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41 Cards in this Set
- Front
- Back
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In order to adequately assess and intervene in a crisis situation, the clinician must possess the following 10 skills
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-therapeutic alliance
-knowledge of risk factors -knowledge of assessment -knowledge of additional resources -ability to include family -hospitalization assessment -intervention to reduce risk factors -short-term and long term tx interventions -knowledge of culture -understanding of legal and ethical |
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What are some things that a compehensive suicide assessment must include? (3)
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-risk and protective factors
-obtained through a minimum of a clinical interview -A therapist may review records, consult, interview family, use instruments |
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name some facts about suicide
-what ranking is in the causes of death - what is the rate - # of suicides - how many completion vs attempts |
In 2000
-11th leading cause of death -10.6 out of 100,000 ppl -29,350 suicides in 2000 -8 to 25 attempts per 1 completion |
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What are the main parts of a suicide assessment? (8)
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LICD PPPP
- Ideation, intent, plan, and means -Previous attempts and family hx -Psychiatric Hx -Current Mental Status (sxs of depression + impulsivity) -Physical illness -Demographics -lack of resources and losses -protective factors/deterrents |
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What is the strongest indicator of increased risk for suicide?
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A history of previous suicide attempts
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What people are at risk for suicide based on psychiatric hx? (6)
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-co-morbid (90% of successful are comorbid)
-previous inpatient hx (5-10 times higher) -1/3 of depressed pts will complete within 6month of leaving the hospital -People whose depressed has recently slightly improved. -outpatient hx (3 to 4 times higher) -People with diagnoses: depression, schizophrenia, AOD, personality d.o. |
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Demographic risks of suicide
-Sex -Race -Age -marital status -immigrant status |
-sex (men- 4x more likely to succeed. Women- 3x more likely to attempt)
-race (whites 2x than non, black males 15-30 y.o. higher than even white males) -age (older than 65, highest rates > 85 y.o. males, also adolescence) -marital status (divorce more than widowed, single, or married) -immigrant status (non native more than native) |
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What are some protective factors for suicide? (4)
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-access to care
-family/community support -prob solving skills -cultural/religious beliefs that discourage suicide |
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What are some indications for outpatient tx of suicidal ideation? (7)
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-lack of strong intent
-no concrete plan -no prior attempts -willingness to contract -good judgment/lack of impulsivity -no comorbidity -family/community support |
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What are the intervention that must take place if outpatient tx is utilized for suicide risk? (8)
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-referral for medication eval
-removing means of harm -safety contract -increased therapist avail, -emergency plan -involvement of family members -treatment -followup |
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Section 5150 vs Section 5250 vs 5260
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Welfare & Institution Codes
5150 = 72 hour hold 5250 = 14 day hold 5260 = another 14 days after 5250 Danger to self (suicidal), Others (homicidal) or Gravely Disabled |
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Evidence Code 1024
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an exception to privilege when pts mental condition causes him to be danger to self (or "to the person or property of others"). Used in a legal proceeding to prevent danger
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2004 stats for ppl 12 and older for violent crimes. What is the trend of those statistics?
(# & rape, assult, robbery, murder) |
-5.2 million violent crimes
-1/1000 rape -2/1000 assault -2/1000 robberies -6/100,000 murders -Figures are steadily declining and are half of what they were 10 years ago |
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2004 stats for perps age/sex/race (+3)
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-60% by persons under age 30
-males > females -Blacks > Whites -large build -poor -low IQ |
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2004 stats for violent crime victims by race
(blacks, whites, others, Indians) |
-26/1000 blacks
-21/1000 whites -13/1000 other -American Indians have highest rate of all |
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2004 stats victim offender relationship
(by gender, rape relation stats, and child murder relation stats) |
-males have = chance of being victimized by a stranger or non-stranger.
-Female greater to be victimized by a non -7 out of 10 women knew rapist -2/3 of children under 5 were murdered by fam or parent |
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High School violence stats
(bullied, fights, threatened-male/female) |
-7% hs students bullied past 6 mos
-13% got into a fight on school prop -12% of male, 6% of female were threatened |
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Violence & Assault Assessment
(7) |
-ideation, intent, plan, and means
-criminal hx and antisocial beh -psychiatric hx -current mental status -demographics (male, non-white, low IQ, under 30) -lack of resources and interpersonal relationships -protective factors |
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ideation, intent, plan and means considerations
(4) |
-intensity and duration of assaultive ideation
-specificity of the assaultive attempt -preparation for assaultive attempt -access and means |
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Psychiatric hx risks for violence (5)
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-Antisocial personality
-AOD -Intermittant explosive d.o. -Schizophrenia -hx of family violence |
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Current mental status risks for violence (4)
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-poor judgment
-impulsivity -negative affectivity/anger -active psychotic symptoms |
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Protective factors for violence assessment
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-lack of strong intent
-not well thought out plan -no prior hx of assault or criminal -activity -willingness to contract -good judgment/lack of impulsivity -lack of significant diagnoses -well modulated affect |
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Outpatient intervention with violent pts (8)
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-referral medication eval
-removing means of violence -safety contract -therapist avail -emergency plan -involvement of family members -tx -follow-up |
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Tarasoff defined
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-Where a pt has communicated a serious threat of physical violence against a reasonably identifiable victim
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Ewing Decision
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Tarasoff extends to information recieved from close relations of the client
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What must a therapist do in Tarasoff situation
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-communicate the threat to victim and to a law enforcement agency
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CDC fact on child abuse in 2002.
How many? Percentages of type of abuse? |
906,000 cases
-19% physical -10% sexual -5% emotional |
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CDC 2002 child abuse How many died? How did they die?
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1500 died
-36% neglect -28% physical -29% multiple types |
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Shaken baby syndrome
How many cases? How many died? What happens to the survivors? |
1200 to 1600 cases
-25 to 30% die -consequence include: visual impair, motor impair, cognitive impair |
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What age group of children at at greatest risk of severe injury or death from abuse?
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-79% of deaths less than 4 y.o. greatest
-infants less than 1 y.o. 44% |
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Children who experience maltreatment are at risk for: (7)
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-smoking,
-AOD -eating d.o., -depression -suicide -sexual prom -certain chronic illnesses |
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Children who are physically abused are at higher risk to be (2)
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-victims
-victimizers |
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Signs of Physical Abuse
-visual -behavioral |
-Burns and bruises most common
-Behavioral: accident proneness, problems with schoolwork and peers, loss of interest, shrinking from physical contact, other sudden changes |
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What are the behavioral and physical signs of chronic physical abuse on children (5)
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-overactive and hypervigilant
-withdrawn -depressed -underactive -overly compliant |
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In addition to the physical abuse signs, some additional sexual abuse signs (8)
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-being secretive
-excessive bathing -sexual provocative -sleep d.o. -anxiety -suicide attempts -fatigue -physical sxs |
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Risk factors toward abuse (9)
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-disabilities
-young or single parents -lack of family cohesion -family violence -AOD in family -parental stress -low SES -parent's lack of understanding childrens needs/development -acceptance of corporal punishment |
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What are the components to a child abuse assessment? (6)
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-interview the child
-observe the child -interview the parents -interview collaterals -refer for a medical evaluation -administer psychological testing |
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Child abuse intervention steps (6)
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CREATE
-ensure child's safety -contact Childrens Services -refer child for medical evaluation and treatment -assess for co-occurring abuse -treatment -eliminating future abuse |
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Behavioral signs of elder/dependent adult abuse (6)
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-Withdrawal
-Fear of being left alone -extreme timidity -anxious or depressed -expression of fear toward a person -financial complaints |
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Elder/Dependent Adult Abuse Assessment (4)
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-Interview the elder
-Observe the elder -interview collaterals -refer for a medical exam |
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Elder/Adult Abuse intervention steps (6)
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-ensure safety
-contact adult services -refer for medical exam -assess for co-occurring abuse -tx -elimination future abuse |
