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40 Cards in this Set

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In order to adequately assess and intervene in a crisis situation, the clinician must possess the following 10 skills
-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
What are some things that a compehensive suicide assessment must include?
-risk and protective factors
-obtained through a minimum of a clinical interview
-A therapist may review records, consult, interview family, use instruments
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
What are the main parts of a suicide assessment?
PADDL PIC
- 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
What is the strongest indicator of increased risk for suicide?
-A history of previous suicide attempts
What people are at risk for suicide based on psychiatric hx?
-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.
Demographic risks of suicide
-Sex
-Race
-Age
-marital status
-immigrant status
-sex (men are 4x more likely than women)
-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)
What are some protective factors for suicide?
-access to care
-family/community support
-prob solving skills
-cultural/religious beliefs that discourage suicide
What are some indications for outpatient tx of suicidal ideation?
-lack of strong intent
-no concrete plan
-no prior attempts
-willingness to contract
-good judgment/lack of impulsivity
-no comorbidity
-family/community support
What are the intervention that must take place if outpatient tx is utilized for suicide risk?
-referral for medication eval
-removing means of harm
-safety contract
-increased therapist avail,
-emergency plan
-involvement of family members
-treatment
-followup
Section 5150 vs Section 5250 vs 5260
5150 = 72 hour hold
5250 = 14 day hold
5260 = another 14 days after 5250
Evidence Code 1024
an exception to privilege when pts mental condition causes him to be danger to self. Used in a legal proceeding to prevent danger
2004 stats for ppl 12 and older for violent crimes. What is the trend of those statistics?
-5.2 violent crimes
-1/1000 rape
-2/1000 assault
-2/2000 robberies
-6/100,000 murders

-Figures are steadily declining and are half of what they were 10 years ago
2004 stats for perps age/race
-60% by persons under age 30
-males > females
-Blacks > Whites
2004 stats for violent crime victims by race
-26/1000 blacks
-21/1000 whites
-13/1000 other
-American Indians have highest rate of all
2004 stats victim offender relationship (by gender, rape relation stats, and child murder relation stats)
-males have equal chance of being victimized by a stranger or non.
-Female > to be victimized by a non
-7 out of 10 women knew rapist
-2/3 of children under 5 were murdered by fam or parentr
School violence stats
-7% hs students bullied past 6 mos
-13% got into a fight on school prop
-12% of male, 6% of female were threatened
Violence assessment - 7 parts
-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
Psychiatric hx risks for violence
-Antisocial personality
-AOD
-Intermittant explosive d.o.
-Schizophrenia
Current mental status risks for violence
-poor judgment
-impulsivity
-negative affectivity/anger
Protective factors for violence assessment
-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
Outpatient intervention with violent pts
-referral medication eval
-removing means of violence
-safety contract
-therapist avail
-emergency plan
-involvement of family members
-tx
-follow-up
Tarasoff defined
-Where a pt has communicated a serious threat of physical violence against a reasonably identifiable victim
Ewing Decision
Tarasoff extends to information recieved from close relations of the client
What must a therapist do in Tarasoff situation
-communicate the threat to victim and to a law enforcement agency
CDC fact on child abuse in 2002.
How many?
Percentages of type of abuse?
906,000 cases
-19% physical
-10% sexual
-5% emotional
CDC 2002 child abuse How many died? How did they die?
1500 died
-36% neglect
-28% physical
-29% multiple types
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
What age group of children at at greatest risk of severe injury or death from abuse?
-79% of deaths less than 4 y.o. greatest
-infants less than 1 y.o. 44%
Children who experience maltreatment are at risk for:
-smoking, AOD, eating d.o.,
-depression
-suicide
-sexual prom
-certain chronic illnesses
Children who are physically abused are at higher risk to be
-victims
-victimizers
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
What are the behavioral and physical signs of chronic physical abuse on children
-overactive and hypervigilant
-withdrawn
-depressed
-underactive
-overly compliant
In addition to the physical abuse signs, some additional sexual abuse signs
-being secretive
-excessive bathing
-sexual provocative
-sleep d.o.
-anxiety
-suicide attempts
-fatigue
-physical sxs
Risk factors toward abuse
-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
DALLY LAP
What are the components to a child abuse assessment?
-interview the child
-observe the child
-interview the parents
-interview collaterals
-refer for a medical evaluation
-administer psychological testing
Child abuse intervention steps

CREATE
-ensure child's safety
-contact Childrens Services
-refer child for medical evaluation and treatment
-assess for co-occurring abuse
-treatment
-eliminating future abuse
Behavioral signs of elder/dependent adult abuse
-Withdrawal
-Fear of being left alone
-extrememly timidity
-anxious or depressed
-expression of fear toward a person
-financial complaints
Elder/Dependent Adult Abuse Assessment
-Interview the elder
-Observe the elder
-interview collaterals
-refer for a medical exam
Elder/Adult Abuse intervention steps
-ensure safety
-contact adult services
-refer for medical exam
-assess for co-occurring abuse
-tx
-elimination future abuse