1. Chapter 3 & 4 Basic Crisis Assessment & Intervention Skills1

2. 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

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

4. 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

5. SAFETY Minimizing psychological and physical danger Client Self Others5

6. 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

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

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

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

10. 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

11. 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

12. 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

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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

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

23. 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

24. 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

25. 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

26. 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

27. 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

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

29. 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

30. 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

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

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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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