Crisis Assessment and Management Flashcards
INDICATORS OF CHILD NEGLECT
Child indicators are
- frequently absent from school,
- begs or steals food or money,
- lacks medical or dental care,
- is consistently dirty,
- lacks appropriate clothing, and
- reports there is no one at home to provide care
Parent/caregiver indicators are
- indifference to the child,
- chronic illness or mental disorder, and
- reports being neglected as a child
INDICATORS OF CHILD PHYSICAL ABUSE
Child indicators are
- unexplained burns, bruises, etc. that vary in stage of healing,
- wears clothing to hide injuries,
- is afraid of parents/caregivers, and
- reports being physically mistreated.
Parent/caregiver indicators are
- offers conflicting or unconvincing explanation for child’s injury,
- describes the child in negative ways,
- uses harsh discipline,
- abuses alcohol or drugs,
- has poor impulse control, and
- reports being physically abused as a child
INDICATORS OF CHILD EMOTIONAL MALTREATMENT
Child indicators are
- extremes in behavior,
- consistently makes derogatory remarks about him/herself,
- has attempted suicide,
- has a habit disorder, and
- reports a lack of attachment to the parent or caregiver
Parent/caregiver indicators are
- constantly blames or belittles the child,
- is unconcerned about the child,
- overtly rejects the child,
- abuses alcohol or drugs, and
- reports being maltreated as a child
INDICATORS OF INTIMATE PARTNER VIOLENCE
The female survivor of IPV may
- complain of insomnia and physical symptoms;
- have symptoms of PTSD, chronic anxiety, or depression;
- report suicidal ideation or attempts;
- have obvious injuries at various stages of healing and/or a history of frequent emergency room visits for injuries with questionable explanations for those injuries;
- exhibit anxiety or fear while being interviewed;
- and be fearful of her partner and turn to her partner before answering questions
The male perpetrator may
- consistently speak for his partner,
- be overly overprotective of and condescending toward her, and
- attempt to control the situation
INTERVENTIONS FOR CLIENTS AT RISK FOR SUICIDE
Hospitalization is appropriate for a client who has just attempted suicide or is at imminent risk for suicide as indicated by the presence of a specific suicide plan with access to lethal means in conjunction with other risk factors such as
- impaired judgment,
- impulsive behavior,
- severe mental illness or chemical dependency,
- a lack of social support,
- and/or a history of previous suicide attempts
Outpatient crisis intervention is appropriate when the client is at moderate risk for suicide as evidenced by suicidal intent with
- fair or good judgment,
- a lack of access to lethal means,
- the presence of adequate social support,
- and a willingness to comply with treatment recommendations.
Outpatient psychotherapy is appropriate as a follow-up to hospitalization or crisis intervention or as the intervention for clients who are at low risk for suicide
- as evidenced by suicidal ideation with an absence of a specific suicide plan,
- generally good judgment,
- the presence of adequate social support, and
- willingness to talk about problems and comply with treatment
INDICATORS OF CHILD SEXUAL ABUSE
Child indicators are
- difficulty walking or sitting,
- sudden disturbances in sleep and changes in appetite
- sudden onset of anxiety, depression, or other syrnptoms,
- unusual sexual behavior or knowledge
- abuses alcohol or drugs
- reports being sexually abused.
Parent/caregiver indicators are
- overly protective or jealous of or disinterested in the child
- socially isolated
- distorted perception of the child’s role
- reports being sexually abused
INDICATORS OF ELDER/DEPENDENT ADULT FINANCIAL ABUSE
Indicators in the adult victim include
- unusual activity in bank account;
- unpaid bills or lack of medical care or amenities despite adequate financial resources
- has changed will or property title in a way that benefits “new friends or relatives”
- has signed documents he/she can‘t understand
- reports loss or theft of money. jewelry. etc.
INDICATORS OF ELDER/DEPENDENT ADULT NEGLECT
Indicators in the adult victim include signs of
- dehydration or malnutrition
- untreated health problems
- inappropriate clothing and poor personal hygiene
- unsanitary or unsafe living conditions
- reports being neglected or mistreated
INDICATORS OF ELDER/DEPENDENT ADULT PHYSICAL ABUSE
Indicators in the adult victim include
- physical injuries that have not been cared for properly, are in various stages of healing, and/or are incompatible with explanations for them
- signs of physical restraint
- evidence of inadequate or inappropriate medication
- fear, depression, confusion, agitation, and/or other behavioral signs
- frequent use of emergency rooms or “doctor-shopping”
- reports being hit, slapped, kicked, or mistreated
INDICATORS OF ELDER/DEPENDENT ADULT SEXUAL ABUSE
Indicators in the adult victim include
- complaints about abdominal pain,
- unexplained vaginal or anal pain or bleeding, or recurrent genital infections
- has unexplained changes in behavior (e.g. aggression, withdrawal)
- reports being sexually assaulted
INTERVENTIONS FOR CLIENTS WHO POSE A DANGER TO OTHERS
The appropriate intervention depends on level of risk and causes of the violent behavior.
Voluntary hospitalization of a client who is a danger to others is usually an option before initiating an involuntary hold.
However. involuntary hospitalization must be considered when the danger the client poses is imminent and due to a mental disorder or chronic alcoholism and the client has refused or is unable to comply with the recommendation to enter a psychiatric hospital voluntarily.
Outpatient management is indicated when the client is sincere in his/her desire to change and the risk for violence is low.
PROTECTION FROM VIOLENT CLIENTS
Methods for protecting oneself from violent clients range from the less to the more intrusive:
Less intrusive methods include
- speaking softly and moving slowly
- maintaining adequate physical distance from the client
- sitting near the door and leaving the door open
- expressing concern for the client‘s well-being
- setting limits on behavior
- suggesting alternatives to violence
More intrusive actions may be necessary when these methods fail and include
- leaving the room
- calling for help
- picking up a potential “weapon”
- if necessary, fighting back.
Note that calling for help (e.g. phoning the police) is acceptable only when the client‘s condition permits a violation of confidentiality or the client gives permission to do so.
RESPONSE TO A CRISIS
A person’s response to a crisis typically involves a combination of symptoms.
-
Cognitive symptoms may include
- flashbacks
- intrusive thoughts
- nightmares
- impaired memory
- concentration
- decision-making
-
Affective symptoms include
- shock
- disbelief
- fear
- anger
- irritability
- anxiety
- sadness
- guilt or shame
- a sense of helplessness
- feelings of loss or emptiness
- a fear of losing control
-
Behavioral symptoms may include
- difficulties accomplishing activities of daily living
- social withdrawal
- an inability to perform work-related tasks
- behaviors that are inappropriate or inconsistent with thoughts and feelings
- impulsive and dangerous actions
- substance abuse
-
Physical symptoms are
- sleep disturbances
- appetite changes
- muscle tension
- nausea and diarrhea or constipation
- sweating
- hyperventilation
- agitation
- headaches
- exaggerated startle response
RISK FACTORS FOR CHILD MALTREATMENT
Child risk factors include
- low birth weight and prematurity
- young age
- difficult temperament
- chronic physical illness
- physical disability
- emotional disorder
Parent/caregiver risk factors include
- a lack of understanding of child development
- poor parenting skills (e.g. role-reversal)
- beliefs that justify maltreatment
- a history of child maltreatment in the family of origin
- substance abuse and/or mental health problems
- certain demographic characteristics (e.g. young age, low education, low income, single parenthood)
Family risk factors include
- the presence of nonibiological, transient caregivers in the home
- social isolation
- family disorganization
- dissolution
- violence
Community risk factors include
- high degree of community violence
- disadvantaged neighborhood (e.g. high unemployment and poverty, residential instability)
RISK FACTORS FOR DANGER TO OTHERS
Risk factors include
- certain demographic characteristics, e.g.
- history of violent behavior
- male gender
- younger age
- lower socioeconomic status
- low intelligence
- history of being abused as a child or witnessing domestic violence
- certain psychiatric diagnosis, e.g.
- Substance Use Disorder
- Antisocial Personality Disorder
- and symptoms (e.g. neurological impairment, violent thoughts and fantasies, poorly controlled anger)
- certain situational factors, eg.
- lack of social support
- high level of stress
- access to weapons
