3 the intervention and assessment models

The Intervention and
Assessment Models
CHAPTER THREE

©2013, Brooks/Cole Cengage Learning

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.
 Establisha 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.
 Policeofficers
 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?


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