Crisis intervention strategies chapter 3 4

TRIAGE ASSESSMENT SYSEM• Assesses severity of clients presenting crisis situation • Assistance for gaining sense of direction for helping client cope with the dilemma • Integrated proble

Chapter 3 & 4 Basic Crisis Assessment & Intervention Skills

TRIAGE ASSESSMENT SYSEM

• Assesses severity of clients presenting crisis

situation

• Assistance for gaining sense of direction for

helping client cope with the dilemma

• Integrated problem-solving process

SEVEN STEP ASSESSMENT PROCESS

LISTENING (PSYCHOLOGICAL FIRST AID)

• Caring support

• Empathic responding

• Concrete information and assistance

• Reuniting social support systems

• Survival needs (Maslow)

• Nonintrusive (Not time for ‘cure’ or ‘fix’)

STEP 1: PREDISPOSITIONING/ENGAGING/INITIATING CONTACT

• From the clients perspective

• Active Listening/Attending Skills (observing,

understanding, and responding)

• Acceptance or positive regard

• Use open ended questions

STEP 2: EXPLORING THE PROBLEM

• Defining the crisis

• From the clients point of view

STEP 3: PROVIDING SUPPORT

• Caring emotional support

STEP 4: EXAMINING ALTERNATIVES

• Exploring choices and options

• Immediate Situational Supports (people)

• Coping mechanism (actions or resources)

• Positive and constructive thinking patterns

(reframing to alter the clients view)

• Look for a few that are appropriate and

realistic to discuss with client (not too many)

STEP 5: MAKING PLANS (ACTION STEPS)

• To restore clients emotional equilibrium

• Easy for client to own and understand

• Short term (minutes, hours, days)

• Identifying additional resources and coping tools

• Systematic problem solving

• Concrete and positive

• Things client can ‘do now’

• Collaborative with since of control and autonomy

STEP 6: OBTAINNG COMMITMENT

• Brief and simple

• Ask client to verbalize the plan

• Written and signed (if severe)

• Handshake

• Free, voluntary and believed to be doable

• Honest, direct and appropriate commitment

• Before termination

• Mobility (autonomous change or coping of

moods, conditions, influences)

• Flexible and adaptable

• Immobility (Not capable of mobility)

ASSESSMENT HELPS DETERMINE:

• Severity of crisis and client functioning

• Client’s current emotional status

• Client’s alternatives and resources

• Client’s level of lethality

• How well counselor is doing in assisting client

to equilibrium and mobility

CLIENT FUNCTIONING

• Affective State (feeling or emotional tone)

• Out of control, withdrawn, detached,

overemotional, etc.

• Behavioral Functioning (activity level)

• The sooner the better

• Cognitive State (thinking patterns)

• Realistic, consistent, rational, exaggerating, etc.

• Able to positively reframe

ASSESSMENT FORMS

• Often take up too much time

• May be inappropriate for client level of functioning

• TAF (Triage Assessment Form)

• Fairly rapid and valid

• Versions

• Law enforcement

• Students

• Civilians

PSYCHOBIOLOGICAL ASSESSMENT IN CRISIS

• Evidence that neurotransmitters play a role in

affective, behavioral, and cognitive

functioning during (and sometimes after)

crisis

• Can cause residual and long term changes

• Impact of mental health medication

• Impact of legal and illegal drugs

REQUIRING COUNSELORS TO ATTEMPT TO ASSESS:

• Prior trauma

• Psychopathology

• Use, misuse, or abuse of drugs

• And is there a correlations with the current

crisis/problem

• Referral may be needed

ASSESSING EMOTIONAL FUNCTIONING

1. Duration of Crisis

• Acute/situational (one time/short term)

• Chronic (recurring, long-term or transcrisis)

2. Current reservoir of emotional stamina

• Helplessness, hopelessness, ‘no future’

3. Clients Ecosystem variables

• Communication system, cultural mores,

accessibility, economic status, etc

FACILITATIVE AFFECTIVE

ASSESSMENT

• Data gleaned about the client are used as a

part of the ongoing helping process

• Institutional, social, vocational, personal

strengths or support systems =people

SUMMARY OF ASSESSMENT

meaningful sense out of it

• Be flexible

• Continue until pre-crisis state is obtained

phase is then over!

LISTENING SKILLS

• Open-ended questions

• Closed-ended questions

• Restatement and Summary clarification

• Owning Feelings (counselor focus)

• Disowned statements and pretending

• Conveying understanding (of situation)

• Value judgments (of situation)

• Positive reinforcement (of behavior)

• Personal integrity and setting limits

• Allowing full feelings, venting, talking, crying in

safe environment (caution: best for those who struggle with feelings)

3. Providing Support

• Validations, affirmation, without dependence

9 BASIC STRATEGIES (CONT.)

4. Increasing Expansion

• Broaden vision, reframe narrow views, gain new

perspective

5. Emphasizing Focus

• Find specific, realistic, manageable components

and options (narrow out-of-control thoughts)

6. Providing Guidance

• Providing direction, knowledge, resources to

9 BASIC STRATEGIES (CONT.)

7 Promoting Mobilization

• Activate client internal/external resources to generate

coping skills and problem solving abilities

CLIMATE OF HUMAN GROWTH

• Communicating Empathy (sensing client

feelings)

• Communicating Genuineness (realness)

• Communicating Acceptance (caring,

unconditional positive regard)

COMMUNICATING EMPATHY

5 Techniques

1 Attending (looking, acting and being attentive)

2 Verbally empathic understanding

• accurately hearing and understanding the core feelings

• Accurately communicating that understanding to the client

3 Reflection of feelings – uncovering feelings

• Caution with getting too deep

• Stay in here and now

COMMUNICATING EMPATHY (CONT.)

4. Non-verbal communication of empathic

NOT COMMUNICATING EMPATHY

• sympathy (taking on the clients feelings)

• distancing (when you don’t know what to say)

“funeral home counseling”

3. Being non-defensive (not feeling attacked)

4. Being consistent (talk agreeing with action)

COMMUNICATING ACCEPTANCE

• Care for and fully accept clients, even when

doing things contrary to beliefs and values

• Put aside personal needs, values and desires

• Allowing client to accept self

CRISIS WORKERS ‘ACTING’ MODES

1 Nondirective Counseling

• Client has as much control as they can handle

• Counselor: Questioning and listening

2 Collaborative Counseling

• Partnership with client in evaluating the problem,

generating alternatives, and implementing steps

• Counselor: catalyst, consultant, facilitator, support

3 Directive Counseling

• Client is too immobile to cope with crisis

• Counselor: Definer and developer of plan, guides and

leads

KINDS OF IMMOBILE CLIENTS

1. Immediate hospitalization due to chemical

use or organic dysfunction

5. Anxiety is high where they cannot function

6. Out of touch with reality

7. In danger to self or others

THESE KINDS OF IMMOBILE CLIENTS

• Often apt to be suicidal

• Or homicidal

• Not ready to be collaborative

• Not ready for nondirective counseling

“Counselor must be ready to make accurate and objective assessment

of the client’s level of mobility.”

STRATEGIES FOR CRISIS WORKERS

• Recognize Individual Differences (avoid

stereotyping, taking for granted)

• Assess Yourself (values, limitations, burnout

etc.)

• Safety for all (you may need to ask for help)

• Provide Client Support (with assertiveness if

needed)

• Define Problem Clearly (focused, practical,

STRATEGIES FOR CRISIS WORKERS (CONT)

• Consider Alternatives (broaden views –

workable and realistic)

• Plan Action Steps – to regain control of life

(short and doable)

• Use clients coping strengths (may need to

be identified, explored and reinstated)

• Attend to Client’s Immediate needs

(contacts, appointments, venting, etc.)

STRATEGIES FOR CRISIS WORKERS CONT)

• Use Referral Resources (keep a ready list)

• See Page 92

• Develop and use Networks (professionals,

community, government, etc)

• Get a summarized verbal commitment

(positive and definite)