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See attached information Application Assignment #2: Suicide Risk Assessment Analysis   Adequate assessment is an absolute necessity in effective crisis intervention. In the rapidly changing scene of an active crisis, assessment can be difficult, puzzling, and frustrating for beginners. Making a valid assessment during an ongoing crisis is perhaps more an art than a science and comes with practice, making mistakes, obtaining feedback, and plunging in again.   In this application assignment, you will explore various suicide risk assessments and select the appropriate assessment for the assigned case study.   For this application assignment, view The Case of Rita that is attached. Consider the various suicide risk assessments provided in chapter 3. What would be the most appropriate assessment to utilize with a suicidal client.   The Assignment:   In a 2-3 page paper: · Select one suicide risk assessment you would utilize with the client. · Discuss the purpose and nature of the assessment instrument. · Evaluate the assessment instruments in term of applicability to suicide risk clients. · Discuss ethical and multicultural concerns/considerations for the assessment. Support your Application Assignment with specific references to all resources used in its preparation. This assignment should be completed using APA formatting with in-text citations. At least two to three references.  Requirement: When you submit your assignment in D2L, use the naming convention "AppAssgn2+last name+first initial" as the Submission Title.   TRIAGE ASSESSMENT FORM: CRISIS INTERVENTION( ©R.A. Myer, R.C. Williams, A.J. Ottens, & A.E. Schmidt CRISIS EVENT: Identify and describe briefly the crisis situation: _________________________________________________________ ____________________________________________________________________________________________________________________________________________________________________________________ AFFECTIVE DOMAIN Identify and describe briefly the affect that is present. (If more than one affect is experienced, rate with #1 being primary, #2 secondary, #3 tertiary.) ANGER/HOSTILITY: ________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ ANXIETY/FEAR: ___________________________________________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________ SADNESS/MELANCHOLY: ___________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________ Affective Severity Scale Circle the number that most closely corresponds with client’s reaction to crisis. 1 2 3 4 5 6 7 8 9 10 No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment Stable mood with normal variation of affect appropriate to daily functioning. Affect appropriate to situation. Brief periods during which negative mood is experienced slightly more intensely than situation warrants. Emotions are substantially under client control. Affect appropriate to situation but increasingly longer periods during which negative mood is experienced slightly more intensely than situation warrants. Client perceives emotions as being substantially under control. Affect may be incongruent with situation. Extended periods of intense negative moods. Mood is experienced noticeably more intensely than situation warrants. Liability of affect may be present. Effort required to control emotions. Negative affect experienced at markedly higher level than situation warrants. Affects may be obviously incongruent with situation. Mood swings, if occurring, are pronounced. Onset of negative moods are perceived by client as not being under volitional control. Decompen-sation or depersonal-ization evident. (All Rights Reserved. May not be reproduced without permission. BEHAVIORAL DOMAIN Identify and describe briefly which behavior is currently being used. (If more than one behavior is utilized, rate with #1 being primary, #2 secondary, #3 tertiary.) APPROACH: _______________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________ AVOIDANCE: ______________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________ IMMOBILITY: ______________________________________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________ Behavioral Severity Scale Circle the number that most closely corresponds with client’s reaction to crisis. 1 2 3 4 5 6 7 8 9 10 No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment Coping behavior appropriate to crisis event. Client performs those tasks necessary for daily functioning. Occasional utilization of ineffective coping behaviors. Client performs those tasks a necessary for daily functioning, but does so with noticeable effort. Occasional utilization of ineffective coping behaviors. Client neglects some tasks necessary for daily functioning is noticeably compromised. Client displays coping behaviors that may be ineffective and maladaptive. Ability to perform tasks necessary for daily functioning is noticeably compromised. Client displays coping behaviors that are likely to exacerbate crisis situation. Ability to perform tasks necessary for daily functioning is markedly absent. Behavior is erratic, unpredictable. Client’s behaviors are harmful to self and/or others. COGNITIVE DOMAIN Identify if a transgression, threat, or loss has occurred in the following areas and describe briefly. (If more than one cognitive response occurs, rate with #1 being primary, #2 secondary, #3 tertiary PHYSICAL (food, water, safety, shelter, etc.): TRANSGRESSION THREAT LOSS _____ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ PSYCHOLOGICAL (self-concept, emotional well being, identity, etc.): TRANSGRESSION THREAT LOSS _____ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SOCIAL RELATIONSHIPS (family, friends, co-workers, etc.): TRANSGRESSION THREAT LOSS _____ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ MORAL/SPIRITUAL (personal integrity, values, belief system, etc.): TRANSGRESSION THREAT LOSS _____ _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Cognitive Severity Scale Circle the number that most closely corresponds with client’s reaction to crisis. 1 2 3 4 5 6 7 8 9 10 No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment Concentration intact. Client displays normal problem-solving and decision-making abilities. Client’s perception and interpretation of crisis event match with reality of situation. Client’s thoughts may drift to crisis event but focus of thoughts is under volitional control. Problem-solving and decision-making abilities minimally affected. Client’s perception and interpretation of crisis event substantially match with reality of situation. Occasional disturbance of concentration. Client perceives diminished control over thoughts of crisis event. Client experiences recurrent difficulties with problem-solving and decision-making abilities. Client’s perception and interpretation of crisis event my differ in some respects with reality of situation. Frequent disturbance of concentration. Intrusive thoughts of crisis event with limited control. Problem-solving and decision-making abilities adversely affected by obsessiveness, self-doubt, confusion. Client’s perception and interpretation of crisis event may differ noticeably with reality of situation. Client plagued by intrusiveness of thoughts regarding crisis event. The appropriateness of client’s problem-solving and decision-making abilities likely adversely affected by obsessiveness, self-doubt, confusion. Client’s perception and interpretation of crisis event may differ substantially with reality of situation. Gross inability to concentrate on anything except crisis event. Client so afflicted by obsessiveness, self-doubt, confusion that problem-solving and decision-making abilities have “shut down.” Client’s perception and interpretation of crisis event may differ so substantially from reality of situation as to constitute threat to client’s welfare. DOMAIN SEVERITY SCALE SUMMARY Affective _____ Cognitive _____ Behavioral _____ Total _____ NCE stduyNNCC Observations (Check all that apply) ___ off medication* ___ hallucinating† (___smells ___sights ___sounds ___touch) ___ bizarre behavior/appearance ___ poor hygiene ___ absurd, illogical, nonsensical speech ___ paranoid/suspicious thoughts ___ flashbacks, loss of reality contact* ___ intoxicated/drugged* ___ possible developmental disability *Support services recommended. †Protective custody recommended. ___ aggressive gestures ___ physically violent† ___ verbal threats to self or others ___ suicidal/homicidal thinking/verbalizing* ___ suicidal/homicidal gestures/behaviors† ___ suicidal/homicidal plan clear† ___ uncooperative ___ reckless behavior ___ impulsivity ___ hysterical* ___ confusion* ___ unable to follow simple directions* ___ unable to control emotions ___ cannot recall personal information* (phone, address) ___ situation perceived as unreal* (spectator) ___ nonresponsive* Figure 3.3 Triage Assessment System for Students in Learning Environments (TASSLE): Observational Checklist. Source : Myer et al., 2007. Chapter Three: The Intervention and Assessment Models ©2017 Cengage Learning Triage Assessment System Evaluates the severity of a crisis situation. Rapid Systematic Intentional Supports the client in gaining: Equilibrium Mobility Autonomy ©2017 Cengage Learning Hybrid Model of Crisis Intervention No longer a linear or stage model. Hybrid Model = linear + systems models. Can be linear or circular Tasks of crisis intervention Safety Predispositioning/Engaging Problem Exploration Providing Support Examining Alternatives Planning in Order to Reestablish Control Obtaining Commitment Follow-up ©2017 Cengage Learning Default Task: Safety ©2017 Cengage Learning Assessing physical and psychological safety is a continuous process. Physical includes basic needs Psychological means the feeling of being safe Safety must be obtained and maintained For the client For the crisis worker For others in the immediate, relevant area High potential for intentional and accidental harm in every crisis situation. 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. Establish a therapeutic bond Inform the client about what to expect ©2017 Cengage Learning Task 1 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. ©2017 Cengage Learning 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 ©2017 Cengage Learning 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 ©2017 Cengage Learning 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 ©2017 Cengage Learning 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. ©2017 Cengage Learning 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! ©2017 Cengage Learning 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. ©2017 Cengage Learning 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 ©2017 Cengage Learning 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. ©2017 Cengage Learning 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. ©2017 Cengage Learning 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. Police officers 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. ©2017 Cengage Learning Do You Know Your ABC’s? Three main domains of triage assessment Affective Feeling or emotional tone Behavioral Action or psychomotor activity Includes verbal and nonverbal communication Cognitive Thinking patterns Beliefs about self and others ©2017 Cengage Learning 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? ©2017 Cengage Learning 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? ©2017 Cengage Learning 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? ©2017 Cengage Learning 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 ©2017 Cengage Learning 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? ©2017 Cengage Learning