Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox

1. NCMHCE Exam Review
Dangerousness and
Abuse
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
Executive Director, AllCEUs Counseling Education
Host: Counselor Toolbox Podcast
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 1

2. Objectives
 Identify the characteristics of a dangerousness assessment
 Identify factors associated with a high risk for violence
 Identify steps in preventing danger to others
 Review special cases
 Domestic violence
 Child Abuse
 Elder Abuse
 Substance Abuse
 Eating Disorders
 Emergency calls from nonclients
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3. Dangerousness Assessment
 Identify the cause of the crisis
 Determine the probability the client will hurt
someone
 Gather information using a mental status exam
 Ask the client about a history of violence and
current plans
 Asses the client’s support system
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4. Factors Associated with a High Risk
 Male
 Alcohol use
 History of violence or threats of violence
 Antisocial behavior
 History of child abuse
 Recent provocation
 Diagnoses: Substance use disorder, delirium, schizophrenia,
mania, personality disorders, intermittent explosive disorder
 Agitation
 Loud or abusive speech
 Poor impulse control
 Emotional lability
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5. Duty to Warn
 Must involve a reasonably identifiable victim and
a credible threat of imminent danger
 Contact law enforcement and the intended victim
 Divulge only information necessary: You name,
the client’s name and the threat (Diagnosis and
other information is not necessary and still
protected)
 Inform the client ahead of time if appropriate
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6. Immediate Intervention
 Provide a calm, controlled environment
 Allow the client to vent feelings
 Build self-esteem
 Explore options for addressing the issue
 Mobilize support
 Help client understand the cause of the crisis*
 Make a no violence contract
 Ensure the client is calm prior to leaving
 If client is unable to regain composure, encourage
voluntary commitment
 Use involuntary commitment as a last resort
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7. Domestic Violence
 Indicators
 Injuries at various stages of healing
 Depression, anxiety, insomnia, nightmares, ASD
 Vague somatic complaints
 Complaints of relationship issues
 Over-dependence on partner
 History of substance abuse
 Behavioral problems in children
If kids in the house, assess for child abuse
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8. DV Intervention
 Use open ended questions
 “How did you get that bruise” instead of “Did your spouse
do this to you?”
 If the perpetrator is present, assess for substance
abuse
 For victim
 Get medical treatment as needed
 Help victim protect herself—referral, escape plan
 Challenge victim’s denial and self blame
 Help client understand the situation (cycle of violence) and
their options
 Support group referral
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9. DV Intervention
 For Perpetrator
 Break through denial
 Get commitment to a no-violence contract
 Teach anger management skills
 Support group referral
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10. Child Abuse Indicators
 In Children
 Sudden change in behavior
 Excessive clinginess
 Regression
 Suicidal behavior
 Antisocial behavior
 Fear of adults
 Overly sexualized behavior
 Sleep disturbances
 Childhood pregnancy or
STD
 School problems
 In Adults
 Unconcerned about child’s
injuries
 Provides false explanations
 Conceals injuries
 Uses harsh discipline
 Has overly high
expectations for the child
 Was abused as a child
 Extremely jealous or
overprotective
 Lacks social support
outside the family
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11. Child Abuse Interventions
 Mandatory reporting
 Medical treatment
 Ensure safety
 Mobilize family support systems
 Refer parents to support groups
 Clarify events that caused the crisis
 Build self esteem, reduce shame and self-blame
 Support and validate positive behaviors in the parents
 Teach parenting skills or refer
 Increase parent’s understanding of the triggers and
dynamics of abuse
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 11

12. Elder Abuse
 Mandatory Reporting
 You see the abuse
 The client tells you of abuse
 You observe physical injuries that clearly indicate abuse
 Caregiver won’t let you see client alone
 Client appears afraid of caregiver
 Types of Abuse
 Emotional
 Financial
 Physical incl. neglect
 Sexual
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13. Elder Abuse Interventions
 Get medical assistance
 Mobilize support system and resources
 Be empathetic and validating
 Explore events leading up to the current crisis
 Help clients and caregivers identify alternate
coping strategies an resources which could
prevent future problems
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14. Severe Eating Disorder or Addiction
 Conduct a mental status exam
 Assess the client’s support system
 Encourage voluntary commitment or involuntary if
needed
 After the crisis is stabilized, proceed with
treatment
 Refer the client to a physician for medical
evaluation
 Consider involving a dietician and psychiatrist
 Instill hope
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 14

15. Crisis Call from a Non-Client
 Get the phone number and address of the caller
 Assess the caller’s level of crisis and ability for
self-management
 Be directive and advocate for steps to ensure the
caller’s safety
 Consider offering an appointment as soon as
possible
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 15

16. Summary
 It is imperative for clinicians to be prepared for
dealing with clients who may be violent or in abusive
situations
 Know your ethical imperatives regarding mandatory
reporting.
 Get additional training on safety practices for working
with victims of abuse
 If confronted with a call from someone who is in crisis
but not your client, it is your responsibility to provide
initial triage and assist the individual in getting to
safety.
AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 16

17. Test Taking Tips
 Sally is a 25 year old graduate student who was
recently raped. She was referred to you by victim
services. Her father, a doctor, whom she is estranged
from calls your office wondering how Sally is doing
 What information do you need to make a diagnosis
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17
 Substance use
 Developmental History
 Sleep Patterns
 Dissociative Symptoms
 Mood
 Cognitive Functioning
 Daily Functioning
 Suicidal/homicidal ideation
 Flashbacks
 Eating patterns
 Date of the rape

18. Test Taking Tips
 What are possible diagnoses
 GAD, ASD, PTSD, MDD, Adjustment Disorder
 What information do you need to make a
diagnosis
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18
 Substance use
 Developmental History
 Sleep Patterns
 Dissociative Symptoms
 Mood
 Cognitive Functioning
 Daily Functioning
 Suicidal/homicidal ideation
 Flashbacks
 Eating patterns
 Date of the rape

19. Test Taking Tips
 You determine that Sally has Acute Stress
Disorder.
 Which of the following would be appropriate
referrals
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19
• Attorney
• Law Enforcement
• Physician
• Psychiatrist
• Family Therapy
• Financial Aid Office

20. Test Taking Tips
 You determine that Sally has Acute Stress Disorder.
 Which of the following would be appropriate to monitor
progress?
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20
• Grades/Class Attendance*
• Finances
• Affective Functioning*
• Sleep quality*
• Energy Level
• Socialization with Family
• Follow Through on Referrals*
• Continuing flashbacks, nightmares*
• Substance Use**