Assessing dangerousness and abuse for the ncmhce (2 hours)
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Counselor Toolbox Podcast with Dr. Dawn-Elise Snipes produces 2 episodes each week and offers CEUs based on the podcast at AllCEUs.com/counselortoolbox
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Assessing dangerousness and abuse for the ncmhce (2 hours)
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 2
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 3
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 4
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 5
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 6
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 7
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 8
- 9. DV Intervention For Perpetrator Break through denial Get commitment to a no-violence contract Teach anger management skills Support group referral AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 9
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 10
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 12
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 13
- 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 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 AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 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? AllCEUs Unlimited CEUs $59 | Addiction Counselor Certificate Training $149 | Specialty Certificates $89 20 • Grades/Class Attendance* • Finances • Affective Functioning* • Sleep quality* • Energy Level • Socialization with Family • Follow Through on Referrals* • Continuing flashbacks, nightmares* • Substance Use**