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FAMILIES IN CRISIS. Chapter 5 – Crisis Case Handling. 1. CRISIS CASES. Broader in Scope Methodological treatment Continuous feedback Leisurely/weekly More background info. More psycho-educational Seeking to change residual, repressive and chronic modes of thinking, feeling and acting

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families in crisis
FAMILIES IN CRISIS

Chapter 5 – Crisis Case Handling

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slide2

CRISIS CASES

  • Broader in Scope
  • Methodological treatment
  • Continuous feedback
  • Leisurely/weekly
  • More background info.
  • More psycho-educational
  • Seeking to change residual, repressive and chronic modes of thinking, feeling and acting
  • Personality change
  • Compressed scope
  • Best guess or set procedures
  • Here and now
  • Minutes/hours
  • Specific crisis info
  • Quick determination of coping skills, resources,
  • Movement to stability
  • Restoration of functioning

LONG TERM CASES

See Tables 5.1, 5.2, 5.3, 5.4

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walk in s types of presenting crises
WALK-IN’S - TYPES OF PRESENTING CRISES
  • Chronic Mental Illness (often multiple problems with inconsistent care)
  • Acute Interpersonal Problems in Social Environment (runaways, crime victims, violent events, unemployed, etc.)
  • Combination of the two (fairly common)

Note: Often with financial problems prohibiting private care

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case handling at community mental health clinic
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC
  • Entry
    • Disposition of the case
    • Possible isolation
    • Case history
    • Thinking processes
    • Threats to self or others
    • Drug abuse
    • Psychiatrist may be needed

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case handling at community mental health clinic cont
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • Commitment to inpatient facility may be needed
    • Voluntary
    • Involuntary (physician orders/evaluation and crisis trained transportation)

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case handling at community mental health clinic cont1
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • (If Coherent) Intake Interview
    • Written and verbal
    • Define the problem
    • Assess for client safety
    • Apprise the client of rights
    • Usually standardized intake sheet
    • Degree of lethality and drug use

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case handling at community mental health clinic cont2
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • Disposition
    • proposed diagnosis
    • treatment recommendations
    • Discuss with client
    • Client chooses to accept or reject
    • Next steps/therapists/clinical team meeting

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case handling at community mental health clinic cont3
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • Anchoring
    • Never left alone
    • Gain feeling of care and support
    • Structured/methodical orientation
    • Establishing rapport, support, encouragement, sense of security

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case handling at community mental health clinic cont4
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • Short-term Disposition (basic physical needs)
  • Long-term disposition (psychiatric or pharmacological evaluation)
    • With objectives, goals, and therapeutic plan and regular review of plan
  • 24 hour telephone service/hotline
    • Evaluating and referring

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case handling at community mental health clinic cont5
CASE HANDLING AT COMMUNITY MENTAL HEALTH CLINIC (CONT)
  • Mobile Crisis Teams/Police
    • When client is out of control and unwilling or unable to go to the clinic
    • Jail is frequent

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crisis intervention team cit
CRISIS INTERVENTION TEAM (CIT)
  • Train Patrol officers to deal with the mentally ill and emotionally disturbed
  • Utilizing Mental Heath Experts and Providers
  • Including relationships with other community and medical resources
  • De-escalation and diffusing techniques
  • Fishbowls (Trainees observe discussions with patients and mental health professionals)

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suicide by cop
SUICIDE BY COP
  • People who do not quite have the courage to kill themselves
  • Engage police in threatening manner
  • Getting themselves shot
  • The cops complete the suicide

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cit training
CIT TRAINING
  • Has helped many police become more caring crisis workers

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transcrisis in long term therapy
TRANSCRISIS IN LONG-TERM THERAPY
  • Behavior Regression to pre-therapeutic functioning
  • Anxiety (Cognitive irrationality, Fear of failure)
    • Suggestions: deep-breathing, role play, review of other successes, support system, security net
  • Regression (maladaptive but familiar ways of behaving, feeling, thinking)
    • Suggestions: Interpreting, reality based confrontation

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transcrisis long term therapy cont
TRANSCRISIS - LONG-TERM THERAPY (CONT)
  • Problems of Termination
    • Dependency issues
    • Preparation may be needed
  • Crisis in Session (opening can of worms?)
    • Stay in control to model appropriate behaviors
  • Psychotic Breaks
    • Delusional or dissociative break with reality
    • Client name, keep client in reality, repeat requests

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transcrisis long term therapy cont1
TRANSCRISIS - LONG-TERM THERAPY (CONT)
  • Manipulative clients (avoiding engagement in new behaviors)
  • Testing the counselors credibility
  • Borderline Personality Disorder
  • Set clear limits, empathic support, caring confrontation, stick to principles
  • Professional detachment and keeping cool
  • Counselor refusing to be ‘used’ and ‘doing all of the work’

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difficult clients
DIFFICULT CLIENTS
  • May need set of Printed Rules (Ex: p. 111)
  • Confront behavior directly (assertive and directive)
  • Termination
  • Consultation with other professionals

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confidentiality in case handling
CONFIDENTIALITY IN CASE HANDLING

The limits of confidentiality and privileged communication come under scrutiny when a case involves the potential for violent behavior.

  • Legal Principles (limited for counselors)
  • Ethical Principles (code of professional conduct)
  • Moral Principles (personal and may be in opposition to ethical codes and legal statuetes)

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duty to warn
DUTY TO WARN
  • Convey to client early on
  • Liability insurance
  • document
  • If unsure:
    • Consult with other professionals
    • Victim identity?, Motive?, Means?, Plan?
    • Client is out of control
    • Doesn’t understand what he or she is contemplating
    • Incapable of collaboration

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duty to warn1
DUTY TO WARN
  • If client is concretely stating a threat – warn authorities
    • Invite client to participate
    • Surrender weapons
    • Inform those who need to know
  • Check State statutes.

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