Crisis Intervention Model: Six Steps You Run

That run sheet is the crisis intervention model. Richard K. James and Burl E. Gilliland built it as a task model in Crisis Intervention Strategies so you have an order when the hour is no longer a regular session. You do not rearrange the steps because a housing form is due or because the person is crying and you want to be useful.

What this crisis intervention model is

A hard session is not this sequence. Intensity is not the bar. The bar is that their usual ways of getting through the next day have stopped working.

You run the six steps in order. James and Gilliland set that order in Crisis Intervention Strategies (8th edition). Run the sequence in the room. Do not use it as police Crisis Intervention Team training. Start at step one.

Record ideation, plan, intent, and means on the suicide risk assessment template. Do not pick a billing code while you are still running these steps. Sort the code after the hour, using the CPT 90839 crisis psychotherapy page.

Stay on the first three steps

Crisis intervention theory is a large shelf. The part you can use at 2:10 p.m. is smaller. Hear the problem in their words. Ask about safety. Show that you are a person who will stay. Then, and only then, move.

Maya’s mistake, on a different afternoon, was step five at minute four. Jordan had said the sentence about not waking up, and Maya answered with a sister, a pharmacy bag, and a text check. Jordan nodded. The nod was relief that someone else had a plan. It was not a commitment. When Maya went back to “what happened since yesterday,” the story was a partner leaving, a night of no sleep, and pills in the bathroom that Jordan had opened and closed twice. The plan still worked. It would have been a better plan if Jordan had named Dana, instead of inheriting her.

You will feel the pull to skip. The person wants out of the feeling. You want a next step you can defend in the chart. Stay on the first three until you can say the precipitant back and you have asked the risk question out loud. If you cannot do those two things, you are not ready for alternatives.

Crisis intervention in social work

Crisis intervention in social work uses the same crisis intervention model. The precipitant is often a piece of paper. An eviction notice. A benefits cutoff. A child-welfare worker who left a voicemail. The paper does not change the order.

Priya, a case manager in the same clinic, had a parent in the lobby that afternoon with an eviction notice and a child asleep in the car. The parent said, “I can’t do this anymore.” Priya’s hands wanted the housing portal. She asked what “can’t” meant today, then asked about the parent’s safety and the child’s, before she opened a resource list. The alternatives included the housing worker, a neighbor who had taken the child before, and the parent’s sister. The parent picked the sister for tonight and the housing worker for the morning. The commitment was a sentence the parent said back: “I call my sister before I drive.”

Agency resources belong in the alternatives step. You do not assign them. An option the person will not use is not an option. A child in the car is part of the safety step, not a detail you add after the referral.

If your agency’s written emergency procedure names a different order for disposition, follow that written procedure. Use this sequence for the conversation you still have in the room.

When you leave the six steps

Leaving the crisis intervention model is a decision, not a failure of the script. Stop the sequence when any of these is true.

• Risk is imminent and you cannot hold it in the office.
• The person needs emergency medical care, including overdose or injury you can see.
• They are too intoxicated, or too shut down, to say a next step back to you.
• A child or another person is in immediate danger.

Then you follow your setting’s emergency path. You do not add another coping skill to delay that call.

The 988 Suicide & Crisis Lifeline is the number you give, and the number you can use yourself. Call, text, or chat. It is free, confidential, and available 24 hours a day, every day, for mental health struggles, emotional distress, alcohol or drug use concerns, or a moment when you need someone to talk to. 988 does not close your chart. You still write the disposition, who you contacted, and what the person agreed to do in the next hour.

After the acute moment, if a collaborative plan is indicated, move to the Stanley-Brown safety plan page linked in the plan step. The VA Safety Planning Intervention Manual lists six steps on the written plan: warning signs, internal coping, people who can distract, people who can help, professionals and urgent services, and making the environment safer. It also says to review and revise the plan periodically, as needed. Do not paste that plan into these six crisis steps and treat them as the same sequence.

What you write after the hour

Write six short lines, in the same order, plus the disposition. A reviewer should not have to hunt.

• Problem, in the person’s words, and the precipitant
• Safety question you asked, and what they said about ideation, plan, intent, means, and time frame
• How you showed you were staying, without a promise that they would be fine
• Options you examined, and which ones you dropped because they were not real
• Plan: person, next action, means step
• Commitment: the sentence they said back, or that they could not say it and what you did instead

If the hour was crisis psychotherapy, read the code rules on the CPT 90839 crisis psychotherapy page. Minutes without the six lines, or six lines without a disposition, both leave the chart thin.

Copy the blank run sheet

Copy this block once per step. One field per line. If you run the fields into a paragraph, you will not find the safety check at the end of the hour.

Download the crisis session time log

The time log is a worksheet for the hour that was crisis psychotherapy. It has lines for crisis versus routine, face-to-face minutes, risk, resources, and disposition. It is not a CMS form. It does not replace the crisis intervention model, and it does not decide the code. Use the CPT 90839 crisis psychotherapy page when you need the code rules.

Write the six lines in the chart yourself. The note does not run the hour, and it does not pick the disposition. If you want the charting handoff after the hour, see how session notes are structured or start a free trial.

References

• 988 Suicide & Crisis Lifeline. (n.d.). 988 Lifeline.
• Centers for Medicare & Medicaid Services. (n.d.). Psychotherapy for crisis.
• James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Cengage Learning.
• Stanley, B., & Brown, G. K. (with MacRae, F., Rotolo, C. A., Hughes, G., Mina, L., & Barry, C. N.). (2021). VA Safety Planning Intervention Manual. U.S. Department of Veterans Affairs.
• Substance Abuse and Mental Health Services Administration. (n.d.). Suicide prevention.
• U.S. Department of Veterans Affairs. (n.d.). Suicide risk assessment reference guide.