Triage Assessment of the Client

Case of Ariadne:

Ariadne, a 17-year-old Hispanic female, ran away from home. The police returned her to her home, but within a week Ariadne had attempted suicide by taking her father’s prescription medication for high blood pressure. Ariadne had been showing signs of depression and was seen for mental health counseling a year previously for eight sessions. After receiving counseling, Ariadne stated that she felt unuseful at home and unwelcome at school. Feelings of worthlessness and anger arose periodically when her parents tried to engage her about school events. Ariadne had several close friends and one young man she called her “beau,” though she claimed there was no serious intimacy between them. She refused to return to counseling sessions, saying that the time was better spent talking with her friends. She complained that her parents were too strict with curfew times and asked too many questions. In the past week, Ariadne was discovered to skip school two days and refused to tell her parents where she had been. Ariadne’s mother found a bottle of pills and a bottle of vodka in her room.

**Headings to use in paper**

Using the Triage Assessment Form

Include the title of your paper centered at the top of the page, not bolded; it is not considered a heading. *This first section is your paper’s introduction.

Triage Assessment of the Client

Complete the Triage Assessment Form for the selected case, including all three domains and the total score. In this section of the paper, summarize the results and provide a logical and articulate rationale for each of the domain ratings with specific descriptions of each, by relating the specifics of the case to the ratings you determine. There is detail about using the TAF in Chapter 3 of your text, as well as the assigned Myer and Conte article. Use appropriate terminology, such as the psychobiological assessment found in Chapter 3 of your text, and language found in the TAF Severity Scales, to guide the course of treatment based upon your total score.

Diagnostic Skills and Techniques

Elaborate on diagnostic skills and techniques that can be used to screen for addiction, aggression, and danger to self and others, as well as co-occurring mental disorders during a crisis, such as the Hybrid Model and the ABC’s of Assessing Crisis Intervention found in Chapter 3 of your text. Discuss what counseling skills you use in a triage assessment of this client.

Developmental and Cultural Considerations in Crisis Assessment and Intervention

In this section of the paper, describe how you would differentiate between the characteristics of crisis states versus developmentally appropriate reactions to life obstacles. Describe crisis assessment and interventions considerations and strategies when working with diverse populations. Consider any cultural, diversity, or even gender issues that may be involved in assessment or intervention with your chosen scenario. Give examples of what you would include in your assessment and intervention.

Triage Assessment Form

Triage Assessment Form: Crisis Intervention© by R. A. Myer, R. C. Williams, A. J. Ottens, & A. E. Schmidt

Crisis Event

Identify and describe briefly the crisis situation:

______________________________________________________________________________________________________________________________________________________________________________________________________________________________

Affective Domain

Identify and describe briefly the affect that is present. (If more than one affect is experienced, rate with number 1 being primary, number 2 secondary, number 3 tertiary.)

Anger/Hostility
____________________________________________________________________________________________________________________________________________________

Anxiety/Fear
____________________________________________________________________________________________________________________________________________________

Sadness/Melancholy
____________________________________________________________________________________________________________________________________________________

Affective Severity Scale

Highlight the number that most closely corresponds with client’s reaction to crisis.

2 3 4 5 6 7 8 9 10
No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment
Stable mood with normal variation of affect appropriate to daily functioning. Affect appropriate to situation. Brief periods during which negative mood is experienced slightly more intensely than situation warrants. Emotions are substantially under client control. Affect appropriate to situation but increasingly longer periods during which negative mood is experienced slightly more intensely than situation warrants. Client perceives emotions as being substantially under control. Affect may be incongruent with situation. Extended periods of intense negative moods. Mood is experienced noticeably more intensely than situation warrants. Liability of affect may be present. Effort required to control emotions. Negative affect experienced at markedly higher level than situation warrants. Affects may be obviously incongruent with situation. Mood swings, if occurring, are pronounced. Onset of negative moods are perceived by client as not being under volitional control. Decompensation or depersonalization evident.

Behavioral Domain

Identify and describe briefly which behavior is currently being used. (If more than one behavior is used, rate with number 1 being primary, number 2 secondary, number 3 tertiary.)

Approach ____________________________________________________________________________________________________________________________________________________

Avoidance ____________________________________________________________________________________________________________________________________________________

Immobility ____________________________________________________________________________________________________________________________________________________

Behavioral Severity Scale

Highlight the number that most closely corresponds with client’s reaction to crisis.

2 3 4 5 6 7 8 9 10
No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment
Coping behavior appropriate to crisis event. Client performs those tasks necessary for daily functioning. Occasional use of ineffective coping behaviors. Client performs those tasks necessary for daily functioning, but does so with noticeable effort. Occasional use of ineffective coping behaviors. Client neglects some tasks necessary for daily functioning. Client displays coping behaviors that may be ineffective and maladaptive. Ability to perform tasks necessary for daily functioning is noticeably compromised. Client displays coping behaviors that are likely to exacerbate crisis situation. Ability to perform tasks necessary for daily functioning is markedly absent. Behavior is erratic, unpredictable. Client’s behaviors are harmful to self and/or others.

Cognitive Domain

Identify whether a transgression, threat, or loss has occurred in the following areas and describe briefly. (If more than one cognitive response occurs, rate with number 1 being primary, number 2 secondary, number 3 tertiary.)

PHYSICAL (food, water, safety, shelter, et cetera):

Transgression _____ Threat _____ Loss _____

____________________________________________________________________________________________________________________________________________________

PSYCHOLOGICAL (self-concept, emotional well-being, identity):

Transgression _____ Threat _____ Loss _____

____________________________________________________________________________________________________________________________________________________

SOCIAL RELATIONSHIPS (family, friends, coworkers, et cetera):

Transgression _____ Threat _____ Loss _____

____________________________________________________________________________________________________________________________________________________

MORAL/SPIRITUAL (personal integrity, values, beliefs):

Transgression _____ Threat _____ Loss _____

____________________________________________________________________________________________________________________________________________________

Cognitive Severity Scale

Highlight the number that most closely corresponds with client’s reaction to crisis.

2 3 4 5 6 7 8 9 10
No Impairment Minimal Impairment Low Impairment Moderate Impairment Marked Impairment Severe Impairment
Concentration intact. Client displays normal problem-solving and decision-making abilities. Client’s perception and interpretation of crisis event match reality of situation. Client’s thoughts may drift to crisis event but focus of thoughts is under volitional control. Problem-solving and decision-making abilities minimally affected. Client’s perception and interpretation of crisis event substantially match reality of situation. Occasional disturbance of concentration. Client perceives diminished control over thoughts of crisis event. Client experiences recurrent difficulties with problem-solving and decision-making abilities. Client’s perception and interpretation of crisis event may differ in some respects from reality of situation. Frequent disturbance of concentration. Intrusive thoughts of crisis event with limited control. Problem-solving and decision-making abilities adversely affected by obsessiveness, self-doubt, confusion. Client’s perception and interpretation of crisis event may differ noticeably from reality of situation. Client plagued by intrusiveness of thoughts regarding crisis event. The appropriateness of client’s problem-solving and decision-making abilities likely adversely affected by obsessiveness, self-doubt, confusion. Client’s perception and interpretation of crisis event may differ substantially from reality of situation. Gross inability to concentrate on anything except crisis event. Client so afflicted by obsessiveness, self-doubt, and confusion that problem-solving and decision-making abilities have “shut down.” Client’s perception and interpretation of crisis event may differ so substantially from reality of situation as to constitute threat to client’s welfare.

Domain Severity Scale Summary

Affective _____ Cognitive _____ Behavioral _____ = Total _____

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