Triage assessment model crisis intervention

Christian Conte University of Nevada, Reno

This article describes the triage assessment system (TAS) for crisis interven- tion. The TAS assesses affective, behavioral, and cognitive reactions of indi- viduals to crisis events. This assessment model offers clinicians an understanding of the type of reactions clients are experiencing as well as the intensity of these reactions. The TAS provides a quick, accurate, and easy-to- use method that is directly usable in the intervention process. The system can also be used to monitor clients’ progress during the intervention pro- cess. Two case illustrations are presented to demonstrate the use of the model. In addition, the Triage Assessment Form: Crisis Intervention is included as an Appendix. © 2006 Wiley Periodicals, Inc. J Clin Psychol: In Session 62: 959–970, 2006.

Keywords: crisis intervention; psychotherapy; trauma; assessment

Effective crisis intervention is dependent on accurate assessment that directly translates into focusing treatment when it is needed. This assessment should give clinicians the information required to answer questions such as the following: What resources are needed for this client to resolve the crisis situation? What approach will be the most effective for the client at this time? Does the client need to be hospitalized? What support from family, friends, or community agencies is needed? Is the client contemplating committing suicide or harming someone else? Answering these questions requires that assessment of clients in crisis be ongoing, and that reactions be monitored in order to adjust the intervention as needed. Simple reliance on diagnostic models, standardized tests, or intake protocols can mislead clinicians in these situations (Hoff, 1995; Myer, 2001). A model specifically designed for crises is needed to guide the assessment process.

Correspondence concerning this article should be addressed to: Rick A. Myer, Ph.D., Associate Professor, Department of Counseling, Psychology, and Special Education, Duquesne University, 600 Forbes Avenue, Pittsburgh, PA 15282; e-mail: myerra@duq.edu

JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 62(8), 959–970 (2006) © 2006 Wiley Periodicals, Inc. Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jclp.20282

Triage Assessment System

The triage assessment system (TAS) for crisis intervention (Myer, Williams, Ottens, & Schmidt, 1992a) provides a framework for understanding clients’ reactions during a cri- sis. This model integrates research from a variety of sources and presumes that reactions to crisis events are seen in three domains: (1) affective, (2) behavioral, and (3) cognitive. Clinicians assess clients’ reactions along all three domains. This point is critical because failure to assess each domain can result in a collapse in the resolution of the crisis and lead to additional problems (James & Gilliland, 2005). The TAS guides clinicians in the identification of the complex interaction among the three domains and helps prevent protracted mental health concerns.

The TAS uses Crow’s (1977) work on emotions associated with crises and research on primary emotions (National Advisory Health Council, 1995; Plutchick, 1980) as the foundation for identifying affective reactions clients experience when in crisis. These reactions are (1) anger/hostility, (2) anxiety/fear, and (3) sadness/melancholy. The expres- sion of these feelings can range from negligible to extremely severe; however, uncom- fortable levels of emotions are more characteristic reactions of people who are experiencing a crisis (Baldwin, 1979).

Assessing clients’emotional reactions is generally straightforward. It is relatively uncom- plicated to determine whether clients are angry, afraid, or sad. However, often clients express a combination of these feelings, bouncing from one to another and back again. We suggest that determining the emotion most frequently expressed identifies the primary affective reac- tion. If others are present, these are considered as secondary or tertiary.

Clients’ behavioral reactions can be assessed as (1) immobility, (2) avoidance, and (3) approach (Myer, Williams, Ottens, & Schimdt, 1992a). Immobility is defined as being stuck, or unable to sustain any consistent attempt to resolve the crisis. Avoidance is defined as an active attempt to escape or bypass problems associated with the crisis. In contrast, approach reactions are those that are active attempts to resolve problems result- ing from the crisis.

In the cognitive domains, reactions are (1) transgression, (2) threat, and (3) loss. Transgression is seen as a “demeaning offense against me and mine” (Lazarus, 1993, p. 26). The perception of the event is that it is happening primarily in the present. Threat, on the other hand, is viewed as potential, that is, something that will occur in the future. The perception is that an impending catastrophe is approaching. The perception of loss is that it occurred in the past and is irrevocable. Clients’ perceptions, whether accurate or not, are used in the assessment of cognitive reactions. The areas of clients’ lives that are perceived to be affected by the crisis include (1) physical, such as health, shelter, safety; (2) psychological/self-concept, such as identity and emotional well-being; (3) social rela- tionships, such as with family, friends, coworkers; and (4) moral/spiritual, such as per- sonal integrity, values, and belief system. Clients can perceive a transgression, threat, or loss in each of these life dimensions.