicians will need access to a vapor wand or laser to collect fingerprints on scene and lab technicians will need access to the Automated Fingerprint Identification System Database.  It will be highly effective for the analysts to have a video player in order to review the footage collected from the surveillance and traffic cameras.  Our newly hired officers will require a need for patrol cars and training.  New databases and equipment require funds.  Policing agencies must apply for funding through grants that are supplied by the Department of Justice.   The Department of Justice houses grants for over 13,000 agencies and will determine if there is a definite need for funding and once approved will allocate the funds to the department.

Conclusion

            Effective crime analysis in law enforcement relies on accurate and organized data.        In order to effectively address the problem and implement a solution for the crimes analysts must follow an acute plan and work with an investigative team comprised of many different departments.  When the data is analyzed and synthesized an effective solution can be enforced to decrease criminal activity in a particular area.  An investigative plan is imperative to rendering a successful solution and can be a complex process.  This report has drafted an extensive investigative plan for city X in response to an increase in robbery crimes and concludes there is imminent need for increased patrol in the city and surrounding jurisdictions.

References:

Robbery. (2010). Retrieved July 24, 2015, from http://www.flsenate.gov/Laws/Statutes/2010/812.13

Florida Department of Law Enforcement. (2015, February 1). Retrieved July 25, 2015, from http://www.fdle.state.fl.us/Content/FSAC/Menu/Crime-Trends/Violent-Crime.aspx

Osterburg, J., & Ward, R. (2010). Criminal investigation: A method for reconstructing the past (6th ed.). Cincinnati, Ohio: Anderson Pub.

Foster, R. (2005). Police technology. Upper Saddle River, NJ: Pearson Prentice Hall.

International Comparison

A criminal justice system is a set of legal and social institutions utilized to enforce criminal law in conjunction with defined procedural rules and regulations.  Around the world, the structure of a criminal justice system can be strategically different, and share a common set of core values.  The focus of a well-defined system is to maintain social control, deter and mitigate crime, and prosecute individuals who violate the law.  This paper will compare and contrast the justice system of England with that of the United States, and will address differences in procedural law, policing systems, and international police cooperation.

Procedural law is defined by certain legal values and directs the operations for legal procedures.  The legal practices of Great Britain have always inspired American law.  The legal system of England and the United States are based on common law.  The United Kingdom does not have a constitution but operates under a parliament and interprets the power of the law through statutes.  (Hirschel & Wakefield, 2007)  The parliament empowers law enforcement and restricts legal protection for offenders and the accused.  The United States of America operates under constitutional law, statutes, administrative regulations, and common law.  In America the defendant’s rights are protected under the Constitution, primarily the Bill of Rights, whereas defendants in the United Kingdom   are protected under the Human Rights Act of 1998.  The Bill of Rights and the Human Rights Act defend individual rights to a fair trial by jury and the right to legal counsel.  Furthermore, the Bill of Rights expands the rights of the accused and protects the individual from unreasonable searches and seizures, self-incrimination, and limits punishment as defined by state and federal law.

Law enforcement in England is organized as a region in conjunction with the country of Wales and receives assistance from the National Crime Agency and Specialist Operations.  The main duties of the English police force are to protect the citizens, preserve peace, and prevent crime.  The public enables law enforcement to act and carry out their powers; this is called policing by consent.  (CIVITAS, 2013)  Law enforcement in the United States is operated through a number of agencies including federal, state, county, and the sheriff’s department.  Officers are granted the power to perform their duties to the public and are regulated through the power of the people and the law.   A law enforcement officer may make an arrest and hold a suspect based on the law of probable cause.  The limitations of power are laid out through laws and statutes.   In the United Kingdom, power is given to the people to make arrests against someone that has visibly committed a crime; this is a very different concept than that of America.  In England officers and citizens are enabled with the same level of power.  Much like the American police force, the territorial police officers or constables must be sworn in and accept the duties to uphold the law in the jurisdiction assigned.  The territorial officers are provided a warrant card that declares the area in which they will work and the powers that are granted are not to exceed the territory.  (CIVITAS, 2013  American law enforcement is assigned jurisdictions and even further the agency may assign zones to be patrolled.  However, the powers granted do extend past the area in which they patrol.  Unlike police officers in America, majority of the English taskforce is not armed with firearms during regular patrols.  Standard equipment issued includes a baton and PAVA spray.  A special task force is trained and permitted to use firearms if needed.  American police force is armed with equipment that not only aides in protecting individuals and their property, but also protects the officer.  Standard equipment includes a firearm, taser, and body armor.  Officers are required to be armed while on and off duty and be prepared to uphold the law at all times.

According to Bureau of European and Eurasian affairs (2015) the United Kingdom is considered to be America’s greatest ally.  This cooperation is reflective of common ideals and legal practices of the two countries.  Together these two nations have founded the North Atlantic Treaty Organization (NATO) and continue to consult on major foreign policy issues.  The United Kingdom is a major contributor to U.S. imports and tourism.  These great nations have united and formed a treaty together in order to strengthen security and public safety.   The treaty between the United Kingdom and the United States of America is concerning defense trade and regulates the export and re-export of defense materials and weaponry. (U.S. Department of State, 2008)  International policing is highly valued and is considered a key element in international crimes such as human trafficking and drug smuggling.  “Utilizing Interpol’s services requires expertise, time, and money, particularly if arrest, extradition, and/or the seizure of property are involved.” (Balzer, 1996)  It is imperative for countries to cooperate with one another in an attempt to control crime from crossing over national borders.  Overcoming the limits of jurisdictional lines enables governments to work together in developing strategies that will bring a halt to international crimes.  Through NATO and other treaty organizations the United Kingdom and the United States have joined forces with 26 other countries in an effort to enforce security and protect public policy.

The United Kingdom and The United States remain unified in democratic policy and foreign affairs.  Commonalities in values and laws are what bring these two nations together.  In an effort to uphold the law and human rights through procedural law, policing strategies and international treaties these great nations will continue to rise and justice will prevail.

References:

BUREAU OF EUROPEAN AND EURASIAN AFFAIRS. U.S. Relations With United Kingdom. (2015, April 30). Retrieved July 21, 2015, from http://www.state.gov/r/pa/ei/bgn/3846.htm

U.S. Department of State. Implementing Arrangement Pursuant to the Treaty Between the Government of the United States of America and the Government of the United Kingdom of Great Britain and Northern Ireland Concerning Defense Trade Cooperation. (2008, February 14). Retrieved July 21, 2015, from http://www.state.gov/t/pm/rls/othr/misc/101101.htm

The Police in England and Wales. (2013). Retrieved July 21, 2015, from http://www.civitas.org.uk/crime/factsheet-police.pdf

Balzer, A. (1996). INTERNATIONAL POLICE COOPERATION: OPPORTUNITIES AND OBSTACLES. Retrieved July 21, 2015, from https://www.ncjrs.gov/policing/int63.htm

Hirschel, J., & Wakefield, W. (2007). Criminal justice in England and the United States (Second ed.). Sudbury, MA: Jones and Bartlett.

Hypothesis and Conclusion

Data collection is compulsory when conducting a research study. Inaccurate data can severely impact the results of a study and can lead to invalid results. Research is conducted in order to answer basic questions, such as: why something occurred or what the consequences are after a particular event happens. (Kunselman & Tewksbury, 2008) There are several methods of data collection that can be utilized in order to answer these questions. This paper will identify and describe five scientific methods of data collection, develop a hypothesis, and form a conclusion using two methods of inquiry.
Observation is a technique used in qualitative studies to collect data through direct contact between the researcher and a person or a group of persons without disturbing their natural state. When observing a group the researcher may choose to be a passive observer, participant observer, or an active observer throughout the study. The passive observer is considered the best way to collect data. The researcher remains at a distance and is able to gather data by monitoring and observing the behavior of the individuals in the study without doing anything that would disturb or interrupt the scene. The researcher would write detailed notes based on the observations and will have no interaction with the group. Often times the individuals being studied may not be aware they are being watched or for what reason. Other times the researcher will need to gain access and be accepted by the parties being observed. Participant observation is a method in which the researcher becomes a participant in the activities while conducting observations for the means of collecting supporting data for the research study. The researcher will gather data by documenting field notes, asking other participants open ended questions, and collecting any available documents. This method allows for the researcher to gain information through an insider’s view, but can also disrupt the natural realm of activities and behavior by the studied individuals. As an active participant the researcher is allowed contact with the studied group, but it is limited. During this method of research the researcher engages in the study as though he is a participant. Passively interacting, the observations are made and recorded. The researcher will identify with the group and even pass him off as one of them, but will hold off on full participation in order to avoid disrupting the natural order of the group. Through the means of observation the researcher is able to gain a better mindset of what is happening without relying on outside information.
Interviewing is a technique used to gather data by asking participant’s questions and recording their reaction and answers. “Researchers use interviews to gain in depth understanding of how individuals experience criminal justice and how attitudes, values, and behaviors are shaped.” (Kunselman & Tewksbury, 2008) Interviews provide incite and a deeper understanding of an area of criminal justice that may be unknown or not well understood. Interviews are also very helpful in gathering Intel from individuals that do not feel comfortable speaking in a group setting. Information provided may be sensitive and highly confidential. Interviewees may remain anonymous. (Gill, Stewart, Treasure, & Chadwick, 2008) The interview questions should be designed to gather as much information as possible using open ended questions. The interviewer may want to start off asking easy to answer questions and lead up to more defining questions that spawn sensitivity and emotion. During the interview the researcher will take note of the answers provided, body language, and emotion. Focus groups are more laid back and involve a large group of people that are actively discussing a topic together. The interviewer acts more as a moderator and takes notes during the discussion. There is less control during a focus group and individuals may digress from the subject at hand. Researchers gravitate towards focus groups in order to retrieve more vivid ideas because the participants bounce thoughts off of one another. Interviews and focus groups are a very common way to collect data particularly to access knowledge in areas not amendable to quantitative methods or where depth, insight, and further understanding are required. (Gill, Stewart, Treasure, & Chadwick, 2008)
In quantitative research, sampling is the process of selecting a group of individuals from a pool in which each individual has an equal chance of being selected for the study. Sampling methods include purposive sampling, quota sampling, and snowball sampling. In purposive sampling the researcher will select individuals that match specific criteria that are relevant to a specific question of research. In quota sampling, the researcher may choose participants based on certain characteristics, such as age or gender and that display experience relevant to the research topic. Snowball sampling is a method of purposive sampling used by researchers as a form of recruitment for the study. In this method, former participants act as a social network and refer people form their social circle that meet the criteria to the researcher in order to contribute to the study.

Hypothesis
American airlines that add one additional air marshal on each flight are less likely to have terrorist’s takeovers on flight.
Harvard Law, (2015) suggests when conducting a research study the researcher should follow the formulation of the hypothesis, by operationalizing the concepts within it. Data will be collected through interviews of pilots and stewards from five major airlines and current U.S. Air Marshalls. It would be essential to get an inside view on current security measures that are implemented on flight and get a glimpse at how the employees view the success of the airline security. What we need to find out is if there is a need for an additional U.S. Air Marshal on flights. During the research study it would be beneficial for the researcher to initiate contact with the airline and regular passengers, by becoming an active participant in the study. Data collected during the active participant stage would include observations during flight, how the employees interact with passengers, and how the U.S. Marshal identifies and disengages any threats during the flight. The researcher would specifically note any challenges the U.S. Marshal may have encountered in disengaging threats. Additional documentation may be collected on how many threats the airline has each week and what type of flights receive the threats. The conclusion of the study would support the hypothesis and prove that it would be less likely for terrorists to take over a flight with an additional U.S. Marshal on the flight.
There are several ways in which data can be collected and analyzed for the purpose of a research study. Methods include, observation, participation, interviews, focus groups, and sampling. The researcher must choose a method that will work best in supporting the hypothesis. Invalid or distorted resources will hinder the research study and can lead to an unsuccessful conclusion challenging public policy and safety.

References:
Vito, G., Tweksbury, R., & Kunselman, J. (2008). Introduction to Criminal Justice Research Methods: An Applied Approach. Springfield: Charles C Thomas Publisher, LTD.
Gill, P., Stewart, K., Treasure, E., & Chadwick, P. (2008, March 22). Methods of data collection in qualitative research: Interviews and focus groups. Retrieved July 5, 2015, from http://www.academia.edu/746649/Methods_of_data_collection_in_qualitative_research_interviews_and_focus_groups

Collecting Data. (2015). Retrieved July 4, 2015, from http://www.law.harvard.edu/library/empirical-research-services/data.html