Purpose and scope
The purpose of this best practice guideline is to focus on how nurses and the interprofessional team can provide effective trauma-informed crisis interventions (immediately and to up to four weeks post-crisis) in adults (18 years and older) in order to optimize evidence-based practices and clinical outcomes. The guideline is applicable in all practice settings and promotes consistent, evidence-based response and care. The guideline is relevant for
- all domains of nursing practice (i.e., clinical practice, research, education, and policy and administration)
- social service
- other members of the interprofessional team across all practice settings at the unit, organization, and system levels
Registered Nurses’ Association of Ontario. (2017). Crisis intervention for adults using a trauma-informed approach: Initial four weeks of management (3rd ed.). Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Crisis Intervention for Adults Using a Trauma-Informed Approach: Initial Four Weeks of Management.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.1: Use brief intervention approaches with persons in crisis to reduce symptoms of crisis and increase motivation for change and other health improvements.
Recommendation 1.2: Support persons experiencing a crisis to engage meaningfully and safely in a critical incident stress debriefing process within 24 to 72 hours post-crisis in order to reduce distress and improve mental health.
Recommendation 1.3: Create crisis plans in collaboration with persons experiencing crisis using strength-based approaches.
Recommendation 1.4: Facilitate access for persons experiencing crisis to community-based outreach support (including outreach visits and mobile crisis teams), as well as appropriate health-care providers, peer support workers, and mental health and substance use services.
Recommendation 1.5: Engage peers trained in evidence-based approaches such as psychological first aid to provide comfort and support to persons experiencing crisis.
Recommendation 1.6: Encourage utilization of telecommunication- and technology-based solutions for people at risk for, or experiencing, crisis as a means for receiving:
a) emergency assessment, triage, and support; and
b) psycho-education and/or online skills and tools to support coping and self-management.
Recommendation 2.1: In collaboration with the person and when needed, provide or refer them to additional or continued supports and services.
Recommendation 3.1: Integrate interactive learning opportunities regarding trauma-informed approaches and support of persons experiencing crisis into curricula for all entry-level nursing and health-care programs.
Recommendation 3.2: Engage in continuing education to enhance knowledge and skill to support persons experiencing crisis through trauma-informed approaches.
Recommendation 4.1: Organizations identify and embed trauma-informed approaches directly within their policies and procedures to support:
a) a framework for approaches to crisis intervention and service delivery, and
b) a safe and supportive work environment for providers who have experienced critical incidents.
Recommendation 4.2: Enhance collaboration between sectors through system-level integration between health systems, social services (e.g., housing and employment), education systems, the justice system, advocates, persons with lived experience, and families in order to improve system capacity to respond in a trauma-informed way to persons experiencing crisis.
Recommendation 4.3: Health, social service, and law enforcement organizations collaborate to ensure that crisis intervention services are accessible to persons experiencing crisis through the establishment of
a) mobile crisis teams,
b) outreach visits, and
c) telephone triage and helplines.
Recommendation 4.4: Police agencies integrate comprehensive crisis training:
a) to enhance police officers’ interaction with persons experiencing crisis, and
b) to encourage police officers to make informed decisions about helping persons access appropriate services.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.