All this scenario Uncooperative – as most

 

All individuals have their own capacity and expectation. The worker needs
to be realistic on the expectations in helping the client. When client shows no
improvement, the worker might doubt his ability. The worker needs to know that
different clients may expect different outcomes (Gerald, 2009,
p. 374). 

 

Recharging oneself by supervision is a way to cushion and deplete the
emotionally disturbed state. As a giver, the worker may drain the emotional
energy. Communicating with someone allows to express the feelings and thoughts
without repressing it (Gerald, 2009, p. 373). 

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Burn-out – Working with families with relationship issues may be tiring
and frustrated when they are uncooperative. If the case reminds the worker part
of their lives, the worker may become overly attached or develop dislike to
working with the client (CeUnit, 2018). The worker needs to
accept that burnout is normal. Thus, the worker has to deal with burnout
actively such as going for holidays, recognise the symptoms, cut down workload,
positive self-talk or even meditation.

  

Psychological and emotional state – worker must evaluate his or her own
emotional and psychological state towards the client. In the case of lacking
honesty will lead to interference of building trust between client and worker
relationship. If the crisis workers find they are focusing on client weaknesses
rather than strength, it is time to look for supervision consultation (CeUnit, 2018).

 

It is paramount vital to look after oneself as a crisis worker. Facing
with scenarios of all types of relationship issues, the worker needs to vent
their frustration and emotions. The worker needs to be aware of the burnout
symptoms like physical and emotional disturb, negative attitudes elevated,
disillusionment of questioning the value of their work and affecting the
quality of life.   

5.0 Discuss the importance of self-care for the crisis worker in this
scenario

 

Uncooperative – as most the cases are referred by government authorities
or hospitals, the client may feel being compelled to seek for help. The client
may be fear, shy or inferior to share their relationship issues. Thus, crisis
worker may need more time to build the trust.

 

Language – the language barrier may cause misinterpretation and mislead
the process of crisis intervention. Worker needs to be aware of the choice of
words and accurate interpretation of client’s response. 

 

Culture – This may create conflicts with those of the wider society.
While worker might recognise that the client is having the same situation like
others such as divorce, worker needs to be mindful of the possible difficulties
may be associated to issues of race, ethnicity, gender or socioeconomic status (Gerald, 2009, p. 328).

 

Vulnerability and safety – this may be experienced when crisis worker
overly care or overly emotionally involved may provoke physical harm from
client due to jealousy or feeling rejected. Thus, crisis worker needs to
maintain an objective and non-judgemental attitude at all times (CeUnit, 2018).

Identify any potential issues you may face as a crisis worker

 

Majority of the suicidal
clients give certain clues to harm themselves. The worker will ask the client
on his or her thoughts of a suicide plan, when was the last time of the suicide
thoughts, warning signals, choice of a lethal method, previous attempts and the
availability of method (Gerald, 2009, p. 260). The worker may ask
the client further on how the loved ones would think if the he or she attempt
it. The worker will get the client to rate based on a scale of 1 to 5 the
potential suicidal risk. 

d.      
Determine the client’s level of lethality
(danger to self and others)

 

The worker need to
facilitate what actions or choices does the client have at current that would help
to restore the person to a state of equilibrium and mobility. The actions taken
by the client must be realistic. The worker to help find the client’s institutional,
social, vocational, or personal strengths to cope with the event. The worker
also assists in determine the available resources to help client cope with the
situation.

c.      
Determine the alternatives, coping mechanisms,
support systems and other resources available

 

The crisis worker
need to assess the time frame of the crisis to determine whether is it acute or
chronic. In the case of chronic crisis, it takes more time and efforts in
counselling to observe coping, support and strength of client to walk out from
the crisis. In many cases, referral to professional counsellors are required.

b.      
Determine the client’s current emotional and
cognitive stability and behavioural mobility

 

Behavioural or
Psychomotor activity – the crisis worker needs to help the client to engage in
a concrete and immediate activity during a crisis.

Affective state –
the crisis worker also needs to observe the client’s emotion. Under conditions
if it is over, the worker needs to assist client express proper emotions to
regain control. 

Cognitive state –
the crisis worker need to assess on how realistic and consistent is the
client’s thinking. This help worker work on altering client’s disorganized
thinking, and develop more positive rational thinking.

a.      
Determine the severity of the crisis

In assessing the crisis intervention, the goals of
assessing are:

 

The last step is to
get the commitment from the client to work on the plan and for the worker to
walk through with the client. The worker may ask the client to summarize the
plan discussed in order to obtain commitment. Example: “After walking through
with you the plan that we conversated for not harming oneself, summarize for me
what actions you will take to ensure that you do not think negatively hurting
yourself and to assure that you keep it from moving into another crisis”. In
case where lethality is concerned, the commitment may be penned down and
endorsed by both client and worker. The commitment must be voluntary and
realistic.

Step 6 – Obtaining commitment

 

Crisis worker to
make a plan together with the client for self-control and autonomy with
consideration on client’s coping capacity, no coercing act, and the available
resources (identify reliable persons that can be contact for urgent support).
Crisis worker may illustrate some coping mechanism like relaxation techniques
to help client keep calm when negative emotions build up. The client needs to
feel taking ownership to the plan. The plan helps the client to get through the
short-term event and to achieve better equilibrium and stability.

Step 5 – Making plans

 

Upon giving support,
the crisis worker will then focus on helping the client to develop options in
regaining control of oneself. One way is to look for situational supports such
as people who relates and care about the client. The crisis worker will also
need to explore with the client on the coping mechanisms that assist the client
to overcome the current crisis. In addition, the crisis worker will help to
change the client way of thinking of the problem by reframing it and mitigate
the negative thoughts and feelings.

Step 4 – Examines alternatives:

 

Ideally for steps 4 to 6, it would be best to implement in collaborative
manner with the client. However, if client is passive and not participative, a
more directive approach to help the client mobilize the coping mechanisms. 

 

The next step for
the crisis worker is to provide instrumental and informational support with
effective communication to the client. Client needs to feel stable, tranquil
and safe. The crisis work needs to accept and value the client unconditionally.

Step 3 -Provide support

 

Next, safety at
forefront. The crisis worker needs to be mindful that client might be disposed
to irrational actions on self and others’ safety. The crisis worker need to
ensure steps taken to prevent any physical and psychological harm. Ensuring
safety is an incessant part of the crisis intervention process.

Step 2 – Ensure client safety

 

In this step, it
focuses on the immediate triggering event to comprehend the client’s
perceptions. Using Carl Roger ‘person-centred counselling’ approach with
effective listening skills, crisis worker need to be congruence, empathy and
having unconditional positive regards to help defining the client’s problem. Joining
and active listening at this stage is vital where the worker needs to clarify
his role for the intervention and respond by using minimal response, paraphrasing
and reflecting feelings (Gerald, 2009, p. 139).

Step 1 – Define the problem

The six-step model is designed to work as an integrated process (James, 2005). It can also be
integrated with the triage assessment. The first three steps have more
listening activities than actions. The balance three steps are largely actions
taken by the worker.

4.0 Choose a suitable crisis intervention strategy

 

d.      
Above 21 = directive for severe impairment to no
control range. Refer for medical evaluation)

c.      
15 to 21 = collaborative for moderate to high
impairment

b.      
14 or less = non-directive stance for minimally
impaired range

a.      
Less than 9 = no or minimal impairment

The total score is out of 30 and is calculated by adding all the three
scales score (out of 10 respectively). While interviewing the client, the
worker mentally computes the severity score, and identifying areas for
intervention. The score is used to determine the action style:

Combining the scales of 3 domains:

 

Behavioural ratings consider the level of deficiency in performing the
daily living activities, to cope with adaptability and effectiveness and possible
harm to oneself and others.  At the
extreme rating, a lethal aspect in relation to self or other may trigger.

c.      
Immobility or paralysed – Freeze

b.      
Avoidance behaviour – Fright

a.      
Approach behaviour – Fight

Behaviour reactions in a crisis includes:

Behavioural domain scale

This can take on disastrous extents at the extreme end of the severity range.
When extremely focused on irrational behaviour, it limits logical problem-solving
thinking. The perceptions can be apparently concern to physical, psychological
and relationship needs. The rating considers the client’s ability to focus,
problem-solve and make decisions. Client with confusion, unmatched reality
perceptions and inadequate ability to control over disturbing thoughts has
higher scores on the cognitive scale.

c.      
A loss experience that is irreversible

b.      
A threat leading to potential harm

a.      
A transgression of their rights being violated

In a crises situation, the client’s distorted thinking such that
perceptions of the event as:

Cognitive domain scale:

 

The crisis worker will ask questions related to affective, identify the
area that best describe the client’s affect, and then rate client on a scale of
severity from 1 to 10. This rating criteria includes stability or lability of
mood, congruence of affect to situation and degree of effort obligatory to keep
volitional control of affect

c.      
Sadness/ Melancholy

b.      
Fear/ Anxiety

a.      
Anger/ Hostility

In assessing the affective domain found in crisis, the primary reactions
are:

Affective domain scale:

 

The triage assessment system was developed by Rick Myer (Myer, 2001), who postulates that
it is mandatory to assess crisis reactions in three domains, they are
affective, cognitive and behavioural. In this case where client is hit by ruinous
relationship, the worker will walk through with him or her in assessing his or
her reactions.

3.0  
Apply appropriate model of triage assessment

 

For the crisis
worker to intervene, he or she needs to perform a pre-intervention assessment to
determine whether the individual is mobile and emotionally equilibrium even
when under upset conditions. If the individual is mobile and stable, then
crisis intervention is not required. This stable group will be recommended to
go for other options like counselling and preventive orientated intervention.
In the case if the individual is immobility and disequilibrium, the crisis
worker may use the triage assessment and six-step model of crisis intervention
to assess him or her further. The goals of intervention are to reinstate the
person to a state of stability and mobility; giving attention to the pressing
problem event; and to deal with the person in crisis with emotional support.

 

f.       
Psychosomatic symptoms

e.      
Regression   

d.      
Tightly focused attention

c.      
Anxiety, confusion and helplessness

b.      
Poor cognitive functioning

a.      
Sense of urgency

The crisis worker
needs to look out for the following to determine the individual is in crisis:

 

Crises usually
associate with danger and risk. Individuals may get overwhelm with the
situations and making negative choices to escape the issues. The crisis’s
experience is just like walking through an entranceway between two rooms. You
may feel that you have left something behind the room you exit even though you
may have brought something out from there. The new room you entered looks
unfamiliar to you. Then you start to feel emotionally due losing the things you
left behind and also feel anxious about things that might happen in the new
room. If all attention is given to apprehension, this may be intimidating. In
the case where client who suffered from relationship issues leading to suicide
thoughts like unfaithfulness from the other partner or even in the process of
divorce, client may feel “why me” and disturb their quality of life. The client
who see little or no improvement to the situation and not able get out from the
room may start to take irrational actions.        

 

d.      
Major personality disorganization would be
referred

c.      
Require to seek for further resources to resolve
the event;

b.      
Stress level and disorganization augmented above
normal person’s capacity to handle the situation;

a.      
To determine whether an individual has adequate
resources or capability to cope with the situation;

Crisis develops in
four different stages (Marino, 1995). They are:

 

The FSC crisis
worker has to understand that crisis is a situation where it abruptly distorts
the participant’s perception from a comfort or acceptable zone (Gerald,
2009, p. 302).
It causes breakdown and preclude the individuals from dealing with the
situations rationally. Crises occur in various ways like naturally,
accidentally, medically, developmentally, emotionally, relationship and in
other ways (Gerald, 2009, p. 303).

2.0 Identify how it is a crisis and list how it meets criteria for a
crisis

 

Family Service Centre (FSC) is one of the Singapore social
help centres to assist community who needs refuge. In this paper, FSC crisis
workers were tasked to help and intervene with appropriate strategy to assist
the higher risk individuals with suicide thoughts who faced upheaval issues
pertaining to relationship. Dysfunctional relationships, broken relationships
and the absence of relationships are the most common cases of emotional crisis
happened in FSC. Some cases involve physical violence where women and children
were emotionally, sexually and physically abuse happening within families. These
clients mentioned in this paper were hit by betrayal from love ones and the
crisis worker were there (FSC) to help them. The paper would also touch on the
possible issues faced by the crisis worker whilst handling the crisis and to be
mindful at all times for self-care.

 

An article from Channel News Asia in year 2015 dispirited the
Singapore’s society. It was reported that there was an average of 400 suicides
and 1,000 cases of attempted suicides per year based on the statistics (CNA/kc, 2015). That translates an egregious
daily event of 1.1 suicides and 3.3 attempted suicides happening in Singapore. It
was also noted out of these cases, the males doubled the females and median age
of persons involved in the suicides was 50.9 in 2014 (CNA/kc, 2015). Among them the Chinese and Indians
outnumbered the Malays. Mr Tan Chuan Jin who was the Minister for Social and
Family Development during this period revealed that the suicides causes were
multifaceted and could be due to a mixture of systemic issues like social,
economic, family, health and mental (CNA/kc, 2015). The mentioned lists
of issues were identified as the common reasons for suicides in a
locally-published study in 2010 (CNA/kc, 2015). Mr Tan mentioned that the Government
agencies such as Ministry of Health, Health Promotion Board and the Ministry of
Social and Family Development were putting efforts in providing the public with
the necessary support, education and prevention programmes (CNA/kc, 2015). Mr Tan mentioned that the healthcare
professionals such as counsellors, psychiatrist, psychologist and social
workers play a vital role in categorizing and providing support to higher risk
individuals like those with suicidal and self-harming history (CNA/kc, 2015).

1.0  
Background

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