A Standardized Method of Preventing and Managing Emergencies Within the Context of Evidence-Based Therapy Implementation

Abstract

Families served within child welfare settings evidence a wide range of emergencies or unexpected crises or circumstances that may lead to danger and make it difficult for them to focus on treatment planning. Mental health treatment providers are often unprepared to effectively manage emergencies during implementation of evidence-based prescribed therapy sessions. In this study, the authors empirically developed a standardized intervention to assist mental health providers in emergency prevention and management (EPM) with their clients. EPM includes assessment of emergent conditions and a self-control procedure that may be utilized by consumers to prevent or resolve emergencies. EPM responses of 26 mothers referred by Child Protective Services for 6 months of evidence-supported treatment were examined. Relevant to clinical utility, the results indicated that providers implemented EPM in a little more than half (56.9%) of their treatment sessions, and all emergencies assessed in EPM were endorsed by at least 8% of the sample throughout their treatment. EPM was implemented with fidelity according to service providers, and corroborated by blind raters. Participants were found to be compliant and satisfied with EPM. The average number of emergencies endorsed over the course of EPM administrations was negatively correlated with the frequency of EPM administrations, suggesting that EPM may have helped reduce emergencies. Pretreatment factors (e.g., household income, child abuse potential, family functioning, parental stress, child behavior problems, number of days child removed from home) and hard drug use (but not marijuana or alcohol) during treatment were associated with the number of emergencies reported by participants.

A controlled evaluation of family behavior therapy in concurrent child neglect and drug abuse.

“…Moreover, many of the separated children experienced instability in their living arrangements and emotional problems. Managing home adjustment issues is certainly appropriate within FBT, which incorporates specific intervention techniques to address common crisis situations and family emergencies as they arise (Urgelles, Donohue, Wilks, Van Hasselt, & Azrin, 2012). However, many of the emergency outcomes (e.g., domestic violence, eviction, financial need, no food) were not formally assessed in this study, supporting the need to develop outcome measures with real-world application.…”

Family Life Education for Families Facing Acute Stress: Best Practices and Recommendations

“…Although family life educators could coordinate with trained professionals to use screening tools, Ager (2002) argued that objective assessments are less helpful than noting how individuals and families themselves understand and respond to emergencies and stressful situations. Urgelles, Donohue, Wilks, Van Hasselt, and Azrin (2012) also identified concerns that can arise when professionals use screening tools. In addition to the fact that the professionals using the tools may not be competent in meeting the needs identified by the tools, other skilled professionals who are competent may not be available for referral in a timely manner, and utilizing outside professional intervention does not prepare individuals and families to respond to situations themselves and learn to meet their own needs in the future.…”

“…The Urgelles et al (2012) strategy was tested as a supplement with families facing emergencies while they were involved with a family behavior therapy program, but some of the aspects of the strategies could be useful for participants in FLE programming. First, the idea proposed both by Ager (2002) and Urgelles et al that the affected families should have an opportunity to determine their own priorities and needs is important and is consistent with the FLE principle of allowing participants to have a role in determining what is done in FLE (Myers‐Walls et al, 2011).…”

“…The Urgelles et al (2012) approach was used with low‐resource families who had established relationships with supportive professionals. Any other professional considering using such an approach should assess the cultural setting, the families, and how the families are likely to respond to the process.…”

“Teaching Moments” in Psychotherapy: Addressing Emergent Life Events Using Strategies From a Modular Evidence-Based Treatment

“…ELEs are common: in a community sample of youth, providers reported ELEs in 69% of clients and 8% of sessions, with a mean of 2.52 ELEs per treatment episode (Chorpita et al, 2014). Consistent with the nature of highly-stressed communities often served in community care (Southam-Gerow, Chorpita, Miller, & Gleacher, 2007; Urgelles, Donohue, Wilks, Hasselt, & Azrin, 2012), families with reported ELEs are significantly more likely to be low-income than those without ELEs (Guan et al, 2017a). The impact of stress on the mental health of low-income, urban youth has been widely documented; for instance, stressful life events significantly predict higher levels of aggression among youth (Attar, Guerra, & Tolan, 1994) as well as higher levels of depression and anxiety (Sheidow, Henry, Tolan, & Strachan, 2014).…”