Utilizing your beginning understanding of crisis work, for this assignment you are being asked to perform a case assessment on a clinical scenario assigned by the instructor.
Rate the client in each of the three domains (Affective, Behavioral, and Cognitive) using the Severity Scale included with each domain on the Triage Assessment Form (TAF) and total the scores. Describe, in detail, the rationale for your ratings
Summarize diagnostic skills and techniques that can be used to screen for addiction, aggression, and danger to self and others, as you note these risks in your client, such as the Hybrid Model and the ABC’s of Assessing Crisis Intervention found in Chapter 3 of your text. Similarly, a possible co-occurring mental disorder (such as substance abuse) may become apparent during a crisis, disaster, or other trauma-causing event that ties in with your assessment during the client’s crisis.
Include your judgment about how intense and directive the treatment should be based upon the total TAF score. Drawing on the theoretical and research literature, develop and propose intervention designed to address the crisis. Your assessment will ideally provide the rationale for your proposed intervention, as will crisis theory and clinical research literatures. The proposal should be sensitive to issues of diversity.
Scenario:
* Tom, his wife Sheila, and his daughter Renee (age 7) live in a small town surrounded by a large agricultural area. Tom is employed as a heavy equipment operator. He likes the outdoors, particularly hunting, and he prides himself on being “macho.” He was an excellent high school athlete and could have gone to a small college on a football scholarship. But he took a job working for his father and an uncle, married Sheila (who had been his classmate and the high school homecoming queen), and obligated himself with a large mortgage on a home next door to his parents’. Tom began to drink heavily, drive fast cars, take frequent risks on the highways, get into fights at taverns, come home late at night, and neglect his physical health. He felt remorseful, guilty, depressed, and suicidal following each fling at a tavern. Sheila and her supervisor at work repeatedly attempted to persuade Tom to see a therapist. Sheila finally prevailed on Tom to call the tricounty crisis line after she walked into their bedroom at 7:30 P.M. Saturday and discovered him preparing to shoot himself in the head. The volunteer crisis worker received the call from Tom later that evening.
Tom: (In a fearful, tense, and anxious voice.) I wouldn’t have called, but my wife insisted. She caught me trying to shoot myself tonight. Now I’m scared as hell. She sort of demanded that I get help.
CW: Tom, I’m glad you called. You did the right thing when you called, because you can be helped, and I want us to start right now. I can hear the tenseness in your voice. What I want to do first is for you to stay on the line, sit down, and tell me what’s happening in your life right now—in the past day or so—that’s brought you so close to killing yourself. That’s what I want to know first.
Tom: Well, everything. All these pressures. Everybody expecting big things from me, and I’m not really worth a shit! My wife and kid would be better off if I was out of the way, and I would be, too. I ain’t the happy-go-lucky guy I look like on the surface.
CW: So Tom, you’re really down; you’ve had a very close call, and you’re frightened. What happened to cause the stress at this time?
Tom: Well, it’s a buildup of lots of things. I’m getting nowhere on a treadmill. And yesterday—it just hit me—I realized I’m a nothing. A dependent kid in a man’s clothing. One of my friends I went to high school with has his MBA. Another one owns a car dealership. I’m still working for my daddy—can’t get away from Mamma. I’m a dud—a nobody. And I’m stuck. A nobody, going nowhere.
CW: So you’re trying yourself, sentencing yourself, and you’ve nearly executed yourself because you’re stuck—and you’re realizing that what you’re really wanting is to be in a successful career, independent from your folks. And it really hurts when you face it head on. You’re feeling powerless right now.
Tom: That’s it. And Sheila deserves a better man than that! I’m stuck, so she’s stuck with me, and I ain’t much to look at.
