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20 Cards in this Set

  • Front
  • Back
What constitutes a crisis?
Suicide, assault, child abuse, elder/dependent abuse, other crisis situations (i.e. medical emergency, grave disability, medication situations)
What knowledge and skills do you need for crisis situations?
* Capacity to establish a therapeutic alliance
* Knowledge of and assessment of risk factors
- static or stable and dynamic or changing risk factors;
- demographic variables, ideation, intent, plan, comorbid psychiatric disorders, medical disorders, etc.
* Knowledge of assessment approaches
- patient interview, collateral interviews, record review, testing
* Knowledge of additional resources
- psychiatric consultation for medication, community resources for additonal support, and emergency resources
* Abitlity to include family as appropriate
- initial assessment, treatement planning, and ongoing risk assessment
* Assessment of need for hospitalization (voluntary or involuntary)
* Specific interventions to reduce imminent risk factors
- ensuring that means of suicide/assault are removed, contracting for safety, increasing session frequency, generating contingency plans, etc.
* Short-term and long-term treatment interventions
- short term treatment directive and crisis-focused emphasizing problem solving and skills building;
- long-term treatment to address undelying problems
* Knowledge of culture and diversity issues
* Understanding of legal and ethical responsibilities
- reproting requirements, hospitalizaiton, and duty to warn
What are the components of a Suicide assessment
- Assessment of risk factors as well as protective factors/deterrents.
- Information obtained through interview of the patient and therapist observations
- When possible review records, consult with other treatment providers, interview family members, and use instruments and scales designed to measure suicidality (e.g. Beck Suicide Scale)
- Ideation, intent, plan, and means (intensity and duration of suicidal ideation; specificity of the suicidal plan; preparation for suicidal attempt; access and means)
- Previous suicide attempts and family history of suicide
(history of previous suicide attemps is the strongest risk factor)
- Psychiatric history (more than 90% of people who kill themselves have a co-morbid psychiatric diagnosis; Diagnosis most commonly associated with suicide include depression, schizophrenia, alcohol and drug dependence, and personality disorders)
- Current mental status (depressed mood, hopelessness, helplessness, guilt, impaired thinking, poor judgment, hallucianations, delusions, and imulsivity and aggression all increase the risk of suicide)
- Physical issness
- Demographics (sex, race, age, marital status, immirant status)
- Losses/Lack of resources
- Protective factors/deterrents (access to effecitve clinical care; family and community suppor; skills in problem solving; cultural and religious beliefs)
Types of Intervention
The clinician must determine whether the patient can be treated on an outpatient basis, or whether the risk is so high that hospitalization (either voluntary or involuntary) is necessary.
What are Outpatient Interventions for Suicidal Clients?
- Referral for medication evaluation (Psychiatrist for a medication evalutation; Clinician should be aware of all medications as well as illicit substances; Barriers to medication compliance should be addressed)
- Removing means of harm
- Safety contract, therapist availability, and emergency plan
- Involvement of family members and significant others (the therapist must evaluate the indications as well as any contraindications for involving family members in the patient's care.
- Treatment (short-term - directive and crisis-focused empahasizing problem-solving and skills building; Longer range interventions focus on underlying psychiatric and medical problems.
- Follow-up
What are inpatient interventions for suicidal clients?
- When sucide risk is high, hospitalization is necessary. As a first option, the patient should be offered voluntary hospitalization
- A patient at high risk that refuses voluntary hospitalization can be hospitalized on an involuntary basis.
What are ethical and legal issues in suicide
- Exeption to confidentiality (safety emergencies are exceptions to confidentiality; Any breach of confidentiality should be limited
- Involuntary hospitalization - The Welfare and Institution Codes:
Section 5150 - 72 hour hold
Section 5250 - 14 day hold
Section 5260 - additonal 14 day hold
- Exception to privilege (Evidence Code 1024 - in a legal proceeding privileged information can be disclosed to prevent the danger)
What are the components of a Violence and Assault Assessment?
- Ideation, intent, plan, and means (intensity and duration of assaultive ideation; Specificity of the assaultive plan; Preparation for assaultive attempt; Access and means)
- Criminal history and antisocial attitudes
-Psychiatric history (Antisocial Personality Disorder is one of the top four risk factors for violence; Alcohol and Drug use and abuse; Intermittent Explosive Disorder; A history of family violence, childhood abuse, or witnessing abuse in the home)
- Current mental status (Poor judgment and impulsivity; Negative affectivity-especialy anger; Feeling stressed, frustrated, and agitated; Active psychotic symptoms)
- Demographics (Males; Young - under age 30; Non-white; Poor; Low IQ)
- Interpersonal relationships/lack of resources
- Protective factors/deterrents (Access to effective clinical care; Family and community support; Commitment to school/work and involvement in social activities; Coping skills; Cultural and religious beliefs; Fear of being hurt and fear of punishment)
What are violence and assault interventions?
The clinician must determine whether the patient can be treated on an outpatient basis or whether the risk is so high that hospitalization (either voluntary or involuntary) is necessary
What are Outpatient interventions for Violence and Assault?
- Referral for medication evaluation (Psychhiatrist for a medication evaluation; Clinician should be aware of all medications as well as illicit substances; Barriers to medication compliance should be addressed in treatment)
- Removing means of violence
- Safety contract, therapist availabiliyt, and emergency plan
- Involvement of family members and significant others (The therapist must evaluate the indications as well as any contraindications for involving family members in the patient's care)
- Treatment (Short-term - directive and crisis-focused emphasizing problem-solving and skills building)
- Follow-up
When is inpatient hospitalization necessary for violence and assault?
When risk of violence is very high, hspitalization is necessary; voluntary hospitalization should be offered as a first option
What are Ethical and Legal issues with Violence and Assault?
- Tarasoff duty (The Tarasoff Statute - civil code 43.02 - "Where the patient has communicated to the psychotherapist a serious threat of physical violence against a reasonably identifiable victim or victims". Ewing Decision - Patient communication extends to information given to the therapist by a close relation of the patient (e.g. spouse or sibling))
- Exception to confidentiality (safety emergencies are exceptions to confidentiality
- Involuntary hospitalization - The Welfare and Institution Codes:
Section 5150 is a 72 hour hold
Section 5250 certification is a 14 day hold
Section 5300 - an additonal 180 day hold
- Exception to privilige (Evidence code 1024 - In a legal proceeding, privileged information can be disclosed to prevent the danger)
What are the components of a Child Abuse Assessment?
- Interview the child (It is recommended that the therapist typically not ask leading questions)
- Observe the child (Look for both physical signs as well as behavioral indicators of abuse)
- Interview the parent(s) (Obtain theri views of what they believed occurred and what changes they've noticed; Inconsistencies should be noted; Ask the parents about how they discipline their child)
- Interview collaterals (Teachers, coaches, other family members who know the child, or any other treatment provider working with the child)
- Refer for a medical evaluation
- Administer psychological testing
What are components of Child Abuse Intervention?
- Ensure the child's immediate safety
- Contact the Department of Children's Services (DCFS)
- Refer the child for medical evaluation and treatment
- Assess for co-occurring abuse inside or outside of the home (assess whether other children, elders in the home, or one of the parents may also be experiencing in the home; Assess whether the perpetrator has access to other potential victims outside of the home)
What are the components of Child Abuse Intervention?
- Treatment (Assess whether any specific disorders have developed secondary to the abuse; Establishing a therapeutic alliance; Education about the abuse; Improve self-esteem and reestablish a sense of safety; Educate parents about the sequelae of abuse)
- Eliminating future abuse (Parent education regarding age-appropriate behaviors in children; Parent skills training; Anger management, problem solving, stress management; Access environmental supports; Develop a safety plan)
What are Ethical and Legal issues in regards to Child Abuse?
- Child abuse reporting (The California penal code - sections 11164-11166 - therapists are legally mandated to report "suspected" child abuse to a child protective agency)
What are the components of an Elder/Dependent Adult Abuse Assessment?
- Interview the elder or dependent adult (Directly interview the elder/dependent adult, initially avoid direct questions)
- Observe the elder or dependent adult (Look for both physical signs and behavioral indicators of abuse)
- Interview collaterals (Talk with people who are in the patient's immediate environment; Inconsistencies should be noted)
- Refer for a medical examination
What are the components of Elder/Dependent Adult Abuse Intervention?
- Ensure the elder or dependent adult's immediate safety
- Contact Adult Protective Services (APS)
- Refer for medical evaluation and treatment
- Assess for co-occurring abuse inside or outside the home (Assess whether other elders or childrenat home may be at risk; Assess whether the perpetrator has access to other victims)
- Treatment (Treat the emotional sequelae of abuse; Assess wheter any specific disorders have developed secondary to the abuse)
- Eliminating future abuse (Educate the family about the needs of the elderly person and reasonable expecations; Access additional support for the family; Secure other living options for the elder or dependent adult if necessary; Refer perpetrators to anger management, stress management, or treatment focused on improving problem solving skills; Develop a plan of safety)
What are the Ethical and Legal issues revolving around Elder/Dependent Adult abuse?
Elder/dependent adult abuse reporting ( The Welfare and institutions Code - Sections 15610, 15630-15634 - Therapists are legally mandated to report physical abuse, abandonment, isolation, financial abuse, or neglect of any elder or dependent adult to an Adult Protective Agency or local law enforcement)
What are some additional Crisis situations?
- Acute medical illness or problems ( Chest pain, difficulty breathing, or delirium requires immediate medical care)
- Drug or alcohol intoxication or withdrawal
- Acute psychosis
- Anorexia/bulimia (can be potentially life threatening)
- Grave disability (Unable to adequately provide for their food, clothing, or shelter, gravely disable patiens must be hospitalized.
- Inrimate partner abuse (Gunshot wound, stab wound, broken bones, or possible internal bleeding requires immediate medical attention.)