3. Triage Assessment System
The triage assessment system (TAS) for crisis intervention
(Myer, Williams, Ottens, &
Schmidt, 1992a) provides a framework for understanding
clients’ reactions during a cri-
sis. This model integrates research from a variety of sources and
presumes that reactions
to crisis events are seen in three domains: (1) affective, (2)
behavioral, and (3) cognitive.
Clinicians assess clients’ reactions along all three domains.
This point is critical because
failure to assess each domain can result in a collapse in the
resolution of the crisis and
lead to additional problems (James & Gilliland, 2005). The TAS
guides clinicians in the
identification of the complex interaction among the three
domains and helps prevent
protracted mental health concerns.
The TAS uses Crow’s (1977) work on emotions associated with
crises and research
on primary emotions (National Advisory Health Council, 1995;
Plutchick, 1980) as the
foundation for identifying affective reactions clients experience
when in crisis. These
reactions are (1) anger/hostility, (2) anxiety/fear, and (3)
sadness/melancholy. The expres-
sion of these feelings can range from negligible to extremely
severe; however, uncom-
fortable levels of emotions are more characteristic reactions of
people who are experiencing
a crisis (Baldwin, 1979).
4. Assessing clients’emotional reactions is generally
straightforward. It is relatively uncom-
plicated to determine whether clients are angry, afraid, or sad.
However, often clients express
a combination of these feelings, bouncing from one to another
and back again. We suggest
that determining the emotion most frequently expressed
identifies the primary affective reac-
tion. If others are present, these are considered as secondary or
tertiary.
Clients’ behavioral reactions can be assessed as (1) immobility,
(2) avoidance, and
(3) approach (Myer, Williams, Ottens, & Schimdt, 1992a).
Immobility is defined as being
stuck, or unable to sustain any consistent attempt to resolve the
crisis. Avoidance is
defined as an active attempt to escape or bypass problems
associated with the crisis. In
contrast, approach reactions are those that are active attempts to
resolve problems result-
ing from the crisis.
In the cognitive domains, reactions are (1) transgression, (2)
threat, and (3) loss.
Transgression is seen as a “demeaning offense against me and
mine” (Lazarus, 1993,
p. 26). The perception of the event is that it is happening
primarily in the present. Threat,
on the other hand, is viewed as potential, that is, something that
will occur in the future.
The perception is that an impending catastrophe is approaching.
The perception of loss is
that it occurred in the past and is irrevocable. Clients’
perceptions, whether accurate or
not, are used in the assessment of cognitive reactions. The areas
5. of clients’ lives that are
perceived to be affected by the crisis include (1) physical, such
as health, shelter, safety;
(2) psychological/self-concept, such as identity and emotional
well-being; (3) social rela-
tionships, such as with family, friends, coworkers; and (4)
moral/spiritual, such as per-
sonal integrity, values, and belief system. Clients can perceive a
transgression, threat, or
loss in each of these life dimensions.
The TAS has been operationalized through the development of
the Triage Assess-
ment Form: Crisis Intervention (Myer, Williams, Ottens, &
Schmidt, 1992b). The Appen-
dix contains a copy of the form. This form adds a severity scale
to each domain that
allows crisis workers to rate the severity of clients’ reactions in
each domain.
Reactions are rated on a scale of 1 to 10 with 10 the most severe
reaction. A “rule
out” process is the most efficient strategy to determine the
severity of each reaction. We
suggest beginning with 10 and going down the scale until
finding a characteristic that
meets the severity of reaction in that domain. This strategy of
ruling out characteristics is
the most rapid and accurate way to assess severity.
960 Journal of Clinical Psychology: In Session, August 2006
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6. Initially, treatment should address the most severe reaction,
permitting clinicians to
address salient needs in a manner appropriate to the severity of
the reactions. As the
severity of the reaction varies throughout the crisis event and
treatment, clinicians should
adjust the treatment to meet clients’ needs. By totaling the
severity scales, crisis workers
can also judge how intense and directive the treatment should
be: the higher the score, the
more direct the intervention. Generally speaking, low scores (3–
12) indicate a recom-
mendation for no treatment or a nondirective approach. Clients
whose total on the sever-
ity scales is in this range may simply need a sounding board to
resolve the crisis. Clients
whose total on the severity scales is in the middle range (13–23)
need clinicians to part-
ner with them to help resolve the crisis. This approach is more
collaborative, requiring
clinicians to be more active. When clients’ total score on the
severity scales is high
(24–30), a direct approach is needed. Clients in this range are
vulnerable and need a
support system. Clinicians will be extremely active and engage
in active problem solving
with clients. If any severity scale score is 10, hospitalization is
strongly recommended.
Case 1
The case of Ann involves a crisis in which she was coping with
her apartment’s being
burglarized. Ann was referred to the clinician by a friend, Gail,
who was worried that she
might need help in dealing with the burglary. Because our
7. article concerns assessment,
we report on the first 15 minutes of the interview. The setting is
an urban agency that
helps people who have been victims of a crime.
Client Description
Ann is a 26-year-old white female. With her was Gail, the
friend who referred her to the
agency. Ann insisted that Gail stay with her during the session.
Ann continually looked
around the room. On the intake form, Ann had indicated that she
worked as a sales
representative in a local business. She also reported that she
was not on any medication
and had not received any mental health services in the past. She
identified having diffi-
culty in concentrating and some trouble in sleeping. In addition,
Ann reported being
angry much of the time. She reported that these problems began
the day after the bur-
glary, which took place 8 days before.
During the first few minutes of the session, Gail blurted out that
Ann was making
statements that were crazy. Following up on this disclosure, the
clinician discovered
that Ann had been planning to get revenge on the person who
burglarized her apart-
ment. As Ann continued to talk she stated that she knew her
former boyfriend had
broken into the apartment. She repeatedly stated that she hated
him for what he had
done. As the session continued, the clinician discovered that
Ann’s boyfriend had been
verbally and psychologically abusive during their 9-month
8. relationship and that Ann
had broken up with him about 1 week before the burglary. Ann
stated that although she
did not have any proof, she “knew” he was the only one who
would have broken into
her apartment. When questioned about her thoughts of reprisal,
Ann admitted she wanted
to make his life the hell he had made hers but was not specific
beyond that. Ann stated
that she did not want to harm him physically, but just spread
lies about him to his
friends. Ann wanted to say things such as they broke up because
he is gay and has
acquired immunodeficiency syndrome or that he was unable to
perform sexually. Add-
ing to Ann’s anger was that when she reported the break-in to
the police they said an
investigation would be done but not to count on any conclusive
resolution. At that time,
Assessment for Crisis Intervention 961
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Gail chimed in, stating that she had told Ann repeatedly to be
cool, but that was becom-
ing increasingly difficult.
Case Formulation
The crisis event in Ann’s case was the burglarizing of her
apartment, allegedly by her
former boyfriend; however, there was no proof for her belief.
The crisis was complicated
9. by the fact that Ann had lingering anger toward the boyfriend,
who had apparently been
abusive in the past. Sorting through the anger became the focus
of treatment as the
clinician worked to help Ann understand her feelings and not let
them be the catalyst for
taking action that would only result in more problems.
Affective Reaction. Ann’s primary affective reaction is
anger/hostility. She repeat-
edly made statements to this effect during the first few minutes
of the session. However,
she was not able to sort through this feeling in a constructive
manner. In fact, over the
past several days the anger had seemed to become increasingly
pronounced. The severity
scale rating was assessed at 8. Ann’s mood was not under her
control and her emotional
reaction, although expected, seemed high. The reason the
clinician assessed the affective
reaction as too high was that it had become stronger until Ann
was considering behaving
in a manner that would likely make the situation worse.
Behavioral Reaction. The clinician assessed Ann’s behavioral
reaction as primarily
approach. This assessment was predicated on the fact that
although Ann had not acted on
her wish to get revenge, she was close to acting on that desire.
The severity of Ann’s
reaction was assessed as 8. Ann appeared to be performing the
tasks of daily living such
as eating and maintaining contact with others, with the
exception of having difficulty in
sleeping. However, she was contemplating engaging in behavior
that could potentially
10. complicate her crisis even more.
Cognitive Reaction. Ann’s primary cognitive reaction was
transgression in social
relationship. She perceived that her boyfriend had wronged her
by allegedly breaking
into her apartment. Her severity scale rating was assessed as 7.
Ann had frequent distur-
bances of concentration and her problem-solving ability was
impaired. In addition, Ann
had decided that her former boyfriend had committed the break-
in yet had no facts to
support this belief, meaning that her interpretation of the event
could not be considered
accurate at this time.
Course of Treatment
Ann’s total score was 23, placing her in the range that suggests
the clinician should use a
more intense and directive treatment. Initially, the clinician
addressed the behavioral
reaction to help ensure Ann’s safety. Because Ann reported that
her boyfriend was ver-
bally and psychologically abusive in the past, the clinician
wanted to make certain she
was not placing herself in harm’s way. Knowing that Ann was
feeling helpless, especially
because the police seemed to offer little hope of finding the
burglar, the clinician sug-
gested she contact the police to ask about the status of the
investigation. The goal of this
suggestion was to empower Ann to take action that would be
beneficial. The clinician
also began helping Ann to separate her feelings of anger at
being a victim of a crime from
11. her feelings toward her former boyfriend. During the
intervention the clinician included
962 Journal of Clinical Psychology: In Session, August 2006
Journal of Clinical Psychology: In Session DOI 10.1002/jclp
Ann’s friend, Gail, as part of the resolution. The clinician
pointed out that Gail was a
person whom she could trust who would help support her. A
suggestion was made that
Ann keep in touch with Gail on a daily basis in order to monitor
her feelings.
Outcome
The severity of Ann’s reactions dropped significantly during the
session. Ann’s affective
reaction decreased to 5. Her emotions were more under control
and seemed appropriate to
the situation. Ann’s behavioral reaction dropped to 3. The
clinician assessed Ann at this
severity level because her behavior regarding the resolution of
the crisis had become
helpful rather than harmful. Her cognitive reaction also
decreased to a 4 because the
thoughts regarding the burglary were still causing some
difficulty in concentrating.
One lesson to be learned from this case involves allowing Ann’s
friend to participate
in the assessment and intervention process. At first, the
clinician was hesitant to allow
Gail to take part. Yet Ann’s insistence that Gail accompany
12. them overrode the clinician’s
hesitancy. As it turned out, Gail provided useful information
that would otherwise been
difficult to obtain. This information allowed the clinician to
make a better and more
accurate assessment of Ann’s reactions. In addition, Gail
became part of the support
system that Ann could rely upon as she grappled with her
feelings of helplessness.
Case 2
The case of Bob demonstrates use of the Triage Assessment
Form: Crisis Intervention in
a crisis that poignantly demonstrates the need to listen to clients
and not make assump-
tions. Initially the clinician made an assumption about the
nature of Bob’s crisis, only to
discover that the precipitating event was not the actual crisis.
Again the first 10 to 15
minutes of the interview are reported. The setting is an urban
mental health clinic that
offers a walk-in crisis service to anyone who enters.
Client Description
Bob, a white man in his mid-40s, entered the clinic late one
afternoon. He was visibly
anxious and his appearance was disheveled. His eyes were red
and he spoke between
sobs. He stated that he had been wandering around “all day” and
needed to talk with
someone as soon as possible. The on-call clinician was
contacted and was available to see
Bob immediately. The only information the on-call clinician had
was that Bob had wan-
13. dered into the clinic and he seemed to be in crisis.
While still in the waiting area Bob began to tell his story. His
speech was slurred by
his continuous sobbing, making it difficult to understand him.
He kept repeating some-
thing about his wife’s being ill and in the hospital. The clinician
interrupted him and
asked whether his wife was in the hospital. Bob put his head in
his hands and began
crying even harder, unable to speak. When he lifted his head he
had a blank expression
and said, “She’s dead, you idiot; haven’t you heard anything
I’ve said?” The clinician
responded by stating his sorrow about the loss. This statement
seemed to calm Bob, and
he said again that his wife had died last night. She had become
ill quite suddenly and died
within a week. He added that he had been wandering around all
night not knowing what
to do or whom to call. He said he had been talking to strangers
on the street, anyone who
would listen to him. Although Bob was dressed appropriately,
his clothes looked unkempt.
His personal hygiene also was poor as evidenced by body odor
and bad breath. Bob did
Assessment for Crisis Intervention 963
Journal of Clinical Psychology: In Session DOI 10.1002/jclp
not appear to be attentive to social cues, in that he disclosed
personal details of his life
loudly in the presence of others.
14. As we sat down in the office, Bob put his head in his hands and
reported that his life
“was ruined.” As Bob told the story his feeling shifted from
anxiety to anger. He kept
saying, “My future is doomed; I can’t live without her.” Bob
also repeatedly said he was
scared, more scared than any time in his life. He constantly
expressed that he did not
know what to do and was “unable to handle” the situation. He
was angrily saying that he
made too many wrong decisions and he “owed too much.” He
admitted suicidal ideations
but had no clear plans on which he could act. He stated he could
not kill himself because
he loved and wanted to live for his children.
At this point, the clinician again expressed his sorrow about the
loss and said that the
death of a spouse is difficult. At this statement Bob looked up
and stated, “Yeah, espe-
cially when she is the one who makes all the money.” This
statement surprised the clini-
cian, and he asked Bob what he needed to talk about. At this
point, Bob disclosed that his
wife was the “breadwinner,” and that he had no idea how he
would be able to keep up
with the mortgage, let alone “every other bill.” He said he was
extremely sad about her
death and loved her, but his biggest concern was money. Bob
stated he had extended
family and friends to help him with her death. What he needed
help figuring out was how
he was going to support his family.
Case Formulation
15. Assessment of a crisis begins by identifying the crisis.
Clinicians should take care not to
assume that the precipitating event is the crisis. In Bob’s case,
the clinician initially assumed
the crisis was the sorrow Bob was experiencing about the death
of his wife. This assump-
tion was corrected when Bob indicated that his crisis was also
the loss of income caused by
his wife’s death. Once the clinician understood the crisis, the
meaning of many of Bob’s ear-
lier statements, such as being doomed, became clear.
Affective Reaction. Bob’s affect was overtly evident in his red
eyes, sobbing, and
difficulty in articulating his thoughts. His revealing of personal
information with an appar-
ent lack of discretion indicated that his feelings were not
entirely under his volitional
control. In other words, he did not use forethought or good
judgment in regard to what he
was revealing or to whom. The easiest determinant of his affect,
however, was his report-
ing that he “was scared.” Assessing the severity reactions rested
on observations made by
the clinician during the first few minutes of the interview.
Although Bob’s affect was
primarily anxiety/fear, his feelings were bouncing around from
fear to anger with some
sadness mixed in. His affective reaction also seemed
incongruent with the situation and
his mood appeared too intense. In addition, Bob was having
difficulty controlling his
emotions. As a result, the clinician placed him in the moderate
impairment category for
affect with a score of 7.
16. Behavioral Reaction. Bob’s behavioral reaction was immobile
and exacerbated his
current crisis. Bob’s wandering throughout the day without
contacting anyone who might
be able to provide him support suggested he was paralyzed and
unable to make decisions
for himself. This situation is not unusual and is expected, given
the circumstances. Bob
could not think beyond the immediacy of his inability to
provide financial support for his
family. Although Bob expressed suicidal ideations, the clinician
determined these were
not at a level of immediate danger. Bob’s inability to perform
routine personal grooming
964 Journal of Clinical Psychology: In Session, August 2006
Journal of Clinical Psychology: In Session DOI 10.1002/jclp
was also an indication of the severity of Bob’s behavioral
reaction. The severity of Bob’s
reactions was certainly elevated beyond moderate impairment;
that is, his coping behav-
iors exacerbated the situation, and his ability to perform daily
tasks was markedly com-
promised. Thus, Bob’s behavioral reactions to the crisis fell
within the marked impairment
range, a score of 9.
Cognitive Reaction. Bob’s primary cognitive reaction was threat
in the area of phys-
ical dimension. He also was perceiving a loss in social
relationships and to a degree a
17. threat to his psychological well being. Bob’s neglect of some
aspects of his routine living
(wandering, disheveled appearance, etc.), though behavioral
indicators, also demon-
strated a lapse in cognitive functioning. He was able to recall
personal information but
needed prompting to do so. However, his perceptions of his
financial status and the
impending crisis were also critical factors in determining the
severity of his cognitive
reaction. These thoughts were intrusive and Bob seemed to have
no control over them.
Because more than half of the descriptors for marked
impairment in the severity scale
were met, Bob was evaluated with a score of 9.
Course of Treatment
The initial assessment indicated that Bob was experiencing a
marked crisis across two of
the three domains (behavior and cognition) with a total severity
score of 25. This score
suggested that the clinician should use a very direct approach in
helping Bob. The imme-
diate course of treatment involved using direct statements to
place Bob on the shortest
course to resolving the crisis. Although the behavioral and
cognitive reactions were assessed
at 9 on the severity scales, the clinician began by addressing
Bob’s behavioral reaction.
The clinician chose this approach to ensure Bob’s safety. The
clinician worked to have
Bob contact his family and use them as a support system. The
discussion focused on
helping Bob work out what he would say. After he talked with
Bob for approximately 45
18. minutes, Bob was able to telephone his family to let them know
where he was and that he
was safe. During the call, Bob talked briefly with them about
what had happened and
asked them to pick him up, and they agreed to do so.
Before Bob’s family arrived, the clinician began helping Bob
sort out his thoughts.
This process involved helping Bob develop a strategy to
determine his financial status.
The clinician recommended that Bob contact someone who
would be able to determine
his financial status. The thought was that Bob was not able at
this time to gather this
information on his own and someone with experience in this
area would be of great
assistance. Although Bob did not know of anyone with this
expertise, he agreed to talk
with his extended family about his fears and to ask their advice
about whom he might
contact.
Outcome
As the clinician and Bob worked through the severity of his
behavioral and cognitive
reactions both decreased to severity rating of 5, yet Bob’s
affective reaction remained
stable at 7. This rating did not surprise the clinician because the
intervention did not
directly address his affect. Also given the experience of Bob’s
spouse’s becoming ill and
dying within a week, Bob’s affective reaction was likely to
remain elevated for a longer
period, but how long was difficult to determine. However,
because he had activated a
19. support system in the form of Bob’s extended family and
provided him with a plan to
Assessment for Crisis Intervention 965
Journal of Clinical Psychology: In Session DOI 10.1002/jclp
verify his financial status, the clinician believed that Bob would
be able to resolve his
crisis.
On reflection, the clinician learned the importance of
understanding a crisis from the
client’s perspective. This point is critical for provision of
effective and efficient interven-
tions. Too often we have supervised clinicians who were
confused and wondered why
clients did not respond to their intervention. We frequently
discover that the clinician has
failed to appreciate the client’s perspective. The clinician has
either made an assumption
about the nature of the crisis or imposed his or her perspective
on the situation. Fortu-
nately, in this case illustration, the clinician was able to recover
from the faulty assump-
tion and provide guidance to Bob.
Clinical Issues and Summary
Assessment in crisis intervention is different from that in other
types of assessment with
respect to goals, process, relation to treatment, and type of
information gathered. Recog-
nition of these differences is essential for clinicians who are
20. involved in providing crisis
intervention. Although skills learned for other types of
assessment are useful, clinicians
cannot rely on these in crises. At times the skills used in other
types of assessment can
actually hinder and prevent effective crisis intervention.
For example, clinicians must often be prepared to provide
treatment within the first
5 minutes of contact. Clinicians must have assessed clients’
reactions well enough to
have begun the intervention process. The luxury of writing a
report and getting results
from standardized tests is not practical in crisis situations.
Clinicians need to be trained to
adapt skills and increase their effectiveness in crisis
assessment.
The TAS is a valuable tool for helping in the assessment of
people in crisis. The
instrument provides structure for the assessment process that
translates directly to treat-
ment. Research indicates that interrater reliability is modest and
content and criterion
validity is promising (Watters, 1997); however, additional
research is needed to establish
validity of the TAS. The TAS may also be used to monitor
reactions in order to adapt the
intervention to the immediate needs of the clients. As clients
move toward resolution of
a crisis the severity of reactions is altered and clinicians must
adjust interventions accord-
ingly. The TAS provides a method for accomplishing this
process.
Select References/Recommended Readings
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trauma: Developmental-ecological inter-
vention. Boston: Lahaska.
Crow, G.A. (1977). Crisis intervention. New York: Association
Press.
Dixon, S.L. (1979). Working with people in crisis: Theory and
practice. St. Louis, MO: C.V. Mosby.
Echerling, L.G., Presbury, J.H., & McKee, J.E. (2005). Crisis
intervention: Promoting resilience
and resolution in troubled times. Upper Saddle River, NJ:
Merrill Prentice.
Greenstone, J.L., & Leviton, S.C. (2002). Crisis intervention:
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970 Journal of Clinical Psychology: In Session, August 2006
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Collecting Requirements
1
Collecting Requirements 6
Introduction
For the last two weeks, Learning Team A has been
dissecting a project of an organization improving inventory
management. Currently, our company’s inventory management
system is manual and in need up upgrades. The main purpose of
this project is to increase field technician efficiency and
accuracy, whilst reducing the cost of lost inventory which
returns revenues back to the organization. The last two weeks,
Learning Team A, has developed a project scope and created a
planning process to get the project off of the ground. This week
Learning Team A will be discussing the collecting requirements
of the project by addressing the following requirements:
25. 1. Identify appropriate inputs required for the requirements
analysis.
2. Define tools and techniques used to render decisions for the
project.
3. Discuss the importance of addressing inputs and gathering
resources when composing the outputs of the project
requirements.
Inputs
Having handled the scope of the project and its actual
boundaries, it is appropriate then to have all the inputs stated
clearly for an input analysis procedure. This will help in the
identification of whether the project is working within its scope.
Having the analysis of inputs will also help in delivering
assurance that the project is set to begin. Project members
should be prepared to face the upcoming changes that will be
brought about by it. This is what is termed as acceptance
procedure.
In this project there are several inputs that are set to be used
through the project life cycle. It is essential to be able to
identify these inputs and the procedures for their acquisition in
order to be made clear and precise. This will help in the
reduction of the effects of redundancy that is brought about by
going through the same procedure again and again unnoticeably.
Most of these inputs are fully techno-involved and therefore
requires very high skill personnel not only during the
acquisition but also during their installation. This will help
ensure that these inputs are in safe hands till the project is
completely finished.
Input collection requirements will be needed for the
project to progress. For this matter, the skilled personnel that
will be used in the installation process are included as the input
and generally termed as labor. Other needed items for this
project include designated software components, computer
hardware and output machines such as printers, photocopiers,
digitizers and plotters. Each of these input items play a vital
role in the achievement of this project by directing project
26. objectives and achieving set goals. These requirements are
bound to a common input need for each of them to work
appropriately while under proper supervision. One of them
being power/electricity and of course labor as already discussed
earlier.
Tools and Techniques
In making choices for all requirements of this project,
there are several factors that keep us focused on specific items
and tools. When handling this project we have to understand
that all that pertains to it is considered to be our responsibility.
We therefore must take precautions as much as possible to aid
in our successful completion of set goals and objectives. All
the employees that take part in carrying out the project
activities are subjected to us and their safety is our
responsibility too. This means that we must be keen enough to
take precautions as we respond to the requirements of the
project.
Initial tools used to develop strategy involved several project
development tactics. An initial brainstorm of ideas was first
drawn out for possibilities. Next we used the WBS work
breakdown structure to dissect aspects of the project to
determine job roles and functions. We also incorporated a
NASA tollgate or phase gate planning tool that further divides
phases of the project to identify major risks. After
brainstorming, assigning tasks and examining potential threats
we utilized a Gant chart to plot out a schedule for goals and
milestone makers. All finalized decisions and schedules were
then consolidated for stakeholder and company review to utilize
their direction and expertise in company operations.
The choices stated above are required tools that are based
on the assessments carried out through several precaution
procedures. These tools ensure that we make the best choices.
It is appropriate that these assessments are done like already
stated and therefore in our project we have done the exact same
thing. As a precaution all the employees will go through an
assessment before the project commences. This action will
27. provide a degree of certainty that we have employed appropriate
team members to meet the needs of the project. As another
precaution this assessment will be duplicated for contractors
who proposed their services.
We also have to ensure the security and safety of all
workers and employees. This includes taking part in ensuring
that the items listed in the requirements are safe to be handled
by the employees. Since procedures are going digital, there are
specific challenges that we will encounter. System hacking and
virus infection could lead to loss of important data. Precautions
such as system security measures will be a tool and require
technique to safeguard such complications. Antiviruses and
manufacturer protection guarantees will be front line safety
measures followed by training personnel on threat avoidance
techniques. Backup systems alongside quality trained technical
support will aid in managing other potential threats.
One of the most appropriate quantitative techniques is to
use the Analysis of Variance commonly known as ANOVA.
This will aid in determining whether there is significant
effectiveness of each item that is to be used depending on the
possible risks that it is exposed to and its positive contributions
to the project.
We took all the ideas and comments and put them on a fishbone
chart and went through the process of weeding out the ideas that
we felt were not the best for the project then we took some of
the better ideas and suggestions and implemented them. Some of
those ideas for example were allowing the technicians to view
their inventory from their computer with the amounts of the
parts, we did this rather than just having the warehouse personal
be the ones to view what’s on the truck so the technicians at a
quick glance could decide whether or not they had the right
equipment for the job.
Gathering Resources
The Collecting Requirements phase is the, “process of
determining, documenting, and managing stakeholder needs and
28. requirements to meet project objectives” (Project Management
Institute, Inc., 2013, Chapter 5.2). This provides a basis for
defining and managing the project scope. The project scope of
this project is to eliminate the human element in the inventory
management process through software installed in technician’s
computers. This will allow inventory to be tracked while in
trucks or warehouses and provide the purchasing department
with real time information on inventory levels. By eliminating
human error, inventory levels will achieve 99% accuracy levels.
To begin the Collecting Requirements phase of the project, data
must be collected on the current inventory process. This will
provide the project with a baseline. Baselines will be used to
compare future results. Benchmarks must be chosen regarding
so comparison can be made once the project is completed.
Competent selection of developers must be found that can
engineer, implement, and provide ongoing service for the new
software. This is a large task so it will probably require review
of numerous proposals from large software companies. Once
this information has been gathered, a presentation must be made
for major project stakeholders, including all employees
involved in the inventory and shipping process. The
presentation must include an outline of who will be doing the
work, when the work will be completed, and where to turn to for
training and technical assistance after the software
implementation.
Conclusion
The initial assessments done before the project begins helps
guide it toward the expected outcome. This will help develop
quality work and expertise within the project. This also gives
the company confidence that the project will be beneficial and
meet the needs of shareholders. There are several tools and
strategies implemented to structure and guide the project to
completion. Resources needed will require extensive
interaction of all parties involved and will include several
safety measures to ensure they are used and managed
appropriately. Ultimately the incorporation of electronical
30. Affective Domain
Identify and describe briefly the affect that is present. (If more
than one affect is experienced, rate with number 1 being
primary, number 2 secondary, number 3 tertiary.)
Anger/Hostility
_____________________________________________________
_____________________________________________________
__________________________________________
Anxiety/Fear
_____________________________________________________
_____________________________________________________
__________________________________________
Sadness/Melancholy
_____________________________________________________
_____________________________________________________
__________________________________________
Affective Severity Scale
Highlight 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
31. 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.
Decompensation or depersonalization evident.
Behavioral Domain
Identify and describe briefly which behavior is currently being
used. (If more than one behavior is used, rate with number 1
being primary, number 2 secondary, number 3 tertiary.)
Approach
_____________________________________________________
_____________________________________________________
__________________________________________
Avoidance
_____________________________________________________
_____________________________________________________
__________________________________________
32. Immobility
_____________________________________________________
_____________________________________________________
__________________________________________
Behavioral Severity Scale
Highlight 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 use of ineffective coping behaviors. Client performs
those tasks necessary for daily functioning, but does so with
noticeable effort.
Occasional use of ineffective coping behaviors. Client neglects
some tasks necessary for daily functioning.
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
33. harmful to self and/or others.
Cognitive Domain
Identify whether a transgression, threat, or loss has occurred in
the following areas and describe briefly. (If more than one
cognitive response occurs, rate with number 1 being primary,
number 2 secondary, number 3 tertiary.)
PHYSICAL (food, water, safety, shelter, et cetera):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
PSYCHOLOGICAL (self-concept, emotional well-being,
identity):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
SOCIAL RELATIONSHIPS (family, friends, coworkers, et
cetera):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
34. _____________________________________________________
__________________________________________
MORAL/SPIRITUAL (personal integrity, values, beliefs):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
Cognitive Severity Scale
Highlight 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 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
35. interpretation of crisis event substantially match 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 may differ in some respects from 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 from 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 from
reality of situation.
Gross inability to concentrate on anything except crisis event.
Client so afflicted by obsessiveness, self-doubt, and 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.
Domain Severity Scale Summary
Affective _____
Cognitive _____
Behavioral _____
= Total _____
1
Running head: TRIAGE ASSESSMENT
36. 1
TRIAGE ASSESSMENT
2Using the Triage Assessment Form Learner First Name MI.
Last Name
Instructor Name
Abstract
There is no indent on an abstract. An abstract is a paragraph
that summarizes the most important parts of the entire paper. It
briefly allows your reader to quickly obtain an overview of your
writing. It is an accurate reflection of the purpose and content
of the text written in clear and concise language within the limit
of 150 to 250 words.
Using the Triage Assessment Form
Include the title of your paper centered at the top of the page,
not bolded; it is not considered a heading. *This first section is
your paper’s introduction. Note that it does not have a heading;
its position at the beginning of the body of the paper implies
that it is the introduction. In the body of your paper, indent the
first line of each paragraph. As always, use double spaced, 12-
point Times New Roman font, and 1.0 margins all around the
page layout. Throughout the paper, please support your work by
citing at least four current resources (including your textbook).
For the purposes of this assignment, simply replace this text
with a brief paragraph in your own words introducing the topic
and informing the reader of the organization of the paper.
Triage Assessment of the Client
Complete the Triage Assessment Form for the selected case,
including all three domains and the total score. In this section
of the paper, summarize the results and provide a logical and
articulate rationale for each of the domain ratings with specific
38. 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 number 1 being
primary, number 2 secondary, number 3 tertiary.)
Anger/Hostility
_____________________________________________________
_____________________________________________________
__________________________________________
Anxiety/Fear
_____________________________________________________
_____________________________________________________
__________________________________________
Sadness/Melancholy
_____________________________________________________
_____________________________________________________
__________________________________________
Affective Severity Scale
Highlight the number that most closely corresponds with
client’s reaction to crisis.
1
39. 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.
Decompensation or depersonalization evident.
Behavioral Domain
Identify and describe briefly which behavior is currently being
used. (If more than one behavior is used, rate with number 1
being primary, number 2 secondary, number 3 tertiary.)
41. noticeable effort.
Occasional use of ineffective coping behaviors. Client neglects
some tasks necessary for daily functioning.
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.
Cognitive Domain
Identify whether a transgression, threat, or loss has occurred in
the following areas and describe briefly. (If more than one
cognitive response occurs, rate with number 1 being primary,
number 2 secondary, number 3 tertiary.)
PHYSICAL (food, water, safety, shelter, et cetera):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
PSYCHOLOGICAL (self-concept, emotional well-being,
identity):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
42. _____________________________________________________
__________________________________________
SOCIAL RELATIONSHIPS (family, friends, coworkers, et
cetera):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
MORAL/SPIRITUAL (personal integrity, values, beliefs):
Transgression _____
Threat _____
Loss _____
_____________________________________________________
_____________________________________________________
__________________________________________
Cognitive Severity Scale
Highlight the number that most closely corresponds with
client’s reaction to crisis.
1
2 3
4 5
6 7
8 9
10
No Impairment
43. 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 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 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 may differ in some respects from 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 from 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 from
reality of situation.
Gross inability to concentrate on anything except crisis event.
Client so afflicted by obsessiveness, self-doubt, and 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.
![Keywords: crisis intervention; psychotherapy; trauma;
assessment
Effective crisis intervention is dependent on accurate
assessment that directly translates
into focusing treatment when it is needed. This assessment
should give clinicians the
information required to answer questions such as the following:
What resources are needed
for this client to resolve the crisis situation? What approach will
be the most effective for
the client at this time? Does the client need to be hospitalized?
What support from family,
friends, or community agencies is needed? Is the client
contemplating committing suicide
or harming someone else? Answering these questions requires
that assessment of clients
in crisis be ongoing, and that reactions be monitored in order to
adjust the intervention as
needed. Simple reliance on diagnostic models, standardized
tests, or intake protocols can
mislead clinicians in these situations (Hoff, 1995; Myer, 2001).
A model specifically
designed for crises is needed to guide the assessment process.
Correspondence concerning this article should be addressed to:
Rick A. Myer, Ph.D., Associate Professor,
Department of Counseling, Psychology, and Special Education,
Duquesne University, 600 Forbes Avenue,
Pittsburgh, PA 15282; e-mail: [email protected]
JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol.
62(8), 959–970 (2006) © 2006 Wiley Periodicals, Inc.
Published online in Wiley InterScience
(www.interscience.wiley.com). DOI: 10.1002/jclp.20282](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)