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73 Cards in this Set
- Front
- Back
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Definition: Crisis
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a period of psychological disequilibrium, experienced as a result of a hazardous event or situation that constitutes a significant problem that can't be remedied by using familiar coping stategies
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Is there a limit on how long a Crisis lasts?
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a Crisis is time-limited
a Crisis ordinarily lasts for no < 6-8 weeks. |
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What are the 4 components of a Crisis? (Golan, 1978)
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1. Hazardous event - initial shock disrupts equilib and starts series of reactions -> crisis.
2. Vulnerable state - all the emotional, bio, cog beh responses to events -> anxiety. 3.Active Crisis State - Disequilibrium/disorganization - 3 stages: (a) physical agitation,( b) preoccupation with events leading to crisis, (c) return to equilibrium - realize coping technqies or seek help. 4. Restoration of equilibrium - success depends on ability to evulate sit'n and coping strategies |
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What are the 2 origins of a Crisis?
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1. Situational Crisis
2. Maturational (Developmental) Crisis |
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Definition: Situational Crisis
Define the 3 components |
Crisis origin is sudden, random, shocking and often catastrophic that cannot be anticipated/expected or controlled.
1. Event threatens sense of psychological well being - disequilibrium 2. Factors effecting if one will interpret crisis = perception of event, ability to cope, social supports. 3. Sources of stress include - physical illness, untimely death, crime, natural dis, war, divorce, material loss |
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Definition: Maturational/developmental Crisis - transitional states
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Crisis origin is embeded in developmental process
Unlike the "Situational" crisis, the Maturational/Developmental can be anticipated/expected. |
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Reactions to a Crisis: What are the 3 overlapping phases during the reaction to a crisis event?
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1. Impact phase (min to hours)
2. Recoil phase 3. Posttraumatic Recovery phase (duration depends on severity) |
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Reactions to a Crisis: What are 6-8 common Affective symptoms of a crisis event?
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1. anger
2. anxiety 3. fear 4. guilt 5. helplessness 6. irritability 7. sadness 8. shame |
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Reactions to Crisis: What are some Cognitive symptoms assoc'd with a crisis event?
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1. behaviors thoughts &
2. feelings (inapprop & inconsistent) 4. concentration 5. confusion 6. decision-making 7. disorientation 8. flashbacks 9. images 10.impaired memory 11.intrusive thoughts 12.nightmares 13.withdrawal |
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Reactions to Crisis: What are some Physical symptoms assoc'd with a crisis event?
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1. appetite changes
2. agitation 3. constipation / diarrhea 4. dizziness 5. heightened startle response 6. hyperventiliation 7. muscle aches/tension 8. nausea 9. palpitations 10.sweating |
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Reactions to a Crisis: What are 3 gen'l Risk Factors that increase risk reactions to a traumatic event?
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1. Pre-event factors
2. Peri-event factors 3. Post-event factors |
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Reactions to a Crisis: What does the term "Anniversary Reaction" involve?
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Behavioral, emotional, and physical symptoms that occur arnd the anniversary of the event that precipitated the crisis.
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Reactions to a Crisis: Why should Culture be considered during crisis intervention?
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Recognition that a person's culture may impact how s/he reacts to and recovers from a crisis.
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Characteristics of Crisis Assess:
How does Crisis Assess differ from other types of assess's? |
1. Crisis Assess is clearly linked to resolving the crisis.
2. Crisis Asess focuses primarily on the immediate problems + address historical info that is pertinent to understand'g & resloving the current crisis 3. It is a collaborative process that includes (a) identifying goals & treatment (b) the client is an active participant regarding decision-making during the treatment |
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What type of Communication Skills are rqr'd during a Crisis Assess?
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Concern
Empathy Sincerity both Close & Open-ended questions Silence via nonverbal attention Reframing/Restatements Reflection/Mirroring |
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What are the 4 MAJOR Assess Domains that should be addressed during a Crisis Assess (Hoff, Hallisey, and Hoff - 2009)?
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1. Risk of Life
2. Origins, Severity, and Development of the Crisis 3. Manifestations of the Crisis * how does the person interpret what led up to the crisis 4. Family, Community, and Sociocultural Factors |
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Assessment Domains: Risk of Life assess should include;
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1. Listen and look for clues to danger:
(a) Verbal clues - "I wanna kill him or myself." PREVIOUS ATTEMPTS (b) Nonverbal - prep for death, - sleep changes, - recent fight, provocation. (c) Collateral reports 2. If signs are present (a) conduct structured inquiry to collect info to determine and implement an approp plan to protect client / others (b) ask direct questions - "are you going to kill yourself?" - when? where? (c) use client's words to clarify vague threats (d) self-harm also includes destructive behavior - abusing drugs/alcohol |
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Assessment Domains: What are 3 key considerations when assessing Crisis Origin, Severity and Development?
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1. What dev stage is client in?
2. Is client in initial or acute stage of crisis? "What event brought your here today?" 3. What recent stress events have occured in client's life. |
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Assessment Domains: What is the goal of determining the Manifestations of the Crisis?
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This aspect of Crisis Assess involved identifying the hazardous events & precipitating factor(s) that led to the person's current distress.
- helps identify approp intervention strategies - establish a baseline for progress in treatment "How do you feel about that just happened?" "How do you usually cope with stressful events?" |
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Types of Assessments: What are the 3 Types of Crisis Assess's?
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1. Triage Assess
2. Crisis Assess (a) Rapid Assess Instr (RAI's) (b) Semi-Structured Interv - e.g., Myer's (2001) Triage Assessment Form 3. Bio-psycho-social Assess |
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Types of Assessments: What is the goal/purpose of a Triage Assess?
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... to determine if an intervention is nec'y
.... to identify the approp intervention |
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Types of Assessments: What is the goal/purpose of a Crisis Assess?
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. to provide a systematic method of organizing client info related to
(a) personal characteristics, parameters of the crisis episode (b) the intensity and duration of the crisis (c) develope effective treatment plans |
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Types of Assessments: How does one Measure or distinguish b/w a Normal reaction to a crisis event and reactions that are excessive or that reflect a pre-existing condition/disorder?
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Rapid Assessment Instruments
1. Rapid Ass Instru (RAI's) 2. Semi-Structured Interviews; - e.g., Myer's (2001) Triage Assessment Form 3. Bio-psycho-social Assess |
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What are the Pre-event factors that can increase a person's risk for adverse reactions to a disaster or traumatic event?
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* previous unresolved trauma/loss
* previous psychiatric hx * Previous substance abuse * Concurrent life stressors * Socioeconomic disadvantage * Female gender |
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What are the Peri-event factors that can incr a person's risk for adverse reactions to a disaster or traumatic event?
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* Sudden/Unexpected Event
* Man-made vs Natural Disaster * Prolonged Exposure to the event * Perceived/Actual to life of self or others * Exposure to horrific scenes experiences * Exposure to horrific sensory experiences * Substantial Personal Loss |
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What are, at least 3-4, Post-event factors that can incr a person's risk for adverse reactions to a disaster or traumatic event?
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* Survivor Guilt
* Performance Guilt * Adverse Reactions by others * Lack of Social Support |
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Define RAI's?
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Rapid Assessment Instruments are brief standardized self-report measures.
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What is the purpose of RAI's
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Used to monitor the progress of treatment
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What is the scoring complexity of RAI's
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They are considered simple/easy to score
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Name 3-4 RAI's?
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* Brief Symptom Inventory
* Beck Depression Inventory (2nd Edison) * Impact of Events Scale (Revised) * CSAS; Lewis-Roberts Crisis State Assessment Scale |
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When is the RAI used?
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* Used during initial assessment of a crisis
* Used to monitor the progress of treatment |
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Semi-Structured Interviews: What 3 specific domains are assessed?
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* Affective
* Behavioral * Cognitive |
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Highest reactions in the Affective Domain might require what gen'l interventions?
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Interventions for this Domain might include:
* Supportive Strategies that validate the clients feelings - catharsis strategies that help express emotions - awareness strategies that help the client become more conscious of his/her emotions |
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Highest reactions in the Behavioral Domain might require what gen'l interventions?
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Interventions for this Domain might include:
* Guiding/Helping identify/obtain resources * safety of Client and others * Mobilization of assistance and support from various sources |
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Highest reactions in the Cognitive Domain might require what gen'l interventions?
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Intervention for this Domain might include:
* Ordering Strategies - promoting rational think'g * Clarifying Strategies - consideration of alternative interpretations * Delimiting Strategies - help'g the client stop catastrophizing the crisis situation |
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How are the Psychological and Physical Domains assessed during a crisis?
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a BioPsychoSocial Assessment (Semi-Structured) Interview is given:
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How many gen'l Core Principles is Crisis Intervention based?
Name the Principles. |
7 Principles
* Proximity * Immediacy * Expectancy * Brevity * Simplicity * Innovation * Practicality |
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Explain the Core Principle of Proximity as it relates to Crisis Intervention.
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This 1st principle means that crisis interventions r ordinarily provided in surroundings surroundings/environment close to the client's normal area of function'g or close to where the precipitating event occured.
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Explain the Core Principle of Immediacy as it relates to Crisis Intervention.
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This 2nd principle means that crisis interventions should be provided - asap; for maximum effectiveness
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Explain the Core Principle of Expectancy as it relates to Crisis Intervention.
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This 3rd principle means that crisis interventions should instill hope - aeap
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Explain the Core Principle of Brevity as it relates to Crisis Intervention.
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This 4th principle means that crisis interventions should have brevity (~ 1-5 contacts)
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Explain how the Core Principle of Simplicity, as it relates to Crisis Intervention.
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The 5th principle of crisis interventions means that they should be simple vs complex; addressing one issues @ a time.
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Explain how the Core Principle of Innovation as it relates to Crisis Intervention.
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The 6th principle of crisis intervention means that there is no one-size-fits-all intervention & should be modified accordingly.
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Explain how the Core Principle of Practicality as it relates to Crisis Intervention.
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The 7th principle of crisis intervention means that the client must be able to carry out the strategies.
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What are the 4 Primary Tasks of Crisis Intervention?
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1. Physical Survival
2. Expression of Feelings 3. Cognitive Mastery 4. Behavioral and Interpersonal Adjustments |
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Explain how the Primary Task of Physical Survival relates to Crisis Interv
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This Primary Task of Crisis Interv is meant to maintain physical health and prevent suicide/homicide
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Explain how the Primary Task of the Expression of Feelings relates to Crisis Interv
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This Primary Task of Crisis Interv is meant to help the person identify and express feelings that r related to the crisis.
This task is also meant to help the person understand how feelings can have an impact on both Psychological and Physical well-being. |
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Explain how the Primary Task of the Cognitive Mastery relates to Crisis Interv
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This task is meant to help the person develop a REALITY-based understand'g of the crisis event via
- addressi'g irrational beliefs - addressing fears - addressing unfinished business - modifying self-image All, in light of the crisis event |
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Explain how the Primary Task of the Behavioral and Interpersonal Adjustments relate to Crisis Interv
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This Primary Task of Crisis Intervention is meant to help the person adapt to daily life changes
of their - activities - relationships - goals and minimize the long-tern negative consequences of the crisis |
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What 3-4 factors should be considered before discontinuing the Crisis Interv?
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Importance considerations should include
Has the client regained 1. equilibrium in all the basic areas of function'g 2. coping capabilities 3. integrated the crisis event into his/her life as a whole 4. Were there any previously unresolved issues triggered by the trauma during the crisis that was successfully worked through? If not, is addt'l treatment required. |
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What are the basic areas of function'g that can be impacted during a crisis and should therefore be regained prior to ending the crisis intervention?
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1. Affective
2. Behavioral 3. Cognitive 4. Somatic/Physical 5. Interpersonal |
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What are 2 main Crisis Intervention Models
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1. Stress-Crisis Continuum Model
2. Seven-Stage Crisis Intervention Model (R-SSCIM) |
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How many levels are in the Stress-Crisis Continuum Model?
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7 Levels
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Name the 7 Levels of the Stress-Continuum Model
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Level 1: Somatic Distress
Level 2: Transitional Crisis Level 3: Traumatic Stress Crisis Level 4: Family Crisis Level 5: Serious Mental Illness Level 6: Psychiatric Emergencies Level 7: Catastrophic Crisis |
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Name the 7 stages of the Seven-Stage Crisis Intervention Model
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Stage 1: Crisis Assessment
Stage 2: Establish Rapport Stage 3: Identify Major Problems Stage 4: Explore Feelings & Emotions Stage 5: Generate & Explore Alternatives Stage 6: Develop & Implement an Action Plan Stage 7: Follow-up |
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What are the 3 main Crisis Intervention Approaches?
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1. Non-directive Approach
2. Collaborative Approach 3. Directive Approach |
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When is a Non-directive Approach approp/most effective?
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This approach is used when
- the client is able to initiate & perform the action steps needed to resolve the crisis - the less severe the crisis, the less directive the approach |
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What techniques are used in the Non-directive Approach?
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The client is supported via
- support - encouragement - suggestions - reinforcement |
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When is the Collaborative Approach approp/most effective?
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This approach is most effective when
- the NON-directive approach isn NOT effective - the client is still able to work collaboratively with the crisis worker to resolve the crisis |
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What function does the Crisis Interventionist serve when using the Collaborative Approach?
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The client is supported via the Clinician's role as a
- facilitator - consultant - catalyst |
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When is the Directive Approach most effective?
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This approach is most effective when the client is too
- immobile to cope effectively with his/her crisis |
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When using a Directive approach, when might the client be too immobile to cope effectively with his/her crisis?
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Specific reasons to use this Crisis Interven Approach occurs when
- the client is severely depressed - the client is severely anxious - the client has a severe psychotic episode - the client has impaired reality testing |
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What is the clinician's role when using the Directive Crisis Intervention Approach?
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The Clinician should
- assume temporary responsibility and control - defines the problems and alternative solutions - facilitates the client's ability to take action by providing instruction and explicit guidance |
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What are 5 Alternative Crisis Interventions?
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1. Psychological First Aid
2. Indvl Intervention 3. Group Intervention 4. Family Intervention 5. Referrals |
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What are the 6 steps to Psychological First Aid?
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1st Immediate Intervention
2nd Establish Rapport 3rd Assessment 4th Take Action 5th Utilize Referral Resources 6th Provide Aftercare |
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When performing Psychological First Aid, why is an "Immediate Intervention" primary to "Establishing Rapport?"
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Safety needs (issues of lethality) should ALWAYS be addressed 1st as it is part of effective triage
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Which is NOT considered a Core Principle of Crisis Interv and Why?
1. Expectancy 2. Proximity 3. Practicality 4. Complexity |
Complexity is the opposite of Simplicity; which is instead one of the Core Principle of Crisis
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Name & Explain one of the major assumptions of Crisis Theory
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People can "learn" how to cope with a crisis by developing approp more adaptive coping behaviors via:
- approp education / understand'g of the current problem - assistance/support |
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What is the key GOAL of Crisis Intervention?
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To help indvls in a crisis learn more effective coping so that they can RESPOND more adaptively to future crisis
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If a patient's confinement is extended (14-days), when is he/she entitled to a "Certification Review Hearing"?
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Within 4 days of the date on which the person is certified for a period of intensive treatment
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Generally speaking, which should take priority over the other:
Suicidal Intent v Hopelessness |
Suicidal Intent > Hopelessness
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Which elevated scales have the most increased risk of functional impairment:
(Pa ,6) +(Sc, 8) + (Ma 9) or (Pa, 6) +(Sc, 8)+ (Pt 7) |
Pa 6 + Sc 8 + Ma 9 > Pa 6 + Sc 8 + Pt 7
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What levels of active participation are required (from the Clinician) when assisting a client with a crsis?
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1. Non-directive
2. Collaborative Partner 3. Directive --- Client is too immobile to cope with t/crisis |
