Chapter 3: Intervention and Assessment Models

Chapter 3: Intervention and Assessment Models

Exercise 1.

Your first job is to try out the triage scale. You’ll need tape recorders for this activity. Think about a traumatic event in your life (it doesn’t have to be the worst!). Act as if that event occurred in the past 24 hours. Have your counseling partner do an exploratory tape on your ABCs. To complete this project, you are going to want to deal with Task 1, Predisposition, and Task 2, Problem Exploration. If you do it well it should take 15 minutes to cover what you need to get an adequate assessment.

Answer the following questions after you have finished the session and listened to the recording.

1.  To you as a client, what aspects of the process were most helpful? What aspects would you like to see improved?

2.  To you as a client, what was the most threatening part of the exercise?

3.  For you as a worker, what did you perceive to be your strongest and most positive intervention technique?

4.  For you as a worker, what did the exercise bring out that you wish to improve upon?

5.  What additional skills or learning do you need in order to make your next session more successful?

Be prepared to discuss the following questions with your partner next session:

1. How did you open up the session?

2. Do you think you were able to make contact and bond?

3. After listening to yourself, would you want this type of counselor counseling you?

4. Discuss your triage rating with your partner. Why did you give that rating? Does your partner agree with the rating? Remember: based on your rating you are going to do something with your client. So, if you give them a 27, they are not going home with mum but could be going directly to a mental health facility, or to jail.

5. As you listen to the tape can you honestly say that you covered affect, behavior, and cognition well enough to get valid ratings? More than likely you left something out, but that’s okay; this is your first time doing a triage, so that’s a pretty common place. But understand what you left out, and DON’T next time!

6. Did you try to solve the client’s problem? That’s a no-no. Shameful! You don’t have enough information for that yet—you are doing assessment right now, and that’s it!

Exercise 2

Role Play: Assessing a Crisis

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. This exercise is designed to allow you to try out your assessment skills in the safety of the classroom. It will further allow you to upgrade your skills as you move through the course. Finally, it will provide you with a way to compare the skills you had at the start of the course to your skills at the end.

Divide into groups of seven. Each person chooses one of the following roles: (1) a suicidal client, (2) a battered client, (3) a violent client, (4) a posttraumatic client, (5) a substance-abusing client, (6) a sexual assault victim, (7) a grieving client. Each person will assume the role of one of the foregoing clients for the next class meeting. It is helpful to quickly read the chapter containing the material on the particular client type before the next class meeting so you can adequately depict the typical dynamics of the crisis.

At the next class meeting, each person is to role-play the client assigned for approximately five minutes. One other person in the group acts as the crisis worker. The crisis worker’s role is to elicit enough information so that a domain severity assessment can be made. While the crisis worker and the client are working with one another, other group members monitor the dialogues and use the Triage Assessment Form in this chapter to assess the severity of the problem in regard to its affective, behavioral, and cognitive components. Write down your thoughts as you systematically go through the form. After each person has completed the role assignment, discuss your respective ratings.

Pay particular attention to why you gave the ratings you did and what those ratings imply for any subsequent intervention you might use. Don’t worry about trying to be perfect or about any lack of knowledge you may have about the problem. Just go ahead and do it! Clearly, there are no wrong answers at this point.

After you have finished, save your notes and ratings. As you move through subsequent chapters, reassemble your group and replay the crisis appropriate to that chapter. The “client” should attempt to replay the role as closely as possible to the initial rendition.

Group members will repeat their triage assessment of the client. You will then pull out your initial ratings and compare them with your current ratings. Group discussion should identify changes that occurred and why members may have rated the person differently from the first time. By reassessing these role plays, you should start to feel more comfortable about making educated guesses in crisis situations.

Exercise 3. Watch the three-part scenario on battering on the “Crisis Intervention in Action” DVD. This is an excellent example of an escalating triage. Our rule of thumb on the triage assessment is that if the students’ ratings are within about 2 points of what you believe the score should be, that is close enough. Two points off either side of your score is close enough for good decision-making in disposition of the client. We encourage you to urge your students to start thinking in terms of neon-light numbers on clients’ foreheads as they do intervention over the course of the semester. The triage assessment should be in continuous use as a way of assessing not only how the client is doing but also how the intervention is working. This should become so much a part of the interventionist’s behavior that it is automatic.

Final Note: This chapter is about the Hybrid Task model as much as it is about the Triage Assessment Form. That said, as you discuss it, you’ll do well to emphasize in the beginning the predisposition/bonding, safety, and exploration tasks, and the assessment function, as opposed to the alternative, planning, commitment, and follow-up tasks at the present time. It is critical that students get these well in hand before they do anything in regard to solving problems.