Crisis Management Flashcards
What is a crisis?
- Decisive intervention is needed.
- Psychological state is severely disrupted
- May be a one-time event (i.e. car crash) or long-term (i.e. suicial ideation)
Why is crisis intervention a therapeutic priority?
- The situation is beyond the client’s resources to control.
- Therapy cannot realistically proceed until crisis is stabilized.
What are common mental health crisis situations?
- Substance Abuse
- Severe Anxiety or Depression
- Harm to self or others
- Rape
- Domestic Violence
- Physical danger (i.e. eating disorders)
- Grave disability
How do you manage a crisis situation?
ACRONYM = QR Moths
- Questions
- Releases
- MSE
- Observation
- Testing
- History
- Strengths
How does human diversity impact crisis situations?
- Past discrimination can impair trust.
- Language barriers.
- Therapist personal values/biases.
- Cultural norms can be pathologized.
What are the goals of crisis intervention?
- Preserve life, protect health/safety.
- Support alternate coping strategies.
- Reduce symptoms.
- Plan for crisis resolution.
- Provide referrals and links to resources.
What do you assess when discussing suicidal thinking with a client?
- METHOD: Does the client have a plan?
- LETHALITY: How lethal is the method?
- MEANS: Does client have access to means?
- INTENT: When does client plan to act?
What are signs that a client is at risk for suicide?
- Previous attempts
- Depressive symptoms, hopelessness
- Recent losses or deaths of loved ones
- Substance abuse
- Life stressors
- Putting personal affairs in order
- Giving away prized possessions
If a client is at risk for suicide, what actions should the therapist consider?
- Taking a directive stance
- Focus on short-term safety
- Increase frequency of visits
- Assess the severity of suicide risk
- May break confidentiality to prevent harm
- If necessary, initiate 5150 or refer to crisis
How does a phone assessment for suicidal ideation differ from an in-person assessment?
Phone assessment should include the following:
- Secure client’s location and identity ASAP
- Identify buffers to slow down attempts
- Determine suicidal actions that have been taken
How does a therapist assess a client for danger to others, violence, or property destruction?
- Specific plan and threat
- Identifiable victim
- Access and/or possession of weapons
- Recent violence/property destruction (past year)
- History of personal and family violence
- Substance abuse
- Poor impulse control, anger management
What strategies can a therapist employ to maintain personal safety with a potentially dangerous individual?
- Be calm, assertive, empathic
- Set limits, provide structure
- Avoid power struggles
- Stay close to exits
- Barriers between self & person
- Don’t block an exit or attempt to restrain them
- Leave the situation
What should a therapist assess to determine if there is child abuse in a home?
- Assess family members individually
Assess for:
- Substance use/abuse
- Family dynamics
- Family/individual supports
- History of abuse/violence in family
- Problems with impulse/anger management
- Assess for physical signs (i.e. bruises in unexplainable places or frequent injuries)
What are general diagnostic indicators of child abuse?
- Unconvincing explanations for injury
- Discrepancy between parent and child on cause of an injury
- Delays obtaining medical care
- Suspicious injuries said to be self-inflicted
- Similar injuries on siblings
- Changes in behavior (i.e. sleep, conduct)
- Changes in attitude towards caregiver
What are common factors to abuse and neglect cases?
- Hazardous conditions (i.e. poor housing)
- Health risks (i.e. rat infestation)
- Life stressors (pregnancy, unemployment)
- Isolation from family and/or social supports
- Substance use/abuse
What are common referrals for child abuse situations?
- Parent education classes
- In-home family support
- Play group for children
- Anger, stress management classes
- Family service agencies
What are the four types of domestic violence?
- Physical
- Sexual
- Psychological/Emotional
- Destruction of property or pets
Describe the three stages of the Cycle of Violence in domestic violence situations.
- Tension building (stress building, victim attempts to calm)
- Explosion into violence (abuser engages in abuse)
- Honeymoon period (loving and contrite, expressions of remorse)
What is the first step a therapist should take in a domestic violence situation where children are in the home?
Assess for child abuse and report accordingly. You cannot report domestic violence.
How should a therapist manage a domestic violence situation?
- Assess safety for all family members
- Separate the pair if necessary
- Increase frequency of sessions/availability
- Help abused partner develop a safety plan
- Explore referrals including Legal Aid/police
What factors should be considered when developing a safety plan with a victim of domestic violence?
- Identifying escape routes for scenarios
- Put important items in a secure place
- Code word for help with friends/family
- Keep packed bag ready (keys, phone, money, ID, legal papers, medical info, clothing)
What are external indicators of possible dependent/elder abuse?
- Signs of physical abuse (i.e. bruises, burns)
- Unpaid bills when someone is supposed to pay them
- Poor self-care/hygiene
- Unsafe conditions in the home
- Lack of basic necessities
What are the psychological indicators of possible dependent/elder abuse?
- Dependent & resigned
- Isolated
- Denies Problem
- Depression
- Fears additional abuse (i.e. withholding food)
- Reluctant to report abuse
What is the recommended role of the therapist during rape crisis management?
- Direct questions
- Support empowerment, reduce helplessness
- Referrals to medical care and legal assistance
What are the stages of Rape Trauma Syndrome?
- Acute Phase: days/weeks following incident. Includes shock, poor recall, sleep concerns, reactivity, panic.
- Rescue/Recovery Phase: months/years following the incident. Includes depression, substance abuse, eating disorders, anxiety.
- Reorganization Phase: Assault ceases to be the main focus of client’s life.
