Crisis Management Flashcards

1
Q

*One clue that you may be seeing a question about crisis is when:

A

*One clue that you may be seeing a question about crisis is when the question asks “what you should do first”

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2
Q

Crisis Management Protocols

A
  • Immediate physical safety is always a higher priority than standard treatment
  • If talking by phone, get their location
  • Assess for suicidality or homicidality
  • Provide services and supports to address immediate safety
  • Call law enforcement or ambulance on their behalf if needed
  • Always provide services in least restrictive means possible
  • Take control of the situation
  • Create (or modify if existing) Safety Plan
  • Coordinate w treatment team
  • Emphasize strengths to help clients regain control
  • Mobilize client’s social support networks (may ask friends or family to stay with crisis clients to provide emotional stability)
  • Establish safe atmosphere, spend adequate time, protect client’s rights, be trauma informed
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3
Q

DSM-5 criteria for Substance Use Disorder

A
  • Taking substance in larger amounts/ for longer time than intended (not being able to stop)
  • Wanting to cut down use but not being able to
  • Spending a lot of time getting, using, or recovering from use
  • Cravings and urges to use the substance
  • Failing to meet responsibilities because of substance use
  • Continuing to use, even when it causes relationship problems
  • Giving up important social, work, or recreational activities because of substance use
  • Continuing to use, even when it puts you in danger
  • Continuing to use, even when you know you have a physical or psychological problem that could have been caused or made worse by the substance
  • Needing more to achieve desired effect (tolerance)
  • Withdrawal symptoms
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4
Q

Functional Analysis Approach

A
  • Understanding the role of substance use in the client’s life
  • Identifying factors that contribute to ongoing use
  • Identify needs being met by substance use
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5
Q

Physical Indicators of Child Physical Abuse

A
  • Injuries, especially if unexplained
  • Bite marks, bruises, burns, broken bones, missing hair tufts
  • Cuts and scratches (especially to eyes, lips, gums, mouth)
  • Missing or loosened teeth
  • Welts
  • Multiple injuries in different stages of healing
  • Lack of treatment or delayed treatment
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6
Q

Behavioral Indicators of Child Physical Abuse

A
  • Disclosure of abuse
  • Little emotion when hurt
  • Developmental regression
  • Overly withdrawn, passive
  • Uncommunicative
  • Self-harm, suicide attempts
  • Avoiding physical contact
  • Arms and legs covered by clothing in warm weather
  • Parent shows little concern
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7
Q

Physical Indicators of Child Sexual Abuse

A
  • Bruises or bleeding from genital or anal regions
  • Blood stained underwear
  • Pregnancy or fear of pregnancy
  • Pain, itching, discomfort in the anal or genital area
  • Urinary tract infections
  • Self-mutilation
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8
Q

Behavioral Indicators of Child Sexual Abuse

A
  • Age-inappropriate knowledge/interest in sexual matters
  • Sexual behaviors inappropriate to age
  • Regression to infantile behavior
  • Sudden unexplained fears
  • Wetting/soiling self or bed
  • Attention-getting, aggression, or clingy behavior
  • Recurrent physical complaints
  • Depression, withdrawal into fantasy pre-occupation
  • Disclosure through play, drawing, or writing
  • Sometimes indirect “I know someone who”
  • Inappropriate expressions of affection
  • Promiscuity, criminal sexual behavior
  • Decline in academic performance
  • Running away from home
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9
Q

Physical Indicators of Child Emotional Abuse

A
  • Depression
  • Eating disorders
  • Fatigue
  • Symptoms of stress
  • Drug use/dependence
  • Wetting, soiling bed, or clothes
  • Physical complaints w/o physical explanation
  • Violent drawings or writing
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10
Q

Behavioral Indicators of Child Emotional Abuse

A
  • Attempted suicide or self-harming behavior
  • Overly passive
  • Overly shy or withdrawn
  • Low self esteem
  • Fire setting
  • Harming animals
  • Truancy or school avoidance
  • Poor peer relationships
  • Disclosure
  • Adult-like behavior
  • Aggressive or delinquent behavior
  • Excessive neatness or cleanliness
  • Fearfulness when approached by known person
  • Disclosures of having witnessed domestic violence
  • Feelings of worthlessness
  • Low frustration tolerance
  • Self-soothing inappropriate to age
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11
Q

Key Indicators of Potential Elder/DA Abuse

Physical Injuries:

A
  • Frequent injuries or in different stages of healing
  • Sexually transmitted diseases
  • Internal injuries, infections
  • Frequent incontinence
  • Difficulty walking
  • Signs of being restrained
  • Injury to face, neck, chest, abdomen, thighs, or buttocks
  • Trauma, especially bleeding around genitals, chest, rectum, or mouth
  • Torn or stained clothing
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12
Q

Key Indicators of Potential Elder/DA Abuse

Emotional State:

A
  • Depression, fearfulness, nervousness, anxiety
  • Requests for care for very minor issues
  • Confusion or disorientation
  • Feeling helpless or ashamed
  • Changes in self-esteem, confidence
  • Anger and frustration
  • Insomnia, unexplained paranoia
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13
Q

Key Indicators of Potential Elder/DA Abuse

Behavior:


A
  • Passivity, reluctant to make decisions, apathy, listlessness
  • Changes in behavior around suspected abuser
  • Over-sedation, reduced physical or mental activity, grogginess or confusion
  • No therapeutic response to prescribed treatment
  • Repeated accidents, frequent falls
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14
Q

Key Indicators of Potential Elder/DA Abuse

Indicators of Financial Abuse

A
  • Confusion around assets and finances
  • Unusually unpaid bills, defaults on payments
  • Accompanied by same person for all financial transactions
  • Overcharges
  • Changes to a will
  • Unusual account activity
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15
Q

Key Indicators of Potential Elder/DA Abuse

Caregiver behavior

A
  • Overly-protective or controlling
  • Conflicting stories
  • Delay in seeking care or reporting an injury
  • Does not leave person unattended
  • Describing elder as “accident prone” or with a hx of sustaining injuries
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16
Q

Physical Indicators of Child Neglect

A
  • Poor personal hygiene
  • Dirty and unwashed appearance
  • Lack of adequate or suitable clothing for conditions
  • Constantly hungry
  • Inadequate nutrition
  • Lack of medical or dental care
  • Developmental delays
  • Untreated physical or medical problems
  • Substance abuse in the home
  • Lack of supervision
17
Q

Behavioral Indicators of Child Neglect

A
  • Poor school attendance
  • Falling asleep in school
  • Attends school even when sick
  • Early arrival or reluctance to leave school
  • Poor school performance
  • Steals, hoards, begs for food
  • Disclosure that no one is home to provide care
  • Vandalism
  • Adults overwhelmed w own problems
18
Q

Indicators of possible elder/dependent adult neglect

A
  • Inadequate nutrition, accommodation, clothing, medical or dental care
  • Poor personal hygiene
  • Exposure to unsafe, unhealthy, unsanitary conditions
  • Malnourishment, unexplained weight loss (if not medical)
  • Hypothermia or overheating
  • Left alone or unattended for long periods
19
Q

Indicators of Intimate Partner Violence

A
  • Includes physical and sexual violence, threats, and intimidation, emotional abuse and economic deprivation
  • One partner exercising a pattern of power and control
  • Jealousy, insults, social isolation, threats of violence, destruction of property, pressure for sex or drug use
  • Indicators that abuse may have taken place
  • Client reporting physical injuries, having been prevented from calling police, being abandoned, partner driving dangerously w victim, forced drug use
20
Q

Symptoms typically correspond to symptoms of PTSD:

A
  • Intrusion
  • Avoidance
  • Mood and cognition
  • Arousal and reactivity
21
Q

Addressing Suicidality

A
  • Routine assessment, especially if history of attempts
  • Identifying triggers as well as calming people/activities
  • Safety Plan
  • Coordinating w other care providers and loved ones
  • Increasing the frequency of contact
  • Raising level of care
  • Hospitalization (voluntary, involuntary)
22
Q

California’s Tarasoff duty, or Duty to Protect

A

Applies when a patient makes a threat to a psychotherapist of serious violence against a reasonably identifiable victim or victims