Angels in Crisis: How Mobile Crisis Intervention Changes Lives

by Bill Martin
A psychologist's poignant account of a challenging case referred by Child Protective Services while working
on a mobile mental health crisis team.
Sections in this Article:
Family History
Introductions
The First Crisis Intervention
Atercare
A Celebration
!I don"t #now why he"s so angry all the time$! Ruby Clarke said of her 11year old son! "ucas.
Ruby had grape #uice all over her hair and clothes! and her face was scratched. $aving met "i% and me!
clinicians for the &obile Crisis 'eam! #ust the week before! Ruby made this first crisis call to help her get
"ucas under control.
(pon discharge from a nineday psychiatric hospitali%ation! "ucas's Child Protective Services )CPS* social
worker referred him to &obile Crisis and gave Ruby our hotline number. +e soon followed up with an
introductory visit. 'he &obile Crisis 'eam goes to a family,s home to deescalate a crisis in order to prevent
unnecessary psychiatric hospitali%ations! and in some cases to facilitate necessary hospitali%ations by
liaising with the police. +e always visit the family first in a noncrisis situation! so they can get comfortable
with us. People would much rather call someone they know at the mobile crisis team than an anonymous
hotline number.
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+e had learned a lot about both "ucas and Ruby at the introductory meeting. "ucas was indeed a troubled
boy. $e once put the family cat inside the microwave. $e used to beat their dog with a sock full of ice. -n the
middle of the night! Ruby would find him on the floor in the hallway! rocking in a da%ed state.
+hen "ucas was four years old! CPS removed him from his home because Ruby and her thenboyfriend!
&att! were operating a methamphetamine lab in the basement. +hen the police crashed the lab! they found
"egos and 'onka trucks on the floor within si. feet of deadly bottles of anhydrous ammonia. Ruby had been
up for eight days straight. &att had been beating both Ruby and "ucas.
Ruby began a trying halfdecade of recovery work! while "ucas spent the ne.t seven years in foster care!
getting kicked out of several foster homes due to his hyperactive and violent behavior. Ruby worked hard to
get her son back! following all the therapy and substance abuse treatments that were asked of her by the
courts. /ven though she had done a lot of work on herself! she still had an edge to her! and could easily
become e.asperated. After seven years without "ucas! and on the heels of a difficult recovery! she found
herself alone! raising this emotionally disturbed child. She sometimes withdrew into her own space in order
to calm down! often chainsmoking cigarettes on the porch.
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0uring our introductory visit! "ucas showed us around his room like a miniature tour guide. $e pointed out
his '1! video games! basketball! and dart game. $e didn,t mention the ducttaped holes in the wall from
previous angry outbursts! and neither did we. -t was no time to rub his nose in it.
'hen "ucas showed us his 2angel doll!3 which seemed out of place amidst the other toys. 'he angel doll was
dressed in a worn white robe with a crinkled gold foil halo. "ucas referred to it as 2my angel.3 Ruby had
bought it for him at a garage sale one Christmas when "ucas was three years old. 4ack then she was so
high most of the time that she almost forgot to buy him anything at all. She had spent most of her money on
drugs. She found the angel doll three days before Christmas! and bought it for two dollars. 'o Ruby! the doll
was now a reminder of a shameful time in her life. She wished "ucas would get rid of it! but she marveled at
how much 2he loves that old thing.3
As "ucas talked about 2his angel!3 "i% and - caught each other,s glance! knowing this doll was significant. -t
was a link to an ideali%ed time! and was the most tangible thing he had of his mother for all those years
apart. 35our doll must be really happy that she,s had you all these years!3 "i% said. 2-t can be scary
sometimes! especially with all the new places you guys have been to.3 "i% had a beautiful way with kids6
she was caring! authentic! fun! and always optimistic about a child,s ability to recover.
2- guess so!3 "ucas said.
2She probably wasn,t too worried! though. - bet she always knew you would never leave her behind.3
"ucas smiled sheepishly! leaned in close and whispered to "i% as if he didn,t want to embarrass her! 25ou
know! she,s #ust a doll. She doesn,t really have feelings. - like her because she can fly and she reminds me
of Christmas.3
"i% acted as if this was the first she,d heard about dolls not having feelings. 27h! - see89
"ucas had a right to be angry! but he didn,t know that. Any irritation in the present triggered an outpouring of
pain from his past. $e feared his angry self. "ucas was also more resilient than he could ever know. $e still
managed to smile! laugh! help others! and even make friends no matter how often he moved. &aintaining
those friendships was tremendously difficult! but he could always win people over initially.
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:ow! si. days after our introductory visit! Ruby called our hotline. "ucas had arrived home from school in a
foul mood! throwing his backpack down hard on the floor. A few days before! Ruby had instituted a ;<
minute =uiet time for "ucas in which he would rela. after school. "ucas had taken to playing his videogames
during this time! which actually only served to further stimulate him. 'he day Ruby called the hotline he was
hyper and irritable! yelling for his mother to cook tater tots while he never took his eyes from the '1 screen!
thumping and tapping buttons and triggers rapidly. +hen Ruby suggested something else for dinner! "ucas
knocked over his grape #uice and began throwing a fit. $e toppled a kitchen chair and stomped one of the
legs off. $e threw things around the house and yelled obscenities at Ruby.
'he &obile Crisis 'eam arrived at the home and we began our intervention. +e address each crisis without
taking sides. +e present ourselves as compassionate to the child,s plight. +e know he,s having a difficult
time and probably has a logical reason to be upset. So we often ask! 2$ow can we figure something out
together>3 ?rom beginning to end! we deal with each crisis with an understanding that the situation is
relational@ there is no one 2bad guy.3 ?rom the introductory visit onward! we make it clear to the parents that
we are not 2the heavy!3 not to be used as a punishment! as in 25ou,d better calm down or -,m gonna call
&obile Crisis on you.3 7ur effectiveness depends entirely on being able to build rapport =uickly and
problemsolve collaboratively. -f e.asperated parents are allowed to remove themselves from the situation!
they tend to insist that we 2fi.3 the child. 'his results in a child feeling scapegoated and colluded against!
and renders crisis intervention ineffective. 'herefore! we also tell parents that this is a family intervention!
and that they will be encouraged to be actively involved in crisis resolution and prevention.
'he first step in a heated situation is to 2separate the combatants3 and 2do crowd control.3 'hat means we
make sure that family members are not milling around! adding to the chaos. Aenerally! we initially meet
privately! first with the parent! and then the child.
+hen we met with "ucas in his room! we allowed him to vent and say horrible things about his mother. +e
told him he had good reason to be frustrated! but that we had to figure out a better way to get his needs met.
"ucas began calming down! so we started guiding him toward a more complete understanding of what had
happened. +e emphasi%ed how his pree.isting mood set him up to e.plode! and how =uiet time can help
prevent problems. +e discussed how he felt in his body when he was getting upset )2&y ears get hot3*. All
of these interventions were aimed at helping "ucas to recogni%e and regulate his own mood. +e e.plored
alternative e.planations for his mother,s intentions! so "ucas could build empathy. /mpathy decreases a
child's motivation to act out aggressively toward others. -t also prevents the abusive cycle of demoni%ing the
other person and believing that they deserve punishment.
+e then brought "ucas out to the living room and had a family meeting in which we developed a brief safety
plan to prevent future crises. 'he plan outlined =uestions Ruby would ask that would prompt "ucas to notice
when he was feeling irritable! at which point "ucas would choose from a list of fun and rela.ing activities to
engage in. +henever he did this! he would earn stickers on a sticker chart! leading to privileges and special
toys. At this point! "ucas got very e.cited. $e chose to earn 0ragonball B cards! which was no surprise to us
6so many boys we worked with said they wanted them as rewards that we put our Pokemon cards in
storage and started supplying 0ragonball B packets to parents. 'he safety plan and sticker chart were
posted on the refrigerator.
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+e continued our crisis interventions for Ruby and "ucas one or two times per week for the ne.t few
months. +e were usually able to calm things down. "ucas only had to be hospitali%ed once more during that
time! for only two days. 0uring this time! we had also referred the family to +raparound Services! which
consists of a team designed around the individual needs and wants of the family. 'he team is made of
mental health professionals! a family partner )i.e.! a peercounselor who is the parent of a child in the mental
health system*! and others! such as the family's pastor or school psychologist.
Ruby and "ucas had a long road ahead of them. "ucas still had conflicted feelings toward his mother6he
re#oiced at being home again! yet feared it could all be taken away at any second@ he was angry at Ruby for
not protecting him earlier in his life! yet he feared that his anger would force her to go away. $e felt she,d left
him because he was bad! and that his anger and dread might again prove his badness. 'he tension caused
him to test limits repeatedly! almost as if he wanted to see if his mother would cut and run before he
committed to loving her. 7ne time! when we asked him if he loved his mom! he replied 2not all the way.3
Sometimes he could be overheard in his room venting to the angel doll as if it were a counselor.
+e knew that Ruby needed to set firm! unemotional! consistent! and fair limits. -n her case! it was essential
that she not e.press e.asperation or otherwise be too emotional when setting limits. "ucas would see that
as a sign that things were still negotiable. $e knew that if he pushed hard enough! she would give in. 'hese
interventions are filed under 9parenting education.9 4ut Ruby and "ucas were also in a developmental crisis
)i.e. a transitional state that anyone would struggle with*. 'hey were suddenly engaged in a parentchild
dynamic. 'hey were a reunited family with emotional baggage left to unpack. So as part of our interventions!
we devised ways to help Ruby and "ucas rebuild their relationship.
4ecause they needed to intensify their positive interactions! the refrigerator soon had a second sticker chart
of a blue sky with some puffy clouds in it. +e gave "ucas and his mom each a roll of smiley sun stickers and
instructed them to put a sticker on the chart anytime they acknowledged the other person doing something
positive. +hen the whole sky was full of sunshine stickers! they earned a very special outing together. "ucas
got a tremendous kick out of being able to give stickers for a change. 'hey earned many outings together
and their relationship blossomed. 'hey saw the $arlem Alobetrotters@ they went on a safari@ they went to an
:4A autograph signing.
-n good mobile crisis work with children and families! the heart of the work is this kind of ongoing aftercare.
'he acute crisis may end =uickly with directive interventions based on ensuring safety and restoring
emotional e=uilibrium. 4ut the family is almost always in a vulnerable state in which other stressful events
will trigger more crises. 'herefore! we focus on crisis prevention. -t's not about putting out fires! it's about
fireproofing. -n addition to parenting education and relationshipbuilding! aftercare involves enlisting )or
developing* the family's natural social support. &ost families don't want to have to rely on professional
support all the time. 'o do so =uickly becomes demorali%ing. 'here are usually a few neighbors! e.tended
family! and friends at work or church who are more than willing to help. Ruby had such helpers as part of her
+raparound team.
?ive months later! things were going well. +raparound was helping a lot! and "ucas was responding well to
a new therapist. "ucas was his 2usual hyper! moody self!3 but he hadn,t had any ma#or outbursts. $e was
passing all his classes at school. All the pieces were coming together6&obile Crisis! +raparound!
psychiatry! therapy. 'he crisis calls tapered off.
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Roughly si. months after our last visit! the +raparound coordinator called to invite us to a celebration for
"ucas! who had #ust made /agle Scout. "i%! now seven months pregnant! nearly fell off her chair when - told
her about the invitation.
'he atmosphere in the home was #ovial and rela.ed. Ruby took our coats and "ucas offered us something to
drink. As often happens when emotionally disturbed kids turn the corner! they seem somehow more mature
than their chronological age! perhaps as a result of all the storms they,ve had to weather. &any familiar
faces were there from the +raparound team! and several new friends that Ruby had met through church.
She had built up =uite a group of support for herself. /veryone was gentle and kind toward "ucas. Several
people made toasts to "ucas and his mom. - spoke about how thankful we were to have worked with them.
"ucas trotted to his room when it came time for us to leave. $e emerged a minute later carrying the angel
doll. As "i% was wrapping her coat around her giant belly! "ucas held the angel doll up to her. 2$ere,s a
present for your baby.3
24ut this is your angel doll!3 "i% said. 25ou,ve had it forever. - couldn,t possibly take it.3
2Ao ahead!3 he said! nudging it toward her. "i% looked over at me.
2+ell!3 - said! 2- think the doll likes you. $ow can you turn down an angel>3 Ruby stood behind "ucas!
smiling the widest smile - had ever seen.
"i%,s eyes were swelling with tears as she took the doll. 2'hank you.3
"ucas seemed concerned. 2-t,s okay. - don,t need it anymore.3
2:o! - suppose you don,t.3 "i% said. +hen we got to the car! she collapsed in tears. 2Can you believe that>
+hat that must mean to him83
'hat was the last we heard from the Clarke family. "i% had a baby boy seven weeks later. She keeps the
angel doll on a shelf in her baby,s room. She plans to give the doll to her son! and one day when he,s old
enough! she,s going to tell him a story about how angels really do e.ist! even against all the odds.
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4ill &artin holds a Ph0 in Clinical Psychology from the (nion -nstitute and (niversity.
Currently a therapist on an inpatient psychiatry unit in the San ?rancisco 4ay Area! 4ill has worked both as a
clinician and a supervisor for two separate mobile crisis teams. $e can be contacted at
bmartinFhsd.cccounty.us.