Cpse - Crisis And Intervention

Front 1

What are components of a crisis? (Golan, 1978)

Back 1

1. Harzardous event - initial shock disrupts equilib and starts series of reactions -> crisis.
2. Vulnerable state - all the emotional, bio, cog beh responses to events -> anxiety.
3.Active Crisis State - Disequilibrium/disorganization - 3 stages a) physical agitation, b) preoccupation with events leading to crisis, c) return to equilibrium - realize cop technqies or seek help.
4. Restoration of equilibrium - success depends on ability to evulate sit and cop strategies

Front 2

Define situational crisis and its components.

Back 2

Crisis origin is sudden, random, shocking and often catastrophic that cannot be anticipated or controlled.
1. Event threatens sense of psychological well being - disequilibrium
2. Factors effecting if one will interpret crisis = perception of event & ability to cope / social supports.
3. Sources of stress include - physical illness, untimely death, crime, natural dis, war, divorce, material loss

Front 3

Define maturational (developmental) cris - transitional states

Back 3

Crisis origin is embeded i developmental process - so can be anticipated.

Front 4

What are the developmenatl transition states and the developmental task of each. 6 stages.

Back 4

1)Childhood - task - socialization - parents, friends, success/failure in school. peer conflict, moving, academic probs.
2)adololescence - IDENTITY - failure in academics or athletics, grdauation, college, breakup wi/bf, pregnant - job search.
3)Young Adulthood - 18-34 - Preoccupied with intimacy, parenthood - career. relat problems, procreating, $ probs, age 30 trans..
4)Middle adult - look at what u have accomp and what u wanted. Physical decline, illness, parenting, moving, regrets about relats, death.
5)Maturity - consolidating experiences & resources -> focus on later life. health problems, retirement, empty nest.
6)Old Age - retirement til death - evaluate past and share wisdom of their life - acheiving satisfaction wi life, lonliness, $, problems with family.

Front 5

What are four common factors that lead a transition state to activate an emotional crisis?

Back 5

1) The person cannot prepare for the changes - prep helps.
2) The accomplishment of the tasks assoc with dev stage is hindered b/c per lacks skills or resources.
3) Unanticipated traumatic event - hurts ability to cope.
4) Crisis because the challenge doesn't fit societies expec for devel level.

Front 6

Positive Crisis Outcomes

Back 6

Problem solving efforts are successful and person returns to precrisis state. May also grow from crisis exp b/c new prob solving methods reduce emotional discomfort

Front 7

Negative Crisis Outcomes

Back 7

a. Person lacks effective means to resolve problem, emotional pain persists - becomes depressed, withdrawn - engages in impulsive behavior - uses drugs - tries to commit suicide - extreme behaviors.
b. Person regains equilibrium thinking that crisis has ended, but has only subsided - transcris states - person in vulnerable to minor prob b/c single stressor may retrigger crisis.

Front 8

What types of questions should be used in the assessment of a crisis?

Back 8

1) Open-ended questions about clients feelings
2) Closed-ended questions to quickly elicit details about what is occuring in their life. i.e. thinking of harming yourself?

Front 9

What does assessment of lethality involve?

Back 9

1) Listen and look for clues to danger: a) verbal clues - I wanna kill him or myself. Also if MENTION PREVIOUS ATTEMPTS b) nonverbal - prep for death, sleep changes, recent fight, provocation. c) reports from others
2)If signs are present - conduct struc inquiry to collect info to determ and implement appropriate plan to protect client / others a) ask direct questions - goin2 kill urself? when? where? b) use client's words to clarify vague threats c) self-harm also includes destructive behavior - abusing drugs/alcohol

Front 10

What distress signals are highly associated with crisis?

Back 10

Difficulty managing feelinsg, Suicidal or homocidal tendencies, drug abuse, inability to use help

Front 11

Key Questions to explore in assessing crisis origin and development

Back 11

1. What recent stress events have occured in client's life.
2. What dev stage is client in?
3. Is client in initial or acute stage of crisis?

Front 12

Assessing Affective Domain in Crisis Intervention

Back 12

1.Abnomral or impaired affect
2.Anxiety and tension
3.Sense of loss/emptiness
4.hopelessness/helplessness
5.fear,anger,guilt,embaras,shame

Front 13

Assessing Cognitive Domain in Crisis Intervention

Back 13

1. Altered Cognitive Processes: memory problems, trouble making decisions.
obessional thoughts about crisis, intrusive thoughts, concentarion problems, dostorted reality due to crisis
2. Pereception of Situation: Feelings are consistent wi perceptions of situation
3. clients subjective interpretation of stres events is determ of crisis res.

Front 14

Ataque de nervios

Back 14

an idiom of distress involving uncontrollable shouting, crying, trembling, physical agression following a stressful event - Latinos from Caribean may report it

Front 15

4 Goals to be addressed in all crisis interventions

+ 2 additional goals in clients wi chronic life history

Back 15

1.relieving clients symptoms
2.identify factors that led to crisis state.
3.return client to precrisis state
4.Applying remedial measures
5.develop coping strategies 4 future
6.help clieny connect stress wi past experiences

Front 16

What are 6 Characteristics of suicide assessment?

Back 16

1.Primary Goal - level of risk they will attempt suicide in nr future.
2.lev of risk varies over time
3.Any level of sui crisis should be treated as emergency
4.Includes data collection, MSE, consultations with md's
5.Ask direct questions about SI
6.Uses direct & indirect techs

Front 17

What are gender risk factors for suicide?

Back 17

-4to5 x as many males commit sui as fems.
-Fem attempt sui 3 x males, but succeed less b/c males choose lethal means

Front 18

What are age factors of suicide?

Back 18

-Attempts highest = 24-44
-Completed suicide = 65+

-Biggest increase in age 10-19 wi largest inc 10-14.

Front 19

Race risks for suicide

Back 19

Highest risk for whites for all ages except teens - Native American are higher. White males highest risk of all.

Front 20

Marital status risks for suicide

Back 20

+Higher rates for suicide for divorced, sep, widowed then single.
-lowest rates among married

Front 21

Living Environments

Back 21

+highest risk living alone
+higher risk living in city

Front 22

Psychiatric History as risk for suicide

Back 22

+50-80% of sui inv have history of sev depression. In these cases sui occurs w/in 3 mos of when symp improve
+ for teens risk inc when comorbid wi CD, sub dep, ADHD

Front 23

Previous suicide attempt as risk

Back 23

+60-80% who commit sui have 1 previous attempt, 80% give warning of their intent

Front 24

subjective distress as risk for suicide

Back 24

+people who commit sui tend to be exp high levels of sub stress, motivated by desire to esc pain or bad situation
-Risk is low if contem sui to influence others

Front 25

biological correlates of suicide

Back 25

Low levels of serotonin and 5 HIAA associated with suicide

Front 26

What are 6 Characteristics of suicide assessment?

Back 26

1.Primary Goal - level of risk they will attempt suicide in nr future.
2.lev of risk varies over time
3.Any level of sui crisis should be treated as emergency
4.Includes data collection, MSE, consultations with md's
5.Ask direct questions about SI
6.Uses direct & indirect techs

Front 27

What are gender risk factors for suicide?

Back 27

-4to5 x as many males commit sui as fems.
-Fem attempt sui 3 x males, but succeed less b/c males choose lethal means

Front 28

What are age factors of suicide?

Back 28

-Attempts highest = 24-44
-Completed suicide = 65+

-Biggest increase in age 10-19 wi largest inc 10-14.

Front 29

Race risks for suicide

Back 29

Highest risk for whites for all ages except teens - Native American are higher. White males highest risk of all.

Front 30

Marital status risks for suicide

Back 30

+Higher rates for suicide for divorced, sep, widowed then single.
-lowest rates among married

Front 31

Living Environments

Back 31

+highest risk living alone
+higher risk living in city

Front 32

Psychiatric History as risk for suicide

Back 32

+50-80% of sui inv have history of sev depression. In these cases sui occurs w/in 3 mos of when symp improve
+ for teens risk inc when comorbid wi CD, sub dep, ADHD

Front 33

Previous suicide attempt as risk

Back 33

+60-80% who commit sui have 1 previous attempt, 80% give warning of their intent

Front 34

subjective distress as risk for suicide

Back 34

+people who commit sui tend to be exp high levels of sub stress, motivated by desire to esc pain or bad situation
-Risk is low if contem sui to influence others

Front 35

biological correlates of suicide

Back 35

Low levels of serotonin and 5 HIAA associated with suicide

Front 36

Suicide risk factors specific to teens and kids

Back 36

1.Most common is interper loss (break up wi bf) argu wi parents
2.most attemp are impulsive & out of desire to get atten of other, escape pain
3.ealry warning signs = talk of death,talk of reun wi dead per, giving away prized posess
4.exposure to suicide..media..classmate

Front 37

Suicide risk factors for elderly

Back 37

+physical/mental ill,ethol, stress,few friends,exlcuded from family matters,losses of growing old,loss of spouse,$,etc.

Front 38

What is direct assessment of suicide?

Back 38

1.Inetnt-have they said they want to kill themself..I'm useless
2.Plan-when,where,how. made will recently?
3.Means-can they pull it off?

Front 39

Means of suicide wi highest risk vers lower risk

Back 39

+Guns,hanging,drowning,CO2 poisoning,sleep pills,antidepressants,aspririn,car crash,extreme cold
-low-wrist cutting,housegas,nonRX drugs,valium, tranquilizers

Front 40

MMPI-2 scores suggestive of suicide

Back 40

T-score of 65+ on scale 2 (Depression,D) = possible suicide...inc risk if also elev on 4 (psychopathic dev, pd), 7 (psychasthenia, Pt), 8 (schiz,Sc) &/or 9 (hypomania, Ma)

Front 41

MCMI-III scores ind of suicide potential

Back 41

1.elv score on Depression scale/2B - closely mont sui.
2.elv on both Depressive scale & Bord scale = extr dif cont aff & behav.
3.high score on maj dep scale associate with sense of hopelessness n pess & SI

Front 42

Steps to be taken if LETHALITY of suicide is assessed to be LOW

Back 42

1.talk over problem wi client
2.elicit ambivalent feelings about suicide
3.offer emotional support
4.explore alts for meeting clients needs
5.provide referrals for outside help
6.obtain agreement that client should contact if change is situation i.e. increased hopelessness

Front 43

Steps to be taken if LETHALITY of suicide is assessed to be HIGH

Back 43

1.Take more directive approach: "I don't want you to harm yourself."
2. Develop No suicide contract
3.If client won'r commit to these, notify support system - get their help in watching client and removing weapons

Front 44

What are the components of NO -SUCIDE contract?

Back 44

1.cl promises to not commit sui for spef period of time (2 days)
2.to not stay alone during that period of time
3.remove all lethal means of sui form environment
4.suggest person stays wi friends/family
5.see cl more often and touch base over reg intervals

Front 45

Steps to be taken if LETHALITY of suicide is assessed to be VERY HIGH

Back 45

1.Encourage voluntary commitment to psychiatric facility by client using support system
2.If they refuse,arrange involuntary hold by contacting person or agency designated.
3.follow up until client is stablized
4.after crisis is stablized, follow up to repair any dam caused by breach of confidentiality

Front 46

How do you know if lethality of client's suicide is VERY HIGH?

Back 46

Client has a lethal plan and previous attempts and is socially isolated or client cannot coopertate with any methods of self-protection due to psychosis, drug use, or lack of support

Front 47

When is OUTPATIENT MANAGEMENT appropriate option for suicide risk?

Back 47

1. Suicide risk is low.
2.when high risk client has adequate support system, willing to use outside resources,agrees to no-suicide contract
3.client wi character pathology has history of vague,nonlethal sui threats

Front 48

Important techniques to use when using outpatient management for suicidal client

Back 48

1.Consult wi colleagues
2.reassure client that desire to commite sui is a temporary state & consider other options until crisis has passed
3.Establish rapport and connection to life
4.Establish increased sense of hope - what SPECIFICALLy caused this crisis
3.Teach cl to use prob solving technques
4.help client to distance self and the feeling state - but that pain is not always permanent condition
5.increased social contact
6.teach family members warining signs of sui - have them encourage client to stay connected wi others
7.refer to md if extremely anx or unable to sleep
8.24 hr clincial backup

Front 49

Goals in Assessing Dangerousness to others?

Back 49

1.idenify cause of current crisis
2.determine prob that cl will cause violent act in future
3.may be wriiten or spoken, direct (kill wife) or indirect (do something crazy)

Front 50

Factors associated with high risk for violence

Back 50

1.specific plan 2 hurt someone (have weapon)
2.history of previous acts of violence (has person exp, witness, or perpetrated violence)
3.behavior-signs of tension, agitation, loud speech
4.personality char- poor impulse cont,very agress,labile affect
5.psych dx- drug intox/withdrw,deler,mania,paranoia,impulse control prob
6.demographic-young age (beg. 15-18 to age 30-35) low s.e.s., minority, les educated
7.low IQ, poor school/work his

Front 51

3 variables to determine how dangerous a client is & how directive you should be

Back 51

1.Plan-can client say how,when,where she plans to commit violent act
2.previous violence
3.willingness to use outside resources - isolated = more chance to harm others

Front 52

Clear and Present Danger in danger to others.

Back 52

1. client names intended victim
2.describes motive
3.specific concrete plan for harming victim
4.intends to carry out plan

Front 53

MMPI-2 scores indicative of possible dangerousness to others.

Back 53

a. High score on scale 6 (Paranoia) - psychotic behavior- often seek revenge on others.
b.High- scale 4 (Psychopathic Deviate)=agressive or assualtive
+High on 4 and 9(Hypomania)=antisocial and act on impulsive
+6,4,9 = Dangerous and poor judgment,acting out violently seems justified

Front 54

MCMI-III scores indicative of possible dnagerousness to others

Back 54

+High score on Antisocial Scale 6a - vengful,agressive,
+6b - sadistic,no shame guilt
+High on both is VERY Dangerous
+High on Paranoid scale P-controlling,belligerenet way,brood over injustice,revenge

Front 55

You should express your duty to warn when..

Back 55

Client has identified a specific person who is at risk for suffering physical harm

Front 56

Gravely Disabled Adult

Back 56

Unable to take care of basic needs:food,shelter,clothing. Cannot prepare food,eat,maintain hygene needed to prevent illness,infection,responding appropriately to life-threatening situations

Front 57

Gravely disabled minor

Back 57

Inability to use elements of life essential to health,safety,development: food, clothing,shelter - even though it has been provided by others

Front 58

Indicates functional impairment - gravely disabled

Back 58

1.disorder interferes wi ability to function during interview
2.poor concentration during assessment tasks
3.general capacity to function
4.difficulty interacting wi interviewer
5.multipple imapired areas of performance in client's daily life

Front 59

Procedures available for assessing functional impairment

Back 59

1.MSE- do u hospitalize?
2.BDI-II- 29 or above is high level of incapacity
3.BSI (brief sys inventory) and STAI (state-trait anxiety inventory) scores
4.MMPI elevated scores on 6 (Pa), 8 (sc) 9 (Ma)
5. GAF scores 30-21 = delus,halluc,impairment in judg; 20-11 = danger to self others,minimal hygiene (smear feces),10-0=clear expectation of death due to neglect of above

Front 60

Evidence Code 1024

Back 60

Law that states that what a client communicates to you is not privileged if u dtermine that disclosure is necessary to prevent danger to self/others.
-client cannot invoke privelege

Front 61

Ethics code standard 4.05

Back 61

-You may discole confidential info about client only as mandated by law or valid purpose
Disclose only what is necessary about client to prevent sucide etc.- tell client that u r going to do this

Front 62

Tarsoff decision?

Back 62

Therapist determines patient presents a serious threat of physical violence to another - is obligated to use care to protect intended victim

Front 63

MMPI-2 scores indicative of possible dangerousness to others.

Back 63

a. High score on scale 6 (Paranoia) - psychotic behavior- often seek revenge on others.
b.High- scale 4 (Psychopathic Deviate)=agressive or assualtive
+High on 4 and 9(Hypomania)=antisocial and act on impulsive
+6,4,9 = Dangerous and poor judgment,acting out violently seems justified

Front 64

MCMI-III scores indicative of possible dnagerousness to others

Back 64

+High score on Antisocial Scale 6a - vengful,agressive,
+6b - sadistic,no shame guilt
+High on both is VERY Dangerous
+High on Paranoid scale P-controlling,belligerenet way,brood over injustice,revenge

Front 65

You should express your duty to warn when..

Back 65

Client has identified a specific person who is at risk for suffering physical harm

Front 66

Gravely Disabled Adult

Back 66

Unable to take care of basic needs:food,shelter,clothing. Cannot prepare food,eat,maintain hygene needed to prevent illness,infection,responding appropriately to life-threatening situations

Front 67

Gravely diabled minor

Back 67

Inability to use elements of life essential to health,safety,develoipment: food, clothing,shelter - even though it has been provided by otehrs

Front 68

Indicates functional impairment - gravely disabled

Back 68

1.disorder interferes wi ability to function during interview
2.poor concentration during assessment tasks
3.general capacity to function
4.difficulty interacting wi interviewer
5.multipple imapired areas of performance in client's daily life

Front 69

Procedures available for assessing fucntional impairment

Back 69

1.MSE- do u hospitalize?
2.BDI-II- 29 or above is high level of incapacity
3.BSI (brief sys inventory) and STAI (state-trait anxiety inventory) scores
4.MMPI elevated scores on 6 (Pa), 8 (sc) 9 (Ma)
5. GAF scores 30-21 = delus,halluc,impairment in judg; 20-11 = danger to self others,minimal hygiene (smear feces),10-0=clear expectation of death due to neglect of above

Front 70

Evidence Code 1024

Back 70

Law that states that what a client communicates to you is not privileged if u determine that disclosure is necessary to prevent danger to self/others.
-client cannot invoke privilege

Front 71

Ethics code standard 4.05

Back 71

-You may discole confidential info about client only as mandated by law or valid purpose
Disclose only what is necessary about client to prevent sucide etc.- tell client that u r going to do this

Front 72

Tarsoff decision?

Back 72

Therapist determines patient presents a serious threat of physical violence to another - is obligated to use care to protect intended victim

Front 73

Civil Code 43.92

Back 73

where patient has communicated to therapist serious threat of physical violence against a reasonably ident victim - duty to warn shall be discharged by therapist to comm threat to victim and law enforcement

Front 74

welfare code 5150

Back 74

When person,due to menatl illness,is danger to self,others,or gravely disabled, a peace officer,memebers of county facility,mobile crisis - may go into custody of DMH for 72 hr tx

Front 75

welfare code 5250

Back 75

A 14 day certification for intensive tx that after 72 hours patient remains dangerous to self/others/gravely diabled

Front 76

WIC 5260

Back 76

a second 14 day hold if a patient continues to present danger to self or others

Front 77

WIC 5300

Back 77

After 2nd 14 day hold if client still remains a serious danger, a 180 day hold may be applied

Front 78

WIC 5350

Back 78

If a client is gravely diabled a conservator may be appointed by a court hearing.. if a person has family who will say in writing they will care for cl, then they may not be considered gravely diabled