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©2013, Brooks/Cole Cengage Learning
CHAPTER THREE
The Intervention and Assessment Models
©2013, Brooks/Cole Cengage Learning
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
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
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.
Establish a therapeutic bond Inform the client about what to expect
©2013, Brooks/Cole Cengage Learning
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
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
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
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
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
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
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
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
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
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
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.
Police officers 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
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
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
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
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
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
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?