Chapter 3 & 4 Basic Crisis Assessment & Intervention Skills 1

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 2

SEVEN STEP ASSESSMENT PROCESS Predispositioning/e ngaging/initiating contact Problem exploration Providing support Examining alternatives Making plans Obtaining commitment to action Follow-up 3

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’) 4

SAFETY Minimizing psychological and physical danger Client Self Others 5

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 6

STEP 2: EXPLORING THE PROBLEM Defining the crisis From the clients point of view 7

STEP 3: PROVIDING SUPPORT Caring emotional support Non possessive Informational support In order to make good decisions Instrumental support Basic needs 8

ACTING (STRATEGIES) Nondirective Collaborative Or Directive (if needed) 9

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) 10

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 11

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 12

CLIENT FUNCTIONING Generally, no time for formal diagnosis or assessment instruments Goal: to assist client with pre-crisis Equilibrium Mobility 13

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) 14

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 15

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 16

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 17

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 18

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 19

ASSESSING EMOTIONAL FUNCTIONING Duration of Crisis Acute/situational (one time/short term) Chronic (recurring, long-term or transcrisis) Current reservoir of emotional stamina Helplessness, hopelessness, ‘no future’ Clients Ecosystem variables Communication system, cultural mores, accessibility, economic status, etc Developmental Stage 20

FACILITATIVE AFFECTIVE ASSESSMENT Data gleaned about the client are used as a part of the ongoing helping process. 21

ASSESSING ALTERNATIVES/RESOURCES List of referral resources Brainstorming Realistic options Impediments to progress? Institutional, social, vocational, personal strengths or support systems =people 22

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! 23

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 24

9 BASIC STRATEGIES Creating Awareness Allowing Catharsis Facing denied, repressed feelings, thoughts and behaviors Allowing Catharsis Allowing full feelings, venting, talking, crying in safe environment (caution: best for those who struggle with feelings) Providing Support Validations, affirmation, without dependence 25

9 BASIC STRATEGIES (CONT.) Increasing Expansion Broaden vision, reframe narrow views, gain new perspective Emphasizing Focus Find specific, realistic, manageable components and options (narrow out-of-control thoughts) Providing Guidance Providing direction, knowledge, resources to 26

9 BASIC STRATEGIES (CONT.) Promoting Mobilization Activate client internal/external resources to generate coping skills and problem solving abilities Implementing Order Helps client with organization and prioritization, for logical thought Providing Protection Safe guarding clients from harmful, feelings, behaviors, and thoughts 27

CLIMATE OF HUMAN GROWTH Communicating Empathy (sensing client feelings) Communicating Genuineness (realness) Communicating Acceptance (caring, unconditional positive regard) 28

COMMUNICATING EMPATHY 5 Techniques Attending (looking, acting and being attentive) Verbally empathic understanding accurately hearing and understanding the core feelings Accurately communicating that understanding to the client Reflection of feelings – uncovering feelings Caution with getting too deep Stay in here and now 29

COMMUNICATING EMPATHY (CONT.) Non-verbal communication of empathic understanding Picking up on unspoken cues, messages, and behaviors Silence Thinking time for the client and counselor 30

NOT COMMUNICATING EMPATHY sympathy (taking on the clients feelings) distancing (when you don’t know what to say) “funeral home counseling” 31

COMMUNICATING GENUINESS Fully oneself Honest Congruent Awareness of self, feelings, and experience 32

COMMUNICATING GENUINESS 5 Essential Components Being role free (genuine in life and counseling) Being spontaneous (free without impulsiveness) Being non-defensive (not feeling attacked) Being consistent (talk agreeing with action) Being a sharer of self (appropriately) 33

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 34

CRISIS WORKERS ‘ACTING’ MODES Nondirective Counseling Client has as much control as they can handle Counselor: Questioning and listening Collaborative Counseling Partnership with client in evaluating the problem, generating alternatives, and implementing steps Counselor: catalyst, consultant, facilitator, support Directive Counseling Client is too immobile to cope with crisis Counselor: Definer and developer of plan, guides and leads 35

KINDS OF IMMOBILE CLIENTS Immediate hospitalization due to chemical use or organic dysfunction Severe depression and cannot function Severe psychotic episodes Severe shock, bereavement or loss Anxiety is high where they cannot function Out of touch with reality In danger to self or others 36

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.” 37

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) 38

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.) 39

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) 40