What is psychoeducation? Why psychoeducation is so important?

Chapter 3 : The Intervention and Assessment Model
What is psychoeducation? Why psychoeducation is so important? (Based your answer in our current crisis – COVID-19 Outbreak).

Chapter Thee: The Intervention and Assessment Models

Triage Assessment System

Evaluates the severity of a crisis situation.

Rapid

Systematic

Intentional

Supports the client in gaining:

Equilibrium

Mobility

Autonomy

Hybrid Model of Crisis Intervention

No longer a linear or stage model.

Hybrid Model = linear + systems models.

Can be linear or circular

Tasks are the foundation

Predispositioning/Engaging

Problem Exploration

Providing Support

Examining Alternatives

Planning in Order to Reestablish Control

Obtaining Commitment

Follow-up

Task 1: Predispositioning/Engaging

Clients may not want to talk or may be so out of control that they are not even aware of the crisis worker’s presence.

Engage in such a way that clients will be receptive to intervention.

Establish a therapeutic bond

Inform the client about what to expect

Task 1 Cont.

How to Engage:

Approach slowly, calmly, and with open body language.

Introduce yourself and ask their name.

Use their name and maintain eye contact.

Use basic listening skills and open-ended questions.

Clarify intentions.

Allow client to cathart without escalation.

Task 2: Problem Exploration

Define the problem from the client’s point of view.

May be difficult during the middle of a chaotic situation

Do not need a complete history

Do need to identify the precipitating event

Task 3: Providing Support

Communicate concern for the client.

Three types of support:

Psychological support

Unconditional positive regard

Logistical Support

Physical support (food, water, shelter, etc.)

Education

Resources

Social Support

Examine the client’s primary support system

May not have the resources

May not be easily accessible

May not be willing

Client may be too embarrassed to seek help

Task 4: Examining Alternatives

Clients often think they have no options or develop tunnel-vision.

Three key components:

Situational supports

Coping mechanisms

Positive thinking patterns

Brainstorm numerous alternatives.

Continuous process due to rapidly changing conditions

Task 5: Planning in Order to Reestablish Control

Creating a plan includes:

Identifying resources for immediate support

Develop coping mechanisms

A good plan needs to be:

Developed by the client

Clear

Realistic

Behaviorally specific

Immediate (minutes, hours, or days)

A plan allows the client to establish autonomy and become mobile.

Task 6: Obtaining Commitment

If Task 5: Planning was done effectively, obtaining commitment may be easy.

May be simply having the client verbally summarize the plan.

If lethality is involved, a commitment may need to be written and signed by both parties.

If there is any hesitation, the crisis worker may need to revisit earlier tasks.

No commitment should be imposed by the crisis worker!

Task 7: Follow-up

Time frame of minutes, hours, or days.

Inquire about the client’s ability to maintain mobility and equilibrium.

Reinforces the crisis worker’s support of the client.

Assessing

Continuous throughout crisis intervention.

Allows the crisis worker to evaluate:

Severity of the situation

Client’s emotional, behavioral, and cognitive status

Client’s level of mobility

Safety (client’s, self, and others)

Success of the crisis worker in deescalating the situation

Factors That Impact One’s Emotional Stability

The duration of the crisis event.

The degree of emotional stamina.

The ecosystem in which the client resides.

The developmental stage of the client.

Psychobiology Related to Crisis Intervention

Traumatic events may impact the:

Release of neurotransmitters

Central and peripheral sympathetic nervous systems

Hypothalamic-pituitary-adrenocortical axis

Abnormal changes in neurotransmitters are involved in mental health disorders.

Both legal and illegal drugs have a major affect on mental health.

Triage Assessment Form (TAF)

Effective method of obtaining a real-time assessment of the client’s affective, behavioral, and cognitive statuses.

Can be performed quickly by a wide spectrum of trained crisis workers.

Police officers

School counselors

Volunteer crisis line workers

Resident hall staff

Informs the crisis worker of the current state of the client and of their own ability to deescalate the situation.

Do You Know Your ABC’S?

Three main domains of triage assessment

Affective

Feeling or emotional tone

Behavioral

Action or psychomotor activity

Cognitive

Thinking patterns

Affective State

Often the first sign of disequilibrium.

Can manifest as overly emotional or withdrawn.

Incongruences among what the client says, how it is said, and non-verbal behaviors.

Key question to ask:

Do people typically show this kind of affect in situations such as this?

Behavioral Functioning

Focus on psychomotor activities.

Approaches

Avoids

Paralyzed

Often difficult for immobilized people to take independent actions.

Attempt to have the client engage in a small concrete and immediate activity.

Key questions to ask:

In the past, what actions did you take that helped you get back in control?

What would you have to do now to get on top of the situation?

Cognitive State

Client’s thinking patterns:

Rationalizing?

Exaggerating?

Downward spiral?

Crisis events are typically perceived as either a:

Transgression (present)

Threat (future)

Loss (past)

Key questions to ask:

How long has the client been engaged in crisis thinking?

How open is the client to reframing?

How often does the client engage in crisis thinking?

Rating Clients using the TAF

Score from high to low to rule out more severe impairments.

Each domain has a range from 1-10 (1=lowest score and 10=highest score).

Total rating ranges from 3-30.

Total score of 3-10 is a rating of minimal impairment

Total score of 11-19 is a rating of moderate impairment

Total score of 20+ is a rating of severe impairment

TAF Rating

Using the sample case of Leron from the textbook, how would you score Leron using the TAF . . .

When Leron first exits Union Avenue?

When the CIT officer initially meets Leron?

When Leron agrees to leave the scene and gets into the police car?

When the CIT officer is following-up with Leron at the legal aid office?

Chapter Four: The Tools of the Trade

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Fundamental Listening Skills

Open-ended questions

Closed-ended questions

Restatement and summary clarification

Owning feelings

Facilitative listening

Open-ended Questions

Encourage clients to respond with more thoughtful answers.

Very helpful during Task Two: Problem Exploration.

Developing open-ended questions:

Request description – “Tell me about…”

Focus on plans – “What will you do…”

Expansion – “So then what happened?”

Assessment – “When that happened, how did you handle it?”

Stay away from “why” questions – client may become defensive

Closed-ended Questions

Seek specific, concrete information.

Usually begin with verbs.

do, did, does, can, have, had, will, are, is, and was

Enable the crisis worker to make a quick assessment.

Often used during:

Early stages of intervention

Obtaining client commitments

Assessing safety issues

Closed-ended Questions Cont.

Guidelines

Request specific information

“Where are you going to go?”

Obtain a commitment

“Are you willing to make an appointment to…?”

Increasing focus

“Are you on track with me?”

Avoid negative interrogatives

Subtle way of coercing the client

Don’t, doesn’t, isn’t aren’t, and wouldn’t seek agreement

Instead, use an assertive owning statement

Restatement and Summary Clarification

The client may not be able to communicate effectively because of the chaotic environment or their cognitive status.

Restatement lets the client know that you are listening.

Often used in Task 6: Obtaining Commitment either by the client or the crisis worker.

Owning Feelings

Use “I” statements.

Helps to create a bond between the client and the crisis worker.

Only use “we” when referencing the crisis worker and the client.

Relational markers shorten the psychological distance between the client and crisis worker.

Use right here, right now words (this, these, we, our, here, and now)

Do not use distancing words (that, those, mine, there, and then)

Owning Feelings Cont.

Do not disown feelings of confusion or frustration.

Convey understanding

Use “I understand” to convey comprehension of the situation, not what the client is going through.

Make value judgments about the client’s current behavior not about their personal character.

Use positive reinforcement to successively approximate a client toward the larger goal.

Set clear limits to maintain personal integrity and safety.

Use assertion statements – direct, specific, owning statements – to obtain a commitment from the client.

Facilitative Listening

Four keys aspects:

Really listen to the client.

Focus entirely on the client.

Attend to both verbal and non-verbal messages.

Assess the client’s readiness to enter into psychological/physical contact with others.

Demonstrate attention by both verbal and non-verbal behavior.

Convey understanding of the crisis situation, both the facts and the emotions, to the client.

Help the client to expand their view of the crisis.

Assist the client in comprehending the full impact of the crisis.

Nine Basic Strategies of Crisis Intervention (Myer and James, 2005)

Creating Awareness

Support the client in becoming cognizant of their emotions, behaviors, and thoughts that may hinder mobility.

Allowing Catharsis

Allow the client to cathart but do not let them escalate.

Appropriate for a client who is not able to express their emotions rather than a client whose feelings are already out of control.

Providing Support

Affirm that the client’s reactions are “common” instead of “normal.”

NEVER support a client’s intentions to harm self or others.

Promoting Expansion

Help the client open up their tunnel vision of the crisis.

Nine Basic Strategies Cont.

Emphasizing Focus

Assist the client to compartmentalize the crisis into specific manageable components.

Providing Guidance

Offer education and referral information to the client.

Promoting Mobilization

Help the client to develop coping and problem solving skills.

Implementing Order

Aid the client to organize and prioritize problems.

Providing Protection

Protect the client from engaging in psychological or physical harm to self or others.

Climate of Human Growth

Three conditions crisis worker must demonstrate to facilitate client growth:

Empathy

Genuineness

Acceptance

Communicating Empathy

Five vital techniques:

Attending

Verbally communicating empathic understanding

Reflecting feelings

Non-verbally communicating empathic understanding

Using silence to communicate empathic understanding

Must differentiate empathy from sympathy and distancing.

Communicating Genuineness

Essential components:

Be role free

Be spontaneous

Be non-defensive

Be consistent

Be a sharer of self

Communicating Acceptance

Complete acceptance of the client

Surpasses the client’s personal qualities, beliefs, problems, situations, situations, or crises.

Crisis worker is able to prize the client even when they are speaking or behaving in a way that is contradictory to the crisis worker’s personal values and beliefs.

Acting in Crisis Intervention

The crisis worker’s level of involvement is on a continuum ranging from:

Directive → Collaborative → Nondirective

Appropriateness of crisis worker’s level of involvement depends on the client’s degree of mobility.

Crisis worker attempts to move from directive to non-directive from the initiating crisis event (client is immobile) to resolution (client is mobile).

Directive Counseling

An “I” approach to crisis intervention.

Necessary when the client is immobile and can not cope with the crisis situation.

Crisis worker is responsible for defining the problem, exploring alternatives, developing a plan, and guiding the client to follow the plan.

Crisis worker takes temporary control and responsibility for the situation.

Triage score in the high teens or twenties.

Collaborative Counseling

A “we” approach to crisis intervention.

The crisis worker is in partnership with the client to assess the problem, explore alternatives, implement a plan, and commit to the plan.

Crisis worker serves as a temporary catalyst, consultant, and facilitator.

Triage score in the high single digits to middle teens.

Nondirective Counseling

A “you” approach to crisis intervention.

Desired when the client is able to initiate and follow through with their own action plan.

Client owns the problem, coping mechanisms, plan, action, commitment, and outcomes.

Goal is to give the client as much control as possible.

Crisis worker serves as a support person who listens, encourages, and reflects.

Triage score in the low to mid single digits.

Types of Immobile Clients

Needs immediate hospitalization due to chemical use or organic dysfunction.

Suffering from severe depression.

Experiencing a psychotic episode.

Suffering from severe shock, bereavement, or loss.

Suffering from severe anxiety.

Experiencing delusion for any reason.

Is a current danger to self or others.

“Rules of the Road” for Crisis Workers

Recognize individual differences

Each crisis situation and client is unique.

Assess yourself

Consistently examine own values, emotional status, limitations, and readiness.

Show regard for client safety

Seek consultation if necessary.

Provide client support

Demonstrate unconditional positive regard for the client.

Define the problem clearly

Focus on one specific problem from the client’s point of view.

Consider alternatives

Be creative and when possible use alternatives generated by the client.

“Rules of the Road” Cont.

Plan action steps

Short-term plans will allow the client to increase their mobility.

Use the client’s coping strengths

Do not ignore the client’s strengths and coping skills.

Use referral resources

Have an up-to-date and easily accessible list of names, telephone numbers, addresses, and contact people for referral.

Develop and use networks

Each individual in a network is a referral source; it is the personal relationship that makes it a network.

Get a commitment

Have the client verbally summarize the action plan and their commitment to it.

Commitment may need to be written and signed if lethality is a factor.

What is psychoeducation? Why psychoeducation is so important?

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