crisis midterm

Basic Counseling Skills

• Maintain eye contact 

  • Gentle 

• Verbal matching 

  • Within limits

    • Ex: if client is speaking soft, don’t speak loud

• Tracking body language

  • How you are sitting, presenting 

  • What is your presence?

• Comment on nonverbals

  • Notice that you are doing xyz

  • How you are feeling today?

    • Notice you are down or less energy

• Express empathy 

• Ask open questions 

• Ask open closed questions

• Encourages

• Clarifies 

  • I heard … Did I get that right?

• reframe/phrases/restate

• Summarizes

• Reflect on feelings

  • How does that feel for you?

• Reflect on meaning 

  • What does that mean for you?

  • Don’t assume

• Focuses 

• Normalizes

• Validates 

• Confronts or challenges 

• Interprets 

Crisis Counseling Skills

• Rapidly build therapeutic relationship 

• Identify crisis 

• Assesses crisis (SI/HI/disability)

  • Directly ask 

• Ensure client’s immediate safety 

• Implements a safety plan 

• Identifies strengths 

• Collaborates with client to develop crisis goals 

• Supports immediate action 

• Collaborate with client to develop crisis goals 

• Supports immediate action 

• Directive as needed 

• Sensitive to cultural factors 

  • Protective factors

  • So they do not harm themselves 

• Assess systemic factors 

What part of documentation plays in the practice of MFT?

• It provides written record of the treatment provided

• Legal and HIPAA requirements 

• Electronic health records

• Frances smith center forms and documents 

What is a patient record?

• Documents which indicated the nature of services rendered

• The clinical documentation created by the provider during the course of therapeutic treatment 

• This includes intake forms, a copy of informed consent, authorizes releasing of info, office policy, and billing info

Why session notes?

• Are medical records

• Identify client’s condition at onset of therapy in order to assess progress

• Allows therapist to memorialize key information about the client needed for development of tx plan

• Help therapist to remain on track

• In crisis, documents on the therapist’s rationale for key decisions made to ensure client safety 

What does the law governing MFTs require for documentation?

• Many types of progress/session 

  • SOAP: Subjective; Objective; Assessment; Plan

  • BIRP: Behavior; Intervention; Response; Plan

  • PIRP: Problem; Intervention; Response; Plan

  • GIRP: Goal; Intervention; Response; Plan

Goals of First Session

• Case management issues

  • Informed consent 

  • Release of information 

  • Review of initial ppw completed by client and clarification of information 

• Begin assessment including identification of presenting complaint(s) and reason for seeking therapy 

Goals of Second Session

• Continued assessment including 

  • Initially should include gathering information necessary to develop treatment plan 

    • Per theoretical orientation, what info is needed to generate case conceptualization

    • Should include treatment goals that are generated by the client or collaboration between therapist and client 

    • Information needed for differential diagnoses

Goals of Ongoing Sessions

• Refer to tx plan 

• What is plan to address treatment goals

  • Break down to smaller goals

Interventions

• Reflection 

• Validation 

• Empathic attunement 

• Tracking 

• Psychoeducation 

• Bibliotherapy 

• Communication skills

• Mindfulness

• Relaxation 

• Anger management 

• Stress management 

• problem-solving 

• Coping skills 

• Identify triggers 

• Boundary setting 

• Self-compassion 

• Breathing exercises

• Grounding techniques

• Grounding techniques 

• Empty chair 

• Letter writing 

• Assertiveness skills 

Response

• Client’s behavior and attitude

• How does the client appear:

  • Appearance: neat, dishelved, bizarre

  • Eye contact: normal, intense, avoidant 

  • Behavior: agitated, withdrawn, shut down

  • Affect: labile, constricted, full range

  • Mood: anxious, angry, irritable, depressed, excited, etc

• Response to interventions 

  • Asked questions 

  • Confusion 

  • Disinterest 

  • Apprehensive

  • Enthusiastic 

  • Use client’s actual words (quotes) when appropriate

Plan

• Hw

• Referrals

• Bibliotherapy 

• Testing 

• Consultation

Documenting Crisis

• When client is in potential crisis situation, this is where documentation needs to be detailed and specific 

  • How did you assess the crisis?

  • Based on assessment, what steps did you take to ensure safety?

  • What was your client’s response to assessment/intervention?

Crisis Related Goals

• When client is in a crisis situation 

  • Harm to self

  • Harm to others

  • Impaired realty testing 

• Goal will always be to stabilize crisis

  • Reduce frequency/intensity of SI; decrease SI related to depressive symptoms via medication 

  • Reduce anger/treat of physical violence

  • Increase reality testing via medication or refer for higher level of care

Suicide Assessment

• Client tells therapist they have been having suicidal thoughts 

  • How recently?

  • What is the frequency and intensity of thoughts?

  • Do they have a plan and access to means?

  • Have they attempted?

  • Is there family history?

  • Does client have of impulsive

  • Was there a precipitating event that preceded SI?

  • Is the client willing to complete a safety plan?

• Based on responses, document reasons for one of clinical decisions

  • Have client complete safety plan (copy for file and client); increase sessions to twice a week or more

ROI

• Sign a ROI before any consultation 

• Up to 1 year

Define Crisis

• Difficult to define as it is personal 

• What you have been through and gone through; resiliency can change

  • Two people can get in a car accident but one is can develop PTSD while another can get into a car immediately 

• Do not make assumptions 

• No right or wrong with experiencing crisis

Subjective experience

• Causes difficulty or distress

• Cannot be resolved through normal means

  • Beyond normal capacity 

• Significant dysfunction if left untreated

  • Mental health diagnoses

  • Physical health 

• Can provide an opportunity for growth if addressed 

If left unaddressed…

• Physical 

  • Somatic 

• Affective 

  • Numbed

  • Angry 

• Cognitive 

  • Memory 

  • Rumination 

  • Intrusive thoughts

• Spiritual 

  • Reevaluate beliefs 

• Behavioral 

  • How we respond 

Domains

• Developmental 

  • Normal process; Can also cause a lot of challenges 

  • Can’t know until it hits you 

• Situational 

  • Uncommon 

  • Still occur 

• Environmental 

  • Large scale and affects everyone in different ways

• Existential

  • Can come from the previous three or on its own

Failure to cope

• Multiple factors can serve as protective factors

  • Material resources 

    • No resources → harder to cope 

  • Social 

  • Personal 

    • Pessimism vs optimism 

Symptom development

• Disbelief 

• Numbness 

• Feelings of anger 

• Blame of others

• Blame of self

Biased Assumption

• Understanding of normal behavior 

  • No standard of normal 

  • Always check w/ client of what that means to them

• Individual, not community, should be focus

  • Community response can be just as important 

• Academic disciples define the concepts 

• Therapist and client understand language

  • Need to clarify 

  • Don’t assume 

• Independence > Dependence 

• More important and effective than natural systems

  • Natural community can be just as valuable, if not more 

• Universal linear thinking 

• Help individuals conform 

• History is irrelevant to context of crisis 

  • Very is relevant

  • Full intake is very important 

• Therapists are aware of their biases and cultural assumptions 

Connecting

• Build rapport 

• Address immediate threats and concerns 

• Provide with info about what steps to take

Assessment

• Current crisis and relevant pre-disaster stressors 

• Identify degree of impairment 

  • How are they handling the situation?

  • Before vs. now

• Identify problem solving, coping skills and support system

  • Likelihood of taking new skills is not high → go to what they already know 

• Identify warning signs of maladaptive coping or suicidal ideation 

• Explore adaptive skills

• Identify risk factors 

Therapists should present as…

• Caring 

• Calming 

• Engage in active listening 

• Nonjudgmental and empathic responding 

• Reflecting crisis-related feelings 

• Clarifying crisis facts 

• Provide realistic hope 

Goals and interventions

• Facilitate the client’s expression 

• Reframe and interpret misunderstanding or maladaptive beliefs

• Help reduce anxiety 

• Assess for emotional readiness to begin problem solving 

• Explore past coping skills or identify new, alternative ones 

• Provide encouragement and convey confidence; highlight strengths 

Action Plan

• Help identify solutions 

• It is common for clients in crisis to have disorganized thinking, concentration problems, and difficulty making decisions or planning 

• Engage and empower clients 

• Identify things that are easily completed to help restore sense of control and capability 

• Break down goals into manageable chunks w/ specific tasks 

• Collaboration is key 

• Referral for additional interventions

Post-Traumatic Growth

• Growth does not occur as a result of trauma, but rather the new cognitive schemas that develop following the traumatic event 

• Causes individual to re-evaluate their world

• Previously held beliefs, attitudes, and coping systems are challenged and in some cases dismantled 

Countertransference

• Therapist projecting their beliefs, attitudes, and feelings onto the client

• In crisis response, therapists can find themselves fantasizing about rescuing their clients leading to preoccupation. It can also cause therapists to question beliefs and people’s propensity toward evil, causing distance or generalizations regarding the trauma.

Burnout

• Response to the powerful strain of working closely with other people, especially people who have experienced traumas and crisis

• Characterized by chronic stress results from frequent and intense personal relationships found in helping professions

• Cumulative – typically manifests with mild symptoms and progressively increases when not addressed

• Results from feeling powerless, frustration, inadequacy in meeting goals, work stressors or pressure from supervisors

Signs of burnout

• Sleeplessness

• Nightmares

• Headaches

• Back and neck pain

• Physical exhaustion

• Repeated illnesses

• Irritability

• Emotional exhaustion

• Aggressive behavior

• Cancelling appointments or showing up late

• Dreading work

• Daydreaming or distracted during sessions

• Feeling emotionally drained

• Feeling overwhelmed

• Decrease in empathy

• Increased feelings of negativity, cynicism, loss of purpose

Compassion Fatigue / Secondary Traumatic Stress

• The natural, consequent behaviors and emotions resulting from knowing about a traumatizing event experience by a significant other. It is the stress resulting from helping or wanting to help a traumatized or suffering person.

• Symptoms similar to PTSD (sleep disturbances, flashbacks/memories, nightmares, anxiety, avoidance, hyperarousal)

Vicarious

• Individuals who work with victims may experience profound psychological effects, effects that can be disruptive and painful for the helper and can persist for months/years after the work with traumatized individuals

• Cumulative and permanent and will manifest in the personal and professional life of the helper.

• Causes profound change in helper’s core sense of self

  • Individual identity

  • Worldview

  • Ability to manage emotions

  • Maintain positive self-esteem

  • Ability to connect with others

  • Can also impact sense of safety, trust, control, dependence, and intimacy

Prevention of Burnout/Compassion Fatigue/Vicarious Trauma

• Quality Supervision

• Peer Consultation

• Education & Training

• Personal coping mechanisms

• Spirituality

• Limiting number of hours / per week

• Environmental settings

• Work/life balance

• Debriefing

• Variety of clients

• Leave work at work

• Establishing boundaries

Recognizing Medical Emergencies

• Breathing problems

• Change in mental status

• Chest pain

• Choking

• Coughing excessively

• Fainting or loss of consciousness

• Sudden, severe pain anywhere in the body

• Sudden dizziness or weakness

• Change in vision

• Unusual headache

• Inability to speak

• Slurred speech

• Lack of alertness or diminished

• response

• Inability to suddenly move limbs

Therapist Actions

• Remain calm, do not panic

• Assess the situation

• Take charge

• Be real & authentic

• Formulate a Plan

Personal Emergencies for the Therapist

• Phone call received during session 

• Feeling unwell or sick 

• Medical emergency 

• Attending another client emergency

• Canceling sessions prior to session, during session, longer duration

Impact on Body

• Reactions can be delayed hours, days, and weeks

• Impact can last a few days, weeks, months, or longer depending on the severity of the crisis, personal experience with crisis/trauma, and developed responding style

• Important to know previous traumas in case they respond differently

Physical Response

• Nausea

• Upset Stomach

• Tremor

• Sweating

• Diarrhea/Constipation

• Headache

Mental Response

• Slower Thinking

• Fearful Thoughts

• Memory Problems

• Detachment

• Flashbacks

• Feeling Insecure

Emotional Response

Anxiety

• Guilt

• Grief

• Sadness

• Overall Numb

• Irritability/Anger

Behavioral Response

• Crying

• Hyperactivity/Agitation

• Withdrawal

• Increased Drug Use

• Snapping at Others

• Loss of Motivation

Long Term Impact on Body

• Cardiovascular Illness

• Immune Functioning

• Gastrointestinal Conditions

• Musculoskeletal & Pain Disorders

• Neurological Disruption

Long Term Impact on Cognitive Functioning

• Impaired Problem Solving

• Impaired Decision Planning

• Intrusive Thoughts, Hyperarousal

• Memory Impairment

• Values & World View

Long Term Impact on Psycho-Emotional

• Emotional Dysregulation

• Dissociation

• Depersonalization

• Derealization

• Mood/Anxiety/Substance

• Abuse/PTSD Disorders

Long Term Impact on Behavioral

• Avoidance

• Withdraw from Social/Interpersonal

• Relationships

• Self-Medicating

• Re-Enactment

• High-Risk & Self-Injury

Symptom Development and DSM

• Acute Stress Disorder

• PTSD

• Reactive Attachment Disorder

• Disinhibited Social Engagement Disorder

• Adjustment Disorders

• Anxiety Disorders

• Depressive Disorders

• Substance-Related & Addictive Disorders

• Personality Disorders

• Somatic Symptoms & Related Disorders

Elder/Dependent Abuse

• Any person 60+

• Dependent Adult 18-59 with physical or mental limitations that restrict

• ability to care for themselves

• 1 in 10 people 60+ who live at home experience abuse

• The number of abuse reports increased 74% from 2004 to 2014

• The most frequently reported abuse by others is financial. Financial institution employees became mandated reporters on January 1, 2007

• Over 225,000 Californians become victims each year, but experts believe the problem to be much larger.

Neglect

• occurs when someone who is caring for an elder or a dependent adult fails to assist in

  • personal hygiene

  • provision of food, clothing, or shelter

  • fails to provide necessary physical or mental health care

  • fails to protect from health or safety hazards

  • fails to prevent malnutrition or dehydration.

• also present if an elder or dependent adult cannot take care of themselves because of poor cognitive functioning, mental limitations, substance abuse, or chronic poor health.

Assault

• unlawful attempt, coupled with a present ability, to commit violent injury on the person of another.

  • Words alone are insufficient to constitute an assault. However, when words are combined with actions, such as the raising of a fist or the brandishing of a knife or firearm, an assault is likely to have occurred.

Assault with a Deadly Weapon

the test of whether something is a deadly weapon is basically whether the object, instrument, or weapon is used in such a manner as to be capable of producing death or great bodily injury.

Battery

• when there has been a willful and unlawful use of force or violence upon the person of another.

  • A punch in the nose would be a willful and unlawful use of force, but the law does not require that the physical contact be that severe.

  • A slight touching can be enough if the touching is unprivileged.

  • A shove or just as a pat on the buttocks could constitute a battery.

Physically restraining an elder or dependent adult

• Grabbing and holding someone is a type of physical restraint.

• Physical restraints are also used in hospitals, skilled nursing facilities, and other care facilities to prevent patients from harming themselves or others. In general, however, physical restraints should only be used pursuant to a physician’s orders, on a temporary basis, to prevent an elder or dependent adult from harming themselves or others. If a physical restraint is being used to restrain an elder or dependent adult for any other purpose, such as for punishment or the convenience of staff, the incident should be reported as abuse

Emotional Abuse

• Fear, agitation, confusion, or severe depression or other forms of serious emotional distress engendered by intimidating behavior, threats, harassment, or deceptive acts or false or misleading statements made with malicious intent to agitate, confuse, frighten, or cause severe depression or serious emotional distress of the elder or dependent adult.

Sexual Battery

touching of an elder’s or dependent adult’s “intimate parts” for sexual arousal or sexual gratification without consent (including over clothing).

Rape in concert

act of rape that is committed by more than one individual against a victim.

Incest

sexual relationship between a parent and a child; ancestors or descendants of every degree; brothers and sisters (of the half or whole blood); or uncles and nieces or aunts and nephews.

Sodomy

act of sexual contact in which the penis of one person contacts the anus of another person.

Oral copulation

act of copulating the mouth of one person with the sexual organ or anus of another person.

Sexual Penetration

penetration of a genital or anal opening or causing another to so penetrate, against a person’s will, for the purpose of sexual arousal, gratification, or abuse by any foreign object, substance, instrument, or device.

Lewd and lascivious acts

Individual has used force, duress, violence, menace, or intimidation to get a dependent person to perform sexual acts for the caretaker’s own sexual gratification

Abandonment

deserting or willfully forsaking an elder or dependent adult under circumstances in which a reasonable person would continue to provide care and custody

Abduction

taking an elder or a dependent adult out of California or preventing them from returning to California without their consent

Isolation

 preventing an elder or a dependent adult from receiving their mail or phone calls; meeting with their visitors; preventing an elder or dependent adult from leaving; or telling a visitor that the elder or dependent adult is not present or does not to interact with the visitor when such information is false.

Financial Abuse

A person or entity takes, conceals, appropriates, or retains real or personal property of an elder or dependent adult for a wrongful use or with intent to defraud.

Exceptions to reporting

• If an elder or a dependent adult tells a psychotherapist that he or she has been abused physically or financially, abandoned, abducted, isolated, or neglected, the psychotherapist does not have to report the incident if all of the following things are true:

  • The psychotherapist is not aware of any independent evidence that corroborates the statement of the alleged abuse.

  • The elder or dependent adult has been diagnosed with a mental illness or dementia, or is the subject of a court-ordered conservatorship because of a mental illness or dementia.

  • In the exercise of clinical judgment, the psychotherapist reasonably believes that the alleged abuse did not occur

2+ Therapists Filing

• Two or more health practitioners may file a single report if the practitioners are all present and agree that abuse has occurred or conclude that at least a suspicion of abuse has risen

• It is possible for a trainee and a supervisor, or an associate and a supervisor, or a licensee in conjunction with other health practitioners, to combine their reporting obligations and file a single report.

Neglect Signs

• Poor hygiene, dirty or torn clothes or lack of appropriate shelter

• Medical conditions that go untreated

• Malnutrition and dehydration

• Bed sores

Physical Signs

• Injuries that are incompatible with explanations

• Bruises, scratches, or other injuries

• Inappropriate use of a physical restraint or medication

Emotional Signs

• Elderly person or dependent adult is withdrawn secretive or is hesitant to talk freely around caregiver

• Family members or caregivers isolate the elder or dependent adult, restricting contact with other family members or friends

Financial Signs

• Unusual bank account activity including unexplained ATM withdrawals

• Unpaid bills, eviction notices or discontinued utilities

• Implausible explanations given about an elder or dependent adult's finances

• Changes in spending patterns often accompanied by the appearance of a new "best friend"

• Missing money, checks, or personal items

Sexual Signs

Difficulty walking or sitting

Signs of depression or withdrawal

Bruising or marks near genital region

Symptoms of STI or UTI

Physical abuse resulting in serious bodily injury (at a long-term care facility)

• Phone report within 2 hours of observing or obtaining knowledge

• Written report within 2 hours of phone report

Physical abuse not resulting in serious bodily injury (at a long-term care facility)

• Phone report within 24 hours of observing or obtaining knowledge

• Written report within 24 hours of observing or obtaining knowledge

Suspected abuse caused by a resident of a long-term care facility and they have a diagnosis of dementia and there is no bodily injury

• Phone report immediately or as soon as practicably possible

• Written report within 24 hours of acquiring the information

Suspected abuse (not physical) (at a long-term care facility)

• Phone report immediately or as soon as practicably possible

• Written report within 2 working days

Abuse occurring in a state mental hospital or developmental center and result led to death or sexual assault

Phone and written report within 2 hours of acquiring the info

Suspected abuse occurred anywhere other than long term care facility or state facility

• Phone report immediately or as soon as practicably possible

• Written report within 2 working days

Mandated Reporting

• In your professional capacity 

  • When you have knowledge of or reasonable suspect 

  • If you observe or suspect child neglect in your capacity 

• When you have knowledge or reasonable suspicion 

  • When you have reasonable suspicion, it is objectively reasonable for a person to entertain suspicion 

• Suspicion of child abuse or neglect 

  • Know key terms and familiarize themselves with definitions

Child Abuse

• Person under the 18 years old 

• Past abuse or neglect of someone who is an adult (18 years of age or older) at the time of disclosure does not warrant a suspected child abuse report.

• Past abuse or neglect of an alleged victim who is still under the age of 18 does call for a mandatory report, even if you are provided with information that a report has already been made sometime in the past.

• Access to children by the alleged perpetrator does not, in and of itself, constitute reasonable suspicion of child abuse. You should consider the known facts and surrounding circumstances to determine if you reasonably suspect abuse or neglect of children by the alleged perpetrator.

• The law does not limit reporting reasonable suspicion of abuse or neglect of children to only those residing in California.

Reportable

• Physical injury or death inflicted by other than accidental means upon a child by another person

• Sexual abuse

• The willful harming or injuring of a child or the endangering of the person or health of a child

• Unlawful corporal punishment or injury as defined

• Neglect.

Physical Injury or Death

• Unless it was an accident, physical injury or death inflicted upon a child by another person warrants a mandatory report. Exceptions include:

  • Accidental injury or death

  • A mutual affray between minors does not fall under the definition of “child abuse or neglect.”

  • Injuries caused by the reasonable and necessary force used by a peace officer acting within the course and scope of their employment.

Sexual Assault

• includes, but is not limited to, rape, statutory rape (certain instances), rape in concert, incest, sodomy, lewd or lascivious acts upon a child, oral copulation, sexual penetration, and child molestation.

  • Sexual abuse also includes the intentional touching of genitals and intimate parts of a child by the perpetrator or of the perpetrator by the child for purposes of sexual arousal or gratification.

  • Intentional masturbation by the perpetrator in a child’s presence also falls under the definition.

  • Nonconsensual sexual activity and incest (even if consensual) involving minors always warrant a mandatory report.

• Pregnancy of a minor does not, in and of itself, constitute a basis for reasonable suspicion of sexual abuse. Other factors, such as consent, age, and indications of exploitation, should be considered to determine whether a report should be made

Sexual Exploitation

• Conduct involving matter that depicts a minor engaged in obscene acts. Alleged perpetrator prepares, sells, or distributes matter depicting a minor engaged in obscene acts. Obscene acts consist of nudity, erotic poses, or sexual activity.

• Involves any person who knowingly promotes, aids, assists, employs, or uses child prostitution, or who persuades, induces, or coerces a child to engage in prostitution or a live performance involving obscene sexual conduct; or to pose or model alone or with others for purposes of preparing a film, photograph, negative, slide, drawing, painting, or other pictorial depiction involving obscene sexual conduct.

• Includes situations in which a person depicts a child in, or who knowingly develops, duplicates, prints, downloads, streams, accesses through any electronic or digital media, or exchanges, a film, photograph, videotape, video recording, negative, or slide in which a child is engaged in an act of obscene sexual conduct, except for those activities by law enforcement and prosecution agencies and other persons defined in the law

Warning Signs of Sexual Abuse

• Trouble walking or sitting.

• Displays knowledge or interest in sexual acts inappropriate to his or her age, or even seductive behavior.

• Makes strong efforts to avoid a specific person, without an obvious reason.

• Doesn’t want to change clothes in front of others or participate in physical activities.

• A sexually transmitted disease (STD) or pregnancy, especially under the age of fourteen.

• Runs away from home.

Emotional Damage

• Knowledge or who reasonably suspects that a child is suffering serious emotional damage or is at substantial risk of suffering serious emotional damage (may make a report, but it is not mandated.) States of being or behavior that include but are not limited to

  • severe anxiety

  • Depression

  • Withdrawal

  • Aggressive behavior toward self or others

Warning Signs of Emotional Abuse

• Excessively withdrawn, fearful, or anxious about doing something wrong.

• Shows extremes in behavior (extremely compliant or extremely demanding; extremely passive or extremely aggressive).

• Doesn’t seem to be attached to the parent or caregiver.

• Acts either inappropriately adult-like (taking care of other children) or inappropriately infantile (rocking, thumb-sucking, throwing tantrums).

Unlawful Corporal Punishment or Injury

Involves a situation where a person willfully inflicts upon any child cruel or inhuman corporal punishment or injury that results in a traumatic condition (a condition of the body, such as a wound, or external or internal injury).

Warning Signs of Physical Abuse

• Frequent injuries or unexplained bruises, welts, or cuts.

• Is always watchful and “on alert” as if waiting for something bad to happen.

• Injuries appear to have a pattern such as marks from a hand or belt.

• Shies away from touch, flinches at sudden movements, or seems afraid to go home.

• Wears inappropriate clothing to cover up injuries, such as long-sleeved shirts on hot days.

Situation in Schools

• Situations that involve an employee of a public school using reasonable and necessary force to stop a disturbance that threatens physical injury to a person or damage to property, to defend themselves, or to obtain possession of weapons or other dangerous objects within control of a student do not warrant a report.

• Situations in which a teacher, vice principal, principal, or other certificated employee of a school district, while performing their professional duties, uses the same degree of physical control over a student that a parent would be legally privileged to exercise to maintain basic order are not reportable as abuse.

Neglect

• means the negligent treatment or the maltreatment of a child by a person responsible for the child’s welfare under circumstances indicating harm or threatened harm to the child’s health or welfare.

•  both affirmative acts and omissions on the part of the responsible person.

• medical care due to religious reasons is not reportable

Severe Neglect

• Means the negligent failure of a person having the care or custody of a child to protect the child from severe malnutrition or medically diagnosed nonorganic failure to thrive.

• Severe neglect also includes situations where any person having the care or custody of a child willfully causes or permits the person or health of the child to be placed in a situation such that their person or health is endangered, including the intentional failure to provide adequate food, clothing, shelter, or medical care.

General Neglect

• Means the negligent failure of a person having the care or custody of a child to provide adequate food, clothing, shelter, medical care, or supervision where no physical injury to the child has occurred.

• Neglect may also be present when parents or caregivers are abusing alcohol or drugs and are unable to provide their children with proper supervision or care. The use of alcohol or drugs by a parent or caregiver, in and of itself, does not constitute reasonable suspicion of neglect. Whether the alcohol or drug use impacts the care and supervision of the child in any way should be considered.

Warning Signs of Neglect

• Clothes are ill-fitting, filthy, or inappropriate for the weather.

• Hygiene is consistently bad (unbathed, matted and unwashed hair, noticeable body odor).

• Untreated illnesses and physical injuries.

• Is frequently unsupervised or left alone or allowed to play in unsafe situations and environments.

• Is frequently late or missing from school.

Characteristics of Crisis Counselor

• Life experience - can make us more empathetic

• Poise - remaining calm under pressure

  • Even if unsure of what’s going on

• Creativity and flexibility - being adaptable with interventions 

• Intellectual quickness - being able to think quickly and adjust as needed

• Energy, resilience, and optimism - personal self-care, energy, and energy and outlook 

• Multicultural competence - understanding how culture shapes reactions to crisis 

• Balance of optimism and realism - holding hope and realistic awareness

• Courage - showing up in the face of fear, modeling techniques

• Identify client strengths - recognize and enforce client’s strengths

Crisis Work

• Resolve immediate concerns and develop short term coping skills

• Reduce immediate stress and incapacitation 

• Return to normal

• Psychoeducation and symptom management 

• Short-term, directive

• Often multiple helpers who interact with the client at different times/places

• Employs multiple forms of intervention based on context and circumstances

Long-Term Therapy

• Resolve life goals through the development of measurable objectives

• Provide long-term strategies for resolution for resolution of life stressors

• Change behaviors, cognitions, affect

• Individual or group

• Long-term, non-directive

• One helper who works individually with client or in small groups

• Development of therapeutic alliance based on theory 

SAFE-R

• Stabilization of situation 

• Acknowledgement of crisis 

• Facilitation of understanding 

• Encouragement of adaptive oping 

• referral/restorement of independent functioning 

Acute Traumatic Stress Management

• Assess for danger/safety 

• Consider mechanism of injury 

• Evaluate level of responsiveness

• Address medical needs

• Observe and identify 

• Connect with individual

• Ground the individual

• Provide support 

• Normalize the response

• Prepare for the future