1	Crisis Intervention & Emergency Psychological Services Foundation For Professional and Ethical Practice
2	Presenting Problems Angry Aggressive Abusive Threatening Destructive Dangerous Violent Homicidal Self-harming Self-abusive Self-destructive Self-mutilating Suicidal
3	Service Continuum Routine Non-urgent Broadest domain of Dx & Tx Chronic Acute Developmental Crisis Intervention Urgent Broad domain of Dx & Tx Acute Developemtal
4	Service Continuum Emergency Psychological Services Emergent Immediate stabilization & disposition Acute Immediate
5	Service Delivery & Context Private practice Outpatient MH Employee assistance Hospital ED Crisis Centers Human resources Emergi-centers Crisis hotlines Inpatient medical Inpatient psychiatric Medical practice Schools Counseling centers Guidance centers Community MH Religious Community Friends/Family People in the Community
6	Services Delivery Interface Medical Triage Screening Examination Lab work up Imaging Assessment Diagnosis Treatment/Procedure Consultation Psychological Intake Screening Evaluation Assessment Diagnosis Treatment/Intervention Consultation
7	Service Delivery Interface (cont) Medical (cont) Disposition Plan Orders Monitoring Transfer Referral Routine admission Direct admission Discharge Follow-up Psychological (cont) Referral Plan Monitoring Referral Termination Follow-up
8	Risk Assessment Immediate Context Clinical Statistical Short Term Clinical Context Statistical
9	Risk Management Issues Legal Civil or Tort Statutory law Federal law Licensing Administrative rules
10	Risk Management (cont) Professional Confidentiality & Duty Presumption of Exceptions Treatment Competence Informed consent Moral Organizational Managed care pressure Fee-for-servce Personal Social/Organizational Personal conscience Levels of care Commitment Effort
11	Risk Management Liability Negligence & Malpractice (4 D’s) Hind site bias Reprehensibility
12	Risk Management Guidelines Differential Diagnostics Evaluation/Examination Risk Assessment Intervention Framework Consultation Clear articulation Documentation
13	Primary Differentials Depression Anxiety/Panic Reactive/Adjustment Personality Disorder Functional Organic D/A Dangerousness
14	Evaluation/Examination Triage ID information Ethnicity/Culture Appearance LOC Motor Function Behavior Cooperation/Attitude Triage (cont) Problem statement Orientation x4 Collateral evidence Vitals Observations Pupils Skin Breath Breath Speech
15	Evaluation/Examination Triage (cont) Drug allergies (NKDA) Physical complaints Known medical problems Current Medical Tx & Rx Hx of current problem Mental Status Affect Symptoms Insight Memory Immediate Short term Long term Thought content Thought process Perception
16	Evaluation/Assessment Mental Status (cont) Tasks Names Backwards Objects 3 words Presidents Directions Serials Math Geography Mental Status (cont) Tasks (cont) Similarities Reading Writing Proverbs
17	Evaluation/Assessment Mental Status (cont) Judgement/impulse control Reliability/Honesty Danger to self/others Ideation Statements Behaviors Hx Mental Status (cont) Unable to care for self Unable to provide for basic needs
18	Evaluation/Assessment History Marital Children Recent loss/trauma Religious/Spiritual Employment Relationships Education Family of origin Medical Hospital History (cont) Psychiatric Hospital Family psychiatric Past medication trials Financial Legal problems Criminal D/A Suicide/Violence
19	Suicide Risk 11 suicide per 100,000 8^th leading cause of death Males 4x’s are like to die as females (80%) White males and female are 90% 3 out 5 are from fire arms. 3^rd leading cause of death in 15 to 24 years Teen suicide rate has tripled since 1955
20	Suicide/Homicide Risk Factors Male Gays, lesbians, bisexual Single, divorced, separated, widowed Teens & Elderly Living alone, isolated Whites, Native Americans Unemployed Physicians, psychiatrists, psychologists, dentists, attorneys Individual Hx of prior attempts Family Hx of suicide Family Hx physical, sexual or drug abuse
21	Suicide Warning Signs Talks about committing suicide Trouble eating/sleep Drastic changes in behavior Withdraws from friends Loss of interest in hobbies, work, school Has attempted before Takes unnecessary risks Recent severe loss Preoccupied with death & dying Loss of interest in appearance Increased D/A use
22	Immediate Risk Behavior Visual Verbal Progressions Social/Group Triggering influences Chemical Surrounding influence Medical/Mental health History Recent Past Social Mental Health Motivations Mental Status
23	Short Term Risk Factors Age Sex Race Religious beliefs Insight Motivational/purpose Mental status Dx & Dx impression D/A Hx Ideation Statements’ Behavior Hx of violence Hx of suicidal behavior Hx of loss, trauma, abuse Self-sufficiency Personal/Social support
24	Short Term Risk Factors (cont) Ability to solve problems Resources to Solve their problems Health status Self-care Honesty/Reliability Collateral opinions
25	Self-Harming & Suicidal Behavior Motivations Change Choice Control Punish self Punish others Psychotic process
26	Aggressive & Violent Behavior Motivations Justice, Revenge or victim rage Freedom Control Carry-over Contempt Acting out Image, status, role, reputation Protection Threat reduction Self-punishment Civil or rationalized disobedience Expose to violence & diffusion of Individual responsibility Psychotic process
27	Factors Contributing To Crisis Resolution Chemical detoxification Positive transference Emotional “Detox” Time w/in safe structure/container Support instituted or renewed Change in relationship Change in perspective Change in behavior Restored health and well-being Bio-chemical gatekeeping
28	Crisis Intervention Goals Information/Knowledge Symptom relief Autonomic arousal Psychomotor acceleration ASE’s Insight/Understanding Normalized perspective Adaptive response/Behavior Can conceptualize a reasonable plan to recover Restoring necessary self or other reliance Can apply contingencies to “what if’s”
29	Crisis Intervention Goals (cont) Reduced Helplessness Hopelessness Isolation
30	Medication Interventions Potential Benefits Restore reality contact Improve judgment Reduced lability Greater cooperation Reduce resistance Relieve symptoms Instill hope Behavioral restraint Potential Problems Exacerbation ASE’s Negative impact single trial learning Medical crisis Increased lability Prophylatic Tx Expectancy & Contingency
31	Dispositions Discharge/Release Degree of collaboration in establishing a plan History and presentation of disorder Ability or resource to support plan Adequate contingencies Response to intervention Ability of others to support Risk that others will undermine
32	Disposition Transfer/Admission Medical vs psychiatric Full mental health evaluation Medical clearance Impression Diagnosis Goals of treatment
33	Referral To ED’s Transport Clinican Family Friends Taxi Secure transport Police EMS Collaborate with ED Participate in Interview Provide/Fax copy of your evaluation Involve family or friends to extent possible
34	Collaboration With Medical Care Medical Screenings Therapeutic levels CBC, WBC, LFTs Thyroid Blood chemistry Fasting glucose Lytes RFT, Urinalysis ECG, EKG Urine drug tox screen Rx’s Antidepressants Anxiolytics Antimanics Antipsychotics
35	Defusing Immediate Risk Strategies Mere presense Establishing a relationship and using it Use reason and rationality Redirecting emotions and motivations Manage, control and eliminate triggers Give directives and set limits Physical restraints, control and redirection Chemical restraint
36	Defusing Immediate Risk Verbal Techniques Calming Persuasion “Clarifiers” & “rapport” builders Distraction Questioning Confrontation
37	Use of Police & 911 Give only that information necessary Answer questions Provide useful and compelling information Anticipate possibility of over and under response Get incident number Insist on speaking with responding officer Take notes Get last name and BPSST of officer