Ethics DEC 3 - class notes PDF

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CRISIS INTERVENTION 6 STEP MODEL OF CRISIS INTERVENTION - Assessing is used throughout crisis intervention - It is action orientated - Fluid application - All 6 steps are carried out under the umbrella of assessment Listening Steps: -

Defining the problem Ensuring the client safety Providing support

Action Steps: -

Examining alternatives Making Plans Obtaining a commitment 1. Defining the Problem - Defining the problem from the client’s point of view - Must perceive it as the client does in order to identify appropriate intervention strategies - Use core listening skills- empathy, genuineness and acceptance - Ask about the precipitating event - When did the client feel bad - What happened to make them call you or make an appointment - Precipitating event-perception-subjective distress-lowered functioning - Change in perception of precipitating event-decrease in subjective distress-increase in functioning - This is how we move clients out of crisis 2. Ensuring client safety - Continually keep client safety at forefront - Defined as minimizing the physical and psychological danger to self and others - Fluid and it remains throughout all steps - It must become a way of thinking during intervention 3. Providing support - Emphasizes communicating with the client that the worker is someone who cares about the client - Cannot assume that a client experiences feeling valued or cared for - Must be able to accept in an unconditional way, the client, whether or not they reciprocate 4. Examining alternatives - In a state of crisis people do not examine best options - Explore a variety of appropriate choices - 3 perspectives: 1) Situational supports 2) Coping mechanisms 3) Positive constructive thinking patterns - Client doesn’t need plenty of options, they need choices that are realistic and appropriate to their situation 5. Making Plans - Flows from step 4 - Should identify persons or groups or other referrals that can be made for immediate support

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Provide coping mechanisms- definable and concrete that the client can own and comprehend - May have to be directive, if possible collaborative so the client feels an ownership in the plan - Explain in detail - Keep in mind client control and autonomy-when clients carry out plans it restores a sense of control and ensures they don’t become dependent on support people 6. Obtaining Commitment - If planning is done effectively then this step is brief - Ask the client to verbally restate the plan - Goal is to enable the client to take or commit to at least one action step to restore equilibrium - Make sure commitment is obtained before the session ends - Worker follows up on client’s progress and make necessary reports - Statement of terms- we defined these last week. Read these over as they are relevant to the above steps - Analogy: The ABC’s of assessing in crisis intervention: -

Assessment allows worker to determine the severity of the crisis, the client's emotional status ( level or emotional mobility or immobility), the alternatives, coping mechanisms and clients level of lethality (danger to themselves or others)

ASSESSING THE SEVERITY OF CRISIS -

Rapid assessment using the Triage Assessment Form Gauges clients level of functioning across affective, behavioural and cognitive domains - The degree of severity may affect the client’s mobility which will give the worker a basis to determine how directive they will be - Looks at the client’s subjective view and the worker’s objective view 1. Affective State - Affective Severity Scale 2. Behavioural Functioning - Behavioural Severity Scale 3. Cognitive state-thinking patterns - Cognitive Severity Scale Attempt to assess prior trauma, psychopathology and drug use ASSESSING CLIENTS EMOTIONAL FUNCTIONING Two major factors: 1. Duration of the crisis- acute or situational or is it chronic (long-term) 2. The degree of emotional stamina - If lacking they need a direct response - Hopelessness is a clue it is running low STRATEGIES FOR ASSESSING EMOTIONAL STATUS -

Age, family, marital status Financial stability, medical history Helps us know if a referral is needed for therapy Physical appearance- grooming, hygiene, dishevelled Psychomotor behaviour- are they pacing, how do they carry themselves physically Emotional tone- overall mood

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Affect- is it appropriate, how intense, is it flat Thought processes- delusions Cognitive- ability to remember place, time, do they know where they are, day etc..

LEVEL OF ACTION BASED ON CLIENTS MOBILITY -

Worker decides how directive to be: Non-Directive—worker feels that client is able to make decisions. Collaborative – worker and client can discuss strategy together and decide together. Directive-- worker must make decision for the client as they are not capable, Let’s talk about examples of above.

ACTION STRATEGIES FOR CRISIS WORKERS -

Recognize individual differences Assess yourself Show regard for client’s safety Provide client support Define problem clearly Consider alternative Plan action steps Use client's coping strengths Attend to their immediate needs Use referral resources Develop and use networks Get a commitment...