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Flashcards in Crisis Assessment and Management Deck (19)
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1

INDICATORS OF CHILD NEGLECT

Child indicators are

  • frequently absent from school,
  • begs or steals food or money,
  • lacks medical or dental care,
  • is consistently dirty,
  • lacks appropriate clothing, and
  • reports there is no one at home to provide care 

Parent/caregiver indicators are

  • indifference to the child,
  • chronic illness or mental disorder, and
  • reports being neglected as a child

2

INDICATORS OF CHILD PHYSICAL ABUSE

Child indicators are

  • unexplained burns, bruises, etc. that vary in stage of healing,
  • wears clothing to hide injuries,
  • is afraid of parents/caregivers, and
  • reports being physically mistreated.

Parent/caregiver indicators are

  • offers conflicting or unconvincing explanation for child's injury,
  • describes the child in negative ways,
  • uses harsh discipline,
  • abuses alcohol or drugs,
  • has poor impulse control, and
  • reports being physically abused as a child

3

INDICATORS OF CHILD EMOTIONAL MALTREATMENT

Child indicators are

  • extremes in behavior,
  • consistently makes derogatory remarks about him/herself,
  • has attempted suicide,
  • has a habit disorder, and
  • reports a lack of attachment to the parent or caregiver

Parent/caregiver indicators are

  • constantly blames or belittles the child,
  • is unconcerned about the child,
  • overtly rejects the child,
  • abuses alcohol or drugs, and
  • reports being maltreated as a child

4

INDICATORS OF INTIMATE PARTNER VIOLENCE

The female survivor of IPV may

  • complain of insomnia and physical symptoms;
  • have symptoms of PTSD, chronic anxiety, or depression;
  • report suicidal ideation or attempts;
  • have obvious injuries at various stages of healing and/or a history of frequent emergency room visits for injuries with questionable explanations for those injuries;
  • exhibit anxiety or fear while being interviewed;
  • and be fearful of her partner and turn to her partner before answering questions 

The male perpetrator may

  • consistently speak for his partner,
  • be overly overprotective of and condescending toward her, and
  • attempt to control the situation

5

INTERVENTIONS FOR CLIENTS AT RISK FOR SUICIDE

Hospitalization is appropriate for a client who has just attempted suicide or is at imminent risk for suicide as indicated by the presence of a specific suicide plan with access to lethal means in conjunction with other risk factors such as

  • impaired judgment,
  •  impulsive behavior,
  • severe mental illness or chemical dependency,
  • a lack of social support,
  • and/or a history of previous suicide attempts

Outpatient crisis intervention is appropriate when the client is at moderate risk for suicide as evidenced by suicidal intent with

  • fair or good judgment,
  • a lack of access to lethal means,
  • the presence of adequate social support,
  • and a willingness to comply with treatment recommendations.

Outpatient psychotherapy is appropriate as a follow-up to hospitalization or crisis intervention or as the intervention for clients who are at low risk for suicide

  • as evidenced by suicidal ideation with an absence of a specific suicide plan,
  • generally good judgment,
  • the presence of adequate social support, and
  • willingness to talk about problems and comply with treatment

6

INDICATORS OF CHILD SEXUAL ABUSE

Child indicators are

  • difficulty walking or sitting,
  • sudden disturbances in sleep and changes in appetite
  • sudden onset of anxiety, depression, or other syrnptoms,
  • unusual sexual behavior or knowledge
  • abuses alcohol or drugs
  • reports being sexually abused.

Parent/caregiver indicators are

  • overly protective or jealous of or disinterested in the child
  • socially isolated
  • distorted perception of the child's role
  • reports being sexually abused

7

INDICATORS OF ELDER/DEPENDENT ADULT FINANCIAL ABUSE

Indicators in the adult victim include

  • unusual activity in bank account;
  • unpaid bills or lack of medical care or amenities despite adequate financial resources
  • has changed will or property title in a way that benefits “new friends or relatives"
  • has signed documents he/she can‘t understand
  • reports loss or theft of money. jewelry. etc.

8

INDICATORS OF ELDER/DEPENDENT ADULT NEGLECT

Indicators in the adult victim include signs of

  • dehydration or malnutrition
  • untreated health problems
  • inappropriate clothing and poor personal hygiene 
  • unsanitary or unsafe living conditions
  • reports being neglected or mistreated

9

INDICATORS OF ELDER/DEPENDENT ADULT PHYSICAL ABUSE

Indicators in the adult victim include

  • physical injuries that have not been cared for properly, are in various stages of healing, and/or are incompatible with explanations for them
  • signs of physical restraint
  • evidence of inadequate or inappropriate medication
  • fear, depression, confusion, agitation, and/or other behavioral signs
  • frequent use of emergency rooms or "doctor-shopping"
  • reports being hit, slapped, kicked, or mistreated

10

INDICATORS OF ELDER/DEPENDENT ADULT SEXUAL ABUSE

Indicators in the adult victim include

  • complaints about abdominal pain,
  • unexplained vaginal or anal pain or bleeding, or recurrent genital infections
  • has unexplained changes in behavior (e.g. aggression, withdrawal)
  • reports being sexually assaulted

11

INTERVENTIONS FOR CLIENTS WHO POSE A DANGER TO OTHERS

The appropriate intervention depends on level of risk and causes of the violent behavior.

Voluntary hospitalization of a client who is a danger to others is usually an option before initiating an involuntary hold.

However. involuntary hospitalization must be considered when the danger the client poses is imminent and due to a mental disorder or chronic alcoholism and the client has refused or is unable to comply with the recommendation to enter a psychiatric hospital voluntarily.

Outpatient management is indicated when the client is sincere in his/her desire to change and the risk for violence is low.

12

PROTECTION FROM VIOLENT CLIENTS

Methods for protecting oneself from violent clients range from the less to the more intrusive:

Less intrusive methods include

  • speaking softly and moving slowly
  • maintaining adequate physical distance from the client
  • sitting near the door and leaving the door open 
  • expressing concern for the client‘s well-being 
  • setting limits on behavior
  • suggesting alternatives to violence

More intrusive actions may be necessary when these methods fail and include

  • leaving the room
  • calling for help
  • picking up a potential “weapon"
  • if necessary, fighting back.

Note that calling for help (e.g. phoning the police) is acceptable only when the client‘s condition permits a violation of confidentiality or the client gives permission to do so.

13

RESPONSE TO A CRISIS

A person's response to a crisis typically involves a combination of symptoms.

  1. Cognitive symptoms may include
    • flashbacks
    • intrusive thoughts
    • nightmares
    • impaired memory
    • concentration
    • decision-making
  2. Affective symptoms include
    • shock
    • disbelief
    • fear
    • anger
    • irritability
    • anxiety
    • sadness
    • guilt or shame
    • a sense of helplessness
    • feelings of loss or emptiness
    • a fear of losing control
  3. Behavioral symptoms may include
    • difficulties accomplishing activities of daily living
    • social withdrawal
    • an inability to perform work-related tasks
    • behaviors that are inappropriate or inconsistent with thoughts and feelings
    • impulsive and dangerous actions
    • substance abuse
  4. Physical symptoms are
    • sleep disturbances
    • appetite changes
    • muscle tension
    • nausea and diarrhea or constipation
    • sweating
    • hyperventilation
    • agitation
    • headaches
    • exaggerated startle response

14

RISK FACTORS FOR CHILD MALTREATMENT

Child risk factors include

  • low birth weight and prematurity
  • young age
  • difficult temperament
  • chronic physical illness 
  • physical disability
  • emotional disorder

Parent/caregiver risk factors include

  • a lack of understanding of child development
  • poor parenting skills (e.g. role-reversal)
  • beliefs that justify maltreatment
  • a history of child maltreatment in the family of origin
  • substance abuse and/or mental health problems 
  • certain demographic characteristics (e.g. young age, low education, low income, single parenthood)

Family risk factors include

  • the presence of nonibiological, transient caregivers in the home
  • social isolation
  • family disorganization
  • dissolution
  • violence

Community risk factors include

  • high degree of community violence
  • disadvantaged neighborhood (e.g. high unemployment and poverty, residential instability) 

15

RISK FACTORS FOR DANGER TO OTHERS

Risk factors include

  1. certain demographic characteristics, e.g. 
    • history of violent behavior
    • male gender
    • younger age
    • lower socioeconomic status
    • low intelligence
    • history of being abused as a child or witnessing domestic violence
  2. certain psychiatric diagnosis, e.g. 
    • Substance Use Disorder
    • Antisocial Personality Disorder
    • and symptoms (e.g. neurological impairment, violent thoughts and fantasies, poorly controlled anger)
  3. certain situational factors, eg. 
    • lack of social support
    • high level of stress
    • access to weapons

16

RISK FACTORS FOR LETHALITY IN INTIMATE PARTNER VIOLENCE

Risk factors for lethality include the following:

  1. The survivor fears being seriously injured by the perpetrator.
  2. The survivor and/or perpetrator have a history of uncontrolled continuous use of alcohol or other substance.
  3. The perpetrator is obsessed with his partner and has negative reactions to her autonomy.
  4. The perpetrator has used a weapon against his partner or threatened to kill his partner, has engaged in sadistic violence or other bizarre forms of violence, or has been convicted for a violent crime or violated a restraining order. 

17

RISK FACTORS FOR SUICIDE

The primary risk factors for suicide include

  1. suicidal thoughts and behaviors, e.g. 
    • suicidal threats
    • giving away possessions
    • a specific suicide plan with access to lethal means
    • history of previous attempts
  2. certain psychiatric diagnoses, e.g. 
    • Major Depressive Disorder
    • Bipolar Disorder
    • and psychiatric symptoms (e.g. feelings of hopelessness, dysphoria, severe anxiety)
  3. certain psychosocial factors, e.g. 
    • chronic stress or a recent severe stressor
    • lack of social support
    • family history of suicide or mental illness
    • specific demographic characteristics (older age, male gender, non-Hispanic White or American Indian, and divorced, widowed, or single)

18

ROBERTS' SEVEN-STAGE CRISIS INTERVENTION MODEL (R-SSCIM)

Roberts‘s (2000) seven-stage crisis intervention model has been applied to a variety of situational and maturational crises.

Its stages, in order, are:

  1. conduct a thorough crisis assessment
  2. establish rapport
  3. identify major problems
  4. explore feelings and provide support
  5. generate and explore alternatives
  6. develop and implement an action plan
  7. plan follow-up sessions

19

SITUATIONAL AND MATURATIONAL CRISES

A situational crisis is triggered by a sudden, uncontrollable, and usually unanticipated event that threatens the person's sense of psychological, biological, and/or social well-being (e.g. serious physical illness, unexpected death of a loved one);

while a maturational (developmental) crisis is embedded in developmental processes and occurs when a person is struggling with the transition from one life stage to another (e.g. transition from childhood to adulthood, change In social status).