Appendix Attachment - A Crisis Case Study

1. 10
Chele Yntema
Case Study – Crisis Intervention
Appendix A – Roberts’ Seven Stage Intervention Model
4. encourage an exploration of feelings and
emotions;
5. generate and explore alternatives and
new coping strategies;
6. restore functioning through
implementation of an action plan;
7. plan follow-up and booster sessions.
What follows is an explication of that model.
Stage I: Psychosocial and Lethality
Assessment
The crisis worker must conduct a swift but
thorough biopsychosocial assessment. At a min-
imum, this assessment should cover the client’s
environmental supports and stressors, medical
needs and medications, current use of drugs
and alcohol, and internal and external coping
methods and resources (Eaton & Ertl, 2000).
3. Identify dimensions of presenting problem(s)
(including the “last straw” or crisis precipitants)
4. Explore feelings and emotions
(including active listening and validation)
5. Generate and explore alternatives
(untapped resources and coping skills)
6. Develop and formulate
an action plan
7. Follow-up
plan and agreement
2. Establish rapport and rapidly establish collaborative relationship
1. Plan and conduct crisis and biopsychosocial assessment
(including lethality measures)
Crisis
resolution
FIGURE 1
Roberts’ Seven Stage Crisis Intervention Model
Source: Copyright ª Albert R. Roberts, 1991. Reprinted by permission of the author.
The Seven-Stage Crisis Intervention Model
Brief Treatment and Crisis Intervention / 5:4 November 2005 333

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Chele Yntema
Case Study – Crisis Intervention
TRIAGE ASSESSMENT FORM: CRISIS INTERVENTION
©R.A. Myer, R.C. Williams, A.J. Ottens, & A.E. Schmidt
CRISIS EVENT:
Identify and describe briefly the crisis situation: _________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
AFFECTIVE DOMAIN
Identify and describe briefly the affect that is present. (If more than one affect is experienced, rate with #1 being primary, #2
secondary, #3 tertiary.)
ANGER/HOSTILITY: ________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
ANXIETY/FEAR: ___________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
SADNESS/MELANCHOLY: ___________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Affective Severity Scale
Circle the number that most closely corresponds with client’s reaction to crisis.
1 2 3 4 5 6 7 8 9 10
No
Impairment
Minimal
Impairment
Low
Impairment
Moderate
Impairment
Marked
Impairment
Severe
Impairment
Stable mood with
normal variation of
affect appropriate
to daily
functioning.
Affect appropriate
to situation. Brief
periods during
which negative
mood is experienced
slightly more
intensely than
situation warrants.
Emotions are
substantially under
client control.
Affect appropriate
to situation but
increasingly longer
periods during
which negative
mood is experienced
slightly more
intensely than
situation warrants.
Client perceives
emotions as being
substantially under
control.
Affect may be
incongruent with
situation. Extended
periods of intense
negative moods.
Mood is experienced
noticeably more
intensely than
situation warrants.
Liability of affect
may be present.
Effort required to
control emotions.
Negative affect
experienced at
markedly higher
level than situation
warrants. Affects
may be obviously
incongruent with
situation. Mood
swings, if occurring,
are pronounced.
Onset of negative
moods are
perceived by client
as not being under
volitional control.
Decompen-
sation or
depersonal-
ization
evident.
DOMAIN SEVERITY SCALE SUMMARY
Affective _____
Cognitive _____
Behavioral _____
Total _____
Appendix B – Triage Assessment Form

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Chele Yntema
Case Study – Crisis Intervention
BEHAVIORAL DOMAIN
Identify and describe briefly which behavior is currently being used. (If more than one behavior is utilized, rate with #1 being primary,
#2 secondary, #3 tertiary.)
APPROACH: _______________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
AVOIDANCE: ______________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
IMMOBILITY:
______________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Behavioral Severity Scale
Circle the number that most closely corresponds with client’s reaction to crisis.
1 2 3 4 5 6 7 8 9 10
No
Impairment
Minimal
Impairment
Low
Impairment
Moderate
Impairment
Marked
Impairment
Severe
Impairment
Coping behavior
appropriate to crisis
event. Client
performs those tasks
necessary for daily
functioning.
Occasional
utilization of
ineffective coping
behaviors. Client
performs those
tasks a necessary
for daily
functioning, but
does so with
noticeable effort.
Occasional
utilization of
ineffective coping
behaviors. Client
neglects some
tasks necessary for
daily functioning is
noticeably
compromised.
Client displays
coping behaviors
that may be
ineffective and
maladaptive.
Ability to
perform tasks
necessary for
daily functioning
is noticeably
compromised.
Client displays
coping behaviors
that are likely to
exacerbate crisis
situation. Ability to
perform tasks
necessary for daily
functioning is
markedly absent.
Behavior is erratic,
unpredictable.
Client’s behaviors
are harmful to self
and/or others.

4. 13
Chele Yntema
Case Study – Crisis Intervention
COGNITIVE DOMAIN
Identify if a transgression, threat, or loss has occurred in the following areas and describe briefly. (If more than one cognitive response
occurs, rate with #1 being primary, #2 secondary, #3 tertiary
PHYSICAL (food, water, safety, shelter, etc.):
TRANSGRESSION THREAT LOSS _____
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
PSYCHOLOGICAL (self-concept, emotional well being, identity, etc.):
TRANSGRESSION THREAT LOSS _____
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
SOCIAL RELATIONSHIPS (family, friends, co-workers, etc.):
TRANSGRESSION THREAT LOSS _____
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
MORAL/SPIRITUAL (personal integrity, values, belief system, etc.):
TRANSGRESSION THREAT LOSS _____
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Cognitive Severity Scale
Circle the number that most closely corresponds with client’s reaction to crisis.
1 2 3 4 5 6 7 8 9 10
No
Impairment
Minimal
Impairment
Low
Impairment
Moderate
Impairment
Marked
Impairment
Severe
Impairment
Concentration intact.
Client displays normal
problem-solving and
decision-making
abilities. Client’s
perception and
interpretation of crisis
event match with
reality of situation.
Client’s thoughts
may drift to crisis
event but focus of
thoughts is under
volitional control.
Problem-solving
and decision-
making abilities
minimally affected.
Client’s perception
and interpretation
of crisis event
substantially match
with reality of
situation.
Occasional
disturbance of
concentration.
Client perceives
diminished
control over
thoughts of crisis
event. Client
experiences
recurrent
difficulties with
problem-solving
and decision-
making abilities.
Client’s
perception and
interpretation of
crisis event my
differ in some
respects with
reality of
situation.
Frequent
disturbance of
concentration.
Intrusive thoughts
of crisis event
with limited
control. Problem-
solving and
decision-making
abilities adversely
affected by
obsessiveness,
self-doubt,
confusion.
Client’s
perception and
interpretation of
crisis event may
differ noticeably
with reality of
situation.
Client plagued
by intrusiveness
of thoughts
regarding crisis
event. The
appropriateness
of client’s
problem-solving
and decision-
making abilities
likely adversely
affected by
obsessiveness,
self-doubt,
confusion.
Client’s
perception and
interpretation of
crisis event may
differ
substantially with
reality of
situation.
Gross inability to
concentrate on
anything except
crisis event. Client
so afflicted by
obsessiveness, self-
doubt, confusion
that problem-solving
and decision-making
abilities have “shut
down.” Client’s
perception and
interpretation of
crisis event may
differ so
substantially from
reality of situation as
to constitute threat
to client’s welfare.

5. 14
Chele Yntema
Case Study – Crisis Intervention
Appendix C – Further Case Specific Questions and Interventions
Based on Sophie’s behaviour and cognitions, the crisis worker may need to attain
more concrete and specific illustrations in which “change” can be facilitated (Greene &
Lee, 2015, p.75). That is to say, what aspect of the crisis, based in Sophie’s presenting
cognitions, needs to be worked on primarily in order to bring about homeostasis.
In understanding that the solution is not the answer, but the process to the solution
is, the crisis worker may ask questions such as the “miracle” or “dream” question, and
elaborate using gentle open questioning techniques:
• “I wonder what ‘safety’ would be like for you?” / “I wonder if you could
name a time when you felt most safe?”
• “What did you feel within your body when you are safe”
• “What were you thinking when you are safe?”
• “What might your emotions have been when you were safe?”
• “How did you know you were safe, what was observable?”
• “I wonder what you might then be able to do the next time you feel
unsafe?”
Working with Sophie in the “here and now” in what she perceives as the most
intrusive thoughts and feelings is vital in order to return her to a state of homeostasis
(Roberts & Ottens, 2005, p.331). Furthermore, and in order for Sophie to flourish,
questions relating to her frame of reference may be vital in establishing the ground work
for building on existing coping mechanisms (McCann & Pearlman, 1990, pp. 158 – 159).
If Sophie’s “stable and consistent way of perceiving the world” (Hall & Lindzey, 1987,
p.171 as cited in McCann & Pearlman, 1990, p. 158) has been shaken due to disrupted
schemas of her view of a previously understood God, it would be vital to Sophie’s well-
being to quickly re-ascertain security in her core values and beliefs. This may come by way
of establishing and redefining what her core values and beliefs are.
Pargament (2001) stated the following questions as openings into where religion
and core values and beliefs have been affected by crisis (p. 360):
• How has the problem affected the greatest significance to Sophie?
• How has Sophie tried to make sense of the situation and deal with it?
• What has worked and what has not (in relation to core values and belief
affiliation)?

6. 15
Chele Yntema
Case Study – Crisis Intervention
• How has Sophie been helped or hindered by the larger social system, as it
pertains to her core values and beliefs?
These questions may indeed segue into where more specific solution focused, or
goal orientated intervention can occur.