1. The Intervention and
Assessment Models
CHAPTER THREE
©2013, Brooks/Cole Cengage Learning

2. Triage Assessment System
 Evaluates the severity of a crisis situation.
 Rapid
 Systematic
 Intentional
 Supports the client in gaining:
 Equilibrium
 Mobility
 Autonomy
©2013, Brooks/Cole Cengage Learning

3. 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
©2013, Brooks/Cole Cengage Learning

4. 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
©2013, Brooks/Cole Cengage Learning

5. 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.
©2013, Brooks/Cole Cengage Learning

6. 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
©2013, Brooks/Cole Cengage Learning

7. 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
©2013, Brooks/Cole Cengage Learning

8. 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
©2013, Brooks/Cole Cengage Learning

9. 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.
©2013, Brooks/Cole Cengage Learning

10. 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!
©2013, Brooks/Cole Cengage Learning

11. 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.
©2013, Brooks/Cole Cengage Learning

12. 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
©2013, Brooks/Cole Cengage Learning

13. 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.
©2013, Brooks/Cole Cengage Learning

14. 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.
©2013, Brooks/Cole Cengage Learning

15. 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.
©2013, Brooks/Cole Cengage Learning

16. 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
©2013, Brooks/Cole Cengage Learning

17. 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?
©2013, Brooks/Cole Cengage Learning

18. 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?
©2013, Brooks/Cole Cengage Learning

19. 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?
©2013, Brooks/Cole Cengage Learning

20. 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
©2013, Brooks/Cole Cengage Learning

21. 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?
©2013, Brooks/Cole Cengage Learning