A GUIDE TO CRISIS

INTERVENTION
Chapter 4
Intervening with Crises Related to Danger
to Self, Others, or Being Gravely Disabled

© 2019 Cengage. All Rights Reserved.

ASSIGNMENT DUE DATES
Ch. 7 MindTap Assignments due by 03/21
Ch. 1 MindTap Assignments due
Online Training #2 due 04/04 by 11:59PM
by 02/07
Ch.8 MindTap Assignments due by 04/04
Ch. 2 MindTap Assignments due by 02/07
Ch. 9 MindTap Assignments due by 04/04
Online Training #1 due 02/07 by
11:59pm Online Training #3 due 04/18 by 11:59pm

Ch. 3 MindTap Assignments due by 02/07 Ch. 10 MindTap Assignments due by 04/18

Ch. 4 MindTap Assignments due by 02/28 Recorded Presentation due 04/18 by

11:59pm
Ch. 5 MindTap Assignments due by 02/28
Ch. 11 MindTap Assignments due by 04/25
Ch. 6 MindTap Assignments due by 03/07 Ch. 12 MindTap Assignments due by 04/25
Mid-Term Exam Opens at 12 Midnight Final Exam Opens at 12 Midnight on
on 03/07/23 and closes at 11:59PMCST 05/09 and due by 11:59pm on 05/09/23
on 03/07/2023

© 2019 Cengage. All Rights Reserved.

FEBRUARY 7 TH, 2023

Class Meets Face-to-Face on Campus

Class Meets Face-to-Face on Campus
Read Chapter 4 Intervening with Crises Related to
Danger to Self, Others, or Being Gravely Disabled
Online Training #1 due 02/07 by 11:59pm
Ch. 1 MindTap Assignments due by 02/07
Ch. 2 MindTap Assignments due by 02/07
Ch. 3 MindTap Assignments due by 02/07

© 2019 Cengage. All Rights Reserved.

ONLINE TRAINING #1 DUE
BY 11:59PMCST ON
02/07/2023
Students are required to complete an online training listed on
Moodle and a 1-page reflection.
In the reflection students should identify 2 takeaways from the
training and how their new knowledge can be applied to a crisis
situation.
Each training is worth 10 points each and is due on deadlines
established on Moodle.
Students may experience a delay to receive the certificate that
documents the training, therefore, students are strongly urged not to
wait until the day before the training is due to start the course.
Points will be deducted for late work submitted.

© 2019 Cengage. All Rights Reserved.

WHEN DO YOU NEED TO
TAKE A BREAK?

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DONNY HATHAWAY: A SONG FOR
YOU
HTTPS://YOUTU.BE/91K2JPMWJ9O

© 2019 Cengage. All Rights Reserved.

LEARNING OBJECTIVES
(1 OF 2)
Gain knowledge about the history of suicide prevention and
intervention.
Understand the signs that someone may be suicidal.
Comprehend the signs of the low risk, middle risk, and high risk
suicidal person.
Identify intervention strategies for the various risk levels.

© 2019 Cengage. All Rights Reserved.

LEARNING OBJECTIVES
(2 OF 2)
Recognize the issues for someone who engages in non-
suicidal self-injurious behaviors.
Comprehend the mental status exam.
Learn how to assess whether someone is a danger to
others.

© 2019 Cengage. All Rights Reserved.

MARSHA AMBROSISUS: FAR AWAY
HTTPS://YOUTU.BE/JVBNIZGJXMQ

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INTRODUCTION (SLIDE 1
OF 2)
The responsibility of protecting society
and its individuals from harm done by
someone with a mental health disorder
has been delegated to the mental health
community.
Psychotic decompensation: A state in
which the client is out of touch with
reality and shows symptoms such as
delusions and hallucinations. This
often happens when a schizophrenic
patient stops taking medication or at
the beginning of a person’s first
schizophrenic episode. The state can
also be associated with bipolar disorder
and paranoid disorders. This person
usually requires involuntary
hospitalization
© 2019 Cengage. All Rights Reserved.
INTRODUCTION (SLIDE 2
OF 2)
Emergency psychiatry:
When services are
provided in an emergency
setting such as a hospital to
people with serious suicide
attempts, life-threatening
substance abuse
conditions, vegetative
depression, psychosis,
violence, or other rapid
changes in behavior.

© 2019 Cengage. All Rights Reserved.

WORKING WITH
SUICIDAL CLIENTS
Suicide is one of the most common crisis situations
encountered by counselors.
There are many risk factors to consider when working
with suicidal clients.
Counselors are aware of the role of disconnection and
use the counseling relationship to foster growth and
connection.
The relationship enhances a sense of safety, mutual
empathy, and understanding.
These aspects are important when working with
suicidal clients for them to feel seen and accepted.
When this occurs, the relationship begins to serve as a
protective factor. © 2019 Cengage. All Rights Reserved.
SUICIDOLOGY

Norman Farberow: An
American pioneer in
the field of suicidology.
Created the first suicide
prevention center and
hotline in Los Angeles.
 Launched the Los Angeles
Suicide Prevention Center and
crisis hotline

© 2019 Cengage. All Rights Reserved.

STATISTICS OF SUICIDE
Suicidal ideation: the cognition component of suicide, the
thinking involved.

Affects more than a million people worldwide

 12.9 per 100,000 in the United States

34% of “lifetime suicide ideators” make a plan

 72% with a plan make an attempt

© 2019 Cengage. All Rights Reserved.

SUICIDE ASSESSMENT

Suicide
assessment
includes
 Suicidal risk
factors and
 Lethality
assessment

© 2019 Cengage. All Rights Reserved.

Counselors may consider using the acronym IS Path
WaRM: Ideation, Substance Abuse,
Purposelessness, Anxiety, Trapped, Hopelessness,
Withdrawal, Anger, Reckless,ness, Mood Changes

© 2019 Cengage. All Rights Reserved.

WARNING SIGNS OF
SUICIDAL BEHAVIOR
Proximal
Imply imminent risk
Said to be particular to the individual’s current state of
being
Talk, behavior, and mood are three domains by ASFP

Risk factors include: health factors, environmental

factors, and historical factors

© 2019 Cengage. All Rights Reserved.

SYMPTOMS AND CLUES
(1 OF 2)
Giving things away
Putting things in order
Writing a will
Withdrawing from usual
activities
Preoccupied with death
Recent death of a friend or
relative

© 2019 Cengage. All Rights Reserved.

SYMPTOMS AND CLUES
(2 OF 2)
Feeling hopeless, helpless, or
worthless
Increased drug and alcohol
use
Psychotic behavior
Agitated depression
Living alone/being isolated
Verbal hints

© 2019 Cengage. All Rights Reserved.

988 SUICIDE AND
CRISIS LIFELINE

© 2019 Cengage. All Rights Reserved.

WHAT IS THE ULTIMATE
GOAL OF SUICIDE
ASSESSMENT?

© 2019 Cengage. All Rights Reserved.

SUICIDE ASSESSMENT
Suicide Assessment: A process in which the crisis worker asks
a series of directive questions to ascertain the seriousness of a
client’s suicidal intent and ideation. It includes identifying
various risk factors, a means for suicide, a plan for suicide, and
reason for wanting to harm oneself.

Risk level: Low, Middle, or High

 Determines type of intervention

Clinicians may be reluctant to use objective suicide

assessment tools
 Limited usefulness or inaccurate

© 2019 Cengage. All Rights Reserved.

WHAT ARE THE CHARACTERISTICS
OF THE LOW MIDDLE, AND HIGH
RISK SUICIDAL CLIENT?

© 2019 Cengage. All Rights Reserved.

WHAT ARE THE
INTERVENTIONS FOR
EACH RISK LEVEL?

© 2019 Cengage. All Rights Reserved.

RISK LEVEL AND
INTERVENTION
Low: Ideation, may have a plan, have no means
 Supportive crisis intervention, verbal no-suicide contract

Middle: Ideation, plan, have means but something can stop

them
 Written no-suicide contract, increased contact, family watch, take away
means, refer to medication evaluation, possible voluntary hospitalization
when very depressed

High: Ideation, plans, have means, nothing can stop them,

angry
 Hospitalization, medication

© 2019 Cengage. All Rights Reserved.

NON-SUICIDAL SELF-INJURY
AND SELF-MUTILATIVE
BEHAVIOR (1 OF 3)
Deliberately damaging one’s own body tissue without suicidal
intent
DSM:
 5 or more days in past year of intentional self-inflicted damage with absence
of suicidal intent
 Self-injurious behavior used to obtain relief, resolve difficulty, or induce
positive feeling

© 2019 Cengage. All Rights Reserved.

NON-SUICIDAL SELF-INJURY
AND SELF-MUTILATIVE
BEHAVIOR (2 OF 3)
DSM:
 Negative feelings and thought, preoccupation with behavior that is difficult to
control, thinking about self-injury when not acted on
 Behavior not socially sanctioned
 Behavior causes significant distress or interferes with important areas of
functioning
 Doesn’t occur exclusively during psychotic or drug induced periods, not
better explained by another syndrome

© 2019 Cengage. All Rights Reserved.

NON-SUICIDAL SELF-INJURY
AND SELF-MUTILATIVE
BEHAVIOR (3 OF 3)
Impulsive disorder prevalent in emotional and personality
disorders
Top methods:
 Cutting or carving one’s skin, picking at a wound, hitting oneself, scraping
one’s skin to draw blood, biting oneself

© 2019 Cengage. All Rights Reserved.

HOW DOES SOMEONE ENGAGE IN
SELF-MUTILIATION DIFFER FROM
SOMEONE WHO IS SUICIDAL?

© 2019 Cengage. All Rights Reserved.

INTERVENTIONS FOR
NSSI
Create safe, non-threatening, and structured environment
Cognitive behavioral components
Psychodynamic psychotherapy
Group therapy
S.A.F.E. (Self-Abuse Finally Ends)

© 2019 Cengage. All Rights Reserved.

MANAGING A CLIENT WHO
IS A DANGER TO OTHERS
(1 OF 2)
Assess for risk:
 History of violence
 Thoughts of committing harm
 Poor impulse control
 Loss of reality testing
 Delusions or command hallucinations

© 2019 Cengage. All Rights Reserved.

MANAGING A CLIENT WHO
IS A DANGER TO OTHERS
(2 OF 2)
Assess for risk:
 Feels outside force is controlling him or her
 Belief that others wish to harm him or her
 Perception of rejection or humiliation
 Under the influence
 Anti-social personality
 Frontal lobe dysfunction

© 2019 Cengage. All Rights Reserved.

PSYCHOTIC BREAKDOWNS:
GRAVELY DISABLED
MENTALLY ILL PERSONS
Psychotic decompensation: Delusions and hallucinations
Gravely disabled: Cannot take care of basic needs
Often need to be stabilized in a hospital and with medications

© 2019 Cengage. All Rights Reserved.

WHAT IS THE PURPOSE
OF THE MENTAL STATUS
EXAM?

This Photo by Unknown Author is licensed under CC BY

© 2019 Cengage. All Rights Reserved.
MENTAL STATUS EXAM
(1 OF 2)
Mental Status Exam: A structured way of observing and
interviewing clients to assess for possible psychotic states.

Formal assessment tool to determine severity of disorder

 Appearance
 Attitude
 Behavior
 Speech
 Mood and affect

© 2019 Cengage. All Rights Reserved.

MENTAL STATUS EXAM
(2 OF 2)
Formal assessment tool to determine severity of disorder
 Thought process
 Thought content
 Perception
 Cognition
 Insight
 Judgment

© 2019 Cengage. All Rights Reserved.

ADMINISTERING A MINI
MENTAL STATUS EXAM

© 2019 Cengage. All Rights Reserved.

AUDRA DAY RISE UP
HTTPS://YOUTU.BE/LWG
R_IMEEGA

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COMING ATTRACTIONS

© 2019 Cengage. All Rights Reserved.

FEBRUARY 14TH, 2023

Asynchronous on-line – This week, class

will not meet at a specific day or time.
There will be a combination of readings,
recorded lectures, videos, and other
materials with due-date
assignments/discussion boards/projects
and proctored exams*. Attendance is
monitored and recorded through
student’s interaction in Moodle.

Read Chapter 5 Developmental and

Cultural Crises

© 2019 Cengage. All Rights Reserved.

FEBRUARY 21, 2023

(Feb 20-21
Mardi Gras
holidays;
university
closed. Feb 22
Ash
Wednesday;
no classes.)
© 2019 Cengage. All Rights Reserved.
FEBRUARY 21, 2023
Class Meets Face-to-Face on Campus
Read Chapter 6 - Existential Therapy
Read Chapter 7: Person-Centered Therapy
Quiz 1: Psychodynamic Theories
Psychoanalytic therapy and Adlerian therapy Quiz Due by 11:59PMCST on
02/23/2023
Watch Carl Rogers and Gloria https://youtu.be/ee1bU4XuUyg
Watch Person-Centered Expressive Arts Therapy. Rogers, N. (Director).
(1997).[Video/DVD] Psychotherapy.net.
https://video.alexanderstreet.com/watch/person-centered-expressive-arts-ther
apy
Watch Role Play: Person Centered Therapy https://youtu.be/4wTVbzvBH0k
Watch Three Approaches to Psychotherapy Part 2
https://youtu.be/UOXQqevUjyk
Watch What is Existential Therapy
https://www.youtube.com/watch?v=08jyb1d20fE

© 2019 Cengage. All Rights Reserved.

FEBRUARY 28 TH, 2023
Asynchronous on-line – This
week, class will not meet at
a specific day or time. There
will be a combination of
readings, recorded lectures,
videos, and other materials
with due-date
assignments/discussion
boards/projects and
proctored exams*.
Attendance is monitored
and recorded through
student’s interaction in
Moodle.
Read Chapter 6 Crises of Loss:
Death, Relationship Breakups,
and Economic Loss
© 2019 Cengage. All Rights Reserved.
 IF YOU HAVE ANY
QUESTIONS OR CONCERNS,
PLEASE CONTACT ME!
Lead Presenter: Chantrelle D. Varnado-Johnson, PhD, BC-TMH,
LPC-S, NCC

Personal Pronouns: She/Her/Hers

Registered Play Therapist

Office location: 255 College of Education and Behavioral Sciences

Phone number: 985-448-4349

Email: [email protected]

Student hours (physical): Tuesdays 11-3/ Wednesdays 10-2/

Thursdays 1-3 by appointment

Student hours (virtual): upon request

© 2019 Cengage. All Rights Reserved.

 PEARLS OF WISDOM:
W.E.B. DUBOIS
W. E. B. Du Bois, (born Feb. 23, 1868, Great Barrington, Mass., U.S.—died
Aug. 27, 1963, Accra, Ghana), U.S. sociologist and civil-rights leader. He
received a Ph.D. from Harvard University in 1895. Two years later he accepted a
professorship at Atlanta University, where he conducted empirical studies on the
social situation of African Americans (1897–1910). He concluded that change
could be attained only through agitation and protest, a view that clashed with that
of Booker T. Washington. His famous book The Souls of Black Folk appeared in
1903. In 1905 Du Bois founded the Niagara Movement, the forerunner of the
NAACP. In 1910 he left teaching to become the NAACP’s director of research
and editor of its magazine, Crisis (1910–34). He returned to Atlanta University in
1934 and devoted the next 10 years to teaching and scholarship. After a second
research position with the NAACP (1944–48), he moved steadily leftward
politically. In 1951 he was indicted as an unregistered agent of a foreign power
(the Soviet Union); though a federal judge directed his acquittal, he was by then
completely disillusioned with the U.S. In 1961 he joined the Communist Party,
moved to Ghana, and renounced his U.S. citizenship.

© 2019 Cengage. All Rights Reserved.

 THANK YOU SO
VERY MUCH!

© 2019 Cengage. All Rights Reserved.