3 the intervention and assessment models

©2013, Brooks/Cole Cengage Learning

CHAPTER THREE

The Intervention and Assessment Models


Triage Assessment System

Evaluates the severity of a crisis situation.

Rapid Systematic Intentional

Supports the client in gaining: Equilibrium Mobility Autonomy


Hybrid Model of Crisis Intervention

No longer a linear or stage model.

Hybrid Model = linear + systems models. Can be linear or circular Tasks are the foundation

Predispositioning/Engaging Problem Exploration Providing Support Examining Alternatives Planning in Order to Reestablish Control Obtaining Commitment Follow-up


Task 1: Predispositioning/Engaging

Clients may not want to talk or may be so out of control that they are not even aware of the crisis worker’s presence.

Engage in such a way that clients will be receptive to intervention.

Establish a therapeutic bond Inform the client about what to expect


Task 1 Cont.

How to Engage: Approach slowly, calmly, and with open body

language. Introduce yourself and ask their name. Use their name and maintain eye contact. Use basic listening skills and open-ended

questions. Clarify intentions. Allow client to cathart without escalation.


Task 2: Problem Exploration

Define the problem from the client’s point of view.

May be difficult during the middle of a chaotic situation

Do not need a complete history Do need to identify the precipitating event


Task 3: Providing Support

Communicate concern for the client.

Three types of support: Psychological support

Unconditional positive regard Logistical Support

Physical support (food, water, shelter, etc.) Education Resources

Social Support Examine the client’s primary support system

• May not have the resources • May not be easily accessible• May not be willing• Client may be too embarrassed to seek help


Task 4: Examining Alternatives

Clients often think they have no options or develop tunnel-vision.

Three key components: Situational supports Coping mechanisms Positive thinking patterns

Brainstorm numerous alternatives. Continuous process due to rapidly changing

conditions


Task 5: Planning in Order to Reestablish Control

Creating a plan includes: Identifying resources for immediate support Develop coping mechanisms

A good plan needs to be: Developed by the client Clear Realistic Behaviorally specific Immediate (minutes, hours, or days)

A plan allows the client to establish autonomy and become mobile.


Task 6: Obtaining Commitment

If Task 5: Planning was done effectively, obtaining commitment may be easy.

May be simply having the client verbally summarize the plan.

If lethality is involved, a commitment may need to be written and signed by both parties.

If there is any hesitation, the crisis worker may need to revisit earlier tasks.

No commitment should be imposed by the crisis worker!


Task 7: Follow-up

Time frame of minutes, hours, or days.

Inquire about the client’s ability to maintain mobility and equilibrium.

Reinforces the crisis worker’s support of the client.


Assessing

Continuous throughout crisis intervention.

Allows the crisis worker to evaluate: Severity of the situation Client’s emotional, behavioral, and cognitive

status Client’s level of mobility Safety (client’s, self, and others) Success of the crisis worker in deescalating the

situation


Factors That Impact One’s Emotional Stability

The duration of the crisis event.

The degree of emotional stamina.

The ecosystem in which the client resides.

The developmental stage of the client.


Psychobiology Related to Crisis Intervention

Traumatic events may impact the: Release of neurotransmitters Central and peripheral sympathetic nervous

systems Hypothalamic-pituitary-adrenocortical axis

Abnormal changes in neurotransmitters are involved in mental health disorders.

Both legal and illegal drugs have a major affect on mental health.


Triage Assessment Form (TAF)

Effective method of obtaining a real-time assessment of the client’s affective, behavioral, and cognitive statuses.

Can be performed quickly by a wide spectrum of trained crisis workers.

Police officers School counselors Volunteer crisis line workers Resident hall staff

Informs the crisis worker of the current state of the client and of their own ability to deescalate the situation.


Do You Know Your ABC’S?

Three main domains of triage assessment

Affective Feeling or emotional tone

Behavioral Action or psychomotor activity

Cognitive Thinking patterns


Affective State

Often the first sign of disequilibrium.

Can manifest as overly emotional or withdrawn.

Incongruences among what the client says, how it is said, and non-verbal behaviors.

Key question to ask: Do people typically show this kind of affect

in situations such as this?


Behavioral Functioning

Focus on psychomotor activities. Approaches Avoids Paralyzed

Often difficult for immobilized people to take independent actions.

Attempt to have the client engage in a small concrete and immediate activity.

Key questions to ask: In the past, what actions did you take that helped you get

back in control? What would you have to do now to get on top of the situation?


Cognitive State

Client’s thinking patterns: Rationalizing? Exaggerating? Downward spiral?

Crisis events are typically perceived as either a: Transgression (present) Threat (future) Loss (past)

Key questions to ask: How long has the client been engaged in crisis thinking? How open is the client to reframing? How often does the client engage in crisis thinking?


Rating Clients using the TAF

Score from high to low to rule out more severe impairments.

Each domain has a range from 1-10 (1=lowest score and 10=highest score).

Total rating ranges from 3-30. Total score of 3-10 is a rating of minimal

impairment Total score of 11-19 is a rating of moderate

impairment Total score of 20+ is a rating of severe impairment


TAF Rating

Using the sample case of Leron from the textbook, how would you score Leron using the TAF . . .

When Leron first exits Union Avenue? When the CIT officer initially meets Leron? When Leron agrees to leave the scene and gets

into the police car? When the CIT officer is following-up with Leron

at the legal aid office?

3 the intervention and assessment models

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