Crisis Flash Cards

Question	Answer
Resiliency	The ability to bounce back after difficulties or setbacks; emotional wellbeing despite difficulties Adaptability Ability to protect oneself from difficulties
Characteristics of Resiliency	Assertiveness Ability to problem solve Self-efficacy + awareness Positive outlook Empathy Having goals +aspirations Maintaining a balance between dependence and interdependence Humor *Sense of duty Abstinence from substances Protective: Internal + externally acts as defense against adversity Risk: If protective factors are limited, maladaptive coping mechanisms may be developed
Loss, Grief, Mourning + Bereavement	Loss: Anything that is missed Not uncommon for the worker to miss identify loss Grief: An emotional response to loss Intensity and duration of grief response relative to what has been lost Mourning: Outward expression of grief Bereavement: Period after loss
Kubler-Ross Theory	Denial --> Anger--> Bargaining -->Depression--> Acceptance
Worden: 4 Tasks of Grieving (1/2)	Must be worked through if grief resolution is to take place Accepting the Reality of Loss: Denial impedes this task, disbelief that loss has occurred or denial of meaning Experience Pain of Grief: Social expectations may make it difficult Ways of not experiencing grief: overinvolvement in work, idealizing the deceased, geographic cure, minimizing significance--> Depression may occur if not resolved
Worden: 4 Tasks of Grieving (3/4)	Adjusting: Survivor may fill the role of the deceased or take on new role and develop new skills. -->If this task isn't resolved, helplessness may occur Withdrawal Emotional Energy, Reinvest into New Relationship: Often misunderstood and many are unable to work through it. It can be seen as dishonoring the deceased. A fear of new loss may impede successful resolution.
Issues that Affect the Intensity/ Duration of Grief	1. Type of Loss: child vs grandparent 2. Nature of attachment: strength, security, ambivalence 3. Mode of Death: Natural, accidental, suicide, homicide 4. Social/ Cultural: traditions/ rituals; social networks 5. Historical aspects: experience of earlier losses, history of depression, previous stress 6. Personality Variables: coping resources styles, psychological resilience, optimism
Interventions With the Grieving	We don't solve/ rescue grief but provide opportunities for coping/ adapting The art of silence: allows for reflection Client's present is not the presenting problem but underlying cause or contributing factor--> Many experiences of grief, loss Focus on basic needs: shelter, safety, food, info Provide client with opportunity to figure out what has happened: an opportunity to talk; normalize feelings, validate and reflect
Interventions continued	Increase the Reality of Loss: Especially important after the loss. Provide ways to say goodbye if possible. Encourage/ support cultural and social traditions + rituals for death/ grief. Express sympathy. Listen to family members talk about deceased and experience with grieving. Allow Time + Place for Expressions of Feeling: Provide quiet setting free of distractions. Give verbal permission to experience emotions/ thoughts. Listen without judgment. Remember 1st year is a continual experience of loss. *Normalize Feeling: Esp. important if they perceive it as inappropriate. Ambivalence is normal/ common. Never minimalize feeling/ emotion.
Interventions continued	Reality Test: Help bereaved understand feelings in context. Help With Problem Solving As They Adjust to New Reality: Practical decisions of new roles and responsibilities. Help break down tasks into smaller steps. Identify sources of support, referrals to social services. Discourage Major Life Decisions Too Soon (Grief work): Life change is inevitable but too soon can be counterproductive/ destructive. When is it too soon? When experience is intense, grief is fresh/ Has difficulty: accepting the pain, reality of los, starting new activities w/out the deceased or are experiencing complicated grief. Encourage Healthy Reinvestment of Emotions (Grief work): Previous roles, responsibilities, new activities/ relationships, allow for individual differences, provide continued support
Special Problems Associated with Grief	Failure to Grieve: Uncertain losses, relationships/ historical/ personality/social factors/avoidance/ uncertainty. Death is unacceptable/ Mourning is not accepted. Absence of social support. Avoidance of Grief: Idealization of deceased. Chronic anger w deceased impeding ability to recognize significance of loss. *Delayed Grief: Survivor is not able to grieve b/c of competing stressors. Grief occurs at later date in response to another loss/ reminder.
Special Problems Associated with Grief continued	Chronic Grief: Grief continues for prolonged period. Years after loss unrelated even triggers intense fresh grief. Loss discussed regularly. Bereaved hasn't resumed daily activities. Exaggerated Grief: Development of phobias. Disabling helplessness. Masked Grief: Other response more prominent than grief. When normal grief can't be expressed b/c of social sanctions, stressors. Anticipatory: Occurring in advance of death
Importance of Understanding Self-Harm	Behavior that communicated pain + self-destructiveness Direct form of violence on one's body Powerful statement of psychological distress--> Maladaptive coping tool to manage/ soothe A sense of powerlessness
Why Self-Harm?	Functions 1. Regulating Affect, Soothing, Dissociations: Provides sense of deep relief from emotional distress. Self-harm used to express/manage intolerable feelings--> External soothing creates a sense of security--> calms w release of endorphins. 2. Seeking Mastery Over Pain + Past Trauma: Creates sense of control. Better to create own pain + be able to control it than being a victim. Sense of mastering past feelings provides hope. 3. Communicating Pain/ Controlling Others + Seeking Nurturance: Unable to put feelings of pain, body reflects message. Can be desperate attempt to make others notice existence, that they are in pain. Wants connection. 4. Securing Authenticating Sense of Self: Difficulty in creating/ maintaining psychological, interpersonal boundaries. Behavior defends injurer from intense emotions of perceived abandonment. Injurer able to experience own vitality through physical sensation. Wounding body connects inner/ outer worlds.
Suicide Statistics	Global: Highest suicide rates are in Eastern Europe. Lowest in Latin America and some Asian countries. Canadian: Homicides 1.73/ 100 k, Suicide 13/ 100k + increasing w pop. growth 90% of population suffers from depression, MH (bipolr, substance abuse, Borderline, schizophrenia) 1/100 attempts are successful 20% of us will have suicide in family, 60% of us will know someone who has died by suicide. High Risk Groups: Men, elderly, LGBTQ, Aboriginals, inmates. Most common age 35-49 but rate is rising in 10-19. Leading cause of death for men 25-29, 40-44. 70-80% of Canadian youth consider suicide before graduation. Rate of Canadian youth 15-19 ranked 3rd/ 23 countries. Aboriginals: Rate in BC for youth= 11%. In Inuit communities, 2-6 x higher than national average. In 1999, suicide #1 COD age 10-19. Elderly: 16/ 100 k. 8:1 ratio completed vs attempted. White males over 85. Almost always succeed. LGBTQ: 2-3 x more likely to engage in non-fatal suicidal behavior. Risk is higher after coming out esp. in males. *Inmates: 4-10 x higher than general population
Risk Alerts + Tasks of Suicide Intervention	[1] Ask if they have thoughts of killing themselves. The word “suicide” is not often used during initial contact. Ask the question directly. Are you thinking about suicide? How often? Do you think it’s a good or bad solution? On a scale of 1-3 how badly do they want to die? Do they see suicide as a weak or strong act? High risk client: Thinks about suicide often, person wants to die, person sees suicide as a good solution, person perceived suicide as a strong act Why ask? Allows you to assess the situation. Sends the message that you’re not judging them (reducing the stigma). Lets person know that the issue needs to be addressed. Lets the person know you care – even if they aren’t thinking about suicide [2] Ask family members if they’re concerned that he person will commit suicide High risk client: Family members don’t believe the person will attempt suicide- sees it as attention seeking [3] Check the person’s plan for suicide: 75% of those with a plan will attempt suicide. The more detailed their plan is = the greater the risk of suicide attempt.
Risk Alerts + Tasks of Suicide Intervention 2	MEANS: Have they made preparations to complete the suicide? Have the means been acquired or is it easily accessible? Is there a suicide note? Completed preparations/suicide note = increased risk. HOW SOON? Have they settled on a specific time? How close is it? How long would it take for someone to discover the suicide attempt? (EG their bedroom at home or in the woods in the middle of nowhere) The shorter the time/the greater the distance = the greater the risk Disabling the plan: If the person cooperates, it means they are less likely to try a different method of suicide. If they are uncooperative and won’t give you the info you need to disable the plan, don’t leave them alone. If the suicide plan is in progress, call police, emergency services, etc. [4] Mental Status: Is the person confused, intoxicated, using drugs? Is there a history of mental illness or depression? [5] Have there been previous attempts at suicide? History is the greatest predictor of the future. Acknowledge the danger. Reinforce the skills they learned in the past in order to cope - how did they manage before
Risk Alerts + Tasks of Suicide Intervention 3	40x greater than the general public. Shows that the client views self destruction as acceptable. Have there been any family or friends that have died as a result of suicide? Have they been in the hospital for attempted suicide before? Increased risk in the first few months after discharge [6] What support systems are in place? Do friends and family know about their intentions of suicide? Who do they talk to when they’re feeling down? How do their family and friends respond to their concerns? Help the client develop links – both formal and informal
Goals of Suicide Intervention	Supportive crisis intervention Encourage client to see a therapist Provide them w educational info Reframe issues Provide empowering statements Connect them w resources
Low/ Medium/ High Risk	Low: Never attempted, has supports, afraid of feelings Medium: Feel like they have no way out, made threats in the past that have been ignored High: Clear in statements. Usually very depressed. History of attempts. Has plan + means.
Principles of Good Safety Plan	• [1] Method  Do they know how they’re going to do it?  The more specific they are, the greater the risks  Assessment of lethality – don’t make an assessment based on the method and how dangerous you perceive that method to be.  If they have chosen a method you need to do something even if you think it’s not going to hurt them • [2] Means  Have they made preparations to complete the suicide?  Has the means been acquired or is it easily available?  Has a suicide note been written?  Completed preparations and easy access = increased risk of carryout • [3] How soon?  Have they decided when?  How close is it?  The shorter the time = the greater the risk of carryout  How long would it take for someone to discover the suicide attempt? – the greater the distance from those who can help – the greater the risk
PTSD	PTSD: A common anxiety disorder that develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened Symptoms: Last at least 1 month- cause distress + lowers functioning 1. Re-experiencing Symptoms: Reoccuring intrusive distressing recollections. Flashbacks: acting/ feeling as if event is occurring in real time. Exaggerated emotion or physical reactions to triggers that are reminder of trauma. 2. Avoidance/ Numbing: Avoids thoughts, feelings, convos, activities, places, people associated with trauma. Inability to recall important details. Significant decreased interest/ participation in activities. Feelings of detachment, estrangement from others. Restricted range of affect. Sense of shortened future.
PTSD continued	3. Hyper Arousal: Difficulty concentrating remembering. Jumpy, easily startled. Insomnia, sleep disturbances. Irritability/ bursts of anger. Exaggerated startled response. Hyper vigilance. PTSD In Body: Undergoes physical changes. FIGHT OR FLIGHT instinct is triggered in brain and body responds as if it is in danger as the rational mind disengages. Groups Most Likely to Suffer: Those w previous trauma; Those w MH diagnoses or a loved one with MH. Very young or old; victims/ witnesses to violent crimes, natural/ unnatural traumatic events
PTSD VS ASD	Acute Stress Disorder: Anxiety disorder characterized by cluster of dissociative + anxiety symptoms that occur w/in 1 month of trauma event. Dissociating, re-experiencing, avoidance, anxiety + arousal Lasts 2 days-4 weeks and causes impairment
Sexual Assault	Includes many forms for sexual activity without consent. Can include: Kissing, fondling, touching, oral/anal sex or sexual intercourse without consent. Not stopping sexual contact when asked to. Forcing someone to engage in sexual intercourse or any other sexual act
Rape Trauma Syndrome (RTA)	RTS – a cluster of emotional response to the extreme stress experienced by the survivor of sexual assault [1] ACUTE PHASE: disorganization. Initial response is shock. Impact reaction: within hours. Expressed style – open display of emotions. Controlled style – energy focused on maintaining composure Immediate effects – first weeks: Somatic manifestations- Physical trauma, Skeletal muscle tension, Gastrointestinal irritability. Emotional responses: Shock confusion, anxiety, numbness, humiliation, embarrassment, fear, self-blame, dulled senses, difficulty concentrating, hyper-vigilance [2] REORGANIZATION PHASE: SHORT TERM up to 3-4 month. Short term effects: Generalized anxiety/ fear, Disturbance of eating, sleeping, thoughts, relationships. Disruption – to create safety, Difficulty maintaining/ establishing relationships, Guilt for not preventing assault, Sudden, unpredictable changes of residence or disappearing, Negative impact of legal processes 
Rape Trauma Syndrome (RTA) continued	INTERMEDIATE UP TO 1 YEAR Intermediate effects: Disruption/change in lifestyle, Increased dependence on family, Sleep disturbances, Fear/phobias, Sexuality, Past abuse, Feelings of being “damaged goods” Long-term reactions: Anger, Diminished capacity to enjoy life, Hyper vigilance to danger, Continued sexual dysfunction Survivors have very individual experiences and reactions – the immediate and long term effects of trauma are very common  Helpful tips: normalize their feelings, let them know they’re not alone[3] REINTEGRATION PHASE: Moving from a victim to a survivor. Intervention: Calm, clear, trustworthy Reassure & validate client’s decision to seek help, Ask questions to get a clear picture of what happened, Identify how client is feeling Coping: How have they coped with crisis in the past? Explore new ways of coping  Using existing support services, Reaching out to new systems  Client needs to make the decisions  The core experiences of trauma are disempowerment and disconnection from others. Recovery is based on empowerment*
Woman Abuse Syndrome	AKA battered women syndrome – a pattern of perceptions and behaviors thought to be characteristic of women who have endured abuse by their partner. A type of PTSD. 3 components: [1] PTSD SYMPTOMS: Women may re-experience trauma in dreams, avoid things associated with the trauma, avoid feelings [2] LEARNED HELPLESSNESS: Develops after trying to leave/get help which was not successful because of a system failure or other factors Learns to survive rather than leave [3] SELF-DESTRUCTIVE COPING RESPONSES TO VIOLENCE: May think her only option is to stay. Often uses drugs/alcohol to escape – or attempts suicide
Substance Abuse	Substance Abuse is: Use of alcohol/drugs that affect a person’s occupational, academic, social, family, emotional or behavioural functioning
4 Substance Abuse Related Traumas	1] MEDICAL Is most severe when alcohol or barbiturates are used. Medical detox is needed. Symptoms include seizures, heart attacks, strokes, liver failure. Heroine withdrawal isn’t usually associated with high medial risks – flu like symptoms Stimulants such as crack/cocaine/crystal meth may result in heart attacks or seizures. [2] LEGAL: Getting arrested, Court ordered treatment. [3] PSYCHOLOGICAL: People might seek crisis support because of intense anxiety, depression, or the sensation of “coming down” that’s associated with the use of certain drugs. Cocaine/crack/meth experience a sense of unreality and delusions- depression can also follow after several days of using More than 50% of suicides are related to substance use. [4] FAMILY: At some point family/friends decide they can’t tolerate the addicts behavior. Family develops coping strategies associated with dependency a decrease in communication  avoidance of issue & expressing their emotions. May keep secrets from the community, Role reversal

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	Created by Bailey Kathleen about 8 years ago