Please no plagiarism and make sure you are able to access all resource on your own before you bid. One of the references must come from James, R. K., & Gilliland, B. E. (2017). I have put in bold the classmates that you will need to respond to according to the instructions of the instructor. I have also attached my discussion and assessment so you can compare to the classmates you respond to. Please follow the instructions to get full credit for the discussion. I need this completed by 09/14/18 at 7pm.
Discussion: TAF Assessment
Respond to at least two of your colleagues’ posts who scored differently. Consider if you were working with this colleague to come to a consensus and provide a respectful defense of your assessment to advocate for the best possible client care.
My Post on Assessment and Ratings
In scoring the assessment for:
Affective: I would score her with 4 for low impairment. She is aware of her feelings and has learned to control them without lashing out at others. Her emotions extreme emotions usually are crisis focused.
Behaviors: I would score her with an 8 for marked impairment. She wants to go to school but going to school is where all her anxiety come from. She is unable to attend classes like her fellow classmate without flashbacks of her past trauma. Her trauma can physically and emotionally paralyze her at times. Having normal conversations with men is not possible right now because it’s like she freezes up.
Cognitive: I would score her with a 4 with low impairment. This one was kind of hard to score for me because with some things I feel that her thinking and decision making is all right. But when it comes to her crisis I feel that it needs help. I supposed I scored her low because despite her trauma, she still pushed her self to attend school and she is concerned about not succeeding in school and her relationships with men not just in her class but in general. So she is thinking about her future concerning this crisis.
In regards to the case study of reference, Amy requires such care needs like deep breathing, meditation, and a healthy diet. I came to know these needs after assessing to determine whether there was an excessive worry, feelings of impending doom and fear. My main reason for assessing to establish whether there was an excessive worry was that I hoped that this will point me to a problem that Amy might be facing. This supports my position in the sense that people that are faced with difficult life problems tend to breathe fast especially when thinking about the problems.
I assessed to determine whether there were feelings of impending doom for the reason that I hoped that this will point me to something that Amy wishes not to happen. This supports my position in the sense that clients that do not want something to happen tend to be disturbed all the time. It is normally difficult for such clients to concentrate on what they are doing. They will hop from one activity to another. In reference to the case study of reference, Amy does not want to fail her exams.
Additionally, I assessed to determine whether there was fear for the reason that people tend to be unsettled when they perceive danger. This supports my position in the sense that an individual that has perceived danger will have an increased in their heartbeat. In the case study of reference, Amy frequently panics thoughts, especially when going to class. The main reason for this is that she perceives the possibility of failing in exams as a danger and her inability to have a relationship with a man. Going to class constantly reminds her that she will at one time sit for exams and not being able to interact with her male classmates hence the thoughts.
References
Hatala, A. R. (2013). Towards a biopsychosocial–spiritual approach in health psychology: Exploring theoretical orientations and future directions. Journal of Spirituality in Mental Health, 15(4), 256–276. doi:10.1080/19349637.2013.776448
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
Classmate C.Bar
TAF Assessment: In the Case of Amy
Any distressing or crisis event that produces a critical threat (physical, emotional, or psychological) to oneself or loved ones can trigger psychological trauma. Those exposed to such traumatic events can experience a large range of emotions, behavioral, and cognitive patterns (American Psychiatric Association, 2017). Dependent upon the crisis and person, full recovery from these events will eventually occur. However, there are some instances in which a person may continue to experience posttraumatic psychophysiological symptoms long after the event. Through this persistent occurrence, a person may develop one or more posttraumatic disorders such as Acute Stress Disorder (ASD) or Posttraumatic Stress Disorder (PTSD). One way to assess the degree of impairment of an individual is through the utilization of the Triage Assessment Form. This form allows crisis workers to assess the degree of impairment of a client in three specific domains (affective, behavioral, and cognitive) and formulate specified interventions that target areas of greatest concern (James & Gilliland, 2017). The TAF will be utilized to evaluate Amy’s degree of impairment.
Amy’s Degree of Impairment
Given the information outlined in the case, Amy meets the criteria for PSTD. Individuals suffering from PTSD may experience recurrent, involuntary, and intrusive recollections of the event, negative alterations in cognitions or moods associated with the event, and heightened sensitivity to potential threat (American Psychiatric Association, 2017). Amy has expressed feelings of heightened anxiety and fear around men or walking alone in the parking garage. These feelings stem from Amy’s past sexually assault encounter while in high school. Her anxiety levels have increased due to being asked on a date by a male colleague. According to the TAF, Amy’s overall impairment score falls into the rating of 11-19. Her impairment is contributing to her difficulty functioning on her own (James & Gilliland, 2017). Guidance and directiveness from the crisis worker are needed. Without proper assistance, Amy’s condition may worsen or escalate. Amy’s degree of affective, behavior, and cognition impairment can be broken down in depth using the TAF assessment.
Affective Domain
Based on the Affective Severity Scale, I would score Amy’s degree of impairment an eight. Amy has had several episodes of panic or anxiety attacks while on campus. Her reactions escalate to the point of where she expressed feelings of dying. She becomes emotionally volatile when asked questions about her behavior, support system status (closeness to family/religion), alcohol intake, and cut marks. The emotions range from shyness, fear, guilt, anger, and desperation. Her emotions are starting to generalize from crisis to other people and situation as she is having extreme difficulty just talking to men in the class. Amy’s heightened level of anxiety and fear causes her to experience tonic immobility. Through tonic immobility, Amy is fully alert and aware, but unable to talk or move (Wilson, Lonsway, Archambault, & Hooper, 2016). These reactions cease once she is safe in her car. She has displayed feelings of frustration due to her emotions and actions.
Behavior Domain
Based on the Behavior Severity Scale, I would score Amy’s degree of impairment a six. Amy’s behaviors are maladaptive but not immediately destructive. She does drink, but only one or two glasses of wine, one to three times a week. Drinking to “numb out” is a typical (yet maladaptive) coping mechanism for individuals suffering from PTSD (dissociation) (James & Gilliland, 2017). Although it is maladaptive, this pattern is not life-threatening (my perception). Although Amy’s daily living task performance is minimally compromised, her act of cutting herself in alarming. That behavior can pose a potential threat to herself. I do not necessarily think she is experiencing suicidal ideation, but I would take that information seriously. I believe behaviors could be controlled with the aid of interventions or counseling treatment (hence why she is seeking help now).
Cognitive Domain
Based on the Cognitive Severity Scale, I would score Amy’s degree of impairment a three. She can articulate her problem in candid detail. An individual’s cognitive processes normally view the event in terms of transgression, threat, and loss (James & Gilliland, 2017). Amy is well aware that her experience of sexual assault is negatively affecting her emotions and behavior. Although her decisions are becoming a little indecisive, her thought process still under control. She expresses that she feels disconnected from her spiritual beliefs and family. She is aware of the views of her family members (and their acknowledgment of her behavioral change), thus deciding to keep her distance (self-induced lack of support). She has developed some patterns of cognitive distortions, as she views herself as damaged goods. She recognizes that emotional, behavioral, and cognitive change must occur to achieve academically and pursue a relationship.
References:
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning
American Psychiatric Association. (2017). Clinical practice guideline for treatment of posttraumatic stress disorder (PTSD) Retrieved from http://www.apa.org/ptsd-guideline/
Wlison, C., Lonsway, K. A., Archambault, J., & Hopper, J. (2016). Understanding the neurobiology of trauma and implications for interviewing victims. End Violence Against Women International. Retrieved from https://evawintl.org/Library/DocumentLibraryHandler.ashx?id=842
Classmate K. Rog
Assessment and Diagnosis
Main Discussion Post
A person in crisis is feeling momentarily out of control, unable to utilize personal resources or those of others around them in an effort to stay in a safe psychological place (James & Gilliland, 2017). It is a crisis worker’s responsibility to help the person re-gain control of their psychological balance (James & Gilliland, 2017). Assessments are critical when working with someone who is experiencing crisis trauma. Assessments help counselors to determine the severity of the crisis, the client’s current emotional, behavioral, and cognitive states of mind, the alternatives, coping skills, and support systems available to the client, the client’s level of harm to self or others, and the progress of the counselor with de-escalating the situation while helping the client to calm down (James & Gilliland, 2017).
Selected TAF Scale
The triage assessment form scale that I have chosen is the behavioral severity scale. When filling out the triage assessment form, the behavioral scale was a 6/7. Based on Amy’s case study, she instantly becomes distant, stutters, and begins to sweat when having to talk to men in class (Laureate Education, 2018). Although she wants to have a relationship with a man, she cannot seem to overcome her anxiety concerning her sexual assault in high school (Laureate Education, 2018). She even recognizes the fact that she will have trouble making her medical rounds as a nurse if she does not overcome her anxiety with her interactions with men (Laureate Education, 2018). Once the crisis exceeds the client’s ability to meaningfully cope in a purposeful manner, the client is considered immobilized, stuck in the approach, avoidance, or behavior no matter how proactive they appear to be (James & Gilliland, 2017). Amy’s behaviors are unstable but not immediately destructive however there is concern for her safety with her cutting herself as a stress reliever. She is struggling with accomplishing daily tasks such as walking throughout campus and being approached by men (Laureate Education, 2018). She recognizes that her anxiety with being around others, especially men, has to subside for her to accomplish her personal goals. Amy also recognizes that her behavior can be controlled with effort which is why she is seeking professional assistance. She needs to know how she can better handle her anxiety, reconnect with her spiritual beliefs, and effectively interact with men without panicking or thinking the worse. With crisis intervention, the best way to get the client mobile is to promote positive actions that the client can do at once (James & Gilliland, 2017). Once the client becomes more involved with doing something concrete, control is restored, and the climate for forward moving is established (James & Gilliland, 2017).
Conclusion
Crisis is time limited and should be assessed from the client’s subjective viewpoint and the crisis worker’s objective viewpoint (James & Gilliland, 2017). Performing an assessment on the client is imperative to know how to approach the crisis that the client is experiencing. The ultimate end goal is to help the client to get back in a position of control and stability. The length of time that the client has been in crisis will help determine how much time the counselor has in which to safely defuse the situation (James & Gilliland, 2017).
References
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
Laureate Education (Producer). (2018). Document: Case Study: Amy [PDF].
Classmate K. Brew
In Amy’s case, as you read on the more and more you realize how big of a crisis she is in. As we read in Chapter 7 of James and Gilliland (2017), Amy clearly exhibits symptoms to meet criteria for a PTSD diagnosis.
In scoring her Triage Assessment form, I felt some scales were easier than others. I noted in the observations section that she reported flashbacks and loss of reality contact and also noted her self-injurious behavior. I think these two issues were clearly identified in the case study.
In scoring the severity scales, I rated Amy moderate impairment on the first two sections (Feelings are primarily negative and are exaggerated or increasingly diminished and efforts to control emotions are not always successful). I rated her this way due to her report of having “bad thoughts and panic and worry”. I also rated her about her emotions not always in control because she does have some coping strategies (although they may not be the healthiest) they have somewhat worked for her. I rated her emotions of the crisis are generalized to other people and situations. I rated her this way due to the nature of her crisis and her stating that her crisis began when a male colleague asked her out on a date. This could very well be a trigger for her repressed trauma and her believing that any other man that she enters a relationship with will sexually assault her again. The last affective question was difficult for me to rate. I went and rated that Amy’s responses to questions/requests are emotional but composed. In reading the narrative of the case study, it does not seem that she has any outbursts until the end, but you can see how that response is linear and warranted. It seems Amy is frustrated that this trauma has prevented her from obtaining what she really wants and that is a healthy, appropriate relationship with a man.
In scoring her behavior, I noted that her behaviors are maladaptive but not immediately destructive. I did this as evidenced by the visual cutting on her arms and the statement, “I cut sometimes to help release my feelings.” This is obviously maladaptive behavior, but since there is not a desire to end her life I would not identify it as a crisis situation. I noted that her ability to perform tasks needed for daily functioning is seriously impaired; this was due to her having to go out to her car and feeling that she cannot be around men in completing her medical rounds. I noted that her behaviors are a minimal threat to self or others. Lastly, I noted that her behavior is becoming unstable and offensive. This one was difficult for me. I think this was the one that fit Amy best due to having to run out to her car to avoid negative stimuli. Behaviors that concern me are the increase in drinking and cutting these two behaviors can definitely lead to being unstable.
Cognitively, I scored Amy low in regards to her decisions and others. It seems that Amy does not blame others for her trauma but places much of the blame on herself. I think that she is not a danger or potential danger to others. The second section, I rated as decision making is frenetic or frozen and not based in reality and shuts down general functioning. I think in Amy’s case, she has frozen up and she reports that it is similar to the night she was assaulted which causes her general functioning to shut down. Next, I scored thoughts about crisis have become pervasive. I think this one was pretty evident that as the symptoms of PTSD have increased it has expanded past just thinking about the trauma and into many of Amy’s thought processes. The next rating, I rated as able to carry on reasonable dialog restricted and has problems understanding and acknowledging views of others. This was another that was muddy for me to work through and process. Ultimately, I thought that Amy could not carry on a dialog with a male and that would be restricted. I don’t know if she would necessarily have problems understanding and acknowledging views of others, but I thought this rating fit her best. Lastly, I rated her problem solving is limited. I rated it this way due to she has some problem solving skills, they problem solving Amy is doing may not be a healthy way to problem solve.
The crisis event is lined out pretty well in the case study. Amy was sexually assaulted on a senior trip in high school and felt that she could not tell anyone but her sister due to the boys family standing in the community. She does not express any anger or hostility. She does express anxiety, fear and frustration. I think that in her behavior she is currently using avoidance and immobility due to her avoiding interacting with men and when she does, she “goes into la la land”. Cognitively, she has a poor self-concept and self-identity (self blame, “damaged goods”). Amy does have some social support with her family that she sees on the weekends, but outside of that she reports no significant friends or other social support. Amy reports that she is “disconnected and does not actively participate” in her Native American beliefs.
James, R. K., & Gilliland, B. E. (2017). Crisis Intervention Strategies (8th ed.). Boston, MA: Cengage.
Required Resources
Readings
James, R. K., & Gilliland, B. E. (2017). Crisis intervention strategies (8th ed.). Boston, MA: Cengage Learning.
- Chapter 2, “Culturally Effective Helping in Crisis”
- Chapter 3, “The Intervention and Assessment Models”
- Chapter 7, “Posttraumatic Stress Disorder”
Optional Resources
American Psychiatric Association. (2017). Clinical practice guideline for the treatment of posttraumatic stress disorder (PTSD). Retrieved from http://www.apa.org/ptsd-guideline/
Hatala, A. R. (2013). Towards a biopsychosocial–spiritual approach in health psychology: Exploring theoretical orientations and future directions. Journal of Spirituality in Mental Health, 15(4), 256–276. doi:10.1080/19349637.2013.776448
National Child Traumatic Stress Network. (n.d.-c). Trauma-informed screening & assessment. Retrieved March 2, 2018, from http://www.nctsn.org/resources/topics/trauma-informed-screening-assessment
Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Trauma-informed care in behavioral health services. Treatment Improvement Protocol (TIP) Series 57. Retrieved from https://store.samhsa.gov/shin/content/SMA14-4816/SMA14-4816.pdf
- Chapter 3, “Understanding the Impact of Trauma”
- Chapter 4, “Screening and Assessment”
Wilson, C., Lonsway, K. A., Archambault, J., & Hopper, J. (2016). Understanding the neurobiology of trauma and implications for interviewing victims. End Violence Against Women International. Retrieved from https://www.evawintl.org/Library/DocumentLibraryHandler.ashx?id=842
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