Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
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.) |