A Partnership Between Roberts Crisis

Intervention Model and the

Multicultural Competencies

David A. Stone, PhD

Jacqueline A. Conley, PhD

Crisis intervention services are an integral component of the mental health continuum of
care. Numerous models of crisis intervention offer extensive steps, strategies, and plans
for intervening effectively with individuals in crisis. African Americans, as a population,
underutilize services offered by the mental health system. The use of multicultural
competencies (counselor awareness of own values and biases; counselor awareness of
client worldview; culturally appropriate intervention strategies) applied to Roberts crisis
intervention model creates a partnership that may provide crisis intervention specialists
with a framework for increasing effectiveness with African Americans. [Brief Treatment and
Crisis Intervention 4:367375 (2004)]

KEY WORDS: crisis intervention, multicultural competencies.

Crisis intervention services are an integral part numerous definitions that will be covered later,
of the mental health treatment delivery system. but the question persists. In reflecting on our
Crisis intervention specialists have specific own life, we have thought about two specific
training designed to allow them to intervene crises that we have encountered, one in which
effectively with clients who are experiencing the death of a loved one was a possibility and
debilitating circumstances in their lives. the other in which the death of a loved one was
While perusing the mental health literature imminent. In an attempt to integrate what we
on crisis and crisis intervention, we have found have gleaned from the literature, and in con-
ourselves wondering, At what point is an sideration of these two personal crises, we
experience a crisis? The literature offers have come to the conclusion that the point of
crisis is reached during an experience in which
the individuals repertoire of life experiences
From Counseling and Human Services, Roosevelt University does not contain a response that is equal to the
(Stone), and Psychology Department, Chicago State crisis circumstance. What comes to mind are
University (Conley).
Contact author: David A. Stone, PhD, 430 S. Michigan
cognitions such as: What am I supposed to
Ave., Chicago, IL 60605-1394. E-mail: dstone@roosevelt.edu. do? I cant deal with this. I dont know
doi:10.1093/brief-treatment/mhh030 what to do. I cant figure out what to do.
Brief Treatment and Crisis Intervention Vol. 4 No. 4, Oxford University Press 2004; all rights reserved.

367
STONE AND CONLEY

How am I going to get out of this? Such upon which crisis intervention rests. Golan
thoughts suggest that the person does not have (1978) posits that a hazardous event or a series
an experiential reservoir from which to draw of successive stressors in rapid sequence up-
that will allow him to cope effectively with sets the individuals homeostasis, rendering the
what is perceived as some degree of upheaval person vulnerable. If the stressful circum-
in his life. Therefore, an experience becomes stances persist, and the person cannot contin-
a crisis at the moment the individual thinks ually draw on adequate coping responses,
there is something insurmountable happening a state of disequilibrium results. As the crisis
about which he can do nothing. situation evolves, the person may perceive the
stressors as threatening to some aspect of his or
her person or circumstance. What is important
Crisis Intervention Literature here is that the crisis is a part of life, an obstacle
or impediment to everyday functioning. Golan
The literature on crisis and crisis intervention is (1978) suggests that the period of disequilib-
plentiful and rich. For our purposes, we chose rium is time limited, depending upon the na-
three definitions that cover a span of 42 years in ture of the crisis, but usually lasts 4 to 6 weeks.
the literature. Caplan (1961) states that people The resolution of the crisis occurs when the
are in crisis when they face an obstacle that person realizes that to this point the coping
is, for a time, insurmountable by the use of responses are inadequate and help is necessary
customary methods of problem solving. A and possibly welcomed. With appropriate and
period of disorganization ensues, a period of adequate intervention, the person enters the
upset, during which many abortive attempts reintegration phase (Golan, 1978) and emerges
at solution are made (p. 18). Brammer (1985) with new and appropriate responses with the
considers crisis to be a state of disorganization experience and new learning integrated into
in which people face frustration of important the self. Without help, however, pathological
life goals or profound disruption of their life or maladaptive behaviors may be the outcome.
cycles and methods of coping with stressors. Crisis intervention services are a necessary
The term crisis usually refers to a persons and vital component of mental health treatment
feelings of fear, shock and distress about the services. Few individuals in life do not ex-
disruption, not the disruption itself (p. 94). perience some degree of crisis at one time or
Lastly, Marino (1995) delineates four stages of another. Many people are able to respond
crisis: (a) A critical situation occurs in which effectively, end the disequilibrium, and resolve
a determination is made as to whether a persons the crisis. But for some people, the experience is
normal coping mechanisms will suffice; (b) in- so far beyond their ability to cope, or the event
creased tension and disorganization surrounding is so catastrophic, that crisis intervention by
the event escalate beyond the persons coping a professional is required.
ability; (c) a demand for additional resources Crisis intervention is a specialty that requires
(such as counseling) to resolve the event is specific training in how to evaluate the degree
needed; and (d) referral may be required to re- of the crisis and determine the intensity of the
solve a major personality disorganization (p. 3). ensuing interventions. The intervention spe-
Crisis intervention services are a specialty in cialist learns models and strategies of crisis
the mental health treatment continuum. There intervention. There are numerous crisis in-
are numerous models of crisis intervention, but tervention models, for example Caplans (1961)
first, it is necessary to consider crisis theory equilibrium model and the cognitive models of

368 Brief Treatment and Crisis Intervention / 4:4 Winter 2004

 Roberts Crisis Intervention Model and the Multicultural Competencies

Ellis (1962), Beck (1976), and Meichenbaum mental illness. Environment, economics, and
(1977). The model on which we wish to focus is social factors among African Americans con-
Roberts (2000) assimilation of models devel- tribute to risk rates as well as psychological
oped by Aguilera and Messick (1982), Beck distress rather than intrapsychic factors (Neigh-
(1976), Burns (1980), Caplan (1964), Golan bors, 1991). African Americans who are sus-
(1978), Parad (1965), and Puryear (1979). ceptible to experiencing mental illness have the
Roberts (2000) model provides a seven-step tendency to underutilize mental health ser-
process designed to address the crisis and to vices. Particularly, it has been noted that factors
restore functioning for the person: such as access to insurance coverage, afford-
able services, perceptions of discrimination,
Step 1. Plan and conduct crisis assessment and ethnicity of the service providers serve as
(including lethality measures). barriers to service among African Americans
Step 2. Establish rapport and rapidly (Cornelius, 2000; Hoberman, 1992).
establish a relationship. Utilization of services research indicates that
African Americans are likely to use emergency
Step 3. Identify major problems (include the
services or seek treatment from a primary care
last straw or crisis precipitants).
physician rather than a mental health pro-
Step 4. Deal with feelings and emotions fessional. A question to ask is, Why is this
(including active listening and validation). phenomenon occurring? Some research indi-
Step 5. Generate and explore alternatives. cates that for African Americans, the culture of
the provider and the severity of the problem
Step 6. Develop and formulate an action plan.
impact the decision to seek services. The 2001
Step 7. Follow-up and come to agreement. Surgeon Generals Report indicates that the
percentage of African American mental health
service providers is proportionally small.
African Americans and Mental Health African American mental health professionals
Services are psychiatrists (2%), psychologists (2%), and
social workers (4%). No figures for licensed
No one is immune from crisis in life. Our clinical professional counselors were presented.
existence does not offer any guarantees that we Service providers who are not African Amer-
are going to be free of experiences that are ican must build upon the cultural strengths of
debilitating and catastrophic. Many people find the people in their care.
it necessary in times of crisis to seek professional In the section of the National Survey of Black
help. Also in times of emotional distress, not Americans dealing with utilization of mental
necessarily crises, individuals seek therapy to health services, Neighbors (1991) found that
assist them with their difficulties. The literature problem severity and problem type contributed
on who seeks mental health treatment suggests to help-seeking behavior among African Amer-
that African Americans as a group underutilize icans. African Americans more often sought
mental health services. Certainly, this includes professional help for physical health problems
crisis intervention services. rather than emotional adjustment problems,
According to the U.S. Surgeon Generals death of a loved one, interpersonal difficulties,
Report (U.S. Department of Health and Human or economic difficulties. Furthermore, in terms
Services, 2001), African Americans in high- of age and gender, women were more likely to
need populations are at particular risk for seek help than men, and older people (3554

Brief Treatment and Crisis Intervention / 4:4 Winter 2004 369

STONE AND CONLEY

and 55 and older) were more likely to seek help upon the crisis intervention professional to
than younger people (1824). Lastly, people work toward elimination of the conditions and
who rated their problems as severe were more treatments that produce them. Sue and Sue
likely to utilize some form of professional health (2003) recommended that mental health pro-
service. fessionals have a personal and professional
According to Sue and Sue (2003), 50% of responsibility to (a) confront, become aware
African American patients terminate after the of, and take actions in dealing with our biases,
first session, while 30% of European American stereotypes, values and assumptions about
patients terminate after the first session. In the human behavior; (b) become aware of the
same study, African Americans attended an worldviews, values, biases and assumptions of
average of 4.7 sessions, while European Amer- clients who differ from us; (c) develop appro-
icans attended an average of 8.7 sessions. priate help-giving practices, intervention strat-
Clearly, African Americans are not as respon- egies, and structures that take into account the
sive to treatment services as their European historical, cultural and environmental experi-
American counterparts. The implications of this ences and influences of our clients; and (d)
phenomenon warrant attention. If African change the policies, practices, programs, and
Americans drop out of treatment after one ses- structures of the institutions that oppress
sion, we as therapists conclude that the pro- groups in our society (p. 38).
blems have not been resolved and said problem In the process of coming to understand the
continues to impair functioning. Perhaps the worldviews of racially/culturally different
lack of multicultural competencies on the part clients, the crisis intervention professional is
of the professional is a contributing factor in going to find that racially/culturally different
the equation, to such an extent that the client clients perceive reality differently from the
makes a decision before the interactions are crisis intervention specialist, and these per-
complete that he or she is not returning. ceptual differences are direct by-products of
When racially/culturally different clients thinking and being different. Ho (1987) delin-
enter the system for crisis intervention services, eates significant value differences between
what assumptions do they bring with them? white middle-class Americans and Asian Amer-
and are these assumptions more accurate than icans, American Indians, Hispanic Americans
the ones made about them by the mental health (Latinos), and African Americans. In compar-
professional? The racially/culturally different ing these ethnic groups, Ho suggests that Afri-
client may make the following assumptions of can Americans perceive nature, time, people
suspicion and mistrust of the system: relations, activity, and the nature of man dif-
ferently than European Americans. Parham,
Are these white people any different than White, and Ajamu (1999) compare eight
all the other ones out there? dimensions of being, which are presented in
Table I.
Is this just an extension of the screwed-up
The previous information represents some of
system that sent me here in the first place?
the ways in which African Americans may
These white people have already decided differ from Euro-Americans. It is not inclusive
about me without even knowing me. of other groups or of all possible differences;
however, it does provide valuable information
Given that there may be some degree of for the professional to be aware of in approach-
accuracy to these assumptions, it is incumbent ing crisis intervention with African Americans.

370 Brief Treatment and Crisis Intervention / 4:4 Winter 2004

 Roberts Crisis Intervention Model and the Multicultural Competencies

TABLE I. Comparison Between Dimensions of Self Based on Ethnicity

Dimension African American Euro-American

Self Holistic/integrated Fragmented/segmented

Feelings Expressed Suppressed/controlled
Survival Collective orientation Self/competitive
Language Oral/in relation to other Written/detached
Time/space orientation Present-centered/past-referenced Commodity/future
Universe Harmony, balance, interrelated Mastery/control
Death Transition to next life Death of body; end
Desire to preserve life
Worth Measured by contribution to Measured by material
community and collective uplifting attainment and possession

The professional must accept that the differ- awareness, knowledge, and skills in both the
ences in orientation to life, the world, and even intra- and interpersonal domains will lead to
death are real and that the crisis intervention counselors responding in culturally appropri-
specialist cannot intervene appropriately with- ate ways that invite the racially/culturally
out awareness, knowledge, and skills that different client to invest in the counseling
address the differences. The underutilization relationship or in the resolution of the crisis.
of mental health services by African Americans White counselors need to know that their
is in part related to the inability of professionals assumptions about people who are racially/
to understand the complexities associated with culturally different may be culture bound if the
African Americans seeking services in the counselor has not had significant contact with
mental health system. individuals who are racially/culturally differ-
In calling for cultural competency from ent. The absence of significant contact will
mental health professionals, it is to be stressed likely result in the white counselor having
that the professional must possess an under- assumptions about racially/culturally different
standing of the sociopolitical realities that exist people that are based upon stereotypes and are
in the United States. Professionals cannot be in therefore inaccurate. Bringing inaccurate in-
denial that specific groups of people are denied formation into the crisis intervention situation
access to full participation in economic and is a detriment to establishing rapport and
social life in our country. These forces that prevents the counselor from learning who the
support exclusion are not random, nor are the client is. Therefore, the counselor must be able
phenomena of poverty, violence, and involve- and willing to recognize her limitations in
ment in the criminal justice system all attribut- cultural competence and allow herself to
able to personal irresponsibility. One task that become the student of the client so that the
professionals must know they need to accom- counselor can develop an awareness of who the
plish is to assist racially/culturally different client really is and not project culture-bound
clients in maintaining a sense of cultural assumptions. The counselors attitude of being
integrity when the clients may not be in teachable allows for the all-important rapport
systems that value their welfare and well- to be established. The counselor with this
being. Professionals must understand the role cultural skill can respond with accurate empa-
of advocacy in counseling. The development of thy, thus increasing the therapeutic bond.

Brief Treatment and Crisis Intervention / 4:4 Winter 2004 371

STONE AND CONLEY

Crisis intervention services are a microcosm of tion and unable to act for the moment in her
the continuum of mental health services. Since own best interests.
there is a dearth of research on African American The first domain of multicultural competen-
utilization of crisis intervention services, we cies and the earliest stages of crisis interven-
speculate that this populations involvement in tionmaking psychological contact and
using this mental health specialization is mir- rapidly establishing the relationshipseem to
rored in its use of other mental health services. dovetail with the notion that counselors need
Perhaps there is a need to provide a partnership to be aware of their own cultural values and
between models of crisis intervention and biases in order to make psychological contact
culturally appropriate intervention strategies. with clients. A culturally unaware counselor
Sue, Arredondo, and McDavis (1992) pro- runs the risk of losing the client if the counselor
posed a set of specific multicultural competen- has no sense of who he or she is as a cultural
cies for counselors. The competencies address being. A lack of awareness such as this jeopard-
three areas in which the counselor must have izes the counselors ability to make significant
mastery. The first is counselors awareness of human contact with the client. For example,
their own cultural values and biases; second is a European American counselor who does not
counselors awareness of the clients world- understand that he or she has negative attitudes
view; and third is culturally appropriate in- toward African Americans interacts with the
tervention strategies. When we juxtapose these client with an undercurrent of bias; the client
areas with Roberts (2000) model of crisis senses this and responds with feelings of
intervention, there is a sensible fit. mistrust toward the counselor. Harboring such
ethnocentric attitudes leads the counselor to
Application: the partnership between Roberts determine that the client possessing differ-
crisis intervention model and the multicultural ent values is inferior or abnormal. In this en-
competencies in case format. Stacy is a 36-year- counter, psychological contact is at best not
old African American woman with three established, and at worst the encounter is
children, ages 3, 10, and 12. Stacy lost her job detrimental to the client, who does not return
3 months ago and has been unable to secure and remains in crisis and possibly ultimately
new employment. She is a certified public develops maladaptive patterns of behavior to
accountant. The father of the two oldest cope, which may become chronic. According to
children is deceased and did not carry any life Sue and Sue (2003), the culturally competent
insurance, thus leaving the children with no professional is one who has respect for and
financial support. The father of the 3-year-old is is comfortable with differences and has an
unemployed and is able to contribute only awareness of his or her own racist, sexist beliefs
a limited amount of financial support for his and attitudes and how these affect clients. The
son. Stacy has been experiencing increasing professional who has not done this work will in
financial difficulty and is now living day to day. all likelihood have a negative impression of
The pressure is mounting and her fear and Stacy, and reciprocally Stacy will have a nega-
anxieties are doing the same. Stacy has been tive reaction to the professional, creating an
informed today that she must withdraw her impasse that may result in Stacy losing faith that
oldest child from an after-school program due this process is going to be helpful. Therefore,
to an inability to pay. This is the last straw for the first domain of the competencies is the portal
Stacy. She presents at the clinic overwhelmed, through which the professional must pass in
anxious, depressed, and angry over her situa- order to aspire to the second and third.

372 Brief Treatment and Crisis Intervention / 4:4 Winter 2004

 Roberts Crisis Intervention Model and the Multicultural Competencies

In the second domain of multicultural com- tion model. When the counselor approaches
petenciescounselor awareness of clients a stage through the domains of the competen-
worldviewculturally unaware counselors cies, the crisis intervention model is contextu-
can impede the establishment of psychological alized to the client. For example, if counselors
contact if they are unable to understand the understand their negative attitudes toward
clients worldview (i.e., internal frame of African American clients, they can take the
reference). In this circumstance, if the counsel- necessary steps to neutralize the impact of
ors experiences in life are far removed from the negative attitude. In the second domain,
those of the clients (e.g., marginalization, counselors allow clients to imprint their world-
poverty, oppression) and these experiences view(s) upon the counselors without the latters
shape the clients worldview, the counselor own worldview(s) interfering with their ability
may be unable to bridge the distance between to understand the clients. In the third domain,
the respective life experiences. Making psy- counselors make efforts to understand the cul-
chological contact may be particularly difficult tural context of the clients and tailor interven-
if the counselor operates from the assumption tions that are consistent with the clients life
that we all have the same life experiences. experiences.
When the professionals possess the knowledge The culturally competent professional under-
contained in the second domain, they can stands the implications of possessing dominant-
respond to Stacy in a respectful and therapeutic culture values, recognizes them as such, and
manner. possesses an understanding that said values are
In consideration of the third domain not superior but different and avoids passing
culturally appropriate intervention strate- judgment on the value systems of the racially/
giesa lack of ability to respond to clients culturally different client.
contextual existence may result in the use of
intervention strategies that are not useful to the
clients. As reflected in practice, the professional Implications for Counselors
is capable of responding in ways that are
consistent with Stacys cultural background Given the degree to which African Americans
and context and is able to communicate underutilize mental health treatment services,
intimately with the client. Further, the pro- it is safe to assume that some degree of that
fessional knows when it is necessary to move underutilization is due to counselors lack of
the process out of the counseling dyad and multicultural competencies. The dropout rates
become an advocate for Stacy when she is and limited number of sessions that African
facing institutional and/or sociopolitical forces Americans attend in comparison with white
that limit her ability to function more fully. The Americans are in part related to the lack of
culturally competent crisis intervention pro- cultural awareness of professionals. Some may
fessional will engage Stacy with a degree of self- take the perspective that they treat every client
awareness that has allowed for the development the same, that when a human being is in crisis,
of the knowledge and skills necessary to work the issues are the same regardless of the racial/
effectively with this racially/culturally differ- cultural background of the client. Others may
ent client. work from the point of view of color blindness.
Each of the three domains of multicultural That is, the professional does not see color when
competencies needs to be applied to each of the working with a client, so the racial/cultural
seven stages of Roberts (2000) crisis interven- background of the client has no meaning.

Brief Treatment and Crisis Intervention / 4:4 Winter 2004 373

STONE AND CONLEY

Both of these approaches, while noble in that References

they try to get at the clinical/crisis issues
straightforwardly and immediately, leave much Aguilera, D. C., & Messick. J. M. (1982). Crisis
to be desired when working with culturally/ intervention: Theory and methodology (4th ed.).
racially different clients. To treat everyone St.Louis: C. V. Mosby.
the same suggests a lack of idiosyncratic ap- Beck, A. T. (1976). Cognitive therapy and the
proaches and a generic application of crisis emotional disorders. New York: International
Press.
interventions regardless of the racial/cultural
Brammer, L. M. (1985). The helping relationship:
background of the client. Each approach de-
Process and skill (3rd ed.). Upper Saddle River,
contextualizes clients who may be racially/
NJ: Prentice Hall.
culturally different by essentially denying and Burns, D. D. (1980). Feeling good. New York: The
discarding any factor or issue that may be New American Library.
related to the clients racial or cultural back- Caplan, G. (1961). An approach to community
ground. There may very well be clients who are mental health. New York: Grune and Stratton.
racially and culturally different vis-a-vis the Caplan, G. (1964). Principles of preventive
dominant group who believe that the difference psychiatry. New York: Basic Books.
has had no meaning in the shaping of their Cornelius, L. J. (2000). Having limited choices
lives, but the counselor cannot be the person for medical care: Does it lead to delays in
making this determination. That can only come seeking care for minority populations? In
from the client, and only then can the pro- C.Houge (Ed.), Minority health in America.
fessional work without paying attention to the Baltimore: Johns Hopkins University
Press.
racial or cultural difference.
Ellis, A. E. (1962). Reason and emotion in
Crisis intervention trainers, counselor educa-
psychotherapy. New York: Lyle Stuart.
tors, social workers, psychologists, counselors,
Golan, N. (1978). Treatment in crisis situations.
and clinical supervisors need to incorporate New York: Free Press.
multicultural competencies into their course- Ho, M. K. (1987). Family therapy with ethnic
work, training, and supervision. The first minorities. Newbury Park, CA: Sage.
domain of the multicultural competencies is Hoberman, H. (1992). Ethnic minority status and
intrapersonal work that the counselor or coun- adolescent mental health services utilization.
selor in training needs to accomplish. The sec- Journal of Mental Health Administration, 19,
ond domain of the multicultural competencies is 246263.
interpersonal work wherein the counselor, now Marino, T. W. (1995). Crisis counseling: Helping
aware of his or her values and biases, becomes normal people cope with abnormal situations.
able to make psychological contact because the Counseling Today, 38, 4046.
work in the first domain allows the counselor to Meichenbaum, D. H. (1977). Cognitive-behavior
modification: An integrated approach. New York:
understand the clients subjective view of
Plenum.
reality. The third domain of the multicultural
Neighbors, H. W. (1991). Mental health. In J. S.
competencies assimilates the first two domains,
Jackson (Ed.), Life in black America. Newbury
and when melded with Roberts (2000) crisis Park, CA: Sage Publications.
intervention model, the counselor is now able to Parad, H. J. (1965). Crisis intervention: Selected
partner with the client to determine the neces- readings. New York: Family Service Association
sary coping strategies and solutions that are of America.
culturally sensitive and necessary to bring the Parham, T. A., White, J. L., & Ajamu, A. (1999).
crisis to resolution. The psychology of blacks: An African-centered

374 Brief Treatment and Crisis Intervention / 4:4 Winter 2004

 Roberts Crisis Intervention Model and the Multicultural Competencies

perspective. Upper Saddle River, NJ: Prentice and standards: A call to the profession. Journal
Hall. of Multicultural Counseling and Development, 20,
Puryear, D. A. (1979). Helping people in crisis. San 6489.
Francisco: Jossey-Bass. Sue, D. W., & Sue, D. (2003). Counseling the
Roberts, A. R. (Ed). (2000). Crisis intervention culturally different: Theory and practice (3rd ed.).
handbook: Assessment, treatment and research New York: John Wiley & Sons.
(2nd ed.). New York: Oxford. U.S. Department of Health and Human Services.
Sue, D. W., Arrendondo, P., & McDavis. R. J. (2001). Surgeon Generals Report. Mental health:
(1992). Multicultural counseling competencies Culture, race, ethnicity. Rockville, MD: Author.

Brief Treatment and Crisis Intervention / 4:4 Winter 2004 375