Crisis Intervention Exam 1

Front 1

Know which organizations were the premise for developing this field of crisis intervention. Created a national movement that turned into crisis. (5)

Back 1

National Save-a-Life League (3) Alcohol Anonymous, Vietnam Veterans, & Women’s Movement of 1970’s (5) WHO

Front 2

Know the definition of crisis is according to authors of text book: (9)

Back 2

For an individual, crisis is the perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms. • Unless the person obtains relief, the crisis has the potential to cause severe affective, behavioral, and cognitive malfunctioning up to the point of instigating injurious or lethal behavior to oneself or others. • At that point the crisis becomes a behavioral emergency

Front 3

Know definition of transcrisis: (12)

Back 3

• Effects of original crisis may extend a good bit beyond the 6 to 8 weeks of the crisis• What occurs during the immediate aftermath of the crisis event determines whether or not the crisis will become a disease reservoir that will be transformed into a chronic and long term state• An adult who has unresolved anger toward a dead parent and transfers that anger to other authority figures, such as supervisors or employers is in a transcrisis state.

Front 4

What is the Definition of Developmental Crisis? (18)

Back 4

events in the normal flow of human growth and evolution whereby a dramatic change or shift occurs that produces abnormal responses

o Example: response to a birth of a child, graduation from college, midlife career change, retirement, or even aging process

o Considered normal

o All persons and all developmental crises are unique and must be assessed and handled in unique ways

Front 5

What is the Definition of Situational Crisis? (18)

Back 5

emerges with the occurrence of uncommon and extraordinary events that an individual has no way of forecasting or controlling

oTerrorist attacks, automobile accidents, kidnappings, rape, job loss, or sudden illness and death

o Is random, sudden, shocking, intense, and often catastrophic

Front 6

What is the Definition of Existential Crisis? (19)

Back 6

includes inner conflicts and anxieties that accompany important human issues of purpose, responsibility, independence, freedom, and commitment

o Age 40 one will never make a significant and distinct impact on a particular profession or organization, remorse, age 50, one chose to never marry or leave one’s parents’ home, never made a separate life, and now has lost forever the possibility of being a fully happy and worthwhile person, age 60, one’s life is meaningless, there is avoid that can never be filled in a meaningful way

Front 7

What is the Definition of Ecosystemic Crisis?

Back 7

occur when some Natural or Human-caused disaster overtakes a person or a group of people who find themselves, through no fault or action of their own, inundated in the aftermath of an event that may adversely affect virtually every member of their environment in which they live.

o Hurricanes, floods, tsunamis, earthquakes, volcanic eruptions, tornadoes, blizzards, mudslides, drought, famine, and forest or grassland/brush fires.

o Can be biologically derived: disease epidemic like ebola or the effects of a huge oil spill

o Can be politically based: war, refugee crisis associated with war or ethnic cleansing,

o Can be severe economic depression : great depression of early 20th century (18-19)

Front 8

5. Know what Erich Lindemann crisis theory is:

Back 8

• Behavioral responses to crisis associated with grief are normal, temporary, and amenable to alleviation through short-term intervention techniques

o These include:

- Preoccupation with the lost one

- Identification with the lost one

- Expressions of guilt and hostility

- Some disorganization in daily routine 

- Some evidence of somatic complaints

• Negated the prevailing perceptions that clients manifesting crisis responses should necessarily be treated as abnormal or pathological

Front 9

6. What Approach does Psychological first aide takes.

Back 9

• Seeks to address the immediate crisis situation and provide immediate relief, possibly to a wide range of individuals. (20)

• Empirically grounded, best practice techniques designed to provide immediate, palliative mental health assistance to survivors

• Defined as establishing the safety of the client, reducing stress-related symptoms, providing rest and physical recuperation, and linking clients to critical resources and social support systems (21)

• Provide caring support, empathic responding, concrete information and assistance, and reuniting of survivors with social support systems.

• Bare bones basics of crisis intervention

• It is palliative: does not cure or fix anything, provides nonintrusive physical and psychological support (21)

Front 10

7. Who are the major providers of crisis intervention in the US (20

Back 10

• Second order intervention or crisis therapy seeks to resolve the crisis and is generally provided by trained, licensed human services professionals

Front 11

8. What is collaborative counseling. What do we know about this approach

Back 11

• Enables the crisis worker to forge a real partnership with the client in evaluating the problem, generating acceptable alternatives, and implementing realistic action steps

• When triage assessment indicates that the client cannot function successfully in a nondirective mode but has enough mobility to be a partner in the crisis intervention process, the worker is collaborative to that degree

• Client has a triage score that is in the high single digits to middle teens the crisis worker can typically operate in a collaborative mode

• It is a WE approach and not an I approach or a YOU approach. (90)

• Full partner in identifying the precipitating problem, examining realistic alternatives, planning action steps, and making a commitment to carrying out a realistic plan.

• Client is not as self-reliant and autonomous as the fully mobile client but does have enough ego strength and mobility to participate in resolving the problem

Front 12

9. Know what the hybrid model of crisis assessment is. Don’t need to know the tasks but need to know what each tasks does. (50-57)

Back 12

• Task 1: Predispositioning- Armed Forces and Government Agencies get supplies, equipment, and Personnel ready to meet a future emergency

• Task 2: Problem Exploration-To see the crisis from the clients’ perspective and then to define the crisis

• Task 3: Providing Support- Communicating to the Client that the Worker is a person who cares about the client.

• Task 4: Examining Alternatives-

1) Situational Supports- people known to the client who might care what happens to the client

2) Coping Mechanisms- actions, behaviors, or environmental resources that the client might use to get through the current crisis

3) Positive and Constructive Thinking Patterns- Reframing the problem into a way that is positive to the client to lesson anxiety and stress level

• Task 5: Planning in Order to Establish Control- Helping Clients create a plan to guide them the resolution of their crisis

• Task 6: Obtaining Commitment- Brief and Simple, have Client Verbally Summarize the Plan

• Task 7: Follow-up- Timeframe is Minutes, Hours, and Days keeping track of client’s success in keeping equilibrium

Front 13

10. What is the greatest concern when doing crisis intervention? (57)

Back 13

Assuring Safety of the Client, Others in the Environment, and Workers

Front 14

11. A why question is what sort of question? (74)

Back 14

• Open-Ended Question that makes the client defend his or her actions, or externalize it without taking responsibility for own actions.

Front 15

12. You need to know how action and mobility work. Might be a graph in book. What level of action matches what type of mobility? Your actions have to match the actions of the client at the time. (graph at top of page 89)

Back 15

Crisis Worker is Directive

------------------------------------>

Client is Immobile

Case Worker is Collaborative

------------------------------------------>

Client is Partially Immobile

CW is Non-Directive

----------------------------->

Client is Mobile

Front 16

13. How should a crisis worker interact with their client? (90)

Back 16

The worker is a support person who may listen, encourage, reflect, reinforce, self-disclose, and suggest.

Front 17

14. When did crisis workers use silence? (85)

Back 17

Silence gives the client and the worker thinking time. Remaining silent but attending closely to the client can convey deep, empathic understanding, nonverbally coming across as “I understand your struggle trying to put those feelings into words, and it’s OK. I know its tough but I believe you can handle it. However, I am right here if you need me.

Front 18

15. What's the best pronoun to use when doing crisis work? (75)

Back 18

• I statements

Front 19

16. Know of the Tarasoff case. Been expanded to people who live in a home of a person. (228)

Back 19

If the School Counselor did not assess for suicide and did not take action, she could be held legally accountable as Negligent. Ethically and Legally bound to take action and report despite Client’s protestations. The School Counselor, like any other helping services professional, has a duty to disclose life-threatening behavior. Duty to Protect allows for Confidentiality to be broken. Professionals also have a duty to Warn about life-threatening behavior towards others.

Front 20

17. Characteristics of effective crisis worker. (last page of chapter 1)

Back 20

• Life experience: (23)

• Personal characteristics: Poise: remaining calm, poised, and in control. Creates a stable and rational atmosphere, steady and well anchored psychologically (24)

• Creativity and flexibility:

• Energy and resiliency: crisis requires energy, organization, direction, and systematic action

• Quick mental reflexes: requires more activity and directiveness than ordinary therapeutic endeavors usually do

• Assertiveness: proactive, assertive, and directive

• Other attributes: tenacity, ability to delay gratification, courage, optimism, a reality orientation, calmness under duress, objectivity, a strong and positive self-concept, abiding faith that human beings are strong, resilient, and capable of overcoming seemingly insurmountable odds. Spiritual sense in that they know when to seek nourishment from that spiritual source when to let that higher power take over them

Front 21

what is the linear model in crisis intervention? ACT Model (22)

Back 21

• Assessment of the Presenting Problem, including emergency psychiatric and other medical needs and trauma assessment

• Connecting clients to support systems

• Traumatic reactions and posttraumatic stress disorders

Front 22

19. what do we do in the planning phase? What activities (55)

Back 22

• Planning action steps that have a good chance of restoring the clients’ emotional, behavioral, and cognitive equilibrium.

• Getting through the short term and restoring stability.

• This can be done by Psycho-education. (56)

Front 23

scenario and we come up with a response

Front 24

what does promoting expansion mean? (80-81)

Back 24

• Crisis worker engages in activities that open up clients’ tunnel vision of the crisis. Helps the client to step back, reframe the problem, and gain new perspectives. Most effective for clients no able to recognize environmental cues that may help them to perceive alternate meanings of events and possible solutions to them.

Front 25

what is a borderline (110)

Back 25

• Clients that do not respond well to treatment and generally got worse. Somewhere between neurosis and psychosis.

Front 26

23. what is: IS PATH WARM?

Back 26

• American Association of Suicidology has created a list of suicide warning signs with the mnemonic IS PATH WARM

• I – Ideation

• S- substance abuse

• P-purposelessness

• A- anxiety and agitation

• T- feeling trapped

• H- hopelessness

• W- withdrawal

• A- Anger

• R- recklessness

• M- mood fluctuations (214)

• Warning signs are different from symptoms

• Symptoms can only be described, warning signs are observable

Front 27

24. SAD PERSONS what does that stand for? (214)

Back 27

• Sex

• Age

• Depressive symptoms

• Previous attempts,

• Ethanol use

• Rational thinking loss

• Social support lacking

• Organized plan

• No spouse

• Sickness

• Designed to assess manifestations of clinical suicide ideation and empirical factors that have been previously identified as being related to risk for suicide attempts.

• Scales accumulate data on relevant demographics, symptoms of suicidal behavior, stress, resources outside of self, personal and social history, and historical and situational variables currently identified in the suicide literature as significant predicators of suicide attempts

• These devices alone have had a notoriously poor track record for predication

• Risk assessment is greatly improved when these instruments are backed up by a clinical interview and their party collateral information (214)

Front 28

25. what is an expressive act in suicidal prevention?

Back 28

• Police deal with a multitude of expressive kinds of crime in which individuals pose a serious threat to themselves or others because of their own anger, fear, vulnerability, depression, or lack of emotional control (102)

• Suicidal/homicidal person is one who is engaged in an expressive act of homicide designed to reduce psychological pain. (203)

o Likely to be emotionally distraught, may feel gravely wronged, depressed, helpless, disempowered, and hopeless, and may attempt to solve their own dilemmas through harm to others and then to themselves. (203)

Front 29

26. Scenarios know what danger signals are for people who are actively suicidal? (239)

Back 29

Many risk factors have been identified that serve as danger signals and help to determine levels of lethality. Some of the highest risks are the presence of serious intent, a history of prior attempts, and evidence of a specific or lethal plan. Clients often send out subtle by definite cues and or/cries for help.

Front 30

27. know the different Types of traumatization’s: (194)

Back 30

• PTSD

Childhood Trauma is important not only for what it does to children, but also for the after effects that carry into adulthood.

• Type 1 Trauma: one sudden distinct traumatic experience

• Type II Trauma: Physical and Sexual Abuse; and Refugee Children from war-torn countries

Front 31

28. Ambivalence and how it plays in a person who is actively suicidal (213 &214)

Back 31

• People with strongest death wishes are invariably ambivalent, confused and grasping for life. They emit clues/hints about serious trouble or call for help in some way, including

• verbal clues

• behavioral clues

• situational clues

• syndromatic clues – include constellations of suicidal symptoms as severe depression, loneliness, hopelessness, dependence, and dissatisfaction with life.

Front 32

29. why does telephone counseling crisis lines work? (pg. 142 and list from page 117 – 119)

Back 32

They are fast, convenient, accessible, cheap, anonymous, and helpful and there is evidence from empirical studies that supports consumer opinion about the efficacy of using multiple electronic resources during a crisis event. (page 142).

The books lists several reasons for popularity of telephone in solving psychological problems: 1.Convenience 2. Client anonymity 3. Control 4. Immediacy of access5. Cost-effectiveness6. therapeutic effectiveness7. access to support systems8. Avoidance of dependency issues9. Worker anonymity 10. Availability of others for consultation 11. Availability of an array of services 12. Service to large and isolated geographic areas and populations

Front 33

30. Who is it that mans the hotlines. What kind of person?

Back 33

Volunteers

Front 34

31. What is the greatest benefit of a phone line that answers when it is a crisis. Instead of sending a person to the home.

Back 34

• They are fast, convenient, accessible, cheap, anonymous, and helpful and there is evidence from empirical studies that supports consumer opinion about the efficacy of using multiple electronic resources during a crisis event.

Front 35

32. Who does the majority of the work?

Back 35

Volunteers

Front 36

33. Why can they do the majority of work and why do people buy into it?

Back 36

• Feedback. In crisis intervention, continuous and immediate feedback is critical and synchronous internet applications can serve this function well. Interventionists can check in with client and client can initiate contact when needed. Disinhibition effect. People tend to open up earlier with more distressing issues then they would normally do in a face to face. Depersonalization and distance make it safer to share intimate information (esp. males).

Front 37

34. So when comparing crisis theory and brief therapy how are they different? (15)

Back 37

• Brief Therapy theory: attempts to remediate more or less ongoing emotional problems

• Basic Crisis Theory: focuses on helping people in crisis recognize and correct temporary affective, behavioral, and cognitive distortions brought on by traumatic events

• Brief or solutions-focused therapy may be the equivalent of crisis intervention in that it seeks to restore the person to a state of homeostasis or equilibrium, not all brief or solution focused therapy is related to crisis intervention (15)

• Differentiating between brief or solution-focused therapy and crisis intervention depends on how intensely the client views the problem as intolerable or on how much emotional disequilibrium over the event may escalate the person into crisis and the therapist into a crisis intervention modality.

Front 38

What is a culturally skilled counselor, and who is the expert on culture?

Back 38

A therapist who has the awareness, knowledge, and skills necessary to treat clients from diverse cultural backgrounds

Client

Front 39

36. What are the ABCs in your assessment?

Back 39

• Crisis is time-limited. The severity of the crisis is assessed from the client’s subjective viewpoint and from the worker’s objective viewpoint. Objective assessment is based on an appraisal of client’s functioning in three areas that may be referred to as ABCs of assessment. Affective (feeling or emotional tone, behavioral (action or psychomotor activity) and cognitive (thinking patterns)

• A = Affective state. Often first sign client is in a state of disequilibrium.

• B = Behavioral functioning. Focus attention on doing, acting out, taking active steps, behaving, etc. Quickest way to get client to become mobile is to facilitate positive actions they can take at once (concrete and immediate activity). The fundamental problem with immobility is loss of control. Doing something concrete helps restore control.

• C = Cognitive state. Assessment of client’s thinking patterns provide answers to several important questions.

Front 40

37. Definition of one skill that crisis workers have to have that other workers don’t have. (51)

Back 40

• Core Listening skills: Empathy, Genuineness, and acceptance or positive regard

Front 41

38. what do open end questions do? (73)

Back 41

• Open ended questions usually start with why or ask for more clarification or details. Open-ended questions encourage clients to respond with fuller statements and at deeper levels of meaning. They are used to elicit from clients something about their feelings, thoughts, and behaviors and helpful during Problem Exploration phase of intervention. Guidelines for forming opening-ended questions:

1. Request description2. Focus on plans 3. Expansion 4. Assessment 5. Stay away from why questions

Front 42

What do Closed Ended Questions do? (74)

Back 42

• Closed ended questions seek specific, concrete information from client. They are designed to elicit specific behavioral data and yes or no responses. Usually begin with verbs such as do, did, does, can, have, had, will, are, is, and was. They elicit specific answers. Particularly suited from obtaining commitments to take action and in regard to safety issues.

Guidelines for forming closed-ended questions: 1. Request specific information2. Obtain a commitment 3. Increasing focus 4. Avoid negative interrogatives (don’t, doesn’t, isn’t, aren’t, wouldn’t tend to imply agreement)

Front 43

40. collaborative counseling what it is and why we use it? (90)

Back 43

• Collaborative counseling is a “we” approach. A collaborative client is a full partner in identifying the precipitating problem, examining realistic alternatives, planning action steps, and making a commitment to carrying out a realistic plan. The worker is needed to serve a as a temporary catalyst, consultant, facilitator, and support person.

Example: Rita: I thought about going to my mother’s or going to a battered women’s shelter or even calling my school counselor friend for a place to stay tonight.

CW: Let’s examine these three choices, and maybe some others available to you that I know of, and we’ll see which one will best meet your requirements.

Front 44

41. what’s the primary goal of suicide assessment and prevention? (222)

Back 44

• The goal is to establish a framework that rewards alternatives to suicidal behavior and minimizes the short-term reinforcements that occur when suicidal ideation and behavior start to develop and develop a safety plan.

Front 45

42. what’s the fastest way to resolve a crisis?

Back 45

• Telephonic Crisis Hotlines

Front 46

43. what behaviors are involved in listening skills? (73 & summary on 95)

Back 46

• Listening includes such techniques as restatement, reflection, owning statements, and open and closed-ended questions. Essential components of effective listening and communication include effect attending, empathy, genuineness, and acceptance.

• (78) Listening is the first imperative in crisis intervention. It is applied broadly to several important behavioral and communications skills.

To function in a facilitative way, workers must give full attention to the client by: 1. focusing their total mental power on the client’s world.2. Attending to the client’s verbal and nonverbal messages (what the client does not say is sometimes more important than what is actually spoken) 3. Picking up on the client’s current readiness to enter into emotional and/or physical contact with others, especially with the worker. 4. Emitting attending behavior by both verbal and nonverbal actions, thereby strengthening the relationship and predisposing client to trust the crisis intervention process.

Front 47

44. what sort of steps are in a viable client plan (action plan) (92&93)

Back 47

• After developing a short, doable list of alternatives, the worker needs to move on to making plans. In crisis intervention, the worker endeavors to assist the client to develop a short-term plan that will help he client get through the immediate crisis as well as make the transition o long-term coping. The plan should include the client’s internal coping mechanisms as well as sources of help in the environment. The coping mechanisms are usually brought to bear on some concrete, positive, constructive action that clients can take to regain better control of their lives. Actions that initially involve some physical movement are preferred. The plan should be realistic in terms of the client’s current emotional readiness and environmental supports. It may involve collaboration with working until the client can function independently. The effective crisis worker is sensitive to the client’s need to function autonomously as soon as feasible.

Front 48

45. why do we use referral sources. What is the purpose of them in crisis intervention? (94)

Back 48

• Networking and referral sources are invaluable in helping cut through bureaucratic red tape, expedite emergency assistance, and personalize many services that might otherwise not be available to clients. It helps spread the responsibilities among other helping professionals.

Front 49

46. scenario: what should you do first (know the 7 steps) (50-57)

Back 49

• Task 1: Predispositioning- Armed Forces and Government Agencies get supplies, equipment, and Personnel ready to meet a future emergency

• Task 2: Problem Exploration-To see the crisis from the clients’ perspective and then to define the crisis

• Task 3: Providing Support- Communicating to the Client that the Worker is a person who cares about the client.

• Task 4: Examining Alternatives- 4) Situational Supports- people known to the client who might care what happens to the client5) Coping Mechanisms- actions, behaviors, or environmental resources that the client might use to get through the current crisis6) Positive and Constructive Thinking Patterns- Reframing the problem into a way that is positive to the client to lesson anxiety and stress level

Front 50

scenario: what do you do. Health and welfare check. Welfare check. When you activate law enforcement and if you need to be there or not (102)

Back 50

• Geriatric or Physically Disabled Clients may be necessary to conduct a home visit. Depending on state statutes is whether or not a mental health professional is part of the Mobile Crisis Team (MCT)

Front 51

50. scenario: billy bob. What would you do? It is active.

Back 51

You don’t just sit there if someone says they will hurt themselves.

Front 52

46. 7 steps continued

Back 52

•Task 5: Planning in Order to Establish Control- Helping Clients create a plan to guide them the resolution of their crisis•Task 6: Obtaining Commitment- Brief and Simple, have Client Verbally Summarize the Plan•Task 7: Follow-up- Timeframe is Minutes, Hours, and Days keeping track of client’s success in keeping equilibrium.