3 the intervention and assessment models


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3 the intervention and assessment models

  1. 1. The Intervention and Assessment Models CHAPTER THREE©2013, Brooks/Cole Cengage Learning
  2. 2. 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
  3. 3. 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
  4. 4. 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.  Establisha therapeutic bond  Inform the client about what to expect©2013, Brooks/Cole Cengage Learning
  5. 5. 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
  6. 6. 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
  7. 7. 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
  8. 8. 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
  9. 9. 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
  10. 10. 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
  11. 11. 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
  12. 12. 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
  13. 13. 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
  14. 14. 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
  15. 15. 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.  Policeofficers  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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. 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
  21. 21. 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