Crisis Theory & Task-Centred Practice

Question 1

Crisis Definitions

Answer 1

An event that an individual perceives as being the major source of stress, causing a temporary but major upset in the psychological equilibrium, with which the individual’s usual coping mechanisms fail. The overwhelming event may cause the individual to experience distress, leading to a breaking point, which could result in functional impairment.

o potential for heightened maturity and growth OR for deterioration and greater vulnerability to future stress
o This theory suggests that when people experience crisis, they tend to follow predictable patterns of response… (Barker)

Question 2

5 types of crisis

Answer 2

1) developmental
2) situational
3) social
4) compound
5) existential

Question 3

Developmental crisis:

Answer 3

normal events in life that create dramatic changes and can produce extreme responses (leaving home, birth of a child, retirement)

Question 4

Situational crisis:

Answer 4

Uncommon, extraordinary and unpredictable events (i.e., physical injuries, sexual assault, loss of a job, major illness or death of a loved one)

Question 5

Social crisis

Answer 5

The effect that larger societal or cultural events or responses have on a particular individual or family. e.g. discrimination, persecution

Question 6

Compound crisis

Answer 6

A current trauma reactivates responses to previous losses that had receded from consciousness

Question 7

Existential crisis

Answer 7

inner conflicts over issues such as the purpose and meaning of life

Question 8

Crisis intervention definition (barker)

Answer 8

• The therapeutic practice used to help clients in crisis.

• promotes effective coping
• leads to positive growth and change through acknowledgment of the problem and its impact while learning methods to cope with similar experiences in the future

Question 9

Crisis response models (Boscarato article)

Answer 9

1) Ride-along model
2) Crisis intervention team model
3) embedded model
4) separate response model

Question 10

Ride-along model:

Answer 10

1 mental health worker and 1 uniformed and armed police officer traveling in unmarked government vehicle.

Advantages:
o Educated/experienced mental health worker
o Unmarked car/less intimidating/more discrete
o Presence of police officer mitigates risk for mental health worker
o Police and mental health worker work together

Question 11

Crisis intervention team model:

Answer 11

police based mobile crisis service, 40 hours of mental health training to increase skills to identify psychiatric symptoms and to de-escalate a crisis situation.

Advantages:
o Mental health training
o Police presence deters “bad behaviour” (behaviour putting yourself/others at risk)
Disadvantages:
o Not enough training, not as much as mental health workers
o Authoritarian aspect (weapons/uniform) is threatening, makes you feel as if you are doing something wrong

Question 12

Embedded model

Answer 12

mental health clinicians are based at police stations, providing treatment to consumers who are brought to station by frontline police officers due to elevated nature of crisis situation.

Advantages:
o Good if client is very aggressive, if they require containment
o Alternative to being admitted to psychiatric hospital
Disadvantages:
o Worry about criminal record
o Draws out length of time before admission to hospital, if individual really requires that service
o Police station – makes people feel like they’ve done something wrong

Question 13

Separate response model:

Answer 13

either police members or mental health clinicians provide first response and request assistance from the other service if encountering a difficult situation.

Advantages:
o Safety of general public
o Two perspectives (CAT team and police)
Disadvantages :
o High risk, no training = situation could worsen
o Service user could be taken to jail
o Time between police arrival and CAT team arrival is too lengthy for individuals who are experiencing sever crisis situation

Question 14

Other Crisis intervention models (5)

Answer 14

1) Generalist model
2) Critical incident debriefing
3) crisis stabilization
4) school-based risk assessment and threat management
5) suicide risk management

Question 15

Generalist model

Answer 15

•	Assessment
	Focus on precipitating event
	Questions: Why now? What are client’s perceptions? Social support? History? Suicidal/homicidal?
•	Planning
	Activities of daily living? Strategies?
•	Implementation
	Cognitive appraisal
	Emotional affect
	Coping mechanisms
	Social support
•	Anticipatory Planning
	Developing future coping mechanisms
	Follow up (figures 5.2 & 5.3 in payne text for more details)

Question 16

Critical incident debriefing:

Answer 16

• Focuses on thorough exploration of traumatic event and affective response typically within 24-72 hours of trauma
• Developed within emergency response systems
• Short term intervention
• Based on belief that humans respond in predictable ways to life threatening situations
• may cause more harm then good in the long run

Question 17

School-based crisis intervention:

Answer 17

• Increased awareness of need for effective crisis prevention and intervention within school systems
• Schools based crises unique because of the structure and sense of community
• Suicide, school shootings, gang activity, drug abuse, natural disasters, grief and loss, medical emergencies
• Schools increasingly dependent upon professionals within school system to address crisis-related issues
• Need for training in suicide, critical incident stress debriefing, violence, grief and death and other issues

Question 18

Suicide Crisis intervention* (Granello, 2010)

Steps 1-7

Answer 18

1) Assess lethality
2) Establish rapport
3) Listen to the story
4) manage the feelings
5) explore alternatives
6) use behavioural strategies
7) follow-up

Question 19

Definition of stress (Barker, 2014)

Answer 19

any influence that interferes with the normal functioning of an organism and produces some internal strain or tension. “Human psychological stress” refers to environmental demands or internal conflicts that produce anxiety.

Question 20

Stress and coping (Lazarus & Folkman 1984)

Answer 20

• stress is a process - not an individual variable nor response
• can include major events or daily hassles
• may be chronic or acute

Question 21

3 categories of psychological stress

Answer 21

1) Harm – a damaging event that has already occurred
2) Threat – a perceived potential for harm that has not yet happened
3) Challenge – an event we appraise as an opportunity rather that occasion for alarm

Question 22

Stress responses (3)

Answer 22

1) Physical – physiological reactions such as ulcers, asthma or high blood pressure
2) Psychological – reactions such as avoidance or use of defence mechanisms
3) Serious mental conditions – such as learned helplessness, anxiety disorders, and dissociate disorders.

Question 23

Coping – Problem focused/Emotion focused coping

Answer 23

• Coping is the process through which the individual manages the demands of the person-environment relationship that are appraised as stressful

Question 24

PTSD symptoms (3)

Answer 24

1) re-experiencing (flashbacks [reliving experience], daytime memories, nightmares – causes severe distress
2) avoidance – avoiding traumatic event as much as possible, become to isolate, detach, avoid social situations to avoid any possible contact with traumatic memory. Can be difficult to experience emotions (happiness, sadness, just numb). The feeling that something bad can happen at any time
3) arousal – being easily startled, lack of going to sleep/staying asleep, being hypervigilant.

Question 25

Task Centered Practice (Barker 2014)

Answer 25

• short-term intervention
  where social worker & client
• identify problems and the tasks needed to change them
• develop a contract in which various activities are to occur at specified times
• establish incentives and a rationale for their accomplishment
• analyze and resolve obstacles as they are identified

Task centered practice may involve

• guided simulation exercises and practice so client’s can be helped to accomplish tasks independently during the week.
• facilitation of a contextual analysis to help the client identify, locate, and use resources and modify distorted perceptions or unrealistic expectations.

Question 26

important requirements of Task-Centred Practice (3)

Answer 26

1) Client acknowledges the problem and is willing to work on it
2) Client is in a position to work on the problem (given help)
3) Problem is specific and limited in scope
- SMART goals; specific, measurable, achievable, realistic, and timely

Question 27

Commonalities between Crisis and Task-Centred practice

Answer 27

• Brief & structured interventions dealing with immediate problems
• Use of contracts
• Focus on improving individual’s ability to solve problems

Question 28

Differences between Crisis and Task-Centred practice

Answer 28

• Task centred deals with wider range of problems versus crisis intervention deals with one major problem
• Task centred identifies and responds to major priorities versus crisis intervention uses practical activities to help people readjust (but also address the emotional responses)
• Task centred takes a pragmatic approach to problem-solving (behavioural theory) versus crisis intervention theory views problems as being rooted in origin of life difficulties (psychodynamic)

Question 29

Strengths of Crisis and Task:Centered:

Answer 29

o research support
o encourages accountability
o focus on practice aspects that are immediate

Question 30

Limitations of Crisis and Task-Centered:

Answer 30

o Use of contracts is common – too formal and creates artificial equality
o Does not focus on larger issues (systemic oppression

Question 31

Crisis theory/task centered practice

Answer 31

o Began in preventative mental health work
o Draws from psychodynamic theory and cognitive behavioural ideas
o Focus on openness and transparency