Diagnosis made easier 2nd edition pdf

the Diagnostic Interview: The Mental Status Exam and Risk and Safety Assessments

Resources

Readings

Morrison, J. (2014). Diagnosis made easier: Principles and techniques for mental health clinicians (2nd ed.). New York, NY: Guilford Press.
o Chapter 10, “Diagnosis and the Mental Status Exam” (pp. 119–126)
o Chapter 17, “Beyond Diagnosis: Compliance, Suicide, Violence” (pp. 271–280)

American Psychiatric Association. (2013s). Use of the manual. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.UseofDSM5

American Psychiatric Association. (2013b). Assessment measures. In Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.AssessmentMeasure s
o Focus on the “Cross-Cutting Symptom Measures” section.

Chu, J., Floyd, R., Diep, H., Pardo, S., Goldblum, P., & Bongar, B. (2013). A tool for the culturally competent assessment of suicide: The Cultural Assessment of Risk for Suicide (CARS) measure. Psychological Assessment, 25(2), 424–434. doi:10.1037/a0031264

The Diagnostic Interview: The Mental Status Exam and Risk and Safety Assessments

Blackboard. (2018). Collaborate Ultra help for moderators. Retrieved from https://help.blackboard.com/Collaborate/Ultra/Moderator

Document: Case Collaboration Meeting Guidelines (Word document)

Document: Collaborating With Your Partner (PDF)

Document: Diagnostic Summary Example (Word document) Media

Laureate Education (Producer). (2018b). Psychopathology and diagnosis for social work practice podcast: The diagnostic interview, the mental status exam, risk and safety assessments [Audio podcast]. Baltimore, MD: Author.

MedLecturesMadeEasy. (2017, May 29). Mental status exam [Video file]. Retrieved from https://youtu.be/RdmG739KFF8

Sommers-Flanagan, J., & Sommers-Flanagan, R. (Producers). (2014). Clinical interviewing: Intake, assessment and therapeutic alliance [Video file]. Retrieved from http://www.psychotherapy.net.ezp.waldenulibrary.org/stream/w aldenu/video?vid=276

o Watch the “Suicide Assessment Interview” segment by clicking the applicable link under the chapters tab. This is the interview with Tommi, which will be used for the Discussion.

o Watch the “Mental Status Examination” segment by clicking the applicable link under the chapters tab. This is the case of Carl, which will be used for the Application.

Assessing Suicide Risk
Discussion: Assessing Suicide Risk

As a social worker, you will likely at some point have a client with a positive suicide risk assessment. Many individuals with suicidal ideation also have a plan, and that plan may be imminent. Even when the risk is not urgent at a given moment, current research shows that most suicides occur within 3 months of the risk being assessed within a formal appointment. Ideation can quickly become a suicide.

For this Discussion, you view an initial suicide risk assessment. As you evaluate the social worker’s actions, imagine yourself in their place. What would you do, and why?

To prepare:

Explore an evidence-based tool about suicide risk assessment and safety planning. See the Week 3 document Suggested Further Reading for SOCW 6090 (PDF) for a list of resources to review.
Watch the “Suicide Assessment Interview” segment in the Sommers-Flanagan (2014) video to assess how it compares to your findings.
Access the Walden Library to research scholarly resources related to suicide and Native American po
a response in which you address the following:

Identify elements of Dr. Sommers-Flanagan’s suicide risk assessment.
Describe any personal emotional responses you would have to Tommi’s revelations and reflect on reasons you might experience these emotions.
Describe the elements of safety planning that you would put in place as Tommi’s social worker in the first week and in the first months.
Identify a suicide risk assessment tool you would use at future sessions to identify changes in her risk level. Explain why you would use this tool.
Explain any adjustments or enhancements that might be helpful given Tommi’s cultural background. Support your ideas with scholarly resources.

Verbal De-escalation

Transcript

Slide 1: Cover Slide

Welcome to the verbal de-escalation webinar. This webinar is part of our series on safety in field and is a required part of training for those who attend skills lab II.

I’m Dr. Donna McElveen, Director of Field Education for the MSW program. Congratulations, as you’re preparing to enter your field placement for your concentration year. Some of you have completed one placement for your foundation year and attended or viewed the first session of safety training. For those of you who are advanced standing, you will be required to view both safety webinars, the one for skills lab I and for skills lab II. Also any of you who If have already completed the first safety training, but want a refresher, you can view the first safety presentation on the Field Experience Website.

Welcome again!

Slide 2: Learning Objectives

Verbal de-escalation is a skill taught to many professionals who interact with individuals who may be prone to emotional escalation. Those in helping professions, such as law enforcement, emergency responders, social workers, or health care professionals may interact with clients who have an escalated response to a situation. For example, those who exhibit symptoms from mental illness may show an escalated response to a situation. While they may not be a danger to themselves or others, at the time, they could be escalating to a violent response. What we know is that a quick assessment of risk and skilled communication can help de-escalate the situation.

During this training, I will review verbal de-escalation techniques and help you identify skills for self-control during the process. I’ll review the proper physical stance needed and identify some key elements of de-escalation.

Slide 3:

Typically, there are 4 phases of escalation that are important to be aware of:

1) There is a challenging of authority or questioning of authority

2) There is a refusal to follow directions

3) There is a loss of control; where the person is becoming verbally agitated

4) The individual becomes threating.

When you notice these things you know that the person is in an escalated emotional state.

Slide 4: Common Signs of Escalation

You’ll notice a few signs when a person is escalating. You may have had a number of experiences where you have worked with an individual who has exhibited these behaviors. Recognizing these are a sign of escalation may help you respond to the situation appropriately. The goal is to notice the signs and have a skilled response.

Slide 5: Verbal-De-escalation Techniques

Recognizing the phases of escalation and the signs that a person is escalated is the first step to a skilled response. First, assessing the risk of harm to themselves or others is key. You would not want to use de-escalation techniques with anyone who has a weapon or is in a potentially violet situation. In situations where there are weapons or violent eruptions, you will want to remove yourself from danger and report the incident to the proper authorities.

Also keep in mind that you can’t reason with an enraged person. They are not in a reasonable state of mind. The goal is to help neutralize the situation. If you find yourself in a situation with someone who is escalated your normal response would be to leave, fight, or freeze. However, it’s important to stay centered and calm, even if scared. However, if the situation is already violent, it is appropriate to leave the situation. De-escalation is an attempt to prevent violence or crisis.

Slide 6: Three Parts to be Mastered in Verbal De-escalation

To master de-escalation techniques you will need to control your own behavior, use a appropriate physical stance, and know how to carry out a de-escalation discussion.

Slides 7-10: Controlling Yourself

Our primary tool in de-escalation is ourselves. It’s important for us to control our behavior and demeanor. We need to appear calm (which is different than being calm) and appear self-assured. One technique to show calmness is to relax your facial muscles. Your anxiety can be picked up by the individual and escalate the situation. Control your tone of voice too, use a low modulated tone and be intentional with what you say. How you present can decrease or increase the intensity. Don’t be defensive, even if negative comments are directed at you. Remember they are not about you. It is not productive to defend yourself or anyone from the insults.

The agitated individual is very sensitive to feelings of shame and disrespect. Show them dignity and respect. Remember the goal is de-escalation, so you can be respectful while setting firm limits. If the situation continues to escalate, you have a choice to leave, tell the client to leave, or call the police. Make sure to know your resources in case you need back-up.

Slides 11-14: The Physical Stance

Our posture and physical presence communicate a lot to others. In escalated situations never turn your back and remain at eye level. It’s a good idea to encourage the client to be seated, this may minimize pacing and other behaviors associated with escalation. Allow for extra space between you and the individual, so there is a buffer.

Facing head-on can be confrontational, so stand at an angle. This also allows you to step away if needed. Constant eye contact can also be disconcerting and confrontational. Allow the client to break the gaze. Avoid a lot of hand gestures, especially pointing or shaking your finger. This may promote shame for the individual and come across as confrontational.

While we may be inclined to be friendly, it’s a good idea to avoid smiling. It could appear as mocking or insincerity. Maintain your space and don’t touch the client. Although we may want to comfort the individual, we don’t know what may trigger an aggressive reaction. Our touch could be misconstrued as hostile or threatening and provoke a violet/aggressive response.

Other tips include, keeping your hands out of your pockets, not engaging in arguments, and avoid being parental.

Slides 15- The De-escalation Discussion

The de-escalation discussion is NOT focused on the content of the discussion, but on trying to calmly bring down the arousal level. Allow the individual to talk, listen attentively, then speak calmly. You can have a selective response by answering questions that are real information seeking questions, but you don’t have to respond to abusive questions. Provide the limits and rules in a firm authoritative tone and give choices to the individual when possible. It’s important to empathize with feelings but not with inappropriate behavior. Remember you can’t reason with a person in an escalated state so avoid trying to interpret feelings or analyzing the situation. Even though you may not be able to reason with them, you can tap into their cognitive process by asking questions that will help you understand them better. You can also suggest alternative behaviors that may calm the situation. For example, you could ask them if they would like a break or have some water. This not only re-directs but shows sensitivity to the current situation.

If the individual shows inappropriate behavior or makes threats, you can provide the consequences of that behavior. Making sure that you show those rules as external and not personal. The de-escalation discussion will not work in every situation. If the individual continues to escalate, stop using the techniques. You’ll know within 2 or 3 minutes if the approach is working. If it is not, you can leave, ask the individual to leave and escort them to the door, or call for help. You should be assessing the situation at all times and trust your instincts.

Slide 21- De-escalation

De-escalation is a communication technique to try to minimize violence and crisis. There is nothing magic ab out it, you are transferring your sense of calm and genuine interest to the situation. You are being respectful, while setting limits hoping that the client can respond positively to your respectful attention.

DO NOT BE A HERO, and DO NOT try de-escalation when a person has a gun. In that case, simply comply.

Slide 22 – Scenario

· Consider how you would handle the scenario on the screen.

· You tell a client that he is required to attend a job skills training. He responds, “I don’t know why I have to sit through a stupid training all day. I could be out looking for a job instead of sitting through another stupid class.”

First, what phase of escalation is the individual in? If you guess challenging authority you are correct. The individual is also speaking in insulting ways, how might you answer? A first response may be to react to the insult and defend the position and authority of the rules. However, keep in mind you want to respect the feelings, but set firm limits on any the behavior. It is also ok to say what the requirements are. You will want to be mindful of your physical stance and ensure you have a calm respectful demeanor.

Slide 23- Scenario

These two scenarios provide different ways we can see an escalated response. Consider how you would respond by ensuring you control yourself, your physical stance, and have a de-escalation discussion.

Slide 24- References

Verbal de-escalation is often used to train helping professionals who work with individuals in crisis and who need to minimize violence in escalated situations. The information provided in this training is from the sources provided here. I hope you have found the information helpful. This webinar is housed on the Field Education Website, so please revisit it when you are close to entering your field placement. Have a wonderful skills lab experience at the on-the-ground session, and I hope to connect with you there.