USW1 COUN 6336 Triage Assessment
Describe in 250 words:
The primary concern of Amy.
Using the Triage Assessment Form (TAF) as a guide, identify Amy’s overall symptom severity on a scale from 1-30.
Identify what would be your next step to help Amy.
Resources:
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” Client Name: ____________________________________________ Time/Date: __________________
Crisis Worker: _________________________ Contact Type: __________ Phone: _______ Office: _______
Field
Crisis Event:
Sexual assault Amy experienced during her high school senior class vacation. This event has caused her to experience flashbacks, anxiety, panic, and hypervigilance while on campus, particularly when walking alone in crowded areas._________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Disposition:
Amy’s current state and needs after experiencing sexual assault. Specifically, Amy is seeking counseling due to her anxiety symptoms and flashbacks, which are impacting her ability to attend school and form relationships. Her disposition requires interventions to address the trauma and help her cope with her symptoms.______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Observations (Check as many that apply)
___ off medication*
__yes_ medication not effective***
_sounds__ hallucinating*** (___smells___
sights___sounds___touch)
___ bizarre behavior/appearance
_yes__ poor hygiene
___ absurd, illogical speech***
__yes_ paranoid/suspicious thoughts***
___ flashbacks, loss of reality contact
___ intoxicated/drugged*
___ under the influence of mood-altering
substance
___ other (explain)
___ oppositional defiant to verbal suggestions
___ coercion/intimidation
___ aggressive gestures*
___ reckless behavior
___ self-injurious behavior
__yes_ physically violent*
___ verbal threats to self or others
___ suicidal/homicidal
thinking/verbalizing
__yes_ suicidal/homicidal
gestures/behaviors*
__yes_ suicidal/homicidal plan clear*
___ uncooperative
___ flat affect
___ impulsivity
___ hysterical
___ confusion
___ unable to follow simple directions
___ unable to control emotions
___ cannot recall personal
information (phone,
address)
___ situation perceived as
unreal (spectator)
___ nonresponsive***
Notes:
_____________________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________________
*** psychiatric Assessment recommended * hold for law enforcement officers or EMTs
Figure 3.2 Triage Assessment Form for Crisis Intervention.
SOURCE: Compiled from Triage Assessment Form (TAF), Triage Assessment System for Students in Learning Environments (TASSLE), Triage Assessment Checklist for Law Enforcement (TACKLE). Crisis Intervention & Preventions Solutions Inc.
Pittsburgh, PA.
SEVERITY SCALES
Check those that apply
1
No
Impairment 2/3
Minimal
Impairment 4/5
Low
Impairment 6/7
Moderate
Impairment 8/9
Marked
Impairment 10
Severe
Impairment
A
F
F
E
C
T
I
V
E Stable mood, control of feelings. Affect elevated but generally appropriate. Evidence of negative feelings pronounced and increasingly inappropriate. Feelings are primarily negative and are exaggerated or increasingly diminished. Feelings are negative and highly volatile or may be nonexistent. Feelings are extremely pronounced to being devoid of feeling.
Feelings are appropriate. Brief periods of slightly elevated negative mood. Duration of feeling intensity longer than situation warrants. Efforts to control emotions are not always successful. Extremely limited control of emotions. No ability to control feelings regardless of potential danger to self or others.
Emotions are under control. Emotions are substantially under control. Emotions are controlled but focused on crisis event. Emotions not under control but remain focused on crisis. Emotions start to generalize from crisis event to other people and situations. Emotions of the crisis are generalized to other people and situations.
Responses
to questions/
requests are calm and composed. Responses to questions/
requests are emotional but composed. Responses to questions/
requests vary from rapid and agitated to slow and subdued. Responses to questions/
requests are emotionally volatile or beginning to shut down. Responses to questions/
requests noncompliant due to interference of emotions. Cannot respond to questions/
requests because of interference of emotions.
B
E
HA
V
I
OR
S Behaviors
are socially appropriate. Behaviors are mostly effective; outbursts, if present, are inconsequential. Behaviors are somewhat ineffective yet not dangerous. Behaviors are maladaptive but not immediately destructive. Behaviors are likely to intensify crisis situation. Behaviors are totally ineffective and accelerate the crisis.
Daily functioning is unimpeded. Can perform tasks needed for daily functioning with minimal effort. Performance of tasks needed for daily living is minimally compromised. Performance of tasks needed for daily living is noticeably compromised. Ability to perform tasks needed for daily functioning is seriously impaired. Unable to perform even simple tasks needed for daily functioning.
Threat or danger is nonexistent. Behavior demonstrates frustration but is nonthreatening. Behaviors are a minimal threat to self or others. Behavior is a potential threat to self or others. Impulsivity has the potential to be harmful to self or others. Behaviors are highly destructive and could possibly cause injury/death to self or others.
Behavior is stable and non-offensive. Behaviors mostly stable and
non-offensive. Behavior is becoming unstable and offensive. Upon request, behaviors can be controlled with effort. Behaviors are very difficult to control, even with repeated requests. Behavior is out of control and nonresponsive to requests.
C
OGN
I
T
V
E Decisions are considerate of others. Decisions may not be considerate of others. Decisions are inconsiderate of others. Decisions are offensive and antagonistic of others. Decisions have the potential to be harmful to self or others. Decisions are a clear and present danger to self and others.
Decisions are logical and reasonable. Decisions are becoming indecisive but only with respect to crisis. Decisions are becoming illogical, unreasonable, and generalized beyond crisis. Decisions about crisis are beginning to interfere with general functioning. Decisions are illogical and have little basis in reality, and general functioning is compromised. Decision making is frenetic or frozen and not based in reality and shuts down general functioning.
Perception of crisis event substantially matches reality. Thinking is influenced by crisis but is under control. Thinking is focused on crisis but is not all consuming. Thoughts are limited to crisis situation and are becoming all consuming. Thoughts about crisis have become pervasive. Thoughts are chaotic and completely controlled by crisis.
Able to carry on reasonable dialog and understand and acknowledge views of others. Able to carry on reasonable dialog and understand and acknowledge views of others. Ability to carry on reasonable dialog restricted and has problems understanding and acknowledging views of others. Responses to questions and requests are restricted or inappropriate and denies understanding views of others. Is defiant to requests and questions and/or inappropriate with and antagonistic of others. Requests and questions are believed as threats and responded to aggressively.
Problem solving is intact. Problem solving is minimally compromised. Problem solving is limited. Problem solving is blocked. Problem solving ability is absent. Problem solving is not observable with no ability to concentrate.
CRISIS EVENT
Identify and describe briefly the crisis situation: Amy is experiencing severe symptoms of depression, including loss of interest in her usual activities, feelings of hopelessness and helplessness, and suicidal ideation. She has also recently lost her job and is struggling financially, which has added to her distress. Amy is experiencing significant emotional distress and is at risk of self-harm, making this a critical situation that requires immediate attention and intervention
AFFECTIVE DOMAIN
Identify and describe briefly the affect that is present.
(If more than one affect is experienced, rate with #1 being primary, #2 secondary, #3 tertiary.)
ANGER/HOSTILITY: #1, evidence by her verbal and physical aggression towards her husband, as well as her use of profanity and threats towards him. Amy also expresses frustration and anger towards the police officers who arrive at the scene, which suggests that her anger is not limited to her husband
ANXIETY/FEAR: #1 Amy expresses worry about her financial situation, the potential loss of her job, and the impact it will have on her family. She is also anxious about the possibility of losing custody of her children if her mental health deteriorates further. This anxiety and fear contribute to her overall distress and sense of crisis.
SADNESS/MELANCHOLY: #3 little evidence
FRUSTRATION: #1, Amy is feeling overwhelmed by her situation and is unable to cope with the stressors in her life. She is frustrated by her financial struggles, her lack of support from her partner, and her feelings of loneliness and isolation. This frustration is evident in her thoughts and behaviors, such as her feelings of hopelessness and her desire to give up. It is possible that her frustration is also contributing to her anxiety and anger/hostility.
BEHAVIORAL DOMAIN
Identify and describe briefly which behavior is currently being used.
(If more than one behavior is utilized, rate with #1 being primary, #2 secondary, #3 tertiary.)
APPROACH: #1 Demonstrated by Amy’s attempts to communicate with her boyfriend and to seek out help from a mental health professional. She is actively trying to address the crisis situation and is seeking solutions to her problems. This approach behavior is a positive sign that Amy is motivated to improve her situation and is taking steps to do so.
AVOIDANCE:
IMMOBILITY:
COGNITIVE DOMAIN
Identify if a transgression, threat, or loss has occurred in the following areas and describe briefly.
(If more than one cognitive response occurs, rate with #1 being primary, #2 secondary, #3 tertiary.)
PHYSICAL (food, water, safety, shelter, etc.): Amy’s cognitive response suggests that she perceives a loss in the physical domain, as she has been evicted from her apartment and is currently homeless. She may be experiencing feelings of insecurity, fear, and anxiety related to her physical safety, access to basic necessities like food and water, and lack of stable shelter.
Transgression_____ Threat_____ Loss__#1____
PSYCHOLOGICAL (self-concept, sense of emotional well-being, ego integrity, self-identity, etc.): Amy may perceive a transgression in her psychological well-being due to the negative comments and criticism from her peers and the threat of being ostracized from her social group. This can lead to a negative impact on her self-concept and self-identity, causing her to question her value and worth.
The criticism and negative comments from her peers can also be perceived as a threat to her emotional well-being, leading to feelings of insecurity, anxiety, and fear. This can further impact her self-identity and self-esteem, causing her to feel inadequate and unworthy.
Transgression____#1_ Threat___#2___ Loss______
SOCIAL RELATIONSHIPS (positive interaction and support, family, friends, coworkers, church, clubs, etc.): Amy has recently moved to a new city and started a new job, which may have resulted in her feeling disconnected and lonely. She also mentioned feeling like she doesn’t have anyone to talk to about her feelings, which suggests a lack of social support. This loss of social connection and support may be contributing to her overall distress and affecting her mental well-being.
Transgression______ Threat______ Loss__#1____
MORAL/SPIRITUAL (personal integrity, values, belief system, spiritual reconciliation): Amy has lost her sense of purpose and meaning in life, which has caused her to question her belief system and values. This is evident when she says that she feels like she has “lost her way” and is struggling to find a reason to keep going. Her previous belief that she was making a difference in the world has been challenged, and she is having a crisis of faith as a result.
TRIAGE ASSESSMENT (X = Initial Assessment/O = Terminal Assessment)
Affective
_8__ Anger ___4 Fear __4_ Sadness
• •
1 2 3 4 5 6 7 8 9 10 Behavioral
___8 Approach ___ Avoidance ___ Immobile
• •
1 2 3 4 5 6 7 8 9 10
Cognitive
___ Transgression ___Threat ___Loss
• •
1 2 3 4 5 6 7 8 9 10
____7__ Physical ____7___ Psychological _____6__ Relationship ___6____ Moral/Spiritual
Initial Total Score: _____31____ Terminal Total Score: _50________ (if used)
Transgression______ Threat______ Loss______
Describe the observations that led you to check the characteristics above:
Amy is primarily experiencing anger and using an approach behavior to cope. In terms of cognitive responses, she is primarily experiencing a sense of physical and psychological loss, with some impact on her relationships and moral/spiritual well- being.____________________________________________________________________________
______________________________________________________________________________________
Amy is seeking counseling due to anxiety symptoms and flashbacks triggered by sexual assault she experienced during her senior high school class vacation. Her symptoms include anxiety, panic, hypervigilance, and flashbacks that occur when she is walking alone in crowded areas on campus. Using the Triage Assessment Form (TAF) as a guide, Amy’s overall symptom severity is marked impairment (8/9). This implies that her symptoms are moderate, and she may have some difficulty carrying out her activities of daily living.
The next step to help Amy is to provide interventions to address the trauma and help her cope with her symptoms. This can include referrals for therapy, medication management, or a combination of both. The therapist can use Cognitive Behavioral Therapy (CBT) to help Amy learn how to manage her anxiety and other symptoms. Additionally, therapists can use Eye Movement Desensitization and Reprocessing (EMDR) therapy to help Amy process the traumatic event and reduce her flashbacks and other PTSD symptoms.
The therapist can also provide education about PTSD, its symptoms, and coping strategies, including relaxation techniques, mindfulness, and self-care. These strategies will help Amy manage her symptoms better and feel more in control of her life. As a crisis worker, it is essential to provide Amy with a safe and supportive environment that allows her to share her experiences and feelings without fear of judgment or ridicule.
It is important to note that crisis intervention is not a one-time event, and recovery from trauma takes time. Therefore, it is essential to schedule follow-up appointments to monitor Amy’s progress and adjust the treatment plan as needed. Additionally, crisis workers can provide Amy with resources such as support groups, hotlines, and community-based organizations that can offer additional support and help her build a strong support system.
