Crisis workers take on many different roles on a daily basis. Crisis workers also come in many different career fields; they are law enforcement officers, therapists, doctors, hospital staff, and many other careers. The responsibility of each individual is broken down into several additional roles. Similar to law enforcement, a crisis worker’s job is always to protect and serve the public. It is clear that Cassandra has been though a lot in her life; her recent break down is of major concern as to what is really going on mentally and physically.
Human crises are never quick and simple, they are and can be extremely difficult and time consuming. The Six Step Model of Assessment helps crisis workers weed through the situation. In Cassandra’s case the model first tells us we have to define the problem. With the information currently given from law enforcement and Cassandra, there are several problems present: 1. Apparent violent altercation with boyfriend (noticeable bruising) 2. Law enforcement suspects she may have murdered her boyfriend.
3. Witnessed father and grandfather physically and sexually abuse mother 4. Family substance abuse problems: dad abuses alcohol, brother abuses heroin 5. 3 past suicide attempts (most recent 3 months ago) 6. Mental state questionable a. Thinks boyfriend still alive and wants to see him b. Brought in talking to self c. Unable to answer direct questions d. Smiles when discussing negative information 7. Homicidal ideation a. “Feel like killing someone, to see how it feels to take someone’s life. ” b.
“Don’t know who, but I want it to be a family member for all the stuff they put me through. ” 8. Frequent nightmares (suspect fear of father) 9. Verbally abusive towards law enforcement While the main issue is a violent altercation with her boyfriend that may have resulted in his death is the current problem, all these other noted problems need to be taken into account. The second step in the model tells us that we as crisis workers need to ensure that the client is safe. Given the surrounding and past circumstances; the client’s safety is of great concern.
Cassandra has a past of attempting suicide, has recently presented possible homicidal ideations, has a currently questionable mental health state, and has become verbally abusive towards law enforcement. It would be in her best interest at this time to admit her into a mental health ward noting a possible suicide watch, and requesting a medication evaluation. The Six Step Model tells us that we are supposed to provide support next. Cassandra’s case is rather complex. She has a rather traumatic past, a currently violent state of life, and very questionable mental health.
At this time it would be best to reassure Cassandra that the people currently around her are not going to hurt her. It is everyone’s goal to support her, to keep her safe, to help her move forward positively, and to help her concur her past. She can be an incredibly strong woman and it is the main goal for everyone to help her get there. At this point it is also imperative that I attempt to gain Cassandra’s trust. I need to reassure her that I truly do care about her, I want to be there for her, and I want to help her get better.
With Cassandra being institutionalized it can be devastating to her and may cause her to shut down and withdraw. If she shuts down or withdraws, it becomes possible that she may not work with me, so I need to be prominent in visiting her and each time assuring that I do care about her. While continuing to provide support to Cassandra, the fourth step of the model can be done. Cassandra needs help finding her supports and any alternatives that she may have access to; many times the client does not realize just how much is out there for them so it is our jobs as crisis workers to help the client find these things.
Many times this step and the remaining two steps of the model are done with the client participating, however, if Cassandra is unable to work collaboratively with me, it may come down to me being more directive than assistive. There are 3 things to look at when searching for Cassandra’s alternatives; situation support, coping mechanisms, and positive thinking patterns. For Cassandra, situational supports could be her mother or any other family member, even friends; as long as it is someone who truly cares about Cassandra’s safety and wellbeing.
Coping mechanisms can be an array of different things that would help Cassandra deal with any type of crisis situation in the future. These can be a number of different behaviors, actions, or resources. Some examples of coping mechanisms are: breathing techniques, journaling, talking with someone, meditation, crafts, exercising, or playing with either kids or pets. Whatever the choice may be, it needs to be a healthy mechanism, unhealthy choices would be hitting something, or substance abuse.
When a person has positive thinking abilities it is not meaning that they have a good work ethic or that they are persistent. A person has positive thinking skills when their thoughts revolve around feelings like contentment, love, or joy. When someone has these types of feelings primarily, they see many more life goals and possibilities. Cassandra needs to be able to find these feelings and let these feelings become more persistent than any type of negative thought. Step five in the model is to make a plan and this step flows right alongside step four.
This part of the crisis worker’s contribution to the client would be to pinpoint other people, groups, and resources that can be available to her at any time. For Cassandra these things could be friends or family that she may have thought about, a church group, a domestic violence support groups, walk in mental health clinics, therapists, or hotlines. Though this step should ideally be done cooperatively with Cassandra, there is always a possibility that I may need to be more directive than supportive.
This is the stage where Cassandra needs to be reminded that my main goal is to help her find the steps to gain the skills to find success. The final step in the Six Step Model is to obtain commitment. If all the other preceding steps have been done successfully, then this final step should be easy. In most cases obtaining commitment is as brief and simple as Cassandra telling me about her plan of action in her recovery process. This commitment should be done in a voluntary state and only when both Cassandra and I feel that her goals are doable.
Should any hesitation become present, the action plan should be reviewed and revised, if needed, until any hesitation has dissipated. Looking back at the initial situation, it was mentioned that there is substance abuse problems within Cassandra’s family. It was reported that Cassandra’s father abused alcohol and her brother abused heroin. One concern that arises is whether or not Cassandra is abusing any type of drug or alcohol. Some studies say that chemical dependency runs in families, while others are not compelled to agree with that theory.
While I personally do not believe that addictions are necessarily genetic, there is always another theory or scientific discovery. The first thing to do is to discover if Cassandra has any chemical addictions is to ask her. Asking several different questions and listening for inconsistencies is one way to judge if she is being honest. If she isn’t giving consistent answers to not abusing any substance, blood testing is always an option. If it is found that she is chemically dependent, she should be entered into either in-patient or out-patient treatment. Getting Cassandra into treatment if it is needed is in her best interest.
Again looking back at the original encounter and the information gained in the initial intake stage, it is possible that Cassandra is suffering from a potential psychological disorder. Given some of the things that she talked about it may be possible that she is suffering from Post-Traumatic Stress Disorder (PTSD). She saw the sexual and physical abuse of her mother, it is questionable whether or not she was abused by her father or grandfather, she was in an obviously violent relationship, she has attempted suicide three times in the past, and she reported frequent nightmares revolving her father.
Another thought is that she is suffering from some sort of moderate to severe depression. This is possible from all the symptoms previously mentioned plus the homicidal ideation, verbally abusive towards law enforcement, concerning mental state, and potential murder of her boyfriend. Cassandra’s mental state is of great concern and needs to be addressed. She has a lot of extreme trauma in her past and current life that need addressing.
The best way to help her given all the facts and aspects of everything explained by her and law enforcement, it is in Cassandra’s best interest to be temporarily sent to an in-patient mental health facility for a more in-depth evaluation, a chemical dependency evaluation, potential medication mandate, and long term therapy. Looking into the ethical considerations involving this particular case, there one thing that strongly needs to be looked at. During the first encounter with Cassandra, law enforcement officers were standing over her refusing to leave even during a confidential interview.
Since Cassandra was in handcuffs and leg shackles there was no possibility of her running to escape or the potential of her becoming violent. With the restraints in place, law enforcement officers should have left the room during the interview; they could have stood just outside the door in order to maintain Cassandra’s right to confidentiality. Although doctor patient confidentiality prevents me from disclosing that Cassandra does have homicidal thoughts, I can stress my concerns for her safety and the safety of others to press that I feel she needs in-patient mental health facility care.
As an on-call psychologist for Mercy Hospital it is my main goal to ensure the safety and well-being of each individual that comes through the doors. It is also my obligation to maintain the trust and confidentiality of each patient. Even when law enforcement is involved, my main priority is still the patient’s best interest. Every crisis worker, law enforcement officer, doctor, or psychologist, takes on several different roles on a daily basis. Each role they take on is then broken down into several different responsibilities.
No matter what the role or responsibility, the main goal is always to protect the individual they are working with. References Gil, R. (2009). Local, State and Federal Law Enforcement Agencies. Retrieved 2011, from Associated Content Home: http://www. associatedcontent. com/article/2076781/local_state_and_federal_law_enforcement_pg2. html? cat=17 Gunter, W. , & Hertig, C. ( 2005). An introduction to theory, practice and career development for public and private investigators. Burlington, Ma. : International Foundation for Protection Officers.
James, Richard K. Crisis Intervention Strategies, 6th Edition. Cengage Learning, 2007. Jines, Johnny K. (2012). Crisis Intervention Teams: Responding to Mental Illness Crisis Calls. Retrieved 2012 from Federal Bureau of Investigations: http://www. associatedcontent. com/article/2076781/local_state_and_federal_law_enforcement_pg2. html? cat=17Justice, N. I. (2002). Crime Mapping Research Center. Retrieved from National Institute of Justice: http://www. ojp. usdoj. gov/cmrc Peak, K. (2009). Policing America. Upper Saddle River, N. J. : Pearson Education.