The Intervention and Assessment Models,The Tools of the Trade
Chapter 3 – The Intervention and Assessment Models
Chapter 4 – Tools of the Trade
Question(s): Case of Elizabeth.
Ana is a 45-year-old white female who is recently divorced. She is not doing well in her love life and comes to you to get some immediate help. She expresses feeling sad most of the time with suicidal ideation. She looks unkempt, sad, and has a hard time putting words together.
1. Of the nine intentional strategies depicted in your book, which ones are the most important ones in this situation (mention 3 in the order of priorities)
2. Why are those the most important? (explain and justify your answer)
Guidelines:The answer should be based on the knowledge obtained from reading the book, no just your opinion. If there are 2 questions in the discussion, you must answer both of them. Your grade will be an average of both questions (50% each question). First question: Mention the adequate strategy for this case scenario (50%). Second part of this question: explain / justify your answer (50%).
Chapter Thee: The Intervention and Assessment Models
©2013, Brooks/Cole Cengage Learning
Triage Assessment System
Evaluates the severity of a crisis situation.
Rapid
Systematic
Intentional
Supports the client in gaining:
Equilibrium
Mobility
Autonomy
©2013, Brooks/Cole Cengage Learning
Hybrid Model of Crisis Intervention
No longer a linear or stage model.
Hybrid Model = linear + systems models.
Can be linear or circular
Tasks are the foundation
Predispositioning/Engaging
Problem Exploration
Providing Support
Examining Alternatives
Planning in Order to Reestablish Control
Obtaining Commitment
Follow-up
©2013, Brooks/Cole Cengage Learning
Task 1: Predispositioning/Engaging
Clients may not want to talk or may be so out of control that they are not even aware of the crisis worker’s presence.
Engage in such a way that clients will be receptive to intervention.
Establish a therapeutic bond
Inform the client about what to expect
©2013, Brooks/Cole Cengage Learning
Task 1 Cont.
How to Engage:
Approach slowly, calmly, and with open body language.
Introduce yourself and ask their name.
Use their name and maintain eye contact.
Use basic listening skills and open-ended questions.
Clarify intentions.
Allow client to cathart without escalation.
©2013, Brooks/Cole Cengage Learning
Task 2: Problem Exploration
Define the problem from the client’s point of view.
May be difficult during the middle of a chaotic situation
Do not need a complete history
Do need to identify the precipitating event
©2013, Brooks/Cole Cengage Learning
Task 3: Providing Support
Communicate concern for the client.
Three types of support:
Psychological support
Unconditional positive regard
Logistical Support
Physical support (food, water, shelter, etc.)
Education
Resources
Social Support
Examine the client’s primary support system
May not have the resources
May not be easily accessible
May not be willing
Client may be too embarrassed to seek help
©2013, Brooks/Cole Cengage Learning
Task 4: Examining Alternatives
Clients often think they have no options or develop tunnel-vision.
Three key components:
Situational supports
Coping mechanisms
Positive thinking patterns
Brainstorm numerous alternatives.
Continuous process due to rapidly changing conditions
©2013, Brooks/Cole Cengage Learning
Task 5: Planning in Order to Reestablish Control
Creating a plan includes:
Identifying resources for immediate support
Develop coping mechanisms
A good plan needs to be:
Developed by the client
Clear
Realistic
Behaviorally specific
Immediate (minutes, hours, or days)
A plan allows the client to establish autonomy and become mobile.
©2013, Brooks/Cole Cengage Learning
Task 6: Obtaining Commitment
If Task 5: Planning was done effectively, obtaining commitment may be easy.
May be simply having the client verbally summarize the plan.
If lethality is involved, a commitment may need to be written and signed by both parties.
If there is any hesitation, the crisis worker may need to revisit earlier tasks.
No commitment should be imposed by the crisis worker!
©2013, Brooks/Cole Cengage Learning
Task 7: Follow-up
Time frame of minutes, hours, or days.
Inquire about the client’s ability to maintain mobility and equilibrium.
Reinforces the crisis worker’s support of the client.
©2013, Brooks/Cole Cengage Learning
Assessing
Continuous throughout crisis intervention.
Allows the crisis worker to evaluate:
Severity of the situation
Client’s emotional, behavioral, and cognitive status
Client’s level of mobility
Safety (client’s, self, and others)
Success of the crisis worker in deescalating the situation
©2013, Brooks/Cole Cengage Learning
Factors That Impact One’s Emotional Stability
The duration of the crisis event.
The degree of emotional stamina.
The ecosystem in which the client resides.
The developmental stage of the client.
©2013, Brooks/Cole Cengage Learning
Psychobiology Related to Crisis Intervention
Traumatic events may impact the:
Release of neurotransmitters
Central and peripheral sympathetic nervous systems
Hypothalamic-pituitary-adrenocortical axis
Abnormal changes in neurotransmitters are involved in mental health disorders.
Both legal and illegal drugs have a major affect on mental health.
©2013, Brooks/Cole Cengage Learning
Triage Assessment Form (TAF)
Effective method of obtaining a real-time assessment of the client’s affective, behavioral, and cognitive statuses.
Can be performed quickly by a wide spectrum of trained crisis workers.
Police officers
School counselors
Volunteer crisis line workers
Resident hall staff
Informs the crisis worker of the current state of the client and of their own ability to deescalate the situation.
©2013, Brooks/Cole Cengage Learning
Do You Know Your ABC’S?
Three main domains of triage assessment
Affective
Feeling or emotional tone
Behavioral
Action or psychomotor activity
Cognitive
Thinking patterns
©2013, Brooks/Cole Cengage Learning
Affective State
Often the first sign of disequilibrium.
Can manifest as overly emotional or withdrawn.
Incongruences among what the client says, how it is said, and non-verbal behaviors.
Key question to ask:
Do people typically show this kind of affect in situations such as this?
©2013, Brooks/Cole Cengage Learning
Behavioral Functioning
Focus on psychomotor activities.
Approaches
Avoids
Paralyzed
Often difficult for immobilized people to take independent actions.
Attempt to have the client engage in a small concrete and immediate activity.
Key questions to ask:
In the past, what actions did you take that helped you get back in control?
What would you have to do now to get on top of the situation?
©2013, Brooks/Cole Cengage Learning
Cognitive State
Client’s thinking patterns:
Rationalizing?
Exaggerating?
Downward spiral?
Crisis events are typically perceived as either a:
Transgression (present)
Threat (future)
Loss (past)
Key questions to ask:
How long has the client been engaged in crisis thinking?
How open is the client to reframing?
How often does the client engage in crisis thinking?
©2013, Brooks/Cole Cengage Learning
Rating Clients using the TAF
Score from high to low to rule out more severe impairments.
Each domain has a range from 1-10 (1=lowest score and 10=highest score).
Total rating ranges from 3-30.
Total score of 3-10 is a rating of minimal impairment
Total score of 11-19 is a rating of moderate impairment
Total score of 20+ is a rating of severe impairment
©2013, Brooks/Cole Cengage Learning
TAF Rating
Using the sample case of Leron from the textbook, how would you score Leron using the TAF . . .
When Leron first exits Union Avenue?
When the CIT officer initially meets Leron?
When Leron agrees to leave the scene and gets into the police car?
When the CIT officer is following-up with Leron at the legal aid office?
©2013, Brooks/Cole Cengage Learning
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