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Triage Assessment System

rapid, but systematic technique for the crisis worker's use in adjudicating the severity of a client's presenting crisis situation and gaining some sense of direction in helping the client cope with the dilemma

assessing

action-oriented, situation-based method for systematically applying several worker-initiated skills

Six step counseling Model

1. defining the problem
2. ensuring client safety
3. providing support
4. examining alternatives
5. making plans
6. obtaining commitment to positive action

Step 1

Defining the Problem from the client's point of view

core listening skills

empathy, genuineness, acceptance, positive regard

Step 2

Ensuring Client Safety

Step 3

Providing Support-communicate to the client that the worker is a person who cares about the client

Step 4

Examining Alternatives-addresses an area that both clients and workers often neglect

3 Perspectives of Alternatives

1. situational supports
2. coping mechanisms
3. positive and constructive thinking patterns

situational supports

people known to the client in the present or past who might care about what happens to the client

coping mechanisms

actions, behaviors, or environmental resources the client might use to help get through the present crisis

positive and constructive thinking patterns

ways of reframing that might substantially alter the client's view of the problem and lessen the client's level of stress and anxiety

Step 5

Making Plans-plan should:
1. identify additional persons, groups and other referral resources that can be contacted for immediate support
2. provide coping mechanisms

Step 6

Obtaining commitment-enable the client to commit to taking one or more definite, positive, intentional action steps designed to move that person toward restoring precrisis equilibrium

equilibrium

state of mental or emotional stability, balance, or poise in the organism

disequilibrium

lack or destruction of emotional stability, balance, or poise in the organism

mobility

a state of physical being whereby the person can autonomously change or cope in response to different moods, feelings, emotions, needs, conditions, influences; being flexible or adaptable to the physical and social world

immobility

a state of physical being whereby the person is not immediately capable of autonomously changing or coping in response to different moods, feelings, emotions, needs, conditions, influences; unable to adapt to the physical and social world

Assessment

enables the crisis worker to determine:
1. the severity of the crisis
2. client's current emotional status-the client's level of emotional mobility or immobility
3. the alternatives, coping mechanisms, support systems, and other resources available to the client
4. the client's level of lethality
5. how well the worker is doing in deescalating and defusing the situation and returning the client to a state of equilibrium and mobility

triage system

allows the worker to gauge the severity of the client's current functioning across affective, behavioral, and cognitive domains

objective assessment

based on an appraisal of the clients functioning in three areas:
1. affective
2. behavioral
3. cognitive

affective state

abnormal or impaired affect is often the first sign that the client is in a state of disequilibrium

behavioral functioning

crisis worker should focus on the doing, acting out, taking active steps, behaving, or any number of other psychomotor activities

cognitive state

assessment of the client's thinking patterns may provide answers to many questions

triage assessment instrument

performed rapidly by a broad cross-section of crisis workers who have had little if any training in standardized testing or assessment procedures

affective severity scale

yellow-anxiety
red-anger
black-depression
orange-frustration

incongruencies to be aware of

1. what the client is saying
2. how the client is saying it
3. what the client's body language says

behavioral severity scale

behavior in a crisis either approaches, avoids, or is paralyzed in the client's attempts to act

cognitive severity scale

the client's processes typically perceive the event in terms of transgression, threat, loss, or any combination of the three

transgression

something that is happening that is bad in the present

threat

cognition that something bad will happen

loss

cognition that something bad has already occurred

3-10 rating

minimal impairment, and generally clients will be self-directing and able to function effectively on their own

11-19 rating

clients are more impaired and may have difficulty functioning on their own and need help and direction

20+ rating

moving deeper into harms way and generally will need a great deal of direction and a secure and safe environment. scores in the high 20s almost always mean that some degree of lethality is involved

psychobiological assessment

attempt to asses prior trauma, psychopathology, and use, misuse, or abuse of legal and illegal drugs in an effort to determine whether they correlate with the current problem

4 factors in assessing emotional functioning

1. the duration of the crisis
2. the degree of emotional stamina or coping at the client's disposal at the moment
3. the ecosystem within which the client resides
4. the developmental stage of the client

duration factor

time frame of the crisis

acute/situational crisis

one time, relatively short duration

chronic/long-term/transcrisis

long-term pattern of recurring crisis

degree factor

concerns the client's current reservoir of emotional coping stamina

ecosystem

very large extraneous variable that can dramatically influence client coping. it includes: geographical region and accessibility, communication systems, language, cultural mores, religious beliefs, economic status, social micro and macro system interactions

acute crisis intervention

requires direct intervention to facilitate getting over the one event or situation that precipitated crisis

chronic crisis intervention

requires a great length of time in counseling

low emotional reservoir

client will have a distorted view of the past and present and will not be able to envision a future

facilitative assessment

the data gleaned about the client are used as a part of the ongoing helping process, not simply filed away or kept in the worker's head

assessing for alternatives

must first consider the client's viewpoint, mobility, and capability of taking advantage of the alternatives

assessing for homicide/suicide

most suicidal and homicidal clients emit definite clues and believe they are calling out for help or signaling warnings

open-ended questions

1. request description
2. focus on plans
3. stay away from why questions

closed-ended questions

particularly suited for obtaining commitments from clients
1. request specific information
2. obtain a commitment
3. avoid negative interrogatives

restatement and clarification

crisis worker can gain agreement from the client on what the client is attempting to say, feel, think, and do

owning feelings

it is important to use your own feelings, thoughts, and behaviors because many clients are using you as a model

disowning statements

1. client and worker can reduce the need to pretend or fake understanding of one another and begin to see more clearly where communications are getting crossed
2. the client can begin to become actively involved with the worker in an attempt to work together

types of owning statements

1. conveying understanding
2. value judgements
3. positive reinforcement
4. personal integrity and limit setting
5. assertion statements

facilitative listening

1. focus their total mental power on the client's world
2. attending to the client's verbal and nonverbal messages
3. picking up on the client's current readiness to enter into emotional and/or physical contact with others, especially with the worker
4. emitting and attending behavior by both verbal and nonverbal actions, thereby strengthening the relationship and predisposing the client to trust the crisis intervention process

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