Chapter 3 & 4 Basic Crisis Assessment & Intervention Skills

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TRIAGE ASSESSMENT SYSEM

• Assesses severity of clients presenting crisis situation

• Assistance for gaining sense of direction for helping client cope with the dilemma

• Integrated problem-solving process

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SEVEN STEP ASSESSMENT PROCESS

1. Predispositioning/engaging/initiating contact

2. Problem exploration

3. Providing support

4. Examining alternatives

5. Making plans6. Obtaining

commitment to action7. Follow-up

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LISTENING (PSYCHOLOGICAL FIRST AID)

• Caring support• Empathic responding• Concrete information and assistance• Reuniting social support systems• Survival needs (Maslow)• Nonintrusive (Not time for ‘cure’ or ‘fix’)

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SAFETY

• Minimizing psychological and physical danger• Client• Self• Others

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STEP 1: PREDISPOSITIONING/ENGAGING/INITIATING CONTACT

• From the clients perspective• Active Listening/Attending Skills (observing,

understanding, and responding)• Respect• Without judgment• Caring• Empathy • Genuineness• Acceptance or positive regard• Use open ended questions• Attending to verbal and non-verbal messages

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STEP 2: EXPLORING THE PROBLEM

• Defining the crisis• From the clients point of view

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STEP 3: PROVIDING SUPPORT

• Caring emotional support• Non possessive • Informational support

• In order to make good decisions• Instrumental support

• Basic needs

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ACTING (STRATEGIES)

• Nondirective • Collaborative• Or Directive (if needed)

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STEP 4: EXAMINING ALTERNATIVES

• Exploring choices and options• Immediate Situational Supports (people)• Coping mechanism (actions or resources)• Positive and constructive thinking patterns

(reframing to alter the clients view)• Look for a few that are appropriate and

realistic to discuss with client (not too many)

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STEP 5: MAKING PLANS (ACTION STEPS)

• To restore clients emotional equilibrium• Easy for client to own and understand• Short term (minutes, hours, days)• Identifying additional resources and coping tools• Systematic problem solving• Concrete and positive• Things client can ‘do now’• Collaborative with since of control and autonomy

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STEP 6: OBTAINNG COMMITMENT

• Brief and simple• Ask client to verbalize the plan• Written and signed (if severe)• Handshake• Free, voluntary and believed to be doable• Honest, direct and appropriate commitment

• Before termination

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CLIENT FUNCTIONING

• Generally, no time for formal diagnosis or assessment instruments

• Goal: to assist client with pre-crisis• Equilibrium• Mobility

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TERMS

• Equilibrium (emotion or mental balance/stability)

• Disequilibrium (Lack or destruction of balance/stability)

• Mobility (autonomous change or coping of moods, conditions, influences)• Flexible and adaptable

• Immobility (Not capable of mobility)

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ASSESSMENT HELPS DETERMINE:

• Severity of crisis and client functioning• Client’s current emotional status• Client’s alternatives and resources• Client’s level of lethality• How well counselor is doing in assisting client

to equilibrium and mobility

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CLIENT FUNCTIONING

• Affective State (feeling or emotional tone)• Out of control, withdrawn, detached,

overemotional, etc.• Behavioral Functioning (activity level)

• The sooner the better• Cognitive State (thinking patterns)

• Realistic, consistent, rational, exaggerating, etc.• Able to positively reframe

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ASSESSMENT FORMS

• Often take up too much time • May be inappropriate for client level of functioning• TAF (Triage Assessment Form)

• Fairly rapid and valid• Versions

• Law enforcement• Students• Civilians

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PSYCHOBIOLOGICAL ASSESSMENT IN CRISIS

• Evidence that neurotransmitters play a role in affective, behavioral, and cognitive functioning during (and sometimes after) crisis

• Can cause residual and long term changes • Impact of mental health medication• Impact of legal and illegal drugs

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REQUIRING COUNSELORS TO ATTEMPT TO ASSESS:

• Prior trauma• Psychopathology• Use, misuse, or abuse of drugs• And is there a correlations with the current

crisis/problem• Referral may be needed

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ASSESSING EMOTIONAL FUNCTIONING

1. Duration of Crisis• Acute/situational (one time/short term)• Chronic (recurring, long-term or transcrisis)

2. Current reservoir of emotional stamina• Helplessness, hopelessness, ‘no future’

3. Clients Ecosystem variables• Communication system, cultural mores,

accessibility, economic status, etc

4. Developmental Stage

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FACILITATIVE AFFECTIVE ASSESSMENT

• Data gleaned about the client are used as a part of the ongoing helping process.

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ASSESSING ALTERNATIVES/RESOURCES

• List of referral resources• Brainstorming• Realistic options• Impediments to progress?• Institutional, social, vocational, personal

strengths or support systems =people

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SUMMARY OF ASSESSMENT

• Taking available information and making meaningful sense out of it.

• Quickly evaluate• Be flexible• Assessment is central and continuous process• Continue until pre-crisis state is obtained• Even then, in many cases…. Only the acute

phase is then over!

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LISTENING SKILLS

• Open-ended questions• Closed-ended questions• Restatement and Summary clarification• Owning Feelings (counselor focus)• Disowned statements and pretending• Conveying understanding (of situation)• Value judgments (of situation)• Positive reinforcement (of behavior)• Personal integrity and setting limits• Assertion statements

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9 BASIC STRATEGIES

1. Creating Awareness • Facing denied, repressed feelings, thoughts and

behaviors2. Allowing Catharsis

• Allowing full feelings, venting, talking, crying in safe environment (caution: best for those who struggle with feelings)

3. Providing Support• Validations, affirmation, without dependence

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9 BASIC STRATEGIES (CONT.)

4. Increasing Expansion• Broaden vision, reframe narrow views, gain new

perspective

5. Emphasizing Focus• Find specific, realistic, manageable components

and options (narrow out-of-control thoughts)

6. Providing Guidance• Providing direction, knowledge, resources to

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9 BASIC STRATEGIES (CONT.)

7. Promoting Mobilization• Activate client internal/external resources to generate

coping skills and problem solving abilities

8. Implementing Order• Helps client with organization and prioritization, for

logical thought

9. Providing Protection• Safe guarding clients from harmful, feelings, behaviors,

and thoughts

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CLIMATE OF HUMAN GROWTH

• Communicating Empathy (sensing client feelings)

• Communicating Genuineness (realness)• Communicating Acceptance (caring,

unconditional positive regard)

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COMMUNICATING EMPATHY

5 Techniques1. Attending (looking, acting and being attentive)2. Verbally empathic understanding

• accurately hearing and understanding the core feelings• Accurately communicating that understanding to the client

3. Reflection of feelings – uncovering feelings• Caution with getting too deep• Stay in here and now

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COMMUNICATING EMPATHY (CONT.)

4. Non-verbal communication of empathic understanding

• Picking up on unspoken cues, messages, and behaviors

5. Silence• Thinking time for the client and counselor

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NOT COMMUNICATING EMPATHY

• sympathy (taking on the clients feelings)• distancing (when you don’t know what to say)

“funeral home counseling”

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COMMUNICATING GENUINESS

• Fully oneself• Honest • Congruent• Awareness of self, feelings, and experience

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COMMUNICATING GENUINESS

5 Essential Components1. Being role free (genuine in life and

counseling)2. Being spontaneous (free without

impulsiveness)3. Being non-defensive (not feeling attacked)4. Being consistent (talk agreeing with action)5. Being a sharer of self (appropriately)

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COMMUNICATING ACCEPTANCE

• Care for and fully accept clients, even when doing things contrary to beliefs and values

• Put aside personal needs, values and desires• Allowing client to accept self

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CRISIS WORKERS ‘ACTING’ MODES

1. Nondirective Counseling • Client has as much control as they can handle• Counselor: Questioning and listening

2. Collaborative Counseling• Partnership with client in evaluating the problem,

generating alternatives, and implementing steps• Counselor: catalyst, consultant, facilitator, support

3. Directive Counseling• Client is too immobile to cope with crisis• Counselor: Definer and developer of plan, guides and

leads

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KINDS OF IMMOBILE CLIENTS

1. Immediate hospitalization due to chemical use or organic dysfunction

2. Severe depression and cannot function3. Severe psychotic episodes4. Severe shock, bereavement or loss5. Anxiety is high where they cannot function6. Out of touch with reality7. In danger to self or others

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THESE KINDS OF IMMOBILE CLIENTS

• Often apt to be suicidal• Or homicidal• Not ready to be collaborative• Not ready for nondirective counseling

“Counselor must be ready to make accurate and objective assessment

of the client’s level of mobility.”

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STRATEGIES FOR CRISIS WORKERS

• Recognize Individual Differences (avoid stereotyping, taking for granted)

• Assess Yourself (values, limitations, burnout etc.)

• Safety for all (you may need to ask for help)• Provide Client Support (with assertiveness if

needed)• Define Problem Clearly (focused, practical,

accurate, problem-solving viewpoint)

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STRATEGIES FOR CRISIS WORKERS (CONT)

• Consider Alternatives (broaden views – workable and realistic)

• Plan Action Steps – to regain control of life (short and doable)

• Use clients coping strengths (may need to be identified, explored and reinstated)

• Attend to Client’s Immediate needs (contacts, appointments, venting, etc.)

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STRATEGIES FOR CRISIS WORKERS CONT)

• Use Referral Resources (keep a ready list)• See Page 92

• Develop and use Networks (professionals, community, government, etc)

• Get a summarized verbal commitment (positive and definite)

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