The Intervention

and Assessment Models

JEANINE
FANTILAGAN
SHARA JOY PALMA
BHUMSERV 2-A (A-1)
INTRODUCTION
The model of crisis intervention you are about to
encounter emphasizes an immediacy mode of
actively, assertively, intentionally, and
continuously assessing, listening, and acting to
systematically help the client regain as much
precrisis equilibrium, mobility, and autonomy as
possible.
 Two of those terms
 A state of mental or emotional stability, balance, or poise in
the organism.

 A state of physical being in which 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.
THEIR ANTONYMS
 Lack or destruction of emotional stability,
balance, or poise in the organism.

 A state of physical being in which the person is

not immediately capable of autonomously
changing or coping in response to different
moods, feelings, emotions, needs, conditions,
influences; inability to adapt to the immediate
physical and social world.
 A Hybrid Model of Crisis
Intervention
 The problem that we have struggled with as we try to teach students like
you about crisis intervention is that at times crisis is anything but linear.

 Therefore, we have combined our former linear model with a systems model
we helped develop (Myer, James, & Moulton, 2011), resulting in what could
more appropriately be called a hybrid model for individual crisis
intervention that is generally linear in its progression but can also be seen in
terms of tasks that need to be accomplished.
 PART ONE Basic Training: Crisis
Intervention Theory and Application
Task 1/Engaging/Initiating Contact

 The first step in a crisis model: placing oneself, or something, in a

position to be of use in some future occurrence.

 Typically, systems such as the armed forces and government agencies

such as FEMA use predispositioning to get supplies, equipment, and
personnel ready to meet some future emergency. Disaster Response,
you will see predispositioning in operation on a very large scale
 In counseling literature, predisposition was originally studied by Prochaska,
DiClemente, and Norcross (1992) in regard to what motivated people who
were suffering from addiction to decide to change.

 Our primary objectives in predisposing an individual to accept crisis

intervention are twofold:
(1) to establish a psychological connection and create a line of
communication and
(2) to clarify intentions with regard as to what is going to happen
Establishing Psychological
Connection

 Firstand foremost, you need to introduce yourself in a way that is

nonthreatening, helpful, and assumes a problem solving as opposed
to an adversarial approach.

 First contact- One of the most important elements in making

 first
contact is getting the client’s name and introducing yourself in
a nonthreatening manner
Clarifying Intentions

 Clarifying intentions means informing the client about what the crisis
intervention process is and what the client can expect to happen.

 For many clients who are in crisis, this will be their first contact with a crisis
interventionist, and they will have little if any idea of what is going to happen
or how it is going to happen
Task 2. Problem Exploration: Defining
the Crisis

 A major initial task in crisis intervention is to define and understand the

problem from the client’s point of view

 Core listening skills- Intervention sessions begin with crisis workers practicing
what are called the core listening skills: empathy, genuineness, and
acceptance or positive regard

 Problem definition of a crisis does not mean going on a psychological

archaeological dig to dredge up and sift every artifact of the client’s past
 Defining the crisis does mean attempting to identify the precipitating
event across the affective, behavioral, and cognitive components of the
crisis. This task serves two purposes

 First, the interventionist sees the crisis from the client’s perspective.

 Second, defining the crisis gives the interventionist information on the

immediate conditions, parties, and issues that led to eruption of the
problem into a crisis
Task 3. Providing Support

 Thethird task in crisis intervention emphasizes communicating to

the client that the worker is a person who cares about the client

 Thesupport step provides an opportunity for the worker to

assure the client that “here is one person who really cares about
you.” We believe that providing support occurs in three ways.
Psychological Support

 Firstand most immediate is providing psychological and

physical support. Deep empathic responding using reflection
of feelings and owning statements about the client’s present
condition serves as a bonding agent that says emphatically, “I
am with you right here.”

” In Task 3, the person providing the support is the crisis

worker. This means that workers must be able to accept, in an
unconditional and positive way, all their clients, whether the
clients can reciprocate or not.
Logistical Support
 In a more general sense, support may be not only emotional but also
instrumental and informational.

 At times the client may not have money, food, clothing, or shelter. Little
psychological support will be desired or progress made until the basic
necessities of living and surviving are met

 Physical support means giving clients concrete assistance to help weather

the crisis. This support comes in many forms, ranging from providing
pamphlets to arranging transportation of clients to organizations that have
the resources needed to help them to simply giving them a drink of water.
Social Support
 Third, providing support means activating clients’ primary support system:
family, friends, coworkers, church members, and so forth.

 For many people in crisis, this primary support system may be absent (a car
accident 600 miles from home), fed up with their behavior (lying and
stealing from them to subsidize an addiction), or unequal to the task of
providing support as a result of the crisis (symptoms of posttraumatic stress
disorder. Conversely, clients may feel too embarrassed or guilty to ask for
help from their immediate support system

 At such times, the interventionist is not only the initial point of contact and
immediate psychological and physical anchor, but also the “expert” who
provides information, guidance, and primary support in the first minutes
and hours after the initiating event
Informational Support
 The need for informational support is particularly critical in the next step,
examining alternatives

 One of the best techniques a crisis interventionist can be in command of is

the ability to provide information on where, how, who, and what resources
clients can access to get out of the predicament they are in.

 That is particularly true of people who after a disaster are trying to access
the basic necessities of living
Default Task: Safety
 Safety is a default task that is always operational. Safety is a
primary consideration throughout crisis intervention for a
variety of reasons that are both physical and psychologically
based. The task of assessing and ensuring the client’s and
others’ safety is always part of the process, whether it is overtly
stated or not.

 When we speak of safety, we are concerned about the physical

safety not only of the client but also of those who may interact
with him or her and, just as important, about keeping ourselves
safe.
Task 4. Examining Alternatives
 Examining alternatives addresses an area that both clients and workers in crisis
intervention often neglect—exploring a wide array of appropriate choices
available to the client.

 Alternatives can be viewed from three perspectives:

 (1) Situational supports are people known to the client in the present or past
who might care about what happens to the client.
 (2) Coping mechanisms are actions, behaviors, or environmental resources the
client might use to help get through the present crisis.
 (3) Positive and constructive thinking patterns on the part of the client are
ways of reframing that might substantially alter the client’s view of the
problem and lessen the client’s level of stress and
 The effective crisis worker may think about an infinite number of
alternatives pertaining to the client’s crisis but discuss only a few of
them with the client.

 Clients experiencing crisis do not need a lot of choices; they need

appropriate choices that are realistic for their situation.
Task 5. Planning in Order to
Reestablish Control
 Reestablishing control means helping clients create a plan to guide them in the resolution of the
crisis. Such a plan needs to consider what options are available to the client and what choices need
to be made regarding those options.

 One of the primary strategies in planning to reestablish control is mobilizing the client.

 The plan should focus on systematic problem solving for the client and be realistic in terms of the
client’s coping ability.

 Planning is about getting through the short term and getting some semblance of equilibrium and
stability restored
 Psychoeducation- means providing information to victims and survivors
about what is happening and is probably going to happen to them
psychologically in the aftermath of a traumatic event.

 Psychoeducation has become an extremely important treatment

component in helping people in crisis get control back in their lives, not
only in preemptive work such as educating people about suicide,
domestic violence, and sexual assault, but also in understanding what
happens in the traumatic wake of a crisis such as the terrifying
flashbacks and nightmares of PTSD (Briere & Scott, 2006; Courtois, Ford,
& Cloitre, 2009; Kleespies, 2009)
Task 6. Obtaining Commitment
 The commitment step is clear, concise, and behaviorally specific. As a
result, it is clear to the client what he or she is going to do and what the
worker will do.

 The objective is to enable the client to commit to taking one or more

definite, positive, intentional action steps designed to move that person
toward restoring precrisis equilibrium

 Commitments should be free, voluntary, and believed to be doable. The

core listening skills are as important to the commitment step as they are
to the problem definition or any other step.
Task 7. Follow-up
 When we speak of follow-up in crisis, we are not talking about days, weeks, or
months. Long-term follow-up after a disaster is a special condition we will
deal with.

 Follow-up in crisis intervention has to do with keeping track of clients’ success

in maintaining precrisis equilibrium, not whether they are maintaining long-
term goals or changing deep-seated personality trait

 Short-term follow-up is also important as a reinforcing event that tells clients

you are still in this with them. Engaging in follow-up is extremely important
when clients have little other social support system.
The model of
crisis intervention
we have been
describing in
some detail is
summarized
briefly in Figure
3.1.
Assessment in Crisis Intervention
 Assessment is a pervasive strategy throughout crisis intervention. This action-oriented,
situation-based assessment is the basis for systematically applying our task mode

 Assessment is critically important because it enables the worker to determine

 (1) the severity of the crisis;
 (2) the client’s current emotional, behavioral, and cognitive status—the client’s level of
mobility or immobility in these three areas;
 (3) the alternatives, coping mechanisms, support systems, and other resources available to
the client;
 (4) the client’s level of lethality (danger to self and others)
 (5) and how well the worker is doing in de-escalating and defusing the situation and
returning the client to a state of equilibrium and mobility
Assessing the Severity of Crisis

 It is important for the crisis worker to evaluate the crisis severity as quickly as possible during
the initial contact with the client. Crisis workers generally do not have time to perform
complete diagnostic workups or obtain in-depth client histories. Therefore, a rapid assessment
procedure, such as the Triage Assessment System

 The degree of severity of the crisis may affect the client’s mobility, which in turn gives the
worker a basis for judging how directive to be. The length of time the client has been in the
present crisis will determine how much time the worker has in which to safely defuse the crisis
The ABCs of Assessing in Crisis
Intervention
 Crisis is time limited; that is, most acute crises persist only a matter of days or weeks (the
exception being large-scale disaster events) before some change—for better or worse—occurs

 The severity of the crisis is assessed from the client’s subjective viewpoint and from the
worker’s objective viewpoint.

 Objective assessment is based on an appraisal of the client’s functioning in three areas that
may be referred to as the ABCs of assessment: affective (feeling or emotional tone),
behavioral (action or psychomotor activity), and cognitive (thinking patterns
Affective State
 Abnormal or impaired affect is often the first sign that the client is in a state of disequilibrium. The
client may be overemotional and out of control or severely withdrawn and detached

 Often the worker can assist the client to regain control and mobility by helping the client express
feelings in appropriate and realistic ways. Some questions the worker may address are:
 Do the client’s affective responses indicate that the client is denying the situation or attempting to
avoid involvement in it?
 Is the emotional response normal or congruent with the situational crisis?
 To what extent, if any, is the client’s emotional state driven, exacerbated, or otherwise influenced by
other people?
 Do people typically show this kind of affect in situations such as this?
Behavioral Functioning
 The crisis worker focuses much attention on doing, acting out, taking active steps, behaving, or any
number of other psychomotor activities

 In crisis intervention, the quickest (and often the best) way to get the client to become mobile is to
facilitate positive actions that the client can take at once.

 People who cope with crisis successfully and later evaluate their experiences favorably report that
the most helpful alternative during a crisis is to engage in some concrete and immediate activity
Cognitive State
 Cognitive state refers to a person's current state of mental processing, including their level of
attention, perception, memory, reasoning, and decision-making. It can be influenced by various
internal and external factors, such as emotions, physical state, environment, and experience.

 The worker’s assessment of the client’s thinking patterns may provide answers to several
important questions:
 How realistic and consistent is the client’s thinking about the crisis?
 To what extent, if any, does the client appear to be rationalizing, exaggerating, or believing
part-truths or rumors to exacerbate the crisis?
 How long has the client been engaged in crisis thinking?
 How open does the client seem to be toward changing beliefs about the crisis situation and
reframing it in more positive terms of cooler, more rational thoughts, or is the client engaged in
a downward spiral of catastrophic thinking with no hope of ameliorating the crisis?
The Triage Assessment System
 Because rapid and adequate assessment of a client in crisis is one of the most critical
components of intervention (Hersh, 1985), assessment has a preeminent place in the crisis
intervention model, as an overarching and ongoing process.

 Constant and rapid assessment of the client’s state of equilibrium dictates what the
interventionist will do in the next seconds and minutes as the crisis unfolds (Aguilera, 1998)

 What the interventionist needs in a crisis situation is a fast, efficient way of obtaining a
real-time estimate of what is occurring with a client.

 It should enable the assessment to be performed rapidly by a broad cross-section of crisis

workers who have had little if any training in standardized testing or assessment procedures
The Triage Assessment Form
 The Triage Assessment Form is used to gather important information about
the patient's condition and to help healthcare professionals make informed
decisions about the level of care needed. It also provides a record of the
patient's assessment that can be used for documentation and follow-up
care.

 Variations of the general TAF have been tested with police officer trainees,
veteran crisis intervention team police officers who deal with the mentally
ill, school counselors, community agency workers, secretaries,
undergraduates, agency and crisis line supervisors, volunteer crisis line
counselors, university professors, residence hall staff, and counselors-in-
training
The Affective Severity Scale
 No crisis situation that we know of has positive emotions attached to it. Crow (1977)
metaphorically names the usual emotional qualities found in a crisis as yellow (anxiety), red
(anger), and black (depression) orange (our students chose this color) for frustration, which
invariably occurs as clients attempt to meet needs.

 Frustration of needs is often the precursor of other negative emotions, thoughts, and
behaviors that plunge the clients further into crisis

 Clients may manifest these emotions both verbally and nonverbally, and the astute crisis
worker needs to be highly aware of incongruencies between what the client is saying, how
the client is saying it (voice tone, inflection, and decibel level), and what the client’s body
language says.
The Cognitive Severity Scale
 Ellis has written at length about the part that thinking plays in emotions and behavior. In a crisis
situation, the client’s cognitive processes typically perceive the event in terms of transgression, threat,
loss, or any combination of the three.

 To differentiate between transgression, threat, and loss, think of these dimensions in terms of time.
Transgression is the cognition that something bad is happening in the present moment, threat is the
cognition that something bad will occur, and loss is the cognition that something bad has occurred.

 When cognitions of the crisis move to the severe impairment end of the continuum, the perception of
the event may be so extreme as to put the client or others at physical risk. This kind of shift, from cool
to hot cognitions (Dryden, 1984), is setting the client up to make some bad decisions. Such decisions
most probably will result in even worse behavioral consequences for the client and others.
Comparison With Precrisis Functioning
 Comparing precrisis ratings with current ratings lets the worker gauge the
degree of deviation from the client’s typical affective, behavioral, and
cognitive operating levels. The worker can then tell how atypical the client’s
functioning is, whether there has been a radical shift in that functioning, and
whether that functioning is transitory chronic.

 For example, a very different approach would be used to counsel someone

with chronic schizophrenia suffering auditory hallucinations compared to an
individual experiencing similar hallucinations from a prescription drug. Such
an assessment can be made in one or two questions without having to ferret
out a great deal of background information.
Rating Clients.
 In rating clients on the TAF, we move from high to low. This backward rating process may seem
confusing at first glance, but the idea is that we rule out more severe impairment first. So if we were
rating affect, we would first look at whether the client fits any of the descriptors under Severe
Impairment. If not, we would then consider the descriptors under Marked Impairment.

 If we were able to check off at least two of those descriptors, the client would receive a rating of 9.
If we could identify fewer than two of the descriptors, the client would receive an 8. We would
repeat this rating process across all three dimensions to obtain a total rating.

 Based on the total rating, which will range from 3 to 30, we generally group clients into three
categories. A 3–10 rating means minimal impairment; these clients are generally self-directing and
able to function effectively on their own.

 A rating of 11–19 means that clients are more impaired; they may have difficulty functioning on their
own and need help and direction. This midscore range is the most problematic as far as disposition of
clients is concerned
 Low teen scores (11–15) call for at least some guidance and directiveness from the worker to get the
client on course as opposed to a single-digit score where the client can be pretty much self-directed
with minimal guidance and information.

 High teen scores (16–19) are indicative of clients who are losing more and more control of their
ability to function effectively and call for a good deal more than passive and palliative responses
from the worker so that they do not escalate into 20 territory.

 Rating clients on the triage scale also means rating the crisis worker! How is this so? If the worker is
effective in stabilizing a client, the triage scale score should go down. If it does not, then the worker
probably needs to shift gears and try another approach
Alternate Forms of the TAF

 Alternate Forms of the TAF The TAF has been modified for use with police, higher
education/student affairs personnel, and disaster relief workers, and is currently being
adapted to families based on the increased interaction with and need to provide services
or actions for mentally ill and emotionally disturbed individuals in each of these venues

 All these alternate forms of the TAF have been developed because of the expanding needs
of a variety of workers who do not have a mental health background yet who come in
contact with emotionally disturbed individuals for whom they are expected to render
service of some kind. All of the following variations of the TAF have been modified for
ease and simplicity of use and have or are undergoing field testing.
Psychobiological Assessment
 Psychobiological assessment, in terms of both immediacy of assessment and the assessment skills
required of most human services workers, there is clear evidence that neurotransmitters, the
receptors they land on and physical changes in brain structures play an exceedingly important role in
the affective, behavioral, and cognitive functioning of individuals both during a crisis and, for some,
long after a crisis.

 For at least three reasons, human psychobiology can be an important consideration in crisis
intervention. First, evidence exists that when people are involved in traumatic events, dramatic
changes occur in the discharge of neurotransmitters, such as endorphins, and in the central and
peripheral sympathetic nervous systems and the hypothalamic pituitary-adrenocortical axis

 Second, research indicates that abnormal changes in neurotransmitters such as dopamine,

norepinephrine, and serotonin are involved in mental disorders that range from schizophrenia (Crow &
Johnstone, 1987) to depression (Healy, 1987) and affective and anxiety disorders in general.
 Third, both legal and illegal drugs have a major effect on mental health. Although the way illegal
drugs change brain chemistry and behavior has gained wide attention, legal drugs may promote
adverse psychological side effects in just as dramatic a manner.

 Therefore, the human services worker should attempt to assess 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.

 “Talking” therapies do little good when neurobiological substrates are involved. If the human
services worker has reason to suspect any of the foregoing problems, an immediate referral should
be made for a neurological/drug evaluation.
Assessing the Client’s Current Emotional
Functioning
 Four major factors in assessing the client’s emotional stability are (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, and (4) the developmental stage of the client.

 The duration factor concerns the time frame of the crisis. Is it a onetime crisis? Is it recurring? Has
it been plaguing the client for a long time? A onetime crisis of relatively short duration is called
acute or situational. A long-term pattern of recurring crisis is labeled chronic, long-term, or trans
crisis.

 The degree factor concerns the client’s current reservoir of emotional coping stamina. Assessing
the degree factor, then, involves the crisis worker’s determining how much emotional coping
strength is left in the client’s reservoir
 The ecosystem is a very large extraneous variable that can dramatically influence client coping
Cogdal, & Gilliland, 2003; Myer & Moore, 2006). Geographic region and accessibility, communication
systems, language, cultural mores, religious beliefs, economic status, and social micro- and
macrosystem interactions are only some of the ecosystemic variables that may have subtle or
profound effects on a client’s emotional coping ability.

 Developmental stages (Collins & Collins, 2005) certainly play a part in the client’s emotional
functioning during a crisis. Merely transitioning from life stage to life stage has its own potential for
crises (Blocher, 2000; Erikson, 1963). Understanding the developmental tasks of different life stages,
which may frame a client’s view of a crisis and how the client responds to it, is critical for crisis
worker
The Client’s Current Acute or Chronic
State
 In assessing the crisis client’s emotional functioning, it is important that the crisis
worker determine whether the client is a normal person who is in a onetime situational
crisis or a person with a chronic, crisis-oriented life history.

 The chronic crisis client usually requires a greater length of time in counseling. That
individual typically needs the help of a crisis worker in examining available coping
mechanisms, finding support people, rediscovering strategies that worked during
previous crises, generating new coping strategies, and gaining affirmation and
encouragement from the worker and others as sources of strength by which to move
beyond the present crisis. The chronic case frequently requires referral for long-term
professional help.
The Client’s Reservoir of Emotional
Strength

 The client who lacks emotional strength needs more direct responses from the crisis worker than
the client who retains a good deal of emotional strength.

 A feeling of hopelessness or helplessness is a clue to a low reservoir of emotional strength. In some

cases, the assessment can be enhanced by asking open-ended questions for the specific purpose of
measuring that reservoir.

 Typically, if the reservoir is low, the client will have a distorted view of the past and present and
will not be able to envision a future.
Strategies for Assessing Emotional
Status.
 The crisis worker who assesses the client’s total emotional status may look at a wide array of
social locations (Brown, 2008) that affect both the duration (chronic versus acute) and the
degree (reservoir of strength) of emotional stability.

 Some factors to be considered are the client’s age, educational level, family situation, marital
status, vocational maturity and job stability, financial stability and obligations, drug and/or
alcohol use, legal history (arrests, convictions, probations), social background, level of
intelligence, lifestyle, religious orientation, ability to sustain close personal relationships,
tolerance for ambiguity, physical health, medical history, and past history of dealing with crises.

 The foregoing example is a facilitative affective assessment of the individual. By “facilitative

assessment,” we mean that 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 Alternatives, Coping Mechanisms,
and Support Systems

 Throughout the helping process, the crisis worker keeps in mind and builds a repertory of
options, evaluating their appropriateness for the client.

 In assessing alternatives available to the client, the worker must first consider the
client’s viewpoint, mobility, and capability of taking advantage of the alternatives. The
worker’s own objective view of available alternatives is an additional dimension.

 Alternatives include a repository of appropriate referral resources available to the client.

Even though the client may be looking for only one or two concrete action steps or
options, the worker brainstorms, in collaboration with the client, to develop a list of
possibilities that can be evaluated
Assessing for Suicide/Homicide
Potential
 Not every crisis involves the client’s contemplating suicide or homicide. However, in
dealing with crisis clients, workers must always explore the possibility of harm to self or
others, because destructive behavior takes many forms and wears many masks.

 Contrary to popular belief, most suicidal and homicidal clients emit definite clues and
believe they are calling out for help or signaling warnings. However, even the client’s
closest friends may ignore those clues and do nothing about them.

 For that reason, every crisis problem should be assessed as to its potential for suicide and
homicide. The most important aspect of suicidal/homicidal evaluation is the crisis
evaluator’s realization that suicide and homicide are always possible in all types of
clients.
THANK YOU!!!!