Test Bank For Crisis Assessment, Intervention, and Prevention,4th Edition by Lisa Jackson-Cherry Bra

Chapter 1 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

Table of Contents

Chapter 1: Basic Concepts of Crisis Intervention

2

Learning Outcome Quizzes

2

Application Exercises

10

Test Items

12

Test Answer Key

16

Chapter 1: Basic Concepts of Crisis Intervention Chapter 1 Learning Outcome Quizzes Learning Objective 1.1: Describe the key terms and concepts in the field of crisis intervention.

[Q1] The experience of an event may or may not impact the individual to the degree where it is categorized as a crisis. Using the trilogy definition for crisis, what elements are needed for an event to be considered a crisis?

1. Perception of the event, adverse childhood reactions, and level of functioning is impacted 2. Perception of the event, exceeds resources, and level of functioning is impacted [correct] 3. Perception of the event, socioeconomic status, and exceeds resources 4. Perception of an event, exceeds resources, and disability status [Feedback for Answer Choice 1] Although adverse childhood reactions is a variable to address with a client to determine coping skills, resources, and experiences, this is not part of the trilogy of the definition of crises.

[Feedback for Correct Answer 2] Individuals differ in how they experience situations/events. Multiple persons may experience the same situation but respond differently. The perception of the event as a crisis is connected to one’s available resources and coping skills. A person who experiences the event as a crisis will often have fewer resources or coping skills to work through a crisis. When this occurs, the individual’s perception of the crisis may cause some dysfunction in their life.

[Feedback for Answer Choice 3] 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Although socioeconomic status may impact the resources that may be available to an individual to address a situation, this is not part of the trilogy of the definition of a crisis.

[Feedback for Answer Choice 4] Although disability status may be a component for some who perceive a situation as a crisis, disability status in itself is not a constant variable correlated with the trilogy of the definition of a crisis.

[Q2] Which of the following is a common and effective technique used in assessing and measuring stress, monitoring increases and decreases in stress (as well as just about any other symptom or variable such as depression, sadness, anger, and so on), or assessing a baseline of functioning?

1. Scaling [correct] 2. Resilience 3. Adaption 4. Traumatic event [Feedback for Correct Answer 1] Scaling is a common and effective technique used in assessing stress, monitoring increases and decreases in stress (as well as just about any other symptom or variable such as depression, sadness, anger, and so on), or assessing a baseline of functioning.

[Feedback for Answer Choice 2] Resilience may be defined as the dynamics that contribute to positive adaptation following exposure to experiences that have the potential to disrupt functioning. It is not measured.

[Feedback for Answer Choice 3] Although adaptation is an outcome of stress or crisis over an extended period and may be measured by the fit between the individual or family system and the environment, it is not the technique to measure stress.

[Feedback for Answer Choice 4] A traumatic event involves threatened or actual death or serious injury, or a threat to the well-being of oneself or to another person. It is not measured.

Learning Objective 1.2: Compare crisis intervention and traditional counseling.

[Q1] Although there are many elements that are similar across both crisis counseling and traditional counseling, it is imperative to understand the differences in order for crisis intervention to be effective. Which of the following is the main difference in the overall goal between crisis intervention and traditional counseling?

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Crisis intervention focuses on safety and stabilization whereas traditional counseling focuses on increasing functioning. [correct] 2. Crisis intervention often involves a team approach whereas traditional counseling involves the counselor.

3. Crisis intervention involves fewer sessions that vary in time whereas traditional counseling may have set timeframes.

4. Crisis intervention focuses on symptoms of distress whereas traditional counseling often involves diagnostic impressions.

[Feedback for Correct Answer 1] Safety and stabilization are the main goals of crisis intervention. Working with clients over a longer period of time to increase their levels of functioning is often the goal of long-term counseling.

[Feedback for Answer Choice 2] Although crisis intervention differs from traditional counseling since crisis work often includes interdisciplinary professionals and teams and traditional counseling often includes a professional relationship between the client and counselor, this is not the goal of crisis intervention.

[Feedback for Answer Choice 3] Although crisis intervention includes fewer sessions than traditional counseling since crisis work often includes assessment and referral to long-term care, this is not the goal of crisis intervention.

[Feedback for Answer Choice 4] Although crisis intervention differs from traditional counseling in that crisis counselors will often report symptoms presented by the client and will not make a diagnosis of clients in crisis, this is not the goal of crisis intervention.

[Q2] Which of the following approaches, which differs from crisis intervention, recognizes that crisis events may overwhelm an individual and manifest in certain symptomatology and assists an individual in restoring a sense of safety, power, and self-worth?

1. Trauma informed care [correct] 2. Directive approach 3. Nondirective approach 4. Collaborative approach [Feedback for Correct Answer 1] Trauma informed care (T IC) recognizes that crisis events may overwhelm an individual and manifest in certain symptomatology. TIC assists an individual in restoring a sense of safety, power, and self-worth. The six guiding principles of TIC include: (1) safety; (2) 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

trustworthiness and transparency; (3) peer support and mutual help; (4) collaboration and mutuality; (5) empowerment, voice, and choice; and (6) cultural, historical, and gender issues.

[Feedback for Answer Choice 2] Directive approaches allow the person in crisis to come up with the directives while the crisis counselor facilitates that process. Although this may be a component used in TIC in how to work with an individual in crisis, it is not a comprehensive approach aimed to assist an individual in restoring a sense of safety, power, and self-worth.

[Feedback for Answer Choice 3] Nondirective approaches allow the person in crisis to come up with the directives while the crisis counselor facilitates that process. Although this may be a component used in TIC in how to work with an individual in crisis, it is not a comprehensive approach aimed to assist an individual in restoring a sense of safety, power, and self-worth.

[Feedback for Answer Choice 4] A collaborative approach is a blend of directive and nondirective approaches. Although this may be a component used in TIC in how to work with an individual in crisis, it is not a comprehensive approach aimed to assist an individual in restoring a sense of safety, power, and self-worth.

Learning Objective 1.3: Describe the roles of various professionals and paraprofessionals who work in crisis teams.

[Q1] Various mental health workers intervene with individuals experiencing crises and can provide crisis intervention. However, there are also differences in their orientation, training, philosophy, and practice perspective. Which of the following are mental health professionals who practice from a prevention, developmental, and wellness perspective?

1. Clinical psychologists 2. Social workers 3. Psychiatrists 4. Professional counselors [correct] [Feedback for Answer Choice 1] Clinical psychologists may engage in crisis intervention and perform many of the same duties as professional counselors; however, the training of clinical psychologists is focused on providing interventions for clients with specific disorders through diagnostic test administration.

[Feedback for Answer Choice 2] Social workers may also engage in crisis intervention and perform many of the same duties as professional counselors; however, the training of social workers focuses on 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

providing and connecting individuals to a wide range of services in community and to social service systems.

[Feedback for Answer Choice 3] A psychiatrist is a medical doctor who focuses on possible chemical imbalances, developmental issues, or traumatic events that cause mental problems in patients. As physicians, psychiatrists often prescribe psychiatric medications to manage mental health symptoms.

[Feedback for Correct Answer 4] Professional counselors are trained to practice from a prevention, developmental, and wellness perspective.

Learning Objective 1.4: Describe approaches crisis workers can take depending on the crisis affecting the client.

[Q1] A crisis counselor is working with a client who is involved in a domestic violence relationship. The client reports he does not plan to return home after the session. In setting up a safety plan, the counselor asks the client his options of where he will live.

The client is able to identify five individuals he believes would be supportive that he can call on but is not sure who may be the best option. The crisis counselor starts to discuss the five options to help him determine the best plan for his safety. This approach is an example of which of the following?

1. Directive approach 2. Nondirective approach 3. Collaborative approach [correct] 4. Noncollaborative approach [Feedback for Answer Choice 1] Directive approaches call for counselors to ―direct‖ or lead the person in crisis in a specific direction. Clients in crisis are typically distracted and less able to plan beyond their current situation. Although the client needs some involvement and direction, he was able to determine his plan of action and generate some options and does not meet the full criteria of the directive approach.

[Feedback for Answer Choice 2] Nondirective approaches allow the person in crisis to come up with the directives while the crisis counselor facilitates that process. Although the client was able to generate his action plan and options, he was not able to decide on the best option to activate his plan solely by himself and needed the crisis counselor to assist in the final details.

[Feedback for Correct Answer 3] A collaborative approach is a blend of directive and nondirective approaches. A crisis counselor, in this approach, provides support and a sense of working together toward a 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

common goal. Collaboration can be particularly beneficial to clients who feel that they have too many choices, as in this situation where the crisis counselor collaborated in working to decide who the best support would be in order to activate the safety plan.

[Feedback for Answer Choice 4] There are three approaches in working with clients in crisis. Noncollaborative is not an approach.

Learning Objective 1.5: Describe historical and contemporary crisis theories.

[Q1] Tamar lost her job recently when the company had to downsize. Her job provided extra financial support for her parents in Hungary who rely on her assistance for rent, food, healthcare, and other basic needs. She has not told them about the job loss, and the guilt and shame she has been experiencing has impacted her ability to be motivated to find another job. She tells the counselor she believes she has a lack of purpose and shame in not being able to provide for her family. Her experience can be identified as which of the following?

1. Existential crisis [correct] 2. Situational crisis 3. Developmental crisis 4. Acute grief theory [Feedback for Correct Answer 1] Although, the crisis could be included in multiple categories, an existential crisis is one that affect one’s sense of meaning, purpose, freedom, independence, forgiveness, shame, or other core beliefs. In this situation the existential issues are underlying her crisis state.

[Feedback for Answer Choice 2] Situational crises are events that are often unexpected and involve some degree of a catastrophic, shocking, or random act. Although, she may perceive the loss of a job as being catastrophic to her, the underlying issues that are perceived as catastrophic are another type of crisis.

[Feedback for Answer Choice 3] Developmental crises are events that are expected to be experienced by most individuals during normal development. Although many in a society may experience the loss of a job, since the feelings associated with the loss emphasize meaning, shame, and other core beliefs, this is not the best example of a developmental crisis.

[Feedback for Answer Choice 4] Lindemann outlined several common clinical features, including somatic distress, feelings of guilt, hostility, disorganization, behavioral changes, and preoccupation with images of the deceased. Lindemann referred to these symptoms as ―acute grief.‖ 7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Although the client may be experiencing grief associated with her loss, in this situation, other issues are underlying her crisis state.

[Q2] By studying and working with individuals who had experienced loss through a fire or similar traumatic events, Caplan (1964) proposed a theory based on the assumption that early intervention following a disaster or traumatic event can promote growth and well-being. This assumption is known as which of the following?

1. Adaptation 2. Resilience 3. Preventative psychiatry [correct] 4. Trauma informed care [Feedback for Answer Choice 1] Adaptation is an outcome of stress or crisis over an extended period and can assist in response to traumatic events. This concept was not used by Caplan.

[Feedback for Answer Choice 2] While resilience may be connected to positive adaptation following a traumatic event and may also be connected to how a person is able to overcome a crisis, it is not the correct concept used by Caplan for this theory.

[Feedback for Correct Answer 3] Caplan (1964) proposed a theory based on the assumption that early intervention following a disaster or traumatic event can promote growth and well-being. This is known as preventative psychiatry.

[Feedback for Answer Choice 4] Trauma informed care (TIC) recognizes that crisis events may overwhelm an individual and manifest in certain symptomatology. TIC assists an individual in restoring a sense of safety, power, and self-worth but it is not what Caplan refers to in his theory.

Learning Objective 1.6: Apply the task model of crisis assessment and intervention to crisis situations.

[Q1] When applying the task model of crisis assessment and intervention in crisis situations, Assessment Task 2 focuses on a holistic bio-psycho-social-spiritual approach and integrating the ABCDE approach. ABCDE includes an assessment of which of the following?

1. Affect, behaviors, cognitions, developmental, existential 2. Affect, behaviors, cognitions, developmental, economics 3. Affect, behaviors, cognitions, developmental, environmental [correct] 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Affect, behaviors, cognitions, developmental, emersion [Feedback for Answer Choice 1] It is essential to assess the baseline functioning of the client during the present crisis situation and prior to the crisis. Most crisis models follow an A BC (affect, behaviors, and cognitions) assessment approach. However, this task model follows an ABCDE assessment approach. This does not include existential as a main assessment although existential issues may be part of the environmental assessment.

[Feedback for Answer Choice 2] It is essential to assess the baseline functioning of the client during the present crisis situation and prior to the crisis. Most crisis models follow an ABC (affect, behaviors, and cognitions) assessment approach. However, this task model follows an ABCDE assessment approach. This does not include economics as a main assessment although socioeconomics issues may be part of the environmental assessment.

[Feedback for Correct Answer 3] It is essential to assess the baseline functioning of the client during the present crisis situation and prior to the crisis. Most crisis models follow an ABC (affect, behaviors, and cognitions) assessment approach. However, this task model follows an ABCDE assessment approach (affect, behaviors, cognitions, development, and environment).

[Feedback for Answer Choice 4] It is essential to assess the baseline functioning of the client during the present crisis situation and prior to the crisis. Most crisis models follow an ABC (affect, behaviors, and cognitions) assessment approach. However, this task model follows an ABCDE assessment approach. This does not include emersion as an assessment component.

Learning Objective 1.7: Apply other models of crisis assessment and intervention to crisis situations.

[Q1] Which of the following is a model of crisis intervention that focuses on the interactions among the stressor event, family resources, and meaning attached to the stressor events that results in a state of disequilibrium (crisis)?

1. Double ABC-X model 2. ABC-X model [correct] 3. Task model of assessment and intervention 4. Ecological perspective [Feedback for Answer Choice 1] The Double ABC-X model expands the ABC-X Model to include (1) additional stressors from the presenting crisis; (2) meaning connected to the additional stressors; (3) resources available currently and previously; and (4) a focus on adaptation and change.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 2] According to the ABC-X model, there is an interaction among a provoking stressor event, the family’s resources, and the meaning that the family attaches to the stressor event. The crisis, a state of acute disequilibrium and immobilization of the family system, is an outcome of this interaction.

[Feedback for Answer Choice 3] The task model of crisis assessment and intervention developed by Jackson-Cherry (2018) focuses on four important tasks of crisis assessment that lead to an effective four-task intervention plan for individuals in virtually every type of crisis, regardless of setting.

[Feedback for Answer Choice 4] The ecological perspective focuses viewing each person in a crisis as unique as the individual will experience the crisis differently than someone else due to the unique and personal ecological determinants.

Chapter 1 Application Exercises Application Exercise 1.1 Learning Objective 1.2: Compare crisis intervention and traditional counseling.

[Q1] Refer to the section on trauma informed care in the chapter. Even among clinicians in the field, there still exists confusion about the differences between crisis intervention and trauma informed care (TIC). How would you explain the difference between crisis intervention and TIC when working with a client to a colleague who still has confusion?

[Q1 Model Response] Crisis assessment is assessing an individual to determine the impact of a crisis (the event). Specific questions and assessments are used depending on the crisis situation.

These questions often come from a standard of practice in the field. Involvement by a crisis counselor is short term and often requires a referral to a high level of care if needed due to level of functioning. Trauma informed care (TIC) recognizes that crisis events may overwhelm an individual and manifest in certain symptomatology. TIC assists an individual in restoring a sense of safety, power, and self-worth. This process may require a referral to long-term counseling to address the trauma. The six guiding principles connected with TIC—(1) safety; (2) trustworthiness and transparency; (3) peer support and mutual help; (4) collaboration and mutuality; (5) empowerment, voice, and choice; and (6) cultural, historical, and gender issues—may be integrated into the work of a crisis counselor in a crisis situation.

Application Exercise 1.2

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Learning Objective 1.3: Describe the roles of various professionals and paraprofessionals who work in crisis teams.

[Q2] Refer to Voices from the Field 1.3: Treating the Whole Person: The Need for Medical and Mental Health Collaborations.

Review Voices from the Field 1.3 and the specific issues that were connected with the client. Then review the various professionals and paraprofessionals outlined in the section on Roles of and Collaboration Among Mental Health Workers During a Crisis.

What other professionals would a crisis counselor try to include from the outlined professionals in the chapter and what other professionals may be included that are not outlined specifically in this chapter for the long-term support of this client?

[Q2 Model Response] This situation certainly needs a team approach to include medical, mental health, essential community supports, issues connected with independent living, and purpose and meaning. Collaboration with the client’s psychiatrist and medical professional treating the client’s diabetes would be a standard of care to meet the necessary medical issues that may be impacted or may impact the mental health concerns. A team at the independent living community may include the case manager, residential counselor, social worker or professional counselor, and other team members. If the facility does not have these professionals, connecting with these in the community would be beneficial.

In addition, depending on the level of functioning, a consultation with the community agencies who may have programs for vocational training opportunities may also be an option in order to assist the client in long-term vocational training. Finally, other connections may include other medical professional (dental), family members, social skills and other support groups, faith based or spiritual leaders if requested, and other interest groups that may offer a sense of belonging, support, and purpose.

Application Exercise 1.3 Learning Objective 1.3: Describe the roles of various professionals and paraprofessionals who work in crisis teams.

[Q3] Review the section on COVID-19 and the impact on crisis counseling. Discuss the benefits and limitations connected with telehealth as an alternate to face-to-face counseling and crisis intervention.

[Q3 Model Response] Society has now adapted telehealth as an alternative to face-to-face counseling in many settings. Although still not preferred by mental health professionals for many situations, including crisis assessments, the ability to receive some form of counseling via telehealth procedures is much better than the absence of counseling. Telehealth has been a great tool when there is a limit of mental health counselors to provide services, 11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

in rural areas, and with various mental health presenting presentations. Considerations still need to be taken when opting for telehealth over face-to-face counseling when working with clients who present with high-risk situations (suicide and homicide) requiring risk assessment, work with young children, stabilization of clients with serious mental illnesses, child or older adult abuse situations, and in situations where individuals have limited privacy, such as clients at home who experience intimate partner violence.

Chapter 1 Test Items Multiple Choice Questions 1. According to James and Gilliland (2017), a crisis is A. the perception of an event as an intolerable difficulty because it exceeds the person’s current resources and coping mechanisms.

B. an event that will always be perceived as traumatic.

C. a negative outcome of direct exposure to risk factors.

D. the immobility of progression in the healing process.

2.

can be measured by degree.

A. Crisis B. Stress C. Trauma D. Transcrisis state

3. One of the earliest pioneers of the field, known as the Father of Crisis Intervention is A. Sigmund Freud.

B. Gerald Corey.

C. Erich Lindemann.

D. Reuben Hill.

4. The study of crisis intervention began during World War II in response to A. soldiers returning from the war effort with (posttraumatic stress disorder) P TSD diagnoses.

B. family reactions when loved ones left home to participate in war efforts.

C. family reactions when soldiers returned from service and resumed their civilian lives.

D. families grieving for loved ones who died in combat.

5. A cluster of symptoms including somatic distress, feelings of guilt, hostility, disorganization, and behavior changes experienced by the surviving family members of nearly 500 individuals who died in a tragic event in the 1940s was labeled ―acute 12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

grief.‖ A disorder that is described in the Diagnostic and Statistical Manual of Mental Disorders (DSM) that seems to parallel acute grief is A. acute stress disorder.

B. posttraumatic stress disorder.

C. adjustment disorder.

D. bereavement.

6. According to Erich Lindemann, a psychiatrist and researcher, who first used the term acute grief said it was not a psychiatric disorder, the treatment for acute grief A. should be provided only by psychiatrists who may prescribe medication.

B. may be provided by psychiatrists (MDs) or psychologists (PhDs) but not counselors or social workers.

C. may be provided by paraprofessionals and helpers other than psychiatrists.

D. is not necessary.

7. According to Raphael (2000), the full impact of trauma frequently is felt A. within 48 hours of a crisis event, during the ―fight or flight‖ period of adjustment.

B. two to four weeks after a crisis event during the period of adjustment known as ―picking up the pieces.‖ C. a considerable time after the crisis event during the ―disillusionment‖ period of adjustment.

D. after individuals or families have completed the ―rebuilding‖ period of adjustment and can reflect on the events of the crisis in totality.

8. According to Hill’s ABC-X model of crises, A. a crisis is caused by a stressor event.

B. as long as there are resources to meet the demands of a stressor event, there will not be a crisis.

C. ―A‖ represents an antecedent event, ―B‖ represents behavioral resources, ―C‖ represents the crisis, and ―X represents treatment or intervention.

D. a crisis is the outcome of an interaction among a stressor event, resources, and cognitive processes involving perception and meaning.

9. According to the Double ABC-X Model proposed by McCubbin and Patterson (1982), long-term change following a crisis event A. would most likely be negative.

B. would most likely be positive.

C. is not likely.

D. may be positive or negative.

10. According to the Task Model proposed by Jackson-Cherry 13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. in order to intervene effectively, the assessment must be accurate.

B. the intervention is not linked to a comprehensive assessment.

C. the assessment and intervention can be conducted simultaneously.

D. the assessment is not important in the process.

11. The Task Model proposed by Jackson-Cherry utilizes the following aspects in the assessment: A. Affect, behaviors, cognitions, development B. Affect, behaviors, cognitions, environment, ecology C. Affect, behaviors, cognitions, developmental, environment D. Affect, behaviors, cognitions 12. The six guiding principles of Trauma informed care include A. safety; trustworthiness and transparency; peer support and mutual help; collaboration and mutuality; empowerment, voice, and choice; and cultural, historical, and gender issues.

B. safety; peer support; collaboration; choice; social justice; and gender issues.

C. genuineness; peer support; collaboration; choice; social justice; and gender issues.

D. safety; peer support; collaboration; choice; social justice; and sexuality.

13. An outcome of stress or crisis—is the degree to which functioning has changed over an extended period and may be measured by the fit between the individual or family system and the environment is A. defense mechanisms.

B. resilience.

C. adaptation.

D. trauma informed care.

14. According to Boss (2002), is a dichotomous variable.

is a continuous variable, whereas

A. distress; eustress B. stress; crisis C. organization; disequilibrium D. coping; adaptation 15. Which of the following statements best describes trauma?

A. Traumatic events almost always involve actual death or serious injury.

B. People experiencing traumatic events respond with intense feelings of fear and helplessness.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. Most people who experience traumatic events develop acute stress disorder or posttraumatic stress disorder.

D. Most people need long-term therapy to overcome stressors.

16. A behavioral or cognitive action that is taken in an effort to manage stress is A. a coping strategy.

B. a defense mechanism.

C. adaptation.

D. a resource.

17. Following a stressor or crisis event, the degree to which functioning has changed over an extended period of time is called A. adaptation.

B. resilience.

C. coping.

D. trauma informed care 18.

does NOT have a positive association with resilience.

A. Attachment B. Mastery C. Cognitive skills D. Affective arousal

19. Compared to psychologists and psychiatrists, professional counselors A. are less trained and less prepared to provide crisis intervention.

B. work from a prevention point of view.

C. would not be likely to diagnose mental or emotional disorders.

D. are less effective advocates because they have masters’ degrees rather than doctoral degrees.

20. Within the mental health community, paraprofessionals A. include counselors.

B. are not permitted to provide crisis intervention because they are not licensed.

C. may provide an outlet for clients to talk and feel less isolated.

D. None of the above is correct.

21. Which of the following statements best describes crisis intervention?

A. It usually occurs between counselors and clients who have no previous relationship.

B. It may be a scheduled component of other forms of counseling.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. It is similar to other forms of counseling in its purpose, setting, time, and design.

D. It may take place within an established ongoing counseling relationship.

22. The procedures for working with clients in crisis begin with A. establishing equilibrium.

B. assessment.

C. debriefing.

D. defusing.

23. Existential crises as defined by the applied theory are A. events that occur and experienced by the majority of individuals within a society.

B. unexpected and catastrophic events that are out of the control of an individual.

C. events that impact one’s personal meaning, purpose, and/or freedom.

D. man-made or natural disasters impacting an individual and systems connected to the individual.

24. Ecological crises as defined by the applied theory are A. events that occur and experienced by the majority of individuals within a society.

B. unexpected and catastrophic events that are out of the control of an individual.

C. events that impact one’s personal meaning, purpose, and/or freedom.

D. man-made or natural disasters impacting an individual and systems connected to the individual.

Extended Response Questions 1. Discuss how crisis intervention differs from traditional counseling (include objectives, time frame and duration, skills, and diagnostic impression) 2. You are a counselor at a local mental health agency. You have just read the intake of a male client that you will see next week. His presenting problem is that he witnessed his brother being shot and killed. According to the ABC-X Model, what might you consider in your assessment while working with this client?

3. According to the Task Model of Assessment and Intervention by Jackson-Cherry, what is the purpose of order of assessment followed by the intervention tasks? How does this model differ from the other proposed models in the chapter that includes the triage approach?

4. Describe the modes in which a crisis worker may work with a client in assessing a client the level of functioning.

5. Describe and give an example of the four categories of crises outlined in the Applied Crisis Theory.

Chapter 1 Test Answer Key 16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Multiple Choice Answer Key: 1. A (see page 2, section titled Key Terms and concepts related to crisis) 2. B (see page 5, section titled Stress) 3. C (see page 19, section titled The Genesis of Crisis Intervention in the United States) 4. B (see page 19, section titled The Genesis of Crisis Intervention in the United States) 5. A (see page 19, section titled The Genesis of Crisis Intervention in the United States) 6. C (see page 19, section titled The Genesis of Crisis Intervention in the United States) 7. C (see page 20, section titled The Genesis of Crisis Intervention in the United States) 8. D (see page 36, section titled The ABC-X and Double ABC-X Models of Crisis) 9. D (see page 37, section titled The ABC-X and Double ABC-X Models of Crisis) 10. A (see page 22, section titled The Task Model of Crisis Assessment and Intervention) 11. C (see page 23, section titled The Task Model of Crisis Assessment and Intervention) 12. A (see page 12, section titled Trauma-Informed Care) 13. C (see page 7, section titled Adaptation) 14. B (see page 4, section titled Stress) 15. B (see page 6, section titled Responses to Trauma) 16. A (see page 6, section titled Coping) 17. A (see page 7, section titled Adaptation) 18. D (see page 8, section titled Resilience) 19. B (see page 12, section titled Professional Counselors) 20. C (see page 14, section titled Paraprofessionals) 21. C (see page 10, section titled Crisis Intervention and Traditional Counseling) 22. B (see page 12, section titled Crisis Intervention and Traditional Counseling) 23. C (see page 21, section titled Applied Crisis Theory) 24. D (see page 40, section titled Ecological and Contextual Considerations) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: 17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

 Objectives: Traditional counseling focuses on improving functioning. Crisis counseling focuses on decreasing symptoms and stabilizations.  Time frame: Traditional counseling is a clinical hour often based on managed care (45 minutes). Crisis intervention is flexible and often requires the time needed to make an assessment and determine a plan.  Sessions: Traditional counseling often is longer term based on managed care (8 sessions or more). Crisis intervention ranges from 1–4 but often no more than 6 sessions.  Skills: Traditional counseling uses all of the basic counseling skills and most often uses the client in the development of their plan and treatment. Formal termination is more frequent and referral is not used often. Crisis counseling may utilize more directive approaches, formal termination is rare, and referrals to other professionals are common.  Diagnosis: Traditional counseling utilizes formal diagnosis in the treatment plan.

Crisis counseling evaluates symptoms as diagnosis is often premature due to lack of time with the client.

2. Model response: Answers will vary, but should include some of the following points:  Coping mechanisms  Meaning placed on the event by the client  Resources available to the client 3. Model response: Answers will vary, but should include some of the following points:  the order is to make an appropriate referral or integrate an appropriate treatment plan an accurate assessment must be conducted. This model differs in that it emphasizes the importance of bio-psycho-social-spiritual components. The medial and spiritual aspects are often not the focus on counselors. It also assesses the traditional components of affect, behaviors, and cognitions but also includes an intentional focus on the assessment of development issues and environment issues unique to the client.

4. Model response: Answers will vary, but should include some of the following points: The response should include information about directive, nondirective, and collaborative crisis intervention.

5. Model response: Answers will vary, but should include some of the following points:  Developmental crises (e.g., birth, death, retirement)  Situational crises (e.g., assaults, injuries resulting in unexpected disability)  Existential crises (e.g., events impacting freedom, meaning, purpose)  Ecological crises (e.g., natural or man-made disasters)

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter

Learning Objective

Chapter 1:

1.1 Describe the key terms and concepts in the field of crisis intervention.

Basic Concepts of Crisis Intervention

Exercises & Quizzes Learning Objective Quiz 1.1 [Q1, Q2]

C ACREP Standards— Section 2: Professional Identity F. 1.l, F.2.h, F.3.e.g.h.

F.5.j.k.l.m F.7.c.d.f.

F.8.e,

blank

1.2 Compare crisis Learning intervention and Objective Quiz traditional counseling. 1.2 [Q1, Q2] Application Exercise 1.1

F.5.j, F.5.k., F.5.i, F.7.l, F.7.5.m F.7.c, F.7.d, F.7.f.

Section 5. CMHC: 5C.2.a, 5C.2.c

blank

1.3 Describe the roles of various

Learning Objective Quiz

F.1.b.

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective professionals and paraprofessionals who work in crisis teams.

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

1.3 [Q1]

F.1.c,

Application Exercise 1.2

F.1.d

Application Exercise 1.3

Section 5: Addiction Counseling 5A.2.a

F.4.b,

Section 5C.2.a, 5C.3.d, 5C.3.e Section 5 School Counseling: 5G.2.b blank

1.4 Describe approaches crisis workers can take depending on the crisis affecting the client.

Learning Objective Quiz 1.4 [Q1]

F.1.c.

F.1.e F.5.l F.5.m F.5.n Section 5 CMHC: 5C.2.a, 5C.3.a,

blank

1.5 Describe historical and contemporary crisis theories.

Learning Objective Quiz 1.5 [Q1, Q2]

F.2.b, F.3.b.

F.3.c.

F.3.d.

F.3.e, Section 5 CMHC: 5C.1.b Section 5 Marriage, Couples, and Family Counseling: 5F.1.b

blank

1.6 Apply the task model of crisis assessment and intervention to crisis situations.

Learning Objective Quiz 1.6 [Q1]

F.3.g

1.7 Apply other models of crisis assessment and intervention to crisis

Learning Objective Quiz 1.7 [Q1]

F.2.b,

Section 5 CMHC: 5C.3.a, Section 5 CMHC: 5C.3.b,

blank

Section 5 CMHC: 5C.1.c, 5C.2.f, 5C.2.j, 5C.3.a,

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

situations.

C ACREP Standards— Section 2: Professional Identity 5C.3.b, Section 5 Marriage, Couples, and Family Counseling: 5F.1.b

21 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 2 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

22 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 2: Safety Concerns in Crisis Situations

1

Learning Outcome Quizzes

1

Application Exercises

10

Test Items

12

Test Answer Key

17

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 2: Safety Concerns in Crisis Situations Chapter 2 Learning Outcome Quizzes Learning Objective 2.1: Explain why it is important for crisis counselors to take a proactive approach to safety.

[Q1] Crises can take an emotional and psychological toll on crisis workers who can be exposed to safety and security concerns. Implementing safety precautions when working with high-risk or dangerous clients can reduce the chances of harm to the counselor, client, crisis workers, and others. Which of the following are components needed for successful crisis intervention?

1. Innovative, brevity, and expected outcomes 2. Personal counseling 3. Critical incident stress debriefing 4. Planning, training, and the preparedness of team members [correct] [Feedback for Answer Choice 1] Although these components are elements in Salmon’s Principles that should be integrated into crisis situations, they are not the primary elements utilized for safety precautions.

[Feedback for Answer Choice 2] Personal counseling should always be an intervention used by crisis counselors to work through personal and mental health concerns that may impact the crisis counselor and work with clients. However, this is not connected to the primary elements utilized for safety precautions.

[Feedback for Answer Choice 3] Critical incident stress debriefing (CISD) is a facilitator-led group process conducted soon after a traumatic event with individuals considered to be under stress from trauma exposure. However, this is not connected to the primary elements utilized for safety precautions.

[Feedback for Correct Answer 4] Basic safety precautions by the crisis counselor when working with high-risk or dangerous clients can reduce the chances of harm to the counselor, client, crisis workers, and others. The ultimate success of crisis intervention depends on planning, training, and the preparedness of team members. A proactive and safetyconscious plan should be in place prior to the actual crisis. Even though most plans 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

will need to be flexible because every crisis is unique, a preliminary plan is better than no plan.

[Q2] The Federal Emergency Management Agency (F EMA; 2021) stresses that crisis planning is an ongoing cycle of which of the following tasks that must be integrated?

1. Planning, organizing, training, eliminating, and improving 2. Planning, organizing, teaching, evaluating, and improving 3. Planning, logistics training, evaluating, and improving 4. Planning, organizing, training, evaluating, and improving [correct] [Feedback for Answer Choice 1] The Federal Emergency Management Agency (FEMA; 2021) stresses that crisis planning is an ongoing cycle. Eliminating is not one of the actual components.

[Feedback for Answer Choice 2] The Federal Emergency Management Agency (FEMA; 2021) stresses that crisis planning is an ongoing cycle. Teaching is not one of the actual components.

[Feedback for Answer Choice 3] The Federal Emergency Management Agency (FEMA; 2021) stresses that crisis planning is an ongoing cycle. Logistics is not one of the actual components.

[Feedback for Correct Answer 4] The Federal Emergency Management Agency (FEMA; 2021) stresses that crisis planning is an ongoing cycle of planning, organizing, training, evaluating, and improving. These components can be used as a framework when setting up safety plans for personal individuals and team safety.

Learning Objective 2.2: Describe the role of collaboration in safely managing a crisis.

[Q1] A crisis team comprising workers from across the community or organization works together in response to a crisis event. Although all team members from across professions have their specific roles during the crisis response, all members of a crisis response team should work together toward the same goal. What is this unified goal?

1. To advance the recovery process following a disaster [correct] 2. To offer referrals for long-term care 3. To maintain personal safety for themselves, coworkers, and the community 4. To offer community connections to meet basic needs 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 1] An interdisciplinary crisis team comprising professionals from across the community works together in response to a crisis event. Although all team members from across professions have their specific roles during the crisis response, all members of a crisis response team should work together toward the same goal, to advance the recovery process following a disaster.

[Feedback for Answer Choice 2] Some individuals impacted by a crisis situation in a community may need referrals to address basic needs and for long-term care. While this may be part of the recovery process, it is not the overall goal of the interdisciplinary crisis team.

[Feedback for Answer Choice 3] While safety is an aspect of the recovery process and an essential element provided by first responder groups, it is not the overall goal of the interdisciplinary crisis team.

[Feedback for Answer Choice 4] Addressing the basic needs of the community impacted by a crisis situation may be part of the recovery process, it is not the overall goal of the interdisciplinary crisis team.

[Q2] A mobile crisis team was deployed based on a referral from a family member to assist with a client who is presenting with current suicidal behaviors. Upon arriving at the home, the mobile crisis team assessed the client as needing to be hospitalized for acute suicidal risk. The client refused to leave the home, became increasingly hostile and combative, and is unable to assure the safety of the team, family, or client. Which of the following should the team do?

1. Schedule a follow-up appointment for outpatient mental health to give the client time to think over their options 2. Contact law enforcement to provide transportation for suicide risk and to offer safety for all involved [correct] 3. Leave the home and inform the client and family they will come back in an hour so the client can calm down and review options 4. Contact the client’s psychiatrist to provide additional assistance [Feedback for Answer Choice 1] If the assessment of the team is that the client presents with acute and immediate high lethality of suicidal behavior requiring a higher level of care (hospitalization), outpatient mental health services do not appear to be the best option for this situation.

[Feedback for Correct Answer 2] 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

If the assessment of the team is that the client presents with acute and immediate high lethality of suicidal behavior requiring a higher level of care (hospitalization), but the client poses a threat to the safety to self, family members, or the team, law enforcement should be considered and involved.

[Feedback for Answer Choice 3] If the assessment of the team is that the client presents with acute and immediate high lethality of suicidal behavior requiring a higher level of care (hospitalization), leaving the client may also have safety consequences for the client and family in this situation.

[Feedback for Answer Choice 4] There may be times when a client’s psychiatrist may be contacted for collaborative purposes. However, if the team has training (and privilege) to assess and treat and the client presents with acute and immediate high lethality of suicidal behavior requiring a higher level of care (hospitalization), contacting the psychiatrist may not be the main priority in the immediate situation.

Learning Objective 2.3: Describe workplace safety issues related to crisis counseling, including high-risk clients, physical counselor safety, and working with individual clients in crisis.

[Q1] Elyse is a self-referred client to a private practice. She presents with high suicidal behaviors. The crisis counselor is discussing safety options. Hospitalization appears to be needed for her degree of lethality. Elyse says that she does not have anyone to take her to the hospital and would agree to voluntary hospitalization if the crisis counselor personally transports her to the emergency room (this is not a mobile crisis team). Which of the following would be the best option?

1. The crisis counselor should transport Elyse since Elyse feels comfortable with the crisis counselor and Elyse requested the transport.

2. The crisis counselor can see if another counselor can ride along on the transport.

3. The counselor should not transport Elyse based on safety and liability concerns but should continue to work on a support in the community or family to assist with the transport. [correct] 4. The counselor should make a follow-up visit for the next day to allow Elyse to find someone to assist in the transport.

[Feedback for Answer Choice 1] For the safety of both the client and counselor, a counselor should never transport a client for hospitalization unless they are part of a mobile crisis team. This decision would not meet safety protocols and may be a liability.

[Feedback for Answer Choice 2] 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Although having an additional counselor may appear to increase safety and decrease liability issues, if this is not the role of the counselor (e.g., a mobile crisis team), they should never transport a client for hospitalization. This decision would not meet safety protocols and may be a liability.

[Feedback for Correct Answer 3] For the safety of both the client and counselor, a counselor should never transport a client for hospitalization unless they are part of a mobile crisis team. Finding an alternate personal support or another manner to transport the client would be the best option.

[Feedback for Answer Choice 4] If the risk is determined to not be high lethality, there are other choices a counselor can make that may include increased outpatient mental health sessions. However, if the client is presenting with high lethality and is in immediate danger to themselves, it is best to consider to consider immediate hospitalization for the client’s safety.

[Q2] During an intake assessment with a high-risk homicidal client, the client becomes increasingly agitated and combative with the counselor who is reviewing the client’s available options. The client gets up and storms out of the office, threatening if the counselor follows him, ―I will take care of you as well.‖ In this situation, the counselor’s best decision would be which of the following?

1. Follow the client and if possible physically get the client to come back into the office.

2. Attempt to get a coworker to help coerce the client back into the office.

3. Contact the next of kin and report the behavior.

4. Attempt to get enough information about the direction the client is leaving, what they are wearing, and contact law enforcement for the safety of the community. [correct] [Feedback for Answer Choice 1] A counselor should never intervene to physically prevent a client from leaving an office who has been assessed as a high risk. This can increase the harm to the counselor, community, and client. In this situation, due to the high-risk and threatening behaviors, this would not be an action a counselor should take.

[Feedback for Answer Choice 2] A counselor should never intervene to physically prevent a client from leaving an office who has been assessed as a high risk. Even if there is a coworker, the counselor should not physically intervene with the client. This can increase the harm to the counselor, community, and client. In this situation, due to the high-risk and threatening behaviors, this would not be an action a counselor should take.

[Feedback for Answer Choice 3] 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Contacting the next of kin may be an option but not the first action taken by the counselor in this situation. In this situation when the client has been assessed as high risk for homicidal behaviors, including the verbal threat to the counselor, this would not be the first action the counselor should take.

[Feedback for Correct Answer 4] In this situation, due to the high-risk and threatening behaviors, the counselor should attempt to get enough information about the direction the client is leaving, what they are wearing, and then should contact law enforcement for the safety of the community as the first action steps.

[Q3] Counselors can become complacent with their safety precautions. Putting a plan into place can be helpful when a client becomes hostile or poses a threat to the safety of a counselor. A proactive best practice plan for safety in an office should include which of the following?

1. Having a planned escape route, removing objects from the office that could be used in an attack, and installing panic alarms [correct] 2. Having a concealed carry permit, making connections with others in the building, and requiring clients sign a liability of threat 3. Making connections with others in the building, requiring clients to sign a liability of threat, and enrolling in self-defense training 4. Having a planned escape route, requiring the client to sign a liability of threat, and enrolling in self-defense training [Feedback for Correct Answer 1] To reduce safety issues for counselors, best practice proactive planning includes having a planned escape route, removing objects from the office that could be used in an attack, and installing panic alarms.

[Feedback for Answer Choice 2] Although having a concealed carry permit is not illegal if permitted in the practicing state, it may not be the best practice in the field. Likewise, requiring a client to sign a liability of threat is not a best practice and would not impact a current safety issue posed by a client. Making connections with others in the building may be a good practice but a counselor cannot control that those persons will always be in the building in situations when the counselor needs to reach out for safety.

[Feedback for Answer Choice 3] Self-defense training can provide additional skills for personal safety, but it is not one of the best practices in the field. Likewise, requiring a client to sign a liability of threat is not a best practice and would not impact a current safety issue posed by a client.

Making connections with others in the building may be a good practice but a 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

counselor cannot control that those persons will always be in the building in situations when the counselor needs to reach out for safety.

[Feedback for Answer Choice 4] Having a planned escape route is a best practice for reducing safety situations. Selfdefense training can provide additional skills for personal safety, but it is not one of the best practices in the field. Likewise, requiring a client to sign a liability of threat is not a best practice and would not impact a current safety issue posed by a client.

Learning Objective 2.4: Describe professional counselor responsibilities and skills related to workplace safety.

[Q1] According to the Bureau of Labor Statistics (2021), the reason health care and social service workers are at a higher risk for workplace violence is due to multiple factors, including a facility design that impedes visual contact with other workers, poor lighting, a lack of means to communicate for help during an emergency, and which of the following?

1. Working with a client population that has a history of violence and/or substance abuse [correct] 2. Working with a client population that has a history of depression 3. Working with a client population that presents with borderline personality traits 4. Working with families [Feedback for Correct Answer 1] According to the Bureau of Labor Statistics (2021), the increased risk to safety of health care and social service workers is due to multiple factors and includes working with a client population that has a history of violence and/or substance abuse.

[Feedback for Answer Choice 2] According to the Bureau of Labor Statistics (2021), the increased risk to safety of health care and social service workers is due to multiple factors but is not connected with clients who have a history of depression.

[Feedback for Answer Choice 3] According to the Bureau of Labor Statistics (2021), the increased risk to safety of health care and social service workers is due to multiple factors but is not connected with clients who present with borderline personality traits.

[Feedback for Answer Choice 4] According to the Bureau of Labor Statistics (2021), the increased risk to safety of health care and social service workers is due to multiple factors but is not increased when working with families.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Q2] Prayla, a crisis counselor, was assaulted by a client following an in-home visit to a residential home. The U.S. Department of Labor (2019) suggests that which of the following should occur?

1. Documentation must be provided to the Department of Labor within 24 hours following the assault.

2. Documentation must be provided to law enforcement within 48 hours following the assault.

3. Determine who needs to be notified, both within and outside of the organization, and make documentation. [correct] 4. An investigation must only be done internally to protect the privacy of the client.

[Feedback for Answer Choice 1] There is no requirement to provide a report of an assault by a client on a health care worker to the Department of Labor.

[Feedback for Answer Choice 2] Although this may be an option of the counselor and the agency, there is no requirement to make a report to law enforcement in every situation of an assault made by a client on a health care worker.

[Feedback for Correct Answer 3] The Department of Labor recommends that in an assault situation, the agency should determine who needs to be notified, both within and outside of the organization, and make documentation.

[Feedback for Answer Choice 4] An agency may choose to only document internally; however, this is not done to protect the client’s privacy when an assault has occurred.

[Q3] Treyvon is preparing to provide training for their crisis team on trauma-informed care based on SAMHSA’s six key principles. What principles would be included in the training?

1. Safety, Trustworthiness and transparency, Peer support, Collaboration and mutuality, Empowerment, voice, and choice, and Cultural, historical, and gender issues. [correct] 2. Safety, Peer support, Collaboration and mutuality, Empowerment, voice, and choice, and Cultural, historical, and gender issues.

3. Trustworthiness and transparency, Peer support, Collaboration and mutuality, Empowerment, voice, and choice, and Cultural, historical, and gender issues.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Safety, Trustworthiness and transparency, Peer support, Collaboration and mutuality, and Empowerment, voice, and choice.

[Feedback for Correct Answer 1] SAMHSA’s six key principles include: Safety, Trustworthiness and transparency, Peer support, Collaboration and mutuality, Empowerment, voice, and choice, and Cultural, historical, and gender issues.

[Feedback for Answer Choice 2] Although SAMHSA’s key principles are accurate, one principle is missing.

[Feedback for Answer Choice 3] Although SAMHSA’s key principles are accurate, one principle is missing.

[Feedback for Answer Choice 4] Although SAMHSA’s key principles are accurate, one principle is missing.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 2 Application Exercises Application Exercise 2.1 Learning Objective 2.3: Describe workplace safety issues related to crisis counseling, including high-risk clients, physical counselor safety, and working with individual clients in crisis.

[Q1] Refer to Pearson eTextbook Video Example 2.1 where a counselor is seeking consultation with another colleague regarding concerns for her safety when dealing with a court-ordered client who becomes intimidating during the session. If you were the colleague, what would you suggest as elements of a plan to decrease safety issues when working with the client?

[Q1 Model Response] A counselor should always put their safety as a priority. A counselor also needs to be reflective when perceiving their safety is at risk. Is this situation impacted by an unresolved issue for the counselor? Is there any countertransference occurring?

Consultation prior to confronting a client should be done with a colleague.

Confrontation may not always be the best response. If the counselor decides to confront the perceived safety issues with the client, they should determine when best to discuss this safety issue, which may include (1) when the client is not heightened in the session, (2) when other coworkers are in the office, and (3) when a plan has been put into place with others in the building. If the counselor decides not to confront the client, it is also important to determine whether working with the client with this perceived fear will impact the client–counselor relationship and client growth.

Application Exercise 2.2 Learning Objective 2.4: Describe professional counselor responsibilities and skills related to workplace safety.

[Q2] Refer to the section on in-home counseling. What are some best practice protocols a counselor can put into place to increase their safety?

[Q2 Model Response] Safety of the counselor is a priority. Having a plan before any incidents take place is prudent to avoid situations and reduce harm in any situations. Having a plan does not mean one will avoid all safety issues. However, having a plan is better than not having a plan. In-home counseling can increase the potential for safety issues. Best practice protocols should include: (1) having co-counselors or behavioral aides accompany the counselor on visits; (2) having a protocol to check in by phone prior 10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

to each session and after leaving the client’s home; (3) being familiar with the community and the environment prior to the actual session (know building exits; adequate lighting); (4) deciding what time of day is best for the visit; (5) asking who will be home when a session is scheduled; and (6) having a plan to vacate if the counselor feels uneasy about the environment.

Application Exercise 2.3 Learning Objective 2.4: Describe professional counselor responsibilities and skills related to workplace safety.

[Q3] Refer to Voices from the Field 2.3: Knowing your Client’s History and Avoiding Retraumatization. If you were the visiting counselor (James Jackson) in this situation where this occurred, what would be your next steps?

[Q3 Model Response] In this situation the counselor (James Jackson) should determine what should be done, even as a visiting counselor. Specifically, the visiting counselor should determine who should be made aware of the actions that occurred for the protection of the client, future situations, and for liability of the counselor. This is dependent on the agency or school environment and leadership. The visiting counselor should also document this incident as in an incident report to submit to their supervisor or for their personal notes. The visiting counselor should consult with colleagues and determine if a consultation with their liability carrier is prudent.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 2 Test Items Multiple Choice Questions 1. During the initial impact of a crisis, A. mental health providers begin long-term treatment planning.

B. mental health providers work independently of the crisis team.

C. mental health providers may assist with basic needs, such as shelter and food.

D. mental health providers are not included in the initial crisis impact.

2. Which of the following referral scenarios represents the greatest potential danger to a sole practitioner?

A. A mobile crisis team B. A group practice C. An isolated private practice D. A dual diagnosed clinic 3. Counselors should understand law enforcement’s main priority is to provide A. safety.

B. additional counseling support.

C. collaboration with community leaders.

D. to offer long-term referrals to counseling.

4. A high-risk suicidal client suddenly jumps up and runs from a counselor’s office.

The counselor should A. call law enforcement or a community service board.

B. run after the client and try to stop the client.

C. call the nearest emergency room and ask them to be on the lookout for the client.

D. call the client to schedule another appointment for follow up.

5. In most crisis response situations, counselors often A. do not have most of the presenting information.

B. Are provided all presenting information.

C. will be briefed with exact information when they arrive.

D. may decide not to want to have all the information.

6. To decrease safety issues, sole practitioner should A. ask for the referral reason.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. only ask for presenting issues if needed.

C. seek supervision before taking a new client.

D. have an office that is open and welcoming.

7. Counselors working with clients at high risk for violence should do all of the following EXCEPT A. secure wall framed items, such as pictures and diplomas, to the wall.

B. display family photos in a prominent place.

C. avoid wearing ties and scarves.

D. install a safety alarm.

8. The majority of stalking cases involve A. female inpatient clients.

B. male inpatient clients.

C. female outpatient clients.

D. male outpatient clients.

9. To increase safety with in-home counseling, A. counselors should not conduct in-home visits alone.

B. counselors should call their agency before and after the in-home appointment.

C. counselors should familiarize themselves with the community and environment.

D. if a counselor feels uneasy, the counselor should leave the premises.

10. Law enforcement agencies who partner with mental health professionals tend to see A. a decrease in arrest rates among violent offenders.

B. an increase in resources given for mental health services.

C. an increase in crimes reported.

D. an increase in arrest rates among domestic violence incidents.

11. As a best practice, counselors working with a team during an actual crisis situation for effective crisis intervention should A. be prepared to take on multiple roles.

B. be assigned one role for control over the crisis situation.

C. intervene wherever possible.

D. take on any group needed to be assessed.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

12. Jussab and Murphy (2015) examined the aftereffects of client violence on counselors. The theme of experiencing fear and having an inner dialogue about what to do to contain the incident is referred to as A. ―processing the moment to moment experience of client violence.‖ B. ―processing supervision involvement.‖ C. ―professional vulnerabilities and needs as a result of client violence.‖ D. ―ruptured therapeutic relationship.‖ 13. It is best for a suicidal client be transported to the hospital by anyone EXCEPT: A. the family of the client.

B. law enforcement.

C. the counselor.

D. a close friend.

14. If a client states he is willing to be voluntarily hospitalized only if the counselor rides along to the hospital, the counselor should A. take the client since this will allow the transition be calm.

B. explain it is not permitted and ask if the client has a close friend or family member to be called.

C. call the next of kin instead of talking this through as an option.

D. be a passenger in the car if a family member is driving.

15. The main role of law enforcement is A. to provide additional supportive services.

B. to increase options available to the client.

C. to protect the public.

D. transportation of clients to social service agencies rather than arrests.

16. As a best practice, self-referrals should be screened by phone for A. presenting problem, any current diagnosis, current symptoms or behaviors leading to concern, current and history of level of risk to self or others, referral source, and emergency contact information.

B. presenting problem is sufficient.

C. legal history, medical history, and family members in the home is a best practice.

D. legal history, medical history, and income level are essential screening items.

17. According to OSHA, the factors that create a dangerous work environment and high risk for assault A. have high competence levels.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. increased hopefulness for job promotion.

C. fear of criticism by supervisors or managers.

D. family supports.

18. According to OSHA, it is recommended that mental health workers who have been assaulted A. have access to debriefing and counseling to address trauma and stress concerns.

B. speak to a supervisor preventative plans for future incidents.

C. take a leave of absence.

D. continue to see clients to get back working with clients.

19. Ongoing training should be provided to counselors with high-risk populations that includes A. the use of self-defense.

B. appropriate restraint practices.

C. restraint-free procedures.

D. all of the above.

20. SAMHSA puts forth six key principles for working from a trauma informed perspective: A. safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; cultural, historical, and gender issues.

B. safety; trustworthiness and transparency; continuing education; collaboration and mutuality; empowerment, voice, and choice; cultural, historical, and gender issues.

C. safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; goal directive.

D. career awareness; trustworthiness and transparency; continuing education; collaboration and mutuality; empowerment, voice, and choice; cultural, historical, and gender issues.

Extended Response Questions 1. If a counselor is deployed during an initial impact of a crisis, what might the counselor be assigned to do and what will the counselor most likely not do during this time frame of the crisis?

2. Discuss the factors that indicate a greater risk for dangerous behaviors from a client.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. What safety procedures can a sole practitioner engage in when seeing a new client?

4. If a counselor works with a population at high risk for violence, what safety steps should the counselor employ to reduce the risk of bodily harm from dangerous clients?

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 2 Test Answer Key Multiple Choice Answer Key: 1. C (see page 47, section titled Collaboration and Crisis Management) 2. C (see page 50, section titled Individual Clients in Crisis) 3. A (see page 47, section titled Collaboration and Crisis Management) 4. A (see page 48, section titled High Risk Clients) 5. A (see page 49, section titled Physical Safety) 6. C (see page 51, section titled Individual Clients in Crisis) 7. A (see page 51, section titled Individual Clients in Crisis) 8. D (see page 56, section titled Stalking) 9. A (see page 56, section titled In Home Counseling) 10. C (see page 47, section titled Collaboration and Crisis Management) 11. B (see page 47, section titled Collaboration and Crisis Management) 12. A (see page 59, section titled Research and Recommendations on Client Violence) 13. C (see page 47, section titled High Risk Clients) 14. B (see page 47, section titled High Risk Clients) 15. C (see page 47, section titled Collaboration and Crisis Management) 16. A (see page 51, section titled Individual Clients in Crisis) 17. C (see page 54, section titled Special Issues Related to Safety and the Counselor) 18. A (see page 54, section titled Special Issues Related to Safety and the Counselor) 19. D (see page 54, section titled Special Issues Related to Safety and the Counselor) 20. A (see page 55, section titled Trauma-Informed Treatment) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: Counselors will not be assigned to provide long-term counseling, treatment planning, or long-term referrals.

Counselors will most likely assist first responders who are working with victims by assisting in providing basic needs (food, shelter, connection with family members).

Counselors may provide assessments of individuals who may be experiencing a crisis to intervene in order to prevent additional crises.

2. Model response: Answers will vary, but should include some of the following points:

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Counselors in greater risk are those who are in solo practice, do not provide a proper pre-screening prior to scheduling the initial appointment, and work with clients requiring involuntary hospitalization. Counselors should limit personal information on websites and in offices.

3. Model response: Answers will vary, but should include some of the following points: screening procedures to include medical, mental health, legal history, and presenting issues; having other staff in the office area or during normal office times during initial intakes. Have safety precautions in place prior to an incident occurring.

4. Model response: Answers will vary, but should include some of the following points: office area set up to decrease physical risks, limited information about personal life, remove instruments or objects that could be used as a weapon. If a client leaves who is a risk to self or others, do not attempt to restrict them, rather take note of what they are wearing, in what direction they are leaving, car tags, and contact law enforcement.

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which includes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Learning Objective Quizzes

Chapter Chapter 2 Safety Concerns in Crisis Situations

C ACREP Standards— Section 2: Professional Identity

2.1 Explain why it is important for crisis counselors to take a proactive approach to safety.

Learning Objective Quiz 2.1

F.2.d

2.2 Describe the role of collaboration in safely managing a crisis.

Learning Objective Quiz 2.2

F.1.b,F.1.e,

[Q1, Q2]

Section 5 School Counseling: 5G.2.b

Learning Objective Quiz 2.3

F.1.f,

[Q1, Q2]

blank

Section 5 CMHC: 5C.2.a, 5C.2.c, 5C.2.d

blank

2.3 Describe workplace safety issues related to crisis counseling, including high-risk clients, physical counselor safety, and working with individual clients in

[Q1, Q2, Q3] Application Exercise 2.1

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Exercises & Learning Objective Quizzes

C ACREP Standards— Section 2: Professional Identity

crisis. blank

2.4 Describe professional counselor responsibilities and skills related to workplace safety

Learning Objective Quiz 2.4

F.1.c, F.2.g,

[Q1, Q2, Q3] Application Exercise 2.2 Application Exercise 2.3

Chapter 3 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford 20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

21 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 3: Ethical and Legal Considerations in Crisis Counseling

1

Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 3: Ethical and Legal Considerations in Crisis Counseling Chapter 3 Learning Outcome Quizzes Learning Objective 3.1: Describe steps counselors can take to prevent ethical and legal problems.

[Q1] Primary prevention of ethical and legal issues in counseling is a far more effective strategy than the costly and distressing efforts to address an ethical or legal lapse after it has occurred. There are five areas to foster core prevention of ethical and legal allegations. These include which of the following?

1. Integrating wellness, continuing education, peer supervision and consultation, ethical decision-making models, and having an understanding of federal laws [correct] 2. Integrating effective theoretical applications, continuing education, peer supervision and consultation, ethical decision-making models, and having an understanding of federal laws 3. Integrating wellness, continuing education, personal counseling, ethical decisionmaking models, and having an understanding of federal laws 4. Integrating wellness, personal counseling, peer supervision and consultation, ethical decision-making models, and having an understanding of federal laws [Feedback for Correct Answer 1] Primary prevention of ethical and legal issues in counseling is a far more effective strategy than the costly and distressing efforts to address an ethical or legal lapse after it has occurred. There are five areas to foster core prevention of ethical and legal allegations: integrating wellness, continuing education, peer supervision and consultation, ethical decision-making models, and having an understanding of federal laws.

[Feedback for Answer Choice 2] Having a theoretical model as a framework is essential but not one of the five areas to assist in reducing ethical or legal lapse.

[Feedback for Answer Choice 3] Participating in personal counseling is beneficial for many counselors but not required for all counselors and is not one of the five areas to assist in reducing ethical or legal lapse.

[Feedback for Answer Choice 4]

1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Participating in personal counseling is beneficial for many counselors but not required for all counselors and is not one of the five areas to assist in reducing ethical or legal lapse.

[Q2] Implementing a decision-making model is a requirement of a counselor’s ethical practice. Regardless of the model chosen, counselors should apply which core principles?

1. Peer supervision, nonmaleficence, beneficence, justice, fidelity, and veracity when making ethical decisions 2. Autonomy, nonmaleficence, beneficence, compassion, fidelity, and veracity when making ethical decisions 3. Autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity when making ethical decisions [correct] 4. Autonomy, maleficence, beneficence, justice, fidelity, and veracity when making ethical decisions [Feedback for Answer Choice 1] Peer supervision will assist in decreasing ethical and legal behaviors but is not one of the core requirements for ethical practice.

[Feedback for Answer Choice 2] Compassion is an essential skill needed to work with clients but is not one of the core requirements for ethical practice.

[Feedback for Correct Answer 3] Regardless of the model chosen, counselors should apply the core principles of autonomy, nonmaleficence, beneficence, justice, fidelity, and veracity when making ethical decisions.

[Feedback for Answer Choice 4] Maleficence is not in this list and should be avoided.

Learning Objective 3.2: Describe HIPAA, a federal law that protects sensitive mental health information.

[Q1] Which of the following is the first federal legislation to protect automated client records, provide security provisions, and require national provider identification numbers?

1. Family Educational Rights and Privacy Act (F ERPA) 2. Buckley Amendment 3. Serious Threat to Safety Act 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Health Insurance Portability and Accountability Act (HIPAA) of 1996 [correct] [Feedback for Answer Choice 1] The Family Educational Rights and Privacy Act (FERPA) gives parents certain rights to their child’s educational records until the child is 18 years of age.

[Feedback for Answer Choice 2] The Buckley Act is another name for the Family Educational Rights and Privacy Act (FERPA), which gives parents certain rights to their child’s educational records until the child is 18 years of age.

[Feedback for Answer Choice 3] The Serious Threat to Safety is one of the reasons for the passing of HIPAA but it is not the same legislation passed to protect automated client records, electronic transactions, provide security provisions, and require national provider identification numbers.

[Feedback for Correct Answer 4] The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first federal legislation to protect automated client records, provide security provisions, and require national provider identification numbers.

[Q2] June was hired by a private practice to work as a billing officer to submit payment for insurance reimbursements. Since she will be involved in collecting and transmitting protected health information, she received additional training in accordance with HIP AA to protect the privacy of client records. Which of the following is June considered under HIPAA? 1. Compliance officer 2. Billing officer 3. Covered entity [correct] 4. Contractual worker [Feedback for Answer Choice 1] Compliance officers make sure companies operate in full compliance with legal regulations and industry-specific guidelines. June is not a compliance officer.

[Feedback for Answer Choice 2] A billing officer must meet compliance with legal regulations and industry-specific guidelines. Billing officers working with health records are required to be covered entities. However not all billing officers work in health care settings and are not required to be covered under HIPAA. [Feedback for Correct Answer 3] 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Those who collect, use, or transmit protected health information and who are covered under the requirements of HIPAA are referred to as covered entities.

[Feedback for Answer Choice 4] Contractual workers are employed on a temporary basis.

Learning Objective 3.3: Explain why counselors working in the higher education settings must comply with a different set of federal guidelines (FERPA).

[Q1] Which of the following is the federal response based on concerns about privacy violations and the inclusion of immaterial comments and personal opinions in educational records?

1. Family Educational Rights and Privacy Act (FERPA) [correct] 2. Covered entities 3. Serious Threat to Safety Act 4. Health Insurance Portability and Accountability Act (HIPAA) of 1996 [Feedback for Correct Answer 1] The Family Educational Rights and Privacy Act (FERPA) is the federal response from concerns about privacy violations and the inclusion of immaterial comments and personal opinions in educational records.

[Feedback for Answer Choice 2] Those who collect, use, or transmit protected health information and who are covered under the requirements of HIPAA are referred to as covered entities.

[Feedback for Answer Choice 3] Serious Threat to Safety is one of the reasons for the passing of HIPAA but it is not the same legislation passed in response to privacy violations and the inclusion of immaterial comments and personal opinions in educational records.

[Feedback for Answer Choice 4] The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was the first federal legislation to protect automated client records, provide security provisions, and require national provider identification numbers. This is not the same legislation passed in response to privacy violations and the inclusion of immaterial comments and personal opinions in educational records.

[Q2] High school counselors in a school district are attending a training regarding situations that meet and do not meet FERPA privacy requirements. Which of the following situations could a school counselor share with others since it is not considered part of a student’s educational record?

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Threatening remarks made by a student and overheard by school personnel [correct] 2. School counselor notes regarding a student’s involvement in a lunch bunch group 3. Notes taken by a counselor regarding students who attend after-school groups 4. Notes taken by a counselor regarding a student’s disclosure of how their parents’ divorce has affected their family [Feedback for Correct Answer 1] Threatening remarks made by a student and overheard by school personnel can be reported to appropriate officials because such remarks are not considered part of the educational record.

[Feedback for Answer Choice 2] A school counselor’s notes regarding a student’s involvement in a lunch bunch group are part of the student’s educational record and are protected under FERPA. [Feedback for Answer Choice 3] Notes taken by a counselor regarding students who attend after-school groups are part of the student’s educational record and are protected under FERPA. [Feedback for Answer Choice 4] Notes taken by a counselor regarding a student’s disclosure of how their parents’ divorce has affected their family are part of the student’s educational record and are protected under FERPA. Learning Objective 3.4: Describe the effects of the Tarasoff v. Regents court case on the duties of counselors.

[Q1] The landmark California Supreme Court case of Tarasoff v. Regents of the University of California (1976) brought forth the requirement for mental health counselors to disclose in situations ―to protect clients or identified others from serious and foreseeable harm or when legal requirements demand confidential information must be revealed.‖ This case has become precedent for many states to execute which specific duty?

1. Duty to protect 2. Duty to warn [correct] 3. Duty to warn and protect as they are the same thing 4. Duty to consult [Feedback for Answer Choice 1]

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Although the terms are mistakenly used interchangeably, a duty to protect specifically is the duty to protect a client who is a harm to themselves (e.g., suicide).

[Feedback for Correct Answer 2] Duty to warn is the duty to protect a third party in situations where there may be harm toward them by another (e.g., homicide) by warning that identifiable victim.

[Feedback for Answer Choice 3] Although the terms are often used interchangeably, duty to protect specifically is the duty to protect a client who is a harm to themselves (e.g., suicide), whereas duty to warn is the duty to protect a third party in situations where there may be harm toward them by another (e.g., homicide) by warning the identifiable victim.

[Feedback for Answer Choice 4] Duty to consult is the responsibility to consult with another professional to determine the next course of action based on legal and ethical standards. Duty to consult was a duty that was the result of the Tarasoff case but it is not the main duty to result from this ruling.

[Q2] In another court ruling, a therapist was held liable for failure to warn an identifiable victim when the information regarding the client’s potential to harm another person was obtained from a credible third party; in this case, a family member. What was this court ruling?

1. Tarasoff v. Regents of the University of California (1976) 2. Ewing v. Goldstein [correct] 3. Baker Act 4. 2018 Amendment made by the Senate and General Assembly of the State of New Jersey: Section 1 of P.L.1991, c.270 (C.2A:62A-16) [Feedback for Answer Choice 1] The landmark California Supreme Court case of Tarasoff v. Regents of the University of California (1976) brought forth the requirement for mental health counselors to disclose in situations in order ―to protect clients or identified others from serious and foreseeable harm or when legal requirements demand confidential information must be revealed.‖ [Feedback for Correct Answer 2] The Ewing v. Goldstein ruling made the decision that a therapist would be held liable for failure to warn an identifiable victim when the information regarding the client’s potential to harm another person was obtained from a credible third party; in this case, a family member.

[Feedback for Answer Choice 3] 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

In Florida, a law called the Baker Act allows doctors, mental health specialists, judges, and law enforcement officials to commit someone to a treatment center for up to 72 hours if they display specific signs of mental illness. This law is specific to Florida.

[Feedback for Answer Choice 4] This amendment only applies to New Jersey.

Learning Objective 3.5: Describe special ethical, legal, and other considerations related to crises.

[Q1] An action by a crisis counselor that involves a dereliction in the duty of care that directly impacts and causes damage to a client can lead to which of the following?

1. Informed consent 2. Malpractice [correct] 3. Confidentiality 4. Standard of care [Feedback for Answer Choice 1] Informed consent requires a counselor to explain to the client ―the purposes, goals, techniques, procedures, limitations, potential risks, and benefits of services; the counselor’s qualifications, credentials, relevant experience, and approach to counseling; continuation of services upon the incapacitation or death of the counselor; and the role of technology‖ in the counseling process. Although a HIPAA requirement, this does not directly lead to malpractice without the other malpractice requirements.

[Feedback for Correct Answer 2] Negligence that occurs in a professional setting may lead to malpractice.

Professional negligence results when a counselor departs (dereliction) from the usual standard of practice (duty or standard of care) that is expected of professionals in a similar situation and causes damage to the clients.

[Feedback for Answer Choice 3] Confidentiality requires counselors to not disclose client information revealed during counseling without the client’s written consent. Although a HIPAA requirement, this alone does not directly lead to malpractice without the other malpractice requirements.

[Feedback for Answer Choice 4] Standard of care refers to the actions taken by others from the same professionals in similar situations. Although this is a component of malpractice, this alone does not directly lead to malpractice without the other malpractice requirements.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Q2] Kayma is a crisis counselor who is able to have six sessions with clients. Knowing the limited time spent with clients can bring up perceptions of abandonment, she discusses termination during which of the following?

1. The final session 2. The second session after all releases are gathered 3. The first session [correct] 4. It is not necessary to discuss termination [Feedback for Answer Choice 1] Waiting until the final session to discuss termination may not prepare the client for appropriate termination and referrals and is not the standard of care in the profession.

[Feedback for Answer Choice 2] Waiting until the second session to discuss termination is not the standard of care in the profession.

[Feedback for Correct Answer 3] Termination should always be discussed in the first session with a client. It is the standard of care in the profession.

[Feedback for Answer Choice 4] Termination should always be discussed with a client.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 3 Application Exercises Application Exercise 3.1 Learning Objective 3.1: Describe steps counselors can take to prevent ethical and legal problems.

[Q1] Refer to Activity 3.1. Using the components outlined in the section on Ethical Decision-Making Models, what components would you integrate into your decision with Ryder?

[Q1 Model Response] There may be various decisions. It is essential to be able to justify the decision made when working with Ryder. However, regardless of the decision-making model selected, the following components should be used as the basis for the decision: (1) identify the problem, (2) check your feelings, (3) identify potential issues (e.g., cultural, spiritual, familial), (4) review relevant professional codes, (5) know laws and regulations, (6) involve the client in the process, (7) obtain peer or supervisor consultation, (8) consider courses of action, (9) consider the implications of decisions, (10) choose a course of action, and (11) follow up with a supervisor, legal counsel, and the client.

Application Exercise 3.2 Learning Objective 3.2: Describe HIPAA, a federal law that protects sensitive mental health information.

[Q2] Refer to Pearson e-Textbook Video Example 3.1. In this video, a school counseling intern encounters an attorney requesting student counseling files and consults with a supervisor. What HIPAA and FERPA requirements prevent you from disclosing information demonstrated in this scenario?

[Q2 Model Response] The counselor should discuss this request with the school point of contact assigned in the school for consultation. Depending on the information requested, offering this information my violate FERPA and HIPAA. Application Exercise 3.3 Learning Objective 3.5: Describe special ethical, legal, and other considerations related to crises.

[Q3] 9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Refer to Pearson e-Textbook Video Example 3.4. In this video, a young student tells her counselor she has been hurting herself. The counselor reviews the limits of confidentiality and next steps. Are there others who need to be informed in this situation?

[Q3 Model Response] In this situation, the parents or caregivers should be included as is discussed with the student in the video. In addition, the director of school counseling or another person in administration should also be contacted in compliance with the school district.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 3 Test Items Multiple Choice Questions 1. HIPAA stands for A. House Insurance Privacy and Accountability Act. B. Health Information Protection and Access Act. C. Healthcare Information Protection and Accessibility Act. D. Health Insurance Portability and Accountability Act. 2. What circumstances brought about the HIPAA legislation?

A. Public perception that healthcare information was not properly controlled.

B. Public perception that healthcare information was not properly protected.

C. Concerns that information was being used to negatively affect people.

D. All of the above.

3. Under HIPAA protected health information (PHI) is applicable to A. information containing personal identification related to healthcare.

B. paper-based medical information only.

C. the electronic transmission of medical information not containing unique identifiers.

D. all electronic correspondence from a clinic.

4.

is NOT required of counselors by HIPAA. A. A privacy officer B. Procedural practices C. Deadbolt locks on medical records D. A written declaration of client rights

5. HIPAA has adversely affected counseling practice through A. reliance on complicated consent forms.

B. helping organizations to become more willing to host research.

C. increasing research volunteers.

D. All of the above.

6. The federal government may waive HIPAA penalties A. when requested by public health officials.

B. as long as the privacy rule has not been violated.

C. even in cases where a public emergency is not declared.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. only when ordered by the President.

7. Release of public health information to law enforcement is allowed only A. with a subpoena from the office of the district attorney.

B. when it is needed to identify or apprehend an escapee or violent criminal.

C. when the client has been forcibly committed for mental illness.

D. None of the above.

8. FERPA stands for A. Family Education Rights and Privacy Act. B. Family Educational Regulation of Privacy Act. C. Federal Education Regulation and Protective Act. D. Fiscal Education Regulatory Provision Act. 9. FERPA is also known as the A. Buckley Amendment.

B. Privacy Amendment.

C. Bodine Act. D. Barkley Amendment.

10. FERPA bestows all of the following rights EXCEPT A. privacy of student records at age 18 years.

B. right to inspect and review the student records.

C. right to amend the student records.

D. right to obtain the original student record.

11. FERPA ended the practice of A. entering medical diagnoses in the student record.

B. placing test results in the student record.

C. untrained people entering mental diagnoses in the student record.

D. entering disciplinary actions into the student record.

12.

prompted the enactment of FERPA. A. Motions of the national Parent Teachers Association B. Decreased confidentiality of student records C. State board of education regulations D. None of the above.

13. According to FERPA, threatening remarks made by a student overheard by school personnel 12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. cannot be released from the medical record.

B. should only be released with parent consent.

C. may be released upon request from the board of education.

D. are not considered part of an educational record.

14. In many states Tarasoff v. Regents of University of California established A. the need to maintain confidentiality.

B. the ACA Code of Ethics.

C. a mental health professional’s duty to warn.

D. privilege to conduct an emergency petition.

15. Duty to protect A. involves taking action to actually reduce the danger to a person.

B. was established by the U.S. Armed Services and Family Resources Division.

C. exists only in educational systems.

D. involves consulting with another mental health professional.

16. When considering breaking confidentiality due to a duty to warn, it is highly recommended that a counselor should foremost A. contact the police.

B. seek consultation or supervision.

C. get the contact information of the potential victim.

D. determine the lethality of the threat.

17. While many states have laws covering duty to warn, other states have A. laws giving only permission to warn.

B. no such law at all.

C. Both of the above.

D. None of the above. is not one of the ―four Ds‖ of malpractice.

18.

A. Dereliction B. Duty C. Distress D. Directly

19. Providing for locked, secured, confidential file storage in crisis situations is A. not practical.

B. to be addressed in crisis planning.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. not expected.

D. the responsibility of F EMA. 20. In disaster circumstances, counselors are expected to obtain consent through each of the following steps EXCEPT: A. introduce themselves and explain their role.

B. describe the general limitations of confidentiality.

C. ask permission to speak with the person.

D. obtain written consent.

21. In order to avoid therapeutic abandonment in disaster circumstances, the counselor should A. personally introduce the client to the local counselor he or she is being referred.

B. provide the client with a referral to local counseling services.

C. maintain periodic contact with the client to ensure care is being continued.

D. All of the above.

22. In disaster counseling, clients who bring up religious or spiritual issues should be A. referred for Christian counseling.

B. redirected in session to more concrete matters.

C. told that the counselor can’t discuss religious matters.

D. allowed to explore the disaster’s spiritual meaning in their life.

23. In disaster situations, marginalized populations will discover A. improved circumstances postdisaster.

B. that predisaster norms will not dictate postdisaster reality.

C. disaster is not a social leveler.

D. All of the above.

Extended Response Questions 1. Explain how both HIPAA and FERPA impact the provision of counseling in crisis circumstances.

2. Describe how a duty to warn would be applied in a crisis counseling circumstance. How differently might Tarasoff v. Regents of University of California be applied in a disaster counseling circumstance?

3. Explain the concepts of negligence and malpractice, and describe how these principles intersect. Describe how a counselor might engage in negligence or malpractice as a result of failing to assess and address spiritual and religious issues.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Explain the concepts of abandonment and termination. Describe the common pitfalls of both as well as their application to crisis and disaster counseling circumstances.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 3 Test Answer Key Multiple Choice Answer Key: 1. D (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 2. D (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 3. A (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 4. C (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 5. A (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 6. C (see page starting at 68, section titled The Health Insurance Portability and Accountability Act) 7. C (see page starting at 72, section titled Family Educational Rights and Privacy Act) 8. A (see page starting at 72, section titled Family Educational Rights and Privacy Act) 9. A (see page starting at 72, section titled Family Educational Rights and Privacy Act) 10. D (see page starting at 72, section titled Family Educational Rights and Privacy Act) 11. C (see page starting at 72, section titled Family Educational Rights and Privacy Act) 12. B (see page starting at 72, section titled Family Educational Rights and Privacy Act) 13. D (see page starting at 72, section titled Family Educational Rights and Privacy Act) 14. C (see page starting at 79, section titled Tarasoff versus Regents Decision) 15. A (see page starting at 79, section titled Tarasoff versus Regents Decision) 16. B (see page starting at 79, section titled Tarasoff versus Regents Decision) 17. C (see page starting at 79, section titled Tarasoff versus Regents Decision) 18. C (see page 83, section titled Negligence and Malpractice) 19. B (see page 85, section titled Documentation and Record Keeping) 20. D (see page 86, section titled Informed Consent) 21. B (see page 90, section titled Termination in Crisis Intervention) 22. D (see page 92, section titled Spiritual and Multicultural Considerations) 23. C (see page 93, section titled Spiritual and Multicultural Considerations) Feedback for the essay question:

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Model response: Answers will vary, but should include some of the following points: limits of confidentiality, how to obtain consents, how information can be transmitted and shared, what information is confidential, any emergency declarations that impact FERPA; duty to warn, protect, consult.

2. Model response: Answers will vary, but should include some of the following points: (1) ensure that the client remains safe, reduce lethality, and stabilize the environment; (2) help the client to regain short-term control; and (3) connect the client with appropriate resources.

3. Model response: Answers will vary, but should include some of the following points: to prove malpractice, negligence must be evident which means the standard of care (care provided by others in the profession) was negligent or not met; Malpractice requires the four Ds (dereliction in the duty of care that directly impacts and causes damages).

4. Model response: Answers will vary, but should include some of the following points: improper or lack of appropriate termination may increase the chances of perceived or complaints of abandonment with clients who are already in crisis and may be experiencing abandonment from support groups or perceived control. Counselors can decrease these allegations or perceptions by setting boundaries, being clear about short time frame of counseling, purpose of crisis work, use of referrals in crisis work, reviewing limits of confidentiality, and reviewing termination protocols.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter Chapter 3 Ethical and Legal Considerations in Crisis Counseling

Learning Objective

Exercises & Quizzes

3.1 Describe steps counselors can take to prevent ethical and legal problems.

Learning Objective Quiz 3.1 [Q1, Q2]

C ACREP Standards— Section 2: Professional Identity F.1.e, F1.f, F.1.g F.7.c, F.7.d, F7.e Section 5 CMHC: 5C.2.l, Section 5 CMHC: 5C.2.m

Application Exercise 3.1

Section 5 Marriage, Couples, and Family Counseling: 5F.2.o

Learning Objective Quiz 3.2

F.1.e, F1.f, F.1.g

blank

3.2 Describe HIPA A, a federal law that protects sensitive mental health information.

F.1.j, F 7.d

[Q1, Q2] Application Exercise 3.2

blank

3.3 Explain why counselors working in higher education settings must

Learning Objective Quiz 3.3

F.1.b,F.1.c,F1.f, F.1.g, F.8.j

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

comply with a different set of federal guidelines (FERPA).

[Q1, Q2]

3.4 Describe the effects of the Tarasoff v. Regents court case on the duties of counselors.

Learning Objective Quiz 3.4

3.5 Describe special ethical, legal, and other considerations related to crises.

Learning Objective Quiz 3.5

C ACREP Standards— Section 2: Professional Identity

blank

F.7.c, F.7.d, F7.e

[Q1, Q2]

blank

F.1.h, F.1.f, F.1.g, F7.d F.8.j

[Q1, Q2]

Section 5: Addiction Counseling 5A.2.l

Application Exercise 3.3

Section 5 CMHC: 5C.2.l,5C.3.c Section 5 School Counseling: 5G.2.n Section 5 Marriage, Couples, and Family Counseling: 5F.2.o

Chapter 4 Test Item File

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 4: Essential Crisis Intervention Skills

1

Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 4: Essential Crisis Intervention Skills Chapter 4 Learning Outcome Quizzes Learning Objective 4.1: Apply essential crisis intervention microskills.

[Q1] There are many similarities and differences between crisis counseling and traditional counseling. What is the primary difference between crisis counseling and traditional counseling?

1. Crisis counseling is time-limited or at least limited to the time required to stabilize the crisis situation. [correct] 2. Crisis counseling does not use advanced skills.

3. Effective skills used differ in crisis counseling.

4. In crisis counseling, the counselor is not concerned with creating a therapeutic alliance. They are concerned with stabilization.

[Feedback for Correct Answer 1] The primary difference between crisis counseling and traditional counseling is that crisis counseling is time-limited or at least limited to the time required to stabilize the crisis situation.

[Feedback for Answer Choice 2] Although crisis counselors may not focus on the treatment of long-term issues impacting a client, advanced skills are still needed in most crisis situations.

[Feedback for Answer Choice 3] The essential foundational skills necessary for effective crisis intervention work are indeed the basic tools on which the success of interventions may depend, whether the counselor is doing crisis or traditional counseling.

[Feedback for Answer Choice 4] Although stabilization and safety is a priority in crisis counseling, effective skills will help create the counselor–client relational conditions necessary for positive change (i.e., therapeutic alliance) needed in crisis counseling.

[Q2] In crisis intervention work, a crisis counselor’s primary concern should be fostering the development of a cohesive and supportive relationship with the client in order to build trust. How counselors conduct themselves in the initial time they spend with the client may encourage or discourage the client to continue in counseling. What is this essential skill called?

1. Rapport [correct] 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Trust 3. Safety 4. Genuineness [Feedback for Correct Answer 1] In crisis intervention work, the development of rapport starts with the initial contact and continues throughout the process. The crisis counselor’s primary concern should be fostering this rapport to develop a cohesive and supportive relationship with the client.

[Feedback for Answer Choice 2] Trust is a component and a result of building rapport. Rapport is needed for trust to occur.

[Feedback for Answer Choice 3] Safety is the perception for the client when trust and rapport is developed. Rapport is needed for safety to occur.

[Feedback for Answer Choice 4] Genuineness from the counselor is also a component of rapport. Rapport is built on the counselor being authentic and genuine.

Learning Objective 4.2: Identify basic attending skills including eye contact, body position, vocal tone, and use of silence.

[Q1] Attending skills are essential for crisis workers and essential for clients in crisis.

Following validation and education, clients ranked which of the following skills as most important in building the therapeutic alliance?

1. Silence 2. Vocal tone 3. Physical distance 4. Nonverbal gestures, presentation, and body language [correct] [Feedback for Answer Choice 1] Clients in crisis need space to think, sort out their thoughts, and process what is happening. The counselor needs that time as well. This point cannot be overemphasized: Silence is important for both clients and professional counselors. It is essential for crisis counselors to develop comfort with silent pauses. However, following validation and education, clients ranked nonverbal gestures, presentation, and body language as most important in building the therapeutic alliance.

[Feedback for Answer Choice 2] 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Pitch, pacing, and volume can all influence how a client responds emotionally to a crisis counselor. There is much to be said for a calm and soothing voice in times of distress, especially when the client is in a crisis. However, following validation and education, clients ranked nonverbal gestures, presentation, and body language as most important in building the therapeutic alliance.

[Feedback for Answer Choice 3] The physical distance between counselor and client should be taken into consideration; getting too close can be overwhelming and uncomfortable, whereas being too distant can make the counselor appear aloof and may be awkward for the client. However, following validation and education, clients ranked nonverbal gestures, presentation, and body language as most important in building the therapeutic alliance.

[Feedback for Correct Answer 4] Following validation and education, clients ranked nonverbal gestures, presentation, and body language as most important in building the therapeutic alliance.

[Q2] There is no universal rule or criterion that exists for what is considered either appropriate or inappropriate eye contact. Eye contact varies among cultures and is influenced by the intensity of emotions involved in the crisis situation. However, which of the following is the general guideline to follow for eye contact?

1. Maintain a moderate amount of eye contact while monitoring your client’s level of comfort and adjust your eye contact accordingly. [correct] 2. Always make direct eye contact as a form of courtesy.

3. Avoid eye contact in crisis situations so not to make the client feel uncomfortable.

4. Discuss eye contact and the use of eye contact in crisis counseling with the client.

[Feedback for Correct Answer 1] A general guideline to follow is to maintain a moderate amount of eye contact while monitoring your client’s level of comfort and adjust your eye contact accordingly.

This guideline will also assist with cultural sensitivity.

[Feedback for Answer Choice 2] Although direct eye contact may be appropriate in many situations and with some cultures, direct eye contact may make others feel uncomfortable. A general guideline to follow is to maintain a moderate amount of eye contact while monitoring your client’s level of comfort and adjust your eye contact accordingly. This guideline will also assist with cultural sensitivity.

[Feedback for Answer Choice 3] Avoiding eye contact in crisis situations may be appropriate for some cultures but not all. Avoiding eye contact may actually make some clients feel uncomfortable or 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

impact rapport. A general guideline to follow is to maintain a moderate amount of eye contact while monitoring your client’s level of comfort and adjust your eye contact accordingly. This guideline will also assist with cultural sensitivity.

[Feedback for Answer Choice 4] Discussing eye contact and the use of eye contact in crisis counseling with the client may not be the best option unless it seems the client is reacting in a manner that is uncomfortable. A general guideline to follow is to maintain a moderate amount of eye contact while monitoring your client’s level of comfort and to adjust your eye contact accordingly. This guideline will also assist with cultural sensitivity.

[Q3] Many beginning counselors are afraid to use silence because they believe silence conveys their incompetence as a counselor. However, silence, if used appropriately and at the right time, can do what?

1. Convey acceptance and empathic understanding [correct] 2. Allow the counselor to control the session 3. Allow the client to take control of the session 4. Be used when the counselor is unsure how to intervene [Feedback for Correct Answer 1] Silence, if used appropriately and at the right time, can convey acceptance and empathic understanding. In essence, the message of silence is ―I am here for you if you need me, yet I respect your need to take your time with this.‖ [Feedback for Answer Choice 2] Although silence can allow clients in crisis to have space to think, sort out their thoughts, and process what is happening, the intention of the use of the skill is not for the counselor to control the session.

[Feedback for Answer Choice 3] Although silence can allow clients in crisis to have space to think, sort out their thoughts, and process what is happening, which can provide some control for the client, the intention of the use of the skill is not for the client to control the session.

[Feedback for Answer Choice 4] Beginning crisis counselors often have difficulty using silence with clients and may ineffectively use silence when they are unsure how to respond. This is not an effective use of the skill.

[Q4] A conceptual framework for active nonverbal listening, S OLER helps counselors remember key nonverbal techniques that convey that they are physically and psychologically present with clients. What does SOLER stand for?

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Silence, adopt an open posture, lean toward the client, make eye contact, stay relaxed 2. Squarely face the client, adopt an open posture, lean toward the client, make eye contact, establish rapport 3. Squarely face the client, adopt an open posture, lean toward the client, be empathetic, stay relaxed 4. Squarely face the client, adopt an open posture, lean toward the client, make eye contact, stay relaxed [correct] [Feedback for Answer Choice 1] Although silence is an intentional skill used in crisis counseling, it is not part of the S OLER framework.

[Feedback for Answer Choice 2] Although rapport is an intentional skill used in crisis counseling, it is not part of the framework SOLER. [Feedback for Answer Choice 3] Although empathy is needed in working with clients in crisis, it is not part of the framework SOLER. [Feedback for Correct Answer 4] A conceptual framework for active nonverbal listening, SOLER helps counselors remember key nonverbal techniques that convey that they are physically and psychologically present with clients. SOLER stands for: Squarely face the client, adopt an open posture, lean toward the client, make eye contact, stay relaxed.

Learning Objective 4.3: Identify the basic listening sequence including asking open and closed questions and reflecting skills.

[Q1] Which of the following is a sequence of interrelated skills used to achieve three overarching goals: (1) to obtain an overall summary and understanding of the client’s presenting issue; (2) to identify the key facts of the client’s situation; and (3) to identify the core emotions and feelings the client is experiencing?

1. Open-ended questioning 2. Paraphrasing 3. Reflecting 4. The basic listening sequence [correct] [Feedback for Answer Choice 1]

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Open-ended questioning is a skill used to achieve the three overarching goals; however, it is not a sequence of interrelated skills used to achieve the three overarching goals.

[Feedback for Answer Choice 2] Paraphrasing is a skill used to achieve the three overarching goals; however, it is not a sequence of interrelated skills used to achieve the three overarching goals.

[Feedback for Answer Choice 3] Reflecting is a skill used to achieve the three overarching goals; it is not a sequence of interrelated skills used to achieve the three overarching goals.

[Feedback for Correct Answer 4] The basic listening sequence is a set of interrelated skills used to achieve three overarching goals: (1) to obtain an overall summary and understanding of the client’s presenting issue; (2) to identify the key facts of the client’s situation; and (3) to identify the core emotions and feelings the client is experiencing.

[Q2] Which of the following are questions that usually elicit fuller and more meaningful responses by encouraging the client to talk at greater length and typically begin with what, how, could, would, or why?

1. Open questions [correct] 2. Closed questions 3. Bombarding questions 4. Multiple questions [Feedback for Correct Answer 1] Open questions usually elicit fuller and more meaningful responses by encouraging the client to talk at greater length and typically begin with what, how, could, would, or why. They are useful to help begin an interview, elaborate the client’s story, and bring out specific details.

[Feedback for Answer Choice 2] Closed questions are good for obtaining the necessary details to aid in assessment and intervention when a client is in crisis. Although important they do not typically begin with what, how, could, would, or why.

[Feedback for Answer Choice 3] Bombarding questions often confuse and frustrate clients and can increase client’s level of anxiety. This can be harmful to clients.

[Feedback for Answer Choice 4] Like bombarding questions, multiple questions often confuse and frustrate clients and can increase the client’s level of anxiety. This can be harmful to clients.

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Q3] Although the basic listing sequence is the same in traditional counseling and crisis counseling, in crisis counseling, adding, ―Is that correct‖ or ―Did I hear you right?‖ is intended for what reason?

1. Ensures accuracy of what the client is saying and to allow enough time in the session 2. Ensures the counselor gains rapport with the client 3. Allows the counselor to direct the session 4. Ensures accuracy of what the client is saying and allows clients to gain control over the situation where they may not have control [correct] [Feedback for Answer Choice 1] In crisis counseling, adding, ―Is that correct‖ or ―Did I hear you right?‖ is intended for the counselor to ensure accuracy of what the client is saying but not to allow for enough time in the session.

[Feedback for Answer Choice 2] Rapport is essential in the client–counselor relationship. However, in crisis counseling, adding, ―Is that correct‖ or ―Did I hear you right?‖ is not intended primarily to build rapport.

[Feedback for Answer Choice 3] Often in crisis counseling, a counselor must work with the client in a directive manner. However, in crisis counseling, adding, ―Is that correct‖ or ―Did I hear you right?‖ is not intended for this reason.

[Feedback for Correct Answer 4] In crisis counseling, adding, ―Is that correct‖ or ―Did I hear you right?‖ is intended for the counselor to ensure accuracy of what the client is saying and for clients to gain control over the situation where they may not have control.

Learning Objective 4.4: Describe basic deescalation skills to help clients regulate emotions.

[Q1] What are the four primary objectives when counseling agitated clients?

1. Rapport, client emotion management to regain control, avoidance of physical restraint, and avoidance of escalating coercive interventions 2. Safety, basic listening sequence, avoidance of physical restraint, and avoidance of escalating coercive interventions 3. Safety, client emotion management to regain control, avoidance of physical restraint, and avoidance of escalating coercive interventions [correct] 7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Safety, client emotion management to regain control, silence, and avoidance of escalating coercive interventions [Feedback for Answer Choice 1] Rapport is needed for the client–counselor relationship but it is not an objective when counseling agitated clients.

[Feedback for Answer Choice 2] The basic listening sequence is needed for the client–counselor relationship but it is not an objective when counseling agitated clients.

[Feedback for Correct Answer 3] The four primary objectives when counseling agitated clients include safety, client emotion management to regain control, avoidance of physical restraint, and avoidance of escalating coercive interventions.

[Feedback for Answer Choice 4] Silence is a skill used when working with clients but it is not an objective when counseling agitated clients.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 4 Application Exercises Application Exercise 4.1 Learning Objective 4.2: Identify basic attending skills including eye contact, body position, vocal tone, and use of silence.

[Q1] Refer to Pearson e-Textbook Video Example 4.1. In this S AMHSA training segment, crisis workers knock on the door of a couple who have been impacted by a natural disaster. The role play shows essential attending skills such as rapport building and empathy to create a trusting relationship. What SOLER techniques and attending skills were used to create this trust?

[Q1 Model Response] The crisis counselors first introduced themselves and the crisis center they were assigned to the couple in order to establish trust, ensure safety, and build rapport.

The crisis counselors used a combination of closed and open-ended questions to gather information. They integrated appropriate silence to allow the clients to think and reflect on their situation as well as appropriate body language and eye contact.

Finally, they offered information to assist the couple with items needed to meet their basic needs and explored options with the couple of what they could integrate to gain more control.

Application Exercise 4.2 Learning Objective 4.3: Identify the basic listening sequence including asking open and closed questions and reflecting skills.

[Q2] Refer to Think About It 4.1. Consider your questioning skills. Self-monitor or record a conversation with a classmate. What types of questioning techniques do you use and in what proportion? How can you improve?

[Q2 Model Response] Students can review their recordings (or have their classmate write down their responses in the conversation). Track what the pattern of responses were in the conversation. Were there only closed questions? Can some of the questions be reconstructed to an open question? Did you use the stem ―Is that accurate?‖ If so, what was the reaction of the friend?

Application Exercise 4.3 Learning Objective 4.3: Identify the basic listening sequence including asking open and closed questions and reflecting skills.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Q3] Refer to the Pearson e-Textbook Video Example 4.3. In the segment, the counselor demonstrates an effective use of a paraphrase in crisis counseling by adding the stem ―Is that accurate?‖ This stem allows for both a check for accuracy and for clients to gain some control over situations. What was the response of the client in the video?

[Q3 Model Response] In this short video, the stem ―Is that accurate?‖ was used and the response from the client was that the counselor was accurate in their interpretation. The use of this stem allowed the client to have control over the interpretation of the counselor.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 4 Test Items Multiple Choice Questions 1. Counselors who develop a strong sense of accord and amity with their clients would be said to have cultivated A. genuineness.

B. empathy.

C. rapport.

D. unconditional positive regard.

2. All of the following are at the bottom of the microskills hierarchy EXCEPT A. body language.

B. questioning.

C. eye contact.

D. tone of voice.

3. All of the following are TRUE statements about questioning in the counseling relationship EXCEPT A. open questions can be a vehicle to glean important information, often in more depth.

B. too many questions can confuse clients and create additional stress.

C. closed questions can give more control to the client.

D. questions can help guide and focus the client.

4. Which of the following is an example of an open question?

A. When did you first start having trouble in your marriage?

B. What goes through your head when your spouse ignores you?

C. How many times each week do you find yourself fighting with your spouse?

D. Are you thinking about getting a divorce?

5. ―Why‖ questions do NOT usually A. encourage clients to intellectualize their problems.

B. put clients on the defensive.

C. cause clients to rationalize their problems.

D. allow clients to explore their issues and emotions at a deeper level.

6. A question with an answer already embedded in it is called a A. why question.

B. closed question.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. leading question.

D. open question.

7. Reflecting skills are NOT A. a way to elicit the facts and specific details of an issue.

B. a form of active listening.

C. a way to display genuineness.

D. a way to prompt deeper examination of a clients’ problems.

8. Reflecting back to a client the essence of something they have shared is considered a A. summary.

B. reflection of feelings.

C. paraphrase.

D. restatement.

9. ―I am still in shock that my husband is having an affair. I really can’t believe it. I thought we had the perfect marriage. How could I have been so stupid to not see this was happening? I feel like such a fool.‖ Based on this scenario from the text, choose the option that is NOT an example of an effective paraphrase.

A. You’re upset with yourself for not recognizing that something was amiss in your marriage. Is that right?

B. You feel like a fool because you thought you had a perfect marriage.

C. It’s difficult for you to come to terms with your husband’s infidelity, especially because you were under the impression that everything was fine.

D. All of the above are examples of effective paraphrases.

10. A session.

summary is most commonly used at the start of a counseling

A. focusing B. signal C. planning D. All of the above.

11. A

summary is frequently used at the end of a counseling session.

A. focusing B. signal C. planning D. All of the above.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

12. A summary is used to help clients transition from one topic to another and can provide direction.

A. focusing B. signal C. planning D. All of the above.

13. ―What brings you to counseling?" or ―What do you make of that?‖ are examples of A. attentive statements.

B. open questions.

C. minimal encouragers.

D. open-ended leads.

14. Open questions are helpful because open questions A. do not limit a client’s answer.

B. address specific topics.

C. allow a client to refuse to answer.

D. All of the above.

15. Reflecting feelings can A. help the client become aware of the emotions experienced in relation to the issue at hand.

B. bring the client to higher levels of self-awareness.

C. have a positive impact on the therapeutic relationship.

D. All of the above.

16.

is a distilled version of the content of the client’s message that restates the facts and thoughts in different words and in a nonjudgmental way.

A. Paraphrase B. Reflection of feeling C. Summarizing D. Reflection of meaning

17. Summarizing can be used to A. signal the client to address the next topic.

B. link content or meanings across several sessions.

C. address past progress and future directions.

D. All of the above.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

18. An appropriate time to use a close-ended question would be A. when you want to draw out the client’s story.

B. during the termination phase of counseling.

C. when you want to help the client go deeper and elicit meaning.

D. to obtain concrete and factual information.

19. ―You believe you let your parents down, and this is what is difficult because their trust in you is the most important thing‖ would best be described as a A. reflection of feeling.

B. reflection of meaning.

C. paraphrase.

D. summary.

20. The basic or core feelings we all experience as humans include each of the following EXCEPT A. anger.

B. depression.

C. sadness.

D. fear.

21. Client: ―We’ve tried everything. We’ve promised to give her things if she’ll agree to stay home. We’ve tried to ground her. What else can I do?‖ Choose the response that best demonstrates a paraphrase.

A. You’ve tried a lot of things, but nothing has worked.

B. Well, maybe your sister could help out.

C. When did all of this begin?

D. You feel angry that your daughter will not be more sensitive to your needs.

22. Client: (describing difficulties at work) ―I try, honestly, but I don’t get anywhere.

Working hard doesn’t seem to make any difference; I am still behind‖ Choose the response that best demonstrates a reflection of feeling.

A. I guess you are depressed.

B. It seems you must feel that working hard does not get you anywhere.

C. It sounds like you feel discouraged about your situation at work.

D. You feel hopeless about your work situation.

23. ―Are you thinking of killing yourself?‖ and ―How old were you when your parents divorced,‖ are examples of A. open questions.

B. closed questions.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. open and closed questions, respectively.

D. None of the above.

24. In a crisis situation, it is best for the counselor’s tone of voice to A. match the client’s.

B. be slow and unruffled.

C. be rapid and cursory.

D. sound monotone.

Extended Response Questions 1. Explain the basic attending skills.

2. Discuss two situations when maintaining moderate eye contact with clients may be more harmful than helpful.

3. What are the advantages and disadvantages of closed and open questions in crisis situations?

4. Discuss why counselors should avoid using leading questions and ―why‖ questions.

5. List and describe the three common types of summaries.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 4 Test Answer Key Multiple Choice Answer Key: 1. C (see page 100, section titled Essential Crisis Intervention Microskills) 2. B (see page 101, section titled Attending Skills) 3. B (see page 106, section titled Asking Open and Closed Questions) 4. B (see page starting at 106, section titled Asking Open and Closed Questions) 5. D (see page starting at 106, section titled Asking Open and Closed Questions) 6. C (see page starting at 106, section titled Asking Open and Closed Questions) 7. A (see page starting at 111, section titled Reflecting Skills) 8. C (see page starting at 111, section titled Reflecting Skills) 9. B (see page starting at 111, section titled Reflecting Skills) 10. A (see page starting at 111, section titled Reflecting Skills) 11. C (see page starting at 111, section titled Reflecting Skills) 12. B (see page 117, section titled Summarizing) 13. B (see page starting at 106, section titled Asking Open and Closed Questions) 14. A (see page starting at 106, section titled Asking Open and Closed Questions) 15. D (see page starting at 111, section titled Reflecting Skills) 16. A (see page 111, section titled Paraphrasing) 17. D (see page 117, section titled Summarizing) 18. D (see page starting at 106, section titled Asking Open and Closed Questions) 19. B (see page starting at 111, section titled Reflecting Skills) 20. B (see page starting at 115, section titled Reflecting Feelings) 21. A (see page starting at 111, section titled Reflecting Skills) 22. C (see page starting at 111, section titled Reflecting Skills) 23. C (see page starting at 115, section titled Reflecting Feelings) 24. B (see page 103, section titled Vocal Tone) Feedback for the essay question 1. Model response: Answers will vary, but should include some of the following points: body posture, silence, eye contact, vocal tone/speed, presence, use of minimizers, and nonverbal behaviors.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Model response: Answers will vary, but should include some of the following points: clients who may be experiencing shame, victims of crimes, and clients with high anxiety and/or paranoia.

3. Model response: Answers will vary, but should include some of the following points: in crisis situations, closed questions provide answers to assessment and baseline norms; often open questions may lead to premature exploration which may prevent thorough assessment. For example, suicide assessments and other risk assessments require definition and fact-based answers that must be discovered prior to exploration of feelings. Closed questions can also allow a sense of control for clients who may be experiencing a loss of control due to a crisis.

4. Model response: Answers will vary, but should include some of the following points: ―why‖ questions often are perceived as shaming/blaming a client and can put the client on the defense which may impact rapport between the client-counselor relationships.

5. Model response: Answers will vary, but should include some of the following points: use of summaries: beginning (to summarize a previous session to set the agenda of the current session or search for progress; middle of a session to refocus or control a session that lacks control or focus; or at the end of a session to summarize the aspects of the session and provide focus for time in between sessions.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

C ACREP Standards— Section 2:

Chapter

Learning Objective

Chapter 4

4.1 Apply essential crisis intervention microskills.

Learning Objective Quiz 4.1

4.2 Identify basic attending skills including eye contact, body position, vocal tone, and use of silence.

Learning Objective Quiz 4.2

4.3 Identify the basic listening sequence including asking open and closed questions and reflecting skills.

Learning Objective Quiz 4.3

F.2.a, F.2.c, F.2.g

[Q1, Q2. Q3]

F.7.c, F.5.m

Essential Crisis Intervention Skills

Professional Identity F.5.m

[Q1, Q2]

blank

F.1.b, F.1.c, F.1.d F.5.f, F.5.m

[Q1, Q2, Q3, Q4] Application Exercise 4.1

blank

F.5.f, F.5.i, F.7.b

Application Exercise 4.2 Application Exercise 4.3

blank

4.4 Describe basic

Learning Objective

F.2.a

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective deescalation skills to help clients regulate emotions.

C ACREP Standards— Section 2:

Exercises & Quizzes

Professional Identity

Quiz 4.4

F.2.b

[Q1]

F2.d F.2.g F.2.h F.5.j F.5.k F.5.l

Chapter 5 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University 19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 5: Loss, Grief, and Bereavement

1

Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 5: Loss, Grief, and Bereavement Chapter 5 Learning Outcome Quizzes Learning Objective 5.1: Describe historical and current perspectives and models of grief work.

[Q1] Erich Lindemann (1944) worked with many of the family members who lost a loved one in the 1942 Cocoanut Grove nightclub fire in Boston. Lindemann identified which three tasks of mourners?

1. (1) Emancipation from the bond to the deceased, (2) readjustment to a life in which the deceased is missing, and (3) formation of new relationships [correct] 2. (1) Emancipation from the bond to the deceased, (2) readjustment to a life in which the deceased is missing, and (3) formation of old relationships 3. (1) Lowering health-related issues, (2) readjustment to a life in which the deceased is missing, and (3) formation of old relationships 4. (1) Emancipation from the bond to the deceased, (2) involving family members, and (3) formation of old relationships [Feedback for Correct Answer 1] Erich Lindemann worked with many of the family members who lost a loved one in the 1942 Cocoanut Grove nightclub fire in Boston. Lindemann identified three tasks of mourners: (1) emancipation from the bond to the deceased, (2) readjustment to a life in which the deceased is missing, and (3) formation of new relationships [Feedback for Answer Choice 2] Formation of old relationships is not one of the three tasks of mourners.

[Feedback for Answer Choice 3] Lowering health-related issues is not one of the three tasks of mourners.

[Feedback for Answer Choice 4] Involving family members is not one of the three tasks of mourners.

[Q2] Worden believes that grieving requires effort, and those who do not take the time to work through the tasks of mourning delay the grief process. Delayed or masked grief reactions can complicate the mourning process. According to Worden (2018), grief that is repressed or denied can result in what?

1. The ability to empathize with others who have experienced losses 2. Substance use 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Aberrant behavior or physical symptoms [correct] 4. Relationship issues [Feedback for Answer Choice 1] It is hopeful that individuals can empathize with others who are also experiencing a loss. However, according to Worden (2018), grief that is repressed or denied does not necessarily result in individuals being able to empathize with others who have experienced losses.

[Feedback for Answer Choice 2] For some who are grieving, a maladaptive coping skill may be the use of a substance. However, according to Worden (2018), grief that is repressed or denied does not necessarily result in this.

[Feedback for Correct Answer 3] According to Worden (2018), grief that is repressed or denied can result in aberrant behavior or can cause physical symptoms. He notes that pain can be a symptom of repressed grief and that many people who are treated for somatoform disorders are really experiencing the pain of loss. This is particularly noticeable if the physical symptoms are like those experienced by the deceased.

[Feedback for Answer Choice 4] For some who are grieving, there may be the development of relationship strains.

However, according to Worden (2018), grief that is repressed or denied does not necessarily result in this.

Learning Objective 5.2: Describe cultural factors in grief work, ambiguous loss, and disenfranchised grief.

[Q1] In the fifth edition, text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-T R; American Psychiatric Association, 2022), what is defined as a healthy and normal reaction connected with a loss which should neither be identified as pathology nor requiring medical intervention?

1. Mourning [correct] 2. Grief 3. Bereavement 4. Ambiguous loss [Feedback for Correct Answer 1] Mourning is a healthy and normal reaction connected with a loss and should neither be identified as pathology nor requiring medical intervention.

[Feedback for Answer Choice 2] 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Grief is the broader term that applies to any loss circumstance.

[Feedback for Answer Choice 3] Bereavement is narrowly defined as the loss of a loved one with whom one has had a close relationship.

[Feedback for Answer Choice 4] Ambiguous losses are often not recognized by others as sharing similar grief reactions, thus leading the grief to becoming disenfranchised. In disenfranchised grief, the ability to move past the loss may be delayed.

[Q2] In the fifth edition, text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-T R; American Psychiatric Association, 2022), what is defined as the loss of a loved one with whom one has had a close relationship?

1. Mourning 2. Grief 3. Bereavement [correct] 4. Ambiguous loss [Feedback for Answer Choice 1] Mourning is a healthy and normal reaction connected with a loss and should neither be identified as pathology nor requiring medical intervention.

[Feedback for Answer Choice 2] Grief is the broader term that applies to any loss circumstance.

[Feedback for Correct Answer 3] Bereavement is narrowly defined as the loss of a loved one with whom one has had a close relationship.

[Feedback for Answer Choice 4] Ambiguous losses are often not recognized by others as sharing similar grief reactions, thus leading the grief to becoming disenfranchised. In disenfranchised grief, the ability to move past the loss may be delayed.

[Q3] Montserrat’s father was recently convicted and sentenced to 6 years in prison.

Montserrat has been experiencing overwhelming grief and adjustment issues from the separation of their father. It has been difficult for Montserrat’s friends to understand what Montserrat may be experiencing. Montserrat’s loss can be defined as what?

1. Mourning 2. Grief 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Bereavement 4. Ambiguous loss [correct] [Feedback for Answer Choice 1] Mourning is a healthy and normal reaction connected with a loss and should neither be identified as pathology nor requiring medical intervention.

[Feedback for Answer Choice 2] Grief is the broader term that applies to any loss circumstance.

[Feedback for Answer Choice 3] Bereavement is narrowly defined as the loss of a loved one with whom one has had a close relationship.

[Feedback for Correct Answer 4] Montserrat is likely experiencing an ambiguous loss since their peers and others are not able to understand their grief, which is connected to the incarceration of their father. Ambiguous losses are often not recognized by others as sharing similar grief reactions, thus leading the grief to becoming disenfranchised. In disenfranchised grief, the ability to move past the loss may be delayed.

Learning Objective 5.3: Understand factors that mediate the grief process in different types of loss.

[Q1] Prolonged or complicated bereavement occurs when symptoms are of unusual duration or severity and interfere with life activities. The DSM-5-TR (American Psychiatric Association, 2022) now includes which of the following as a classification of mental disorder?

1. Complex grief disorder 2. Persistent complex bereavement disorder [correct] 3. Adjustment disorder 4. Mood disorder [Feedback for Answer Choice 1] Complicated grief disorder is not a disorder outlined in the DSM-5-TR. [Feedback for Correct Answer 2] Persistent complex bereavement disorder is now a classification in the DSM-5-TR. [Feedback for Answer Choice 3] Adjustment disorders is a broad classification in the DSM-5-TR but is not the correct classification in this example.

[Feedback for Answer Choice 4] 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Mood disorders is a broad classification in the DSM-5-TR but is not the correct classification in this example.

[Q2] Jayme self-referred to a crisis clinic in the early stages of grief and mourning of her mother. At the completion of the assessment, the crisis counselor has not assessed any risk or abnormal dysfunction and notes that Jayme’s reactions appear within the normal reactions associated to the grief over the loss of one’s mother. What would be ineffective and potentially harmful for the crisis counselor to do at this time?

1. Make a referral for medication treatment or render a diagnosis that does not consider the normal reactions to a loss [correct] 2. Make a referral to longer-term counseling 3. Make a follow-up appointment 4. Provide a referral for a grief support group [Feedback for Correct Answer 1] When a person is in the early stages of grief and mourning, as seems to be the case in this situation with Jayme, it would be ineffective and potentially harmful to prematurely refer the client for medication treatment or render a diagnosis that does not consider the normal reactions to a loss, unless the client is experiencing severe dysfunction. The client appears to be grieving within the normal range for the loss she has experienced. Referral for medication may actually impede the healing process.

[Feedback for Answer Choice 2] Depending on all the variable presented, making a referral for longer-term counseling may be appropriate for the client.

[Feedback for Answer Choice 3] If additional support and time is needed, and the crisis counselor has the ability to make a follow-up appointment, this may be an appropriate option for the client.

[Feedback for Answer Choice 4] Grief support groups have been documented to be effective in the grief process for many clients experiencing grief. This may be an appropriate referral for this client.

Learning Objective 5.4: Describe effective interventions with various types of grief and across the lifespan.

[Q1] The FICA Spiritual Assessment Tool was developed by Christine Pulchaski to understand whether a patient’s religion and spirituality influences their holistic care.

FICA includes what four components?

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. (1) Faith, Belief, and Meaning; (2) Importance and Influence; (3) Community; (4) Apply and Address [correct] 2. (1) Faith, Belief, and Meaning; (2) Importance and Influence; (3) Church; (4) Apply and Address 3. (1) Faith, Belief; (2) Importance and Influence; (3) Community; (4) Apply and Address 4. (1) Faith, Belief, and Meaning; (2) Importance; (3) Community; (4) Apply and Address [Feedback for Correct Answer 1] FICA includes (1) Faith, Belief, and Meaning; (2) Importance and Influence; (3) Community; (4) Apply and Address.

[Feedback for Answer Choice 2] Missing from this answer is Community, and FICA does not refer to Church.

[Feedback for Answer Choice 3] Missing from this answer is Meaning.

[Feedback for Answer Choice 4] Missing from this answer is Influence.

Learning Objective 5.5: Assess difficulties in the grieving process.

[Q1] Participating in a client’s grieving process has a profound effect on crisis counselors, who must make sure that their own issues do not get in the way. Worden is particularly concerned with three specific areas that might affect a crisis counselor’s ability to be helpful: (1) Counselors with a similar loss that they have not worked through, (2) counselors working with a client’s loss when they fear a similar loss of their own, and 1. (3) faith trauma experienced by the counselor 2. (3) developmental issues that impact the counselor 3. (3) the counselor’s cultural influences of grief 4. (3) existential fears resulting from the counselor’s failure to come to terms with their own mortality.[correct] [Feedback for Answer Choice 1] A counselor’s potential faith trauma was not outlined as one of the three areas of Worden’s concern.

[Feedback for Answer Choice 2]

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Developmental issues were not outlined as one of the three areas of Worden’s concern.

[Feedback for Answer Choice 3] The counselor’s cultural influences of grief were not outlined as one of the three areas of Worden’s concern.

[Feedback for Correct Answer 4] Worden is particularly concerned about three specific areas that might affect a crisis counselor’s ability to be helpful: (1) counselors with a similar loss that they have not worked through, (2) counselors working with a client’s loss when they fear a similar loss of their own, and (3) existential fears resulting from the counselor’s failure to come to terms with their own mortality.

Learning Objective 5.6: Understand the components required for effective death notifications.

[Q1] A crisis team has been asked to provide assistance to first responders who are planning to provide death notifications to several families in a neighborhood where three teenagers were killed in an automobile accident. Immediately following the death notification, the crisis counselors would want to provide which of the following to the first responders in order to review the process of the death notification and any impact on them?

1. Referral to counseling to explore the related situation and impact on their mental health 2. Debriefing [correct] 3. Follow up with the counselors the following day 4. Pre-crisis briefing [Feedback for Answer Choice 1] A referral to counseling may be an option but it is not the first option immediately following the death notification.

[Feedback for Correct Answer 2] Debriefing with team members should occur immediately after the death notification.

This debriefing time should be used to plan for any follow-up and to review how the death notification process was implemented and received.

[Feedback for Answer Choice 3] A follow up with a counselor the following day may be an option after the debriefing is conducted but it is not the first option immediately following the death notification.

[Feedback for Answer Choice 4] 7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A pre-crisis briefing would be conducted prior to the death notification to share details of the situation for preparation purposes.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 5 Application Exercises Application Exercise 5.1 Learning Objective 5.4: Describe effective interventions with various types of grief and across the lifespan.

[Q1] Imagine you are working as a supervisor with a counselor who seems to be struggling with their personal faith and how it may impact their work with clients.

Using the FICA Spiritual Assessment Tool, what topics and questions would be important to explore with the counselor?

[Q1 Model Response] Some important questions would be generated around the following four components of FICA and may involve questions such as: (1) Faith, Belief, and Meaning: Do you consider yourself a spiritual or religious person? Where do you find meaning in life?

(2) Importance and Influence: How important is your faith to your life? How do your beliefs help you to cope in times of stress?

(3) Church and Community: Are you a part of a faith-based or religious community? If so, what type of support does this community provide?

(4) Apply and Address: How would you like me to address or apply this information in our work together?

[Q2] You are working with a child who has recently experienced the death of their grandmother. As a crisis counselor providing support and psychoeducation with the parents for their child, what things might you want to make sure the parents know to assist their child for effective grieving?

[Q2 Model Response] The information shared with parents should include the following: (1) Bereaved children need to have their questions answered in an age-appropriate way. They need to know that they were not responsible in any way for the death. (2) Children need to feel involved. Developing a ritual, allowing children to be involved in the funeral and including them in decision making are important. (3) Children’s routines should be kept as consistent as possible. (4) Children need a way to remember the deceased.

Learning Objective 5.6: Understand the components required for effective death notifications.

[Q3] 9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

You are providing training to a mobile crisis team on the most effective components to integrate into a death notification. What are these components?

[Q3 Model Response] (1) In person and in pairs: Whenever possible, death notifications should be made in person and in pairs. The human presence during the notification of the death of a loved one is essential. The presence of more than one person can be crucial if there is more than one survivor and in needing to meet the needs and reactions to multiple survivors. (2) In Time and with Accurate Information: Timeliness of a death notification is essential so that an individual is informed in person by the appropriate individual rather than by hearing it from a third party. At the same time, it is imperative to first verify the accuracy of the information to be sure that correct information regarding the correct person is being given to a survivor. This must be done in a short amount of time, given the nature of the event. (3) In Plain Language: It is important that the death notification be given to the survivor in a calm, direct, and simple manner by the crisis counselor. Too much or vague information can cause survivors to panic before getting the full, accurate information.

(4) With Compassion: Presence and compassion may be the only resources crisis counselors can provide during the initial death notification process. It is important for them to accept the survivor’s reactions and emotions to the death notification and also important to recognize their own emotions associated with the notification. (5) Follow-Up: Crisis counselors should always leave their names and phone numbers with survivors, or information on a referring counselor, and a follow-up contact with the survivor should be scheduled for the next day, since most funeral arrangements must be made soon after the death. (6) Debriefing with Team Members: Debriefing with team members should occur immediately after the death notification.

This debriefing time should be used to plan for any follow-up with the survivors and to review how the death notification process was implemented and received.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 5 Test Items Multiple Choice Questions 1. When developing a crisis plan or offering a referral, crisis counselors should attempt to understand A. how a loss can impact and cause other losses and how these multiple losses are perceived by the person experiencing the loss.

B. the timeframe of the loss.

C. if the person has stopped working.

D. if the person has moved residences.

2. Which of the following best describes Kubler-Ross’s five stages of death and dying?

A. People move through the stages consecutively.

B. Kubler-Ross later applied the same theory to grief and grieving.

C. Everyone experiences all five stages.

D. This is a task model.

3. The order of Kubler-Ross’s five stages of death and dying is A. denial, rage and anger, bargaining, depression, and acceptance.

B. denial, bargaining, rage and anger, depression, and acceptance.

C. rage, anger, bargaining, depression, and denial.

D. bargaining, depression, denial, rage, and anger.

4. Which of the following is TRUE of Worden’s task model of grieving?

A. There are seven tasks of grieving that must be accomplished.

B. Experiencing and working through the pain is an important task.

C. It is basically the same model as Kubler-Ross’s stage theory.

D. None of the above.

5.

are universal reactions to grief and loss.

A. Tears, depressed mood, anger, and disorganization B. Tears, depressed mood, anger, and wanting to join the deceased C. Tears, depressed mood, anger, and celebration of life D. Tears, depressed mood, anger, and naming children after the deceased

6.

is a culturally specific reaction to grief and loss.

A. Naming a child after the deceased B. Isolating relatives into a special area 11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. Self-injury or destroying photos of the deceased D. All of the above.

7.

are coping skills helpful to someone grieving a loss.

A. Spirituality and religion B. Exercise C. Cognitive behavioral therapy D. All of the above.

8.

is not an example of ambiguous loss.

A. The kidnapping of a child B. Alzheimer’s disease C. Infertility D. Death by suicide

9. The loss of a pet can be as upsetting as the loss of a loved one. Which of the following is NOT a true statement?

A. For some people, especially the elderly, the pet is a daily (and sometimes only) source of love.

B. Pets can provide affection and unconditional love.

C. Most people love their pets more than their family members.

D. Caring for a pet provides a reason to carry on.

10. Which of the following is NOT an appropriate way to work with a grieving child?

A. Help them to develop a ritual surrounding the loss of a parent.

B. Encourage returning to routines as soon as possible.

C. Put photos and photo albums around the house so they can remember their loved one.

D. Encourage the bereaved parent to remarry so life can get back to normal as soon as possible.

11. Which of the following is a challenge for counselors who provide crisis counseling?

A. Keeping one’s own feelings and experiences about death separate.

B. Empathizing too deeply with the client’s grief.

C. Compassion fatigue.

D. All of the above.

12. Which of the following would be consistent with Carl Rogers’s beliefs about working with a bereaved client?

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. Accompany the client to the funeral or memorial service.

B. Identify cognitive distortions that are interfering with the grieving process.

C. Be fully present and responsive to the needs of the bereaved.

D. Help the client find appropriate distractions from their loss.

13. What should crisis counselors do to address their own issues surrounding grief and loss?

A. Share their own grief experiences with clients.

B. Seek supervision.

C. Avoid working with grieving clients until their own issues have been addressed.

D. Refer clients to someone who specializes in grief and loss.

14. The acronym

represents a four question spiritual assessment.

A. LOSS B. FICA C. PETA D. BOLA 15. Which of the following items could be helpful for children who have lost a parent?

A. Participating in funeral arrangements and viewing photos of the deceased.

B. Keeping a transitional object that belonged to the parent.

C. Maintaining stability in the home during the first year after the death.

D. All of the above.

16. Death by suicide creates special circumstances for the bereaved in addition to the loss of their loved one. Which of the following is NOT TRUE? A. Some people might blame the family for the death.

B. People don’t know what to say to the bereaved.

C. Death by suicide brings up concerns about one’s own mortality.

D. Family members might disagree on disclosing cause of death.

17. Counselors traditionally have become involved with death notifications A. as part of a team called to give a death notification.

B. to brief a team who has given a death notification.

C. after a death and as part of the counseling process.

D. None of the above.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

18. The DSM-5-TR recommends considering the following diagnostic impression when working with someone showing symptoms of ―complicated grief‖ due to the death of a loved one.

A. Other specified trauma- and stressor-related disorder (e.g., persistent complex bereavement disorder) B. Major depressive disorder C. Bipolar disorder D. Anxiety disorder 19. Death notifications should be conducted A. in person and in pairs.

B. in person and alone.

C. over the phone.

D. None of the above.

20. When working in a team with law enforcement, the main role of the crisis counselor is A. to be the point person to give the notification.

B. to be a support needed for the law enforcement officer.

C. there is no reason for a counselor to ever be in involved with law enforcement for the purpose of giving a death notification.

D. None of the above.

21. When giving a death notification, the information must be A. in plain language and with specific details of the death.

B. timely and with accurate information.

C. timeliness is not as important as is the accuracy of the information.

D. accuracy of information is not as important as timeliness of the information.

22. Use of technology, rather than ―in person‖ death notifications should A. never be used.

B. be used with the same guidelines as outlined in the text.

C. be used with additional support for the survivor if permitted.

D. None of the above.

23. When giving a death notification, you should take into account A. the age of the survivors.

B. the developmental and neurological states of the survivors.

C. violent history, if known.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. All of the above.

24. When giving a death notification, you should A. use vague statements about the death so as not to overwhelm a person.

B. use specific language so not to mislead or confuse the survivor.

C. go alone.

D. None of the above.

25. Debriefings A. are not needed after each death notification if they seemed to go well.

B. should always be conducted after a death notification.

C. can be done at a monthly team meeting to assess multiple death notifications.

D. All of the above.

26. During a death notification, counselors can assist by A. normalizing the reactions that each family member may express.

B. driving the survivor to the hospital.

C. All of the above.

D. None of the above.

Extended Response Questions 1. Describe the symptoms of ―normal‖ bereavement.

2. Describe Kubler-Ross’s five stages of death and dying.

3. How is working with bereaved children different than working with adults? What considerations must be factored in?

4. What is the change in the DSM-5 that addresses complicated grief?

5. Describe elements that should be integrated into making the most effective death notification.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 5 Test Answer Key Multiple Choice Answer Key: 1. A (see page 124, section titled Historical and Current Perspectives and Models of Grief Work) 2. B (see page 125, section titled The Death Awareness Movement: Kübler-Ross) 3. A (see page 125, section titled The Death Awareness Movement: Kübler-Ross) 4. B (see page 125, section titled The Death Awareness Movement: Kübler-Ross) 5. A (see page 128, section titled Attachment and Loss) 6. A (see page 129, section titled Understanding Grief) 7. D (see page 129, section titled Understanding Grief) 8. D (see page 130, section titled Ambiguous Loss and Disenfranchised Grief) 9. C (see page 130, section titled Ambiguous Loss and Disenfranchised Grief) 10. D (see page 147, section titled Working with Children) 11. D (see page 154, section titled Counseling the Crisis Counselor) 12. C (see page 137, section titled Normal versus Complicated Bereavement and the D SM-5-TR) 13. B (see page 130, section titled Ambiguous Loss and Disenfranchised Grief) 14. B (see page 141, section titled Restoring Life’s Meaning) 15. D (see page 147, section titled Working with Children) 16. C (see page 147, section titled Working with Children) 17. C (see page starting at 154, section titled Effective Death Notifications) 18. A (see page 137, section titled Normal versus Complicated Bereavement and the D SM-5-TR) 19. A (see page starting at 154, section titled Effective Death Notifications) 20. B (see page starting at 154, section titled Effective Death Notifications) 21. B (see page starting at 154, section titled Effective Death Notifications) 22. C (see page starting at 154, section titled Effective Death Notifications) 23. D (see page starting at 154, section titled Effective Death Notifications) 24. B (see page starting at 154, section titled Effective Death Notifications) 25. B (see page starting at 154, section titled Effective Death Notifications) 26. A (see page starting at 154, section titled Effective Death Notifications) Feedback for the essay question: 16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Model response: Answers will vary, but should include some of the following points: new DSM-5-TR definition of normal bereavement, symptoms and duration of bereavement and when the symptoms exceed normal bereavement.

2. Model response: Answers will vary, but should include some of the following points: the original purpose of the model (a model for caregivers); what a stage model is compared to a task model; the specific stages and a description of each stage (denial, rage/anger, bargaining, depression, acceptance).

3. Model response: Answers will vary, but should include some of the following points: developmental differences in children and adults; adults misunderstanding the needs of children and bereavement; impact of relationship and cause of death; death of animals as instrumental in the death process; perceived guilt associated with death; decision to attend and participate in burial rituals; consistency of facts in information given to children; parents should understand the need for children to remember the deceased and importance of staying to routines for healing.

4. Model response: Answers will vary, but should include some of the following points: the major difference is the inclusion of bereavement as a normal reaction. New diagnostic impression of other specified trauma- and stressor-related disorder (e.g., persistent complex bereavement disorder) should be considered for complicated grief/bereavement. With this diagnosis, and explanation of the symptoms, duration, and severity should be included. Other losses due to trauma can also be included in this diagnosis.

5. Model response: Answers will vary, but should include some of the following points in person and in pairs; in time and with accurate information; in plain language; with compassion; follow up; and debriefing team members.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

C ACREP Standards— Section 2:

Chapter

Learning Objective

Chapter 5

5.1 Describe Learning historical and Objective Quiz current perspectives 5.1 [Q1, Q2] and models of grief work.

F.1.a, F.2.a, F,2,b, F.2.d, F.3.a, F.3.g, F.2.h, F 7.c.

5.2 Describe cultural factors in grief work, ambiguous loss, and disenfranchised grief.

Learning Objective Quiz 5.2

F.2.c, F.2.e, F.2.f

5.3 Understand factors that mediate the grief process in different types of loss.

Learning Objective Quiz 5.3 [Q1, Q2]

F.3.g,F.3.a, F.3.f

5.4 Describe effective interventions with various types of

Learning Objective Quiz 5.4

F.3.g

Loss, Grief, and Bereavement

Professional Identity

blank

[Q1, Q2, Q3]

blank

blank

Section 5. CMHC: 5C.3.a, 5C.3b

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective grief and across the lifespan.

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

[Q1] Application Exercise 5.1 Application Exercise 5.2

blank

5.5 Assess difficulties in the grieving process.

Learning Objective Quiz 5.5

F.3.g, F.2.d

[Q1] blank

5.6 Understand the components required for effective death notifications.

Learning Objective Quiz 5.6

F.2.b, F.2.d

[Q1] Application Exercise 5.3

Chapter 6 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition 19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 6: Risk Assessment and Intervention: Suicide, Non-suicidal SelfInjury, and Homicide

1

Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 6: Risk Assessment and Intervention: Suicide, Non-suicidal Self-Injury, and Homicide Chapter 6 Learning Outcome Quizzes Learning Objective 6.1: Describe the prevalence and rates of suicide, homicide, and NSSI [Q1] The use of terminology is important when discussing suicide since the language chosen could reflect personal attitudes and affect those impacted by suicide. Once common language, ―committing suicide‖ is now less acceptable, as it implies a negative perspective of the person. What is an example of more acceptable language?

1. Died by/of suicide [correct] 2. Committed suicide 3. Unsuccessful attempt 4. Suicide attempter [Feedback for Correct Answer 1] The use of terminology is important when discussing suicide since the language chosen could reflect personal attitudes and affect those impacted by suicide. If we define a person solely by the label of a mental illness, we diminish the whole person.

Died by suicide is the more acceptable language.

[Feedback for Answer Choice 2] The use of terminology is important when discussing suicide since the language chosen could reflect personal attitudes and affect those impacted by suicide. The phrase ―committed suicide,‖ although once common, is less acceptable as it implies a negative perspective of the person.

[Feedback for Answer Choice 3] The use of terminology is important when discussing suicide since the language chosen could reflect personal attitudes and affect those impacted by suicide. The phrase ―unsuccessful attempt,‖ although once common, is less acceptable as it implies a negative perspective of the person.

[Feedback for Answer Choice 4] The use of terminology is important when discussing suicide since the language chosen could reflect personal attitudes and affect those impacted by suicide. The phrase ―suicide attempter‖ is less acceptable as it implies a negative perspective of the person.

1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Learning Objective 6.2: Describe risk factors, protective factors, and warning signs of suicide.

[Q1] Risk factors increase the likelihood of a person experiencing suicidal thoughts or behaviors. Risk factors are often seen as the absence of something but may include underlying meaning-related factors that often increase risk lethality. Although agencies and clinicians may have different ways to inquire about risk factors, risk factors are placed into what three main categories?

1. Health factors, environmental factors, and historical factors [correct] 2. Health factors, medical factors, and historical factors 3. Health factors, environmental factors, and protective factors 4. Protective factors, environmental factors, and historical factors [Feedback for Correct Answer 1] Risk factors increase the likelihood of a person experiencing suicidal thoughts or behaviors. Although agencies and clinicians may have different ways to inquire about risk factors, risk factors are placed into three main categories: Health factors, environmental factors, and historical factors.

[Feedback for Answer Choice 2] Environmental factors are missing in this answer.

[Feedback for Answer Choice 3] Historical factors are missing in this answer.

[Feedback for Answer Choice 4] Health factors are missing in this answer.

[Q2] Talking about wanting to die; researching methods of dying, preparations, or rehearsal of taking one’s own life; talking about feeling hopeless or having no purpose; self-hate statements; talking about being a burden to others; and recent hospital discharge are examples of which of the following?

1. Protective factors 2. Lethality signs 3. Warning signs [correct] 4. Environmental factors [Feedback for Answer Choice 1] Protective factors are those factors that prevent the person from following through on taking their life. This is not the correct answer.

2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] Level of lethality is the result of assessing risk and protective factors and warning signs. This is not the correct answer.

[Feedback for Correct Answer 3] Aside from assessment of risk, counselors should be aware of various warning signs that a client may present and provide psychoeducation and information to family members and friends. The above examples are warning signs.

[Feedback for Answer Choice 4] Environmental factors are a category of risk factors used to assess suicide lethality.

This is not the correct answer.

Learning Objective 6.3: Distinguish between acute and chronic suicidal risk.

[Q1] An individual who reports or presents with a desire to die in a foreseeable time frame—usually 24 hours or less with statements about a specific plan, intent, means, and method—is considered as which of the following?

1. Chronic suicidal risk 2. Acute suicidal risk [correct] 3. Moderate suicidal risk 4. Low suicidal risk [Feedback for Answer Choice 1] Individuals with chronic risk can be described as having ―markers‖ of a potential suicide risk that is not currently imminent. In other words, individuals may present with some identifiers of persons who could become acutely suicidal but are not currently in imminent danger.

[Feedback for Correct Answer 2] Individuals with acute risk are those who present or report with a desire to die in a foreseeable time frame—usually 24 hours or less—with statements about a specific plan, intent, means, and method. These have a high lethality and should have a priority for safety.

[Feedback for Answer Choice 3] Individuals with moderate suicidal risk can be described as having ―markers‖ of a potential suicide risk but suicide is likely not currently imminent. In other words, individuals may present with some identifiers of persons who could become acutely suicidal but are not currently in imminent danger.

[Feedback for Answer Choice 4]

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Individuals with low suicidal risk can be described as having ―markers‖ of a potential suicide risk but suicide is likely not currently imminent. In other words, individuals may present with some identifiers of persons who are more likely to have some chronic risk suicidal but are not currently in imminent danger.

[Q2] Individuals described as having ―markers‖ of a potential suicide risk over a period of time but are likely not in imminent danger are considered as which of the following?

1. Chronic suicidal risk [correct] 2. Acute suicidal risk 3. Moderate suicidal risk 4. Low suicidal risk [Feedback for Correct Answer 1] Individuals with chronic risk can be described as having ―markers‖ of a potential suicide risk over a period of time that is not currently imminent. In other words, individuals may present with some identifiers of persons who could become acutely suicidal but are not currently in imminent danger.

[Feedback for Answer Choice 2] Individuals with acute risk are those who present or report with a desire to die in a foreseeable time frame—usually 24 hours or less—with statements about a specific plan, intent, means, and method. These have a high lethality and should have a priority for safety.

[Feedback for Answer Choice 3] Individuals with moderate suicidal risk can be described as having ―markers‖ of a potential suicide risk but suicide is likely not currently imminent. Due to not having the information to determine if this is also chronic, this is not the best answer.

[Feedback for Answer Choice 4] Individuals with low suicidal risk can be described as having ―markers‖ of a potential suicide risk but is likely not currently imminent. The person may or may not be chronic. Due to not having the information to determine if this is also chronic, this is not the best answer.

Learning Objective 6.4: Describe how counselors assess a client’s suicidal risk as no, low, moderate, or high.

[Q1] The field has produced a variety of acronyms to assist counselors in recalling risk and protective factors and warning signs during suicide assessments. Although they should not replace a formal model and Q-tree, they may be helpful in gathering 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

information on risk and protective factors. IS PATH WARM is an acronym for which of the following?

1. Ideation, Suicide, Purpose, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Reckless, and Mood 2. Ideation, Substances, Plan, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Reckless, and Mood 3. Ideation, Substances, Purpose, Anxiety, Trapped, Hopefulness, Withdrawal, Anger, Reckless, and Mood 4. Ideation, Substances, Purpose, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Reckless, and Mood [correct] [Feedback for Answer Choice 1] Suicide is not part of IS PATH WARM. [Feedback for Answer Choice 2] Plan is not part of IS PATH WARM. [Feedback for Answer Choice 3] Hopefulness is not part of IS PATH WARM. [Feedback for Correct Answer 4] IS PATH WARM is an acronym for Ideation, Substances, Purpose, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Reckless, and Mood.

Learning Objective 6.5: Describe effective questions and assessment strategies for suicide intervention.

[Q1] Madison received a referral for a new client from the intake coordinator at the crisis clinic. The intake assessment done by the intake coordinator does not indicate any suicide intentions. What should Madison do regarding a risk assessment?

1. Madison does not have to do a risk assessment since the intake coordinator should have done the risk assessment.

2. Madison only needs to do a risk assessment if the client reports any risk in the session.

3. Madison should do a risk assessment in the beginning of the session, regardless of whether the intake person did a risk assessment. [correct] 4. Madison can gauge the risk assessment and provide one throughout the session if needed.

[Feedback for Answer Choice 1] Madison should not rely on another professional to have completed a thorough risk assessment, even if it is documented on the intake form.

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] Madison should not rely on the client’s report of any suicide intentions to proceed with a risk assessment. As a counselor Madison has the duty of care to provide a thorough risk assessment.

[Feedback for Correct Answer 3] A suicide risk assessment should always begin at the first session in counseling, and it should be the main assessment goal in any crisis, regardless of whether the intake person also conducted a risk assessment. It is Madison’s due diligence to provide the risk assessment and she could be held negligent if she did not provide one for the client and the client attempted or took their own life. A standard of care in our profession is to not only provide a risk assessment of every person, regardless of the client’s presenting problem, but also to have a framework (model) upon which to base the assessment.

[Feedback for Answer Choice 4] Leaving a suicide risk assessment at the end of the session may not allow for a thorough assessment.

Learning Objective 6.6: Describe appropriate treatment planning and care management with a suicidal client, including a safety plan, outpatient and inpatient treatment, and postvention.

[Q1] Glynn is constructing a safety plan with a client who is having vague thoughts of wanting to take their own life. The plan should include which of the following main components after identifying specific risk?

1. Resources, actions, and coping mechanisms [correct] 2. Resources, actions, and referrals 3. Resources, maladaptive affect, and coping mechanisms 4. Model for assessing risk, actions, and coping mechanisms [Feedback for Correct Answer 1] Safety plans should always involve resources, actions, and coping mechanisms that the client is able and willing to put into place, that are specific to the situation, and that are written with clear behaviorally specific verbiage.

[Feedback for Answer Choice 2] A referral may be part of the resources but is not one of the main components. In addition, coping mechanisms is missing from the safety plan.

[Feedback for Answer Choice 3] Maladaptive affect is not one of the three components in the safety plan. In addition, actions is missing from the safety plan.

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 4] Using a model for assessing risk is a standard of care needed to be completed by the counselor but is not one of the three components in the safety plan. In addition, resources is missing from the safety plan.

Learning Objective 6.7: Describe assessments and treatment for NSSI, including the use of a Q-tree.

[Q1] Nafin, a crisis counselor, is conducting an NSSI assessment with a client. Using the Q-tree model for the assessment, she asks the client if they ―ever found a wound they had no recollection of inflicting?” This question seeks to gather what information?

1. Basic information 2. Contextual information [correct] 3. Functioning information 4. Coping information [Feedback for Answer Choice 1] This question is not a question that is seeking basic information.

[Feedback for Correct Answer 2] According to Wester and Trepal (2017), the NSSI assessment should gather: (1) basic information, (2) contextual information, and (3) functional/reasoning information. Upon gathering this information and assessing NSSI risk, a crisis counselor can provide effective referral for a client. Contextual information builds on the basic reporting of NSSI behaviors and seeks to gather additional information regarding the context of the behavior. This is an example of contextual information.

[Feedback for Answer Choice 3] This question is not a question that is seeking functioning information.

[Feedback for Answer Choice 4] Coping may be part of the overall assessment but is not one of the three NSSI information seeking categories.

Learning Objective 6.8: Describe threat assessment and treatment options for intervention with people who are homicidal or are threats to others.

[Q1] A high level of threat is which of the following?

1. The threat suggests that concrete steps have been taken toward carrying it out. [correct] 7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. The threat suggests that the person issuing the threat has given some thought to how the act will be carried out.

3. The threat is vague and indirect.

4. Information contained within the threat is inconsistent.

[Feedback for Correct Answer 1] A high level of threat is a threat that appears to pose an imminent and serious danger to the safety of others; it includes a direct, specific, plausible plan, and suggests that concrete steps have been taken toward carrying it out.

[Feedback for Answer Choice 2] A threat that could be carried out, although it may not appear to be entirely realistic; has some thought to how the act will be carried out but not definitive; may include possible place and time (although not detailed plan); and includes no strong indication that the person who issued the threat has taken preparatory steps is considered a moderate level of threat.

[Feedback for Answer Choice 3] A threat that poses a minimal risk to victim and public safety; is vague and indirect; is inconsistent with the details; lacks realism; and suggests the person is unlikely to carry it out is considered a low level of threat.

[Feedback for Answer Choice 4] A threat that poses a minimal risk to victim and public safety; is vague and indirect; is inconsistent with the details; lacks realism; and suggests the person is unlikely to carry it out is considered a low level of threat.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 6 Application Exercises Application Exercise 6.1 Learning Objective 6.2: Describe risk factors, protective factors, and warning signs of suicide.

[Q1] You are a crisis counselor in the community who has been asked to provide a training on risk assessment. You are discussing risk and protective factors. What is essential to relay regarding this information?

[Q1 Model Response] To make an appropriate lethality assessment, counselors must ask about risk and protective factors, which are individualized and depend on unique client circumstances. Therefore, no single risk or protective factor can be used across clients to indicate certain lethality and risk. Risk factors increase the likelihood of a person experiencing suicidal thoughts or behaviors. Risk factors are often seen as the absence of something (e.g., supports, medication compliance, medical wellness, loss of loved ones) but may include underlying meaning-related factors (e.g., feelings of guilt/shame, abandonment, being a burden) that often increase risk lethality. Health, environment, and historical factors are important risk factors to review. Protective factors make a client less likely to engage in suicidal behavior.

Protective factors can also promote resilience and ensure connectedness with others during difficult times, thereby making suicidal behaviors less likely. Often, the factors listed as risk factors for some clients may also be protective factors.

Application Exercise 6.2 Learning Objective 6.6: Describe appropriate treatment planning and care management with a suicidal client, including a safety plan, outpatient and inpatient treatment, and postvention.

[Q2] Refer to Pearson eTextbook Video Example 6.4. Dr. Sommers-Flannagan develops a collaborative safety plan with a 15-year-old client. What important components were listed in the safety plan?

[Q2 Model Response] The answer should include components of warning signs (crying without being able to stop, parents arguing, feeling like she cannot get out of bed), risk factors (plan and means to take her life and access to the means), and protective factors (removing herself from the home when parents argue, reaching out to specific friends, her counselor, hotlines, etc.). It is also important to note the counselor

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

involved the client and looked at various options, made a copy for the client, and reviewed what they spoke about in session.

Application Exercise 6.3 Learning Objective 6.7: Describe assessments and treatment for NSSI, including the use of a Q-tree.

[Q3] Why is it now a standard of care to assess for NSSI with clients? What are the key aspects to include in an NSSI assessment?

[Q3 Model Response] The high correlation of NSSI and future suicide attempts prompted the D SM-5-TR (American Psychiatric Association, 2022) to add suicidal behavior and NSSI into section 2, ―other conditions that may be a focus of clinical attention.‖ Furthermore, it is a standard of care to integrate an NSSI assessment as part of all suicide risk assessments. It is essential to understand the intentions of those who participate in NSSI to properly assess intent, implement the most effective treatment strategy, or appropriately refer to additional care. Just as with suicidal risk assessment, the counselor should weigh the risk factors and protective factors to gather all the information required for treatment planning and referral. As a note, often NSSI behaviors can serve as protective factors so the counselor is cautioned to not eliminate NSSI behaviors without evaluating the impact of stopping the NSSI behavior, or exploring the elimination, as this could increase suicidal thoughts or behaviors.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 6 Test Items Multiple Choice Questions 1. The National Director of the Council for Suicide Education (fictitious title) should use the following statement when giving a public address: A. Over 46,000 people in the United States died by suicide.

B. Over 46,000 people in the United States chose to end their lives.

C. Over 46,000 in the United States killed themselves.

D. Over 46,000 in the United States committed suicide.

2. Rate has to do with the number of people in a uniformly sized group in the population so that comparisons can be made across different at-risk groups.

Which is the correct value below that is always associated with rate, as it relates to suicide or illness categories.

A. 12th B. 12.0 C. 10,000 D. 100,000 3.

are considered high risk for suicide.

A. Persons who have previously attempted suicide B. The elderly C. Native Americans D. All of the above.

4.

is considered a warning sign of suicidal risk.

A. Identifying as a survivor of abuse B. A family member who has attempted suicide C. Stable mood or behaviors D. Giving things away

5. In order of highest risk to lowest risk, which of the following is accurate, according to the NSPL concepts related to desire, intent, capability, and buffers?

A. Desire without buffers is considered high risk.

B. Desire plus capability with buffers is considered low risk.

C. Desire plus intent with buffers is considered high risk.

D. Desire plus capability plus intent is considered the highest risk with or without buffers.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

6. Among the many challenges for the clinician when assessing and managing suicide risk, the is NOT a concern.

A. limited availability of quality suicide intervention resources from the Internet, books, monographs, and research on best practices B. risk assessment that depends on good clinical judgment C. counselor’s internal emotional reaction (as per the Core Competencies for Assessing and Managing Suicide Risk by the A AS/SPRC) D. tension between managing the counselor’s goal to intervene and the client’s goal to end pain through suicide 7. Which of the following is accurately paired as acute or chronic?

ACUTE

CHRONIC

A. Has reasons for living

has suicidal intent

B. Recent suicidal behavior/thoughts

relationship problems, no intent, no plan

C. Has no organized plan for suicide

high risk in hours or days

D. Long history of problems

recent loss or significant stressor

8. Postvention involves A. assisting survivors of suicide loss after a suicide has occurred.

B. assisting individuals who have attempted suicide.

C. advocacy activities that survivors of suicide loss can do to assist in prevention.

D. All of the above.

9. Of the options listed below, is considered the LEAST valid treatment option for an acute risk client.

A. measures put in place to remove means B. including a family member about safety planning C. a paper signed by the client that he or she will not hurt oneself D. considering a higher level of care 10. Crisis counselors who assist family members or friends after a suicide might expect indications of all of the following EXCEPT signs of A. trauma.

B. elevated trust in the professional community at the scene of the suicide.

C. elevated risk of suicide.

D. complicated mourning.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

11. It is now a standard of practice to conduct a suicide risk and NSSI A. during the same session.

B. only if there are signs of NSSI. C. an NSSI is not required.

D. you should not overwhelm the client with both assessments.

12. The Q-tree approach for NSSI includes gathering the following.

A. Basic information; contextual information, and; functional/reasoning information B. Basic information; extended information, and; functional/reasoning information C. Basic information; contextual information, and; extended information D. Basic information; contextual information, and; functional/reasoning information 13. A brief nine-session intervention to treat NSSI behaviors in young adults without borderline personality disorder that can be used as a standalone treatment or an adjunctive intervention is A. CBT. B. DBT. C. T-SIB. D. meditation.

14. The primary motivation for school shootings appears to be A. academic problems.

B. school culture.

C. interpersonal rejection.

D. community mores.

15. The majority of workplace homicides involve A. love triangles.

B. robberies.

C. salary disputes.

D. fired employees.

16. According to the CDC, all of the following are dangerous workplace risk factors EXCEPT A. working from home.

B. driving a taxi.

C. contact with the public.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. working late at night.

17. ―I hate my mother-in-law. Sometimes I imagine what it would be like to run her down with my car. Seriously! I could take her out.‖ This indicates which level of threat?

A. Lethal B. Nonexistent C. Medium D. Low 18. Medium level threat clients A. do not need to be monitored but should schedule a follow up session.

B. should be hospitalized immediately.

C. pose no threat.

D. should be monitored and may need to be hospitalized.

19. The highest risk of violent and homicidal behavior has been found in individuals with A. A diagnosis of social anxiety.

B. a dual diagnosis of substance abuse and anti-social personality disorder.

C. a diagnosis of schizophrenia.

D. a dual diagnosis of depression and borderline personality disorder.

20. It is crucial that

be emphasized when working with homicidal clients.

A. goals for the future B. self-esteem C. values D. compliance with medication 21. When homicide survivors feel a sense of unfairness regarding the justice system, it may be helpful for them to A. let go and move on.

B. avoid discussing specifics of the murder for one year.

C. advocate for change.

D. seek individual rather than group counseling.

22. Suicidal individuals who evidences that he or she may hurt himself or herself in 24 hours or less, stating specificity about a plan, intent, means, and method are considered A. chronic risk.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. acute risk.

C. sub-acute risk.

D. minimal risk.

Extended Response Questions 1. Discuss your ideas for how faith-based communities could enhance their responsiveness to persons at risk for suicide.

2. Elaborate on the connection among suicide prevention, intervention, and postvention. Offer ideas about how mental health professionals can use their advocacy skills and/or consultative skills in any of these arenas.

3. Regarding Tarasoff v. Board of Regents of the University of California, explain how this case has influenced practice and ethical codes in respect to public protection. In what ways might state laws diverge from ethical codes regarding duty to warn?

4. Provide examples of indicators that could be used for threat assessment in the workplace.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 6 Test Answer Key Multiple Choice Answer Key: 1. A (see page 166, section titled Suicide Terminology) 2. D (see page 164, section titled Prevalence and Rates of Suicide, Homicide, and NS SI) 3. D (see page 164, section titled Prevalence and Rates of Suicide, Homicide, and NS SI) 4. D (see page 170, section titled Warning Signs) 5. D (see page starting at 167, section titled Risk Factors) 6. A (see page starting at 167, section titled Risk Factors) 7. A (see page 170, section titled Acute and Chronic Suicidal Risk) 8. D (see page 187, section titled Postvention) 9. C (see page 182, section titled Safety Plan) 10. B (see page 187, section titled Postvention) 11. A (see page 191, section titled Non-suicidal Self-Injury) 12. D (see page 192, section titled Non-suicidal Self-Injury) 13. C (see page 193, section titles Treatment Approaches) 14. C (see page 197, section titled School Homicide and Violence) 15. B (see page 200, section titled Workplace Violence and Homicide) 16. A (see page 200, section titled Workplace Violence and Homicide) 17. C (see page 201, section titled Threat Level Assessment) 18. D (see page 201, section titled Threat Level Assessment) 19. B (see page 201, section titled Threat Level Assessment) 20. D (see page 201, section titled Threat Level Assessment) 21. C (see page 201, section titled Threat Level Assessment) 22. B (see page 170, section titled Acute and Chronic Suicidal Risk) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: The response should include information on the importance of faith—communities to have referrals and resources available; importance of being nonjudgmental even if faith conflicts with suicide impact; to offer education and awareness to members.

2. Model response: Answers will vary, but should include some of the following points: preventative measures can include awareness and information to start opening up 16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

dialogue and breaking down taboos of suicide; intervention plans should be set up prior to a suicide and can include assessment information, how to identify someone who may be suicidal, having referrals and resources available for the suicidal individuals/family members/children, etc. Like preventative measures, postvention may include various support groups for families and resources for individuals.

3. Model response: Answers will vary, but should include some of the following points: in many states, some aspect of Tarasoff allows for the break in confidentiality when a person is at risk of killing himself/ herself (duty to protect) or if a person is identified as the victim of homicide based on reliable source (duty to warn). In duty to warn, the laws may differ depending on the reliability of the person giving the information, the intent of follow through, if preparatory behaviors have not been proven, and if there is no identifiable person to warn.

4. Model response: Answers will vary, but should include some of the following points: the threat being direct/plausible, the source being reliable, preparatory behaviors are reported or assessed, prior attempt are evident/assessed, and/or if steps have been taken to carry out the plan.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A),

Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter Chapter 6 Risk Assessment and Intervention: Suicide, Nonsuicidal SelfInjury, and Homicide

Learning Objective

Exercises & Quizzes

6.1 Describe the prevalence and rates of suicide, homicide, and NS SI.

Learning Objective Quiz 6.1

6.2 Describe risk factors, protective factors, and warning signs of suicide.

Learning Objective Quiz 6.2

C ACREP Standards— Section 2: Professional Identity Section 5 School Counseling: 5G.2.g

[Q1]

Blank

[Q1, Q2] Application Exercise 6.1

F 3.5.l, F 7.c.

Section 5. CMHC: 5C.3.a, 5C.3b Section 5 School Counseling: 5G.2.g

Blank

6.3 Distinguish between acute and chronic suicidal risk.

Learning Objective Quiz 6.3

F 7.c.

[Q1, Q2]

Section 5 School Counseling: 5G.2.g

Section 5. CMHC: 5C.3.a, 5C.3b

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

6.4 Describe how counselors assess a client’s suicidal risk as no, low, moderate, or high.

Learning Objective Quiz 6.4

6.5 Describe effective questions and assessment strategies for suicide intervention.

Learning Objective Quiz 6.5

6.6 Describe appropriate treatment planning and care management with a suicidal client, including a safety plan, outpatient and inpatient treatment, and postevention.

Learning Objective Quiz 6.6

6.7 Describe assessments and treatment for NSS I, including the use of a Q-tree.

Learning Objective Quiz 6.7

C ACREP Standards— Section 2: Professional Identity

Blank

F 3.5.l, F 7.c.

Section 5 CMHC: 5C.3.a, 5C.3.b,

[Q1]

Blank

F 3.5.l, F 7.c.

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

Blank

F 3.5.l Section 5. CMHC: 5C.3.a, 5C.3.5C.2.c

[Q1] Application Exercise 6.2

Blank

F 3.5.l, F 7.c.

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1] Application Exercise 6.3

Blank

6.8 Describe threat assessment and treatment options for intervention with people who are homicidal or are threats to others.

Learning Objective Quiz 6.8

F 7.c.

Section 5. CMHC: 5C.2.c

[Q1]

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 7 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 7: Understanding and Treating Substance Use Disorders with Clients in Crisis

1

Learning Outcome Quizzes

1

Application Exercises

8

Test Items

10

Test Answer Key

14

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 7: Understanding and Treating Substance Use Disorders with Clients in Crisis Chapter 7 Learning Outcome Quizzes Learning Objective 7.1: Understand the nature of and importance of substance use in society, including classification of drugs and current research.

[Q1] The Comprehensive Drug Abuse Prevention and Control Act of 1970 classified controlled drugs into five schedules based on a continuum of potential for abuse, accepted medical use, and potential for dependence. Which of the following have the highest potential for abuse and dependence and have no current medical application in the United States?

1. Schedule I [correct] 2. Schedule II 3. Schedule IV 4. Schedule V [Feedback for Correct Answer 1] Schedule I substances are defined as drugs with no currently accepted medical use and a high potential for abuse (e.g., heroin and lysergic acid diethylamide [L SD]).

[Feedback for Answer Choice 2] Schedule II substances include methadone, oxycodone, fentanyl, morphine, opium, codeine, and hydrocodone.

[Feedback for Answer Choice 3] Schedule IV drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence such as Xanax, Valium, Ambien, and Tramadol.

[Feedback for Answer Choice 4] Examples of Schedule V substances include most cough preparations such as Robitussin and Phenergan with Codeine®.

Learning Objective 7.2: Describe the etiology and risk factors of substance use and dependence.

[Q1] Numerous risk factors have been identified as contributing to initial substance use.

When does the initial use of substances typically begin?

1. Early childhood 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Adolescence [correct] 3. Early adulthood 4. Late adulthood [Feedback for Answer Choice 1] Early childhood is not the correct answer.

[Feedback for Correct Answer 2] Numerous risk factors have been identified as contributing to initial substance use.

Since initial use often occurs during adolescence, most of the commonly identified risk factors reflect events and issues relevant to that developmental stage. Some of the more common factors include poor academic performance, alcohol and other drug (AOD) availability, peer pressure, living in a dysfunctional family environment, and undiagnosed problems, such as learning disabilities.

[Feedback for Answer Choice 3] Early adulthood is not the correct answer.

[Feedback for Answer Choice 4] Late adulthood is not the correct answer.

Learning Objective 7.3: Articulate procedures for the screening, assessment, and diagnosis of substance use disorders and symptoms, including screening procedures, commonly used assessment instruments, assessment, diagnosis, assessing a client’s readiness to change, and treatment admission and placement processes.

[Q1] According to the DSM-5-TR, how many of the diagnostic criteria must be met for an individual to be diagnosed with a substance use disorder?

1. One 2. Two [correct] 3. Three 4. Five [Feedback for Answer Choice 1] According to DSM-5-TR, more than one criteria must be met for an individual to be diagnosed with a substance use disorder.

[Feedback for Correct Answer 2] According to DSM-5-TR, at least two of the following criteria must be met for an individual to be diagnosed with a S UD: (1) significant problems exist at home, school, or work due to use; (2) physical hazards occur due to repeated episodes of impaired driving or operating machinery while under the influence; (3) substance use 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

results in recurring legal problems (e.g., public intoxication); (4) tolerance increases; (5) withdrawal occurs; (6) increasing amounts of the substance are taken over time; (7) usage levels are not being reduced; (8) a lot of time is spent acquiring the substance; (9) social or work activities are sacrificed due to use or recovery from use; (10) use continues despite interpersonal and physical effects; and (11) there is craving, a strong urge, or desire for the substance.

[Feedback for Answer Choice 3] According to DSM-5-TR, fewer than three of the criteria must be met for an individual to be diagnosed with a substance use disorder.

[Feedback for Answer Choice 4] According to DSM-5-TR, fewer than five of the criteria must be met for an individual to be diagnosed with a substance use disorder.

[Q2] Jordan has been in counseling for substance use. Recently, his prior resistance has diminished and he has made a decision to change but is uncertain how to go about this process. Using Norcross et al.’s (2011) five-stage change model, what stage is Jordan at now?

1. Precontemplative 2. Contemplative 3. Preparation [correct] 4. Action [Feedback for Answer Choice 1] The precontemplation stage is characterized by resistance to change or denying that a problem exists. This is not the correct answer.

[Feedback for Answer Choice 2] The contemplation stage is evidence by ambivalence as the client is contemplating the effects of substance use as well as weighing the advantages and disadvantages of continued use. This is not the correct answer.

[Feedback for Correct Answer 3] The preparation stage is when the resistance has waned and the client has made a decision to change but is uncertain how to go about this process. This is the correct answer.

[Feedback for Answer Choice 4] The action stage is when the client is committed to making a change and has demonstrated specific goals and behaviors toward this end. This is not the correct answer.

[Q3] 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Addison has been in counseling for a substance use. Recently, she has demonstrated resistance to change or consistently denies that a substance problem exists. Using Norcross et al.’s (2011) five-stage change model, what stage is Addison at now?

1. Precontemplative [correct] 2. Contemplative 3. Preparation 4. Action [Feedback for Correct Answer 1] The precontemplation stage is characterized by resistance to change or denying that a problem exists. This is the correct answer.

[Feedback for Answer Choice 2] The contemplation stage is evidence by ambivalence as the client is contemplating the effects of substance use as well as weighing the advantages and disadvantages of continued use. This is not the correct answer.

[Feedback for Answer Choice 3] The preparation stage is when the resistance has waned and the client has made a decision to change but is uncertain how to go about this process. This is not the correct answer.

[Feedback for Answer Choice 4] The action stage is when the client is committed to making a change and has demonstrated specific goals and behaviors toward this end. This is not the correct answer.

Learning Objective 7.4: Explain substance use crisis treatment, including relapse and crisis, harm reduction, support groups, couples and family treatment, and cooccurring disorders.

[Q1] The two highest-ranked, most effective approaches to address substance use disorders and symptoms are brief interventions and which of the following?

1. Motivational enhancement approaches [correct] 2. Person-centered approaches 3. Existential meaning making approaches 4. Narrative therapies [Feedback for Correct Answer 1] The two most effective approaches to address substance use disorders and symptoms are brief interventions and motivational enhancement approaches.

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Integrating a crisis model that aligns with these approaches allows the counselor to effectively address both the crisis response and substance use disorder.

[Feedback for Answer Choice 2] Person-centered approaches are not the most effective.

[Feedback for Answer Choice 3] Existential meaning making approaches are not the most effective.

[Feedback for Answer Choice 4] Narrative therapies are not the most effective.

[Q2] Which of the following is the most common co-occurring disorder with severe mental illness?

1. Substance use disorder [correct] 2. Mood disorder 3. Anxiety disorder 4. Personality disorder [Feedback for Correct Answer 1] Substance use disorder is the most common co-occurring disorder with severe mental illness.

[Feedback for Answer Choice 2] Mood disorder is not the most common co-occurring disorder with severe mental illness.

[Feedback for Answer Choice 3] Anxiety disorder is not the most common co-occurring disorder with severe mental illness.

[Feedback for Answer Choice 4] Personality disorder is not the most common co-occurring disorder with severe mental illness.

Learning Objective 7.5: Explain multicultural perspectives on substance use in crisis situations.

[Q1] Counselors must be knowledgeable about and implement multicultural counseling competencies in their practice. Ratts et al. (2015) outlined four multicultural counseling competencies: (1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling and advocacy interventions. Each also comprise what four dimensions?

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Attitudes and beliefs, awareness, skills, and actions 2. Attitudes and beliefs, knowledge, resources, and actions 3. Attitudes and beliefs, knowledge, skills, and answers 4. Attitudes and beliefs, knowledge, skills, and actions [correct] [Feedback for Answer Choice 1] Awareness is not one of the dimensions.

[Feedback for Answer Choice 2] Resources is not one of the dimensions.

[Feedback for Answer Choice 3] Answers is not one of the dimensions.

[Feedback for Correct Answer 4] Counselors must be knowledgeable about and implement multicultural counseling competencies in their practice. Ratts et al. (2015) outlined four multicultural counseling competencies (1) counselor self-awareness, (2) client worldview, (3) counseling relationship, and (4) counseling and advocacy interventions. Each also comprise the following four dimensions: attitudes and beliefs, knowledge, skills, and actions.

Learning Objective 7.6: Identify elements of crisis intervention related to substance use, including safety and self-care, diagnostic considerations during a crisis, and essential substance use–specific crisis intervention skills.

[Q1] Jona is working with a client and assessing the client’s drug use and motivation to change. Jona is still concerned about the client’s strained emotional state and works to establish a plan in the event that the client’s condition worsens before the next session. Jona considers using the commitment to treatment statement (CTS). What is the purpose of the C TS? 1. The CTS is an agreement to commit to the treatment process and to living. [correct] 2. The CTS is an agreement to commit to not relapsing.

3. The CTS is an agreement to serve as a peer mentor.

4. The CTS is an agreement that focuses on the cognitions and behaviors leading to relapse.

[Feedback for Correct Answer 1] The CTS is an agreement to commit to the treatment process and to living, and a crisis response plan that outlines specific behaviors the client will engage in if the crisis escalates.

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] Although the plan may connect with relapse prevention, the CTS is not an agreement to commit to not relapsing.

[Feedback for Answer Choice 3] The CTS is not an agreement to serve as a peer mentor.

[Feedback for Answer Choice 4] The CTS is not an agreement that focuses on the cognitions and behaviors leading to relapse.

[Q2] The most effective crisis approach when working with substance use clients involves which of the following?

1. A nondirective approach with a compassionate and empathic manner 2. A CBT approach with a compassionate and empathic manner 3. A collaborative approach with a compassionate and empathic manner 4. A directive approach with a compassionate and empathic manner [correct] [Feedback for Answer Choice 1] A nondirective approach is not the most effective approach.

[Feedback for Answer Choice 2] A CBT approach is not the most effective approach.

[Feedback for Answer Choice 3] A collaborative approach is not the most effective approach.

[Feedback for Correct Answer 4] Using a directive approach, conducted in a compassionate and empathic manner, allows for clarification and understanding of the crisis threat so that appropriate courses of action can be taken.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 7 Application Exercises Application Exercise 7.1 Learning Objective 7.3 Articulate procedures for the screening, assessment, and diagnosis of substance use disorders and symptoms, including screening procedures, commonly used assessment instruments, assessment, diagnosis, assessing a client’s readiness to change, and treatment admission and placement processes.

[Q1] Refer to Pearson eTextbook Video Example 7.1. The client identifies one to two main goals to frame counseling sessions. With the counselor’s guidance, the client targets better coping skills as one of her main goals and the counselor helps the client identify positive activities and pastimes. What other screening questions would be important to utilize in the session?

[Q1 Model Response] A critical step in the treatment process is properly evaluating the degree to which substance use is problematic and the extent to which it has influenced the individual, especially those clients who are dealing with crisis or trauma situations. Careful screening, assessment, and diagnosis not only provide an accurate clinical picture but also help the counselor conceptualize applicable theoretical models, formulate preliminary treatment goals, and implement techniques and approaches that will align with the client’s presenting issue(s) and motivation for change. The primary focus of substance use assessment is to gather detailed information on substance use patterns, including drug(s) used; progression of use (amount and frequency of use over time); route of administration; reason for periods of increased usage or abstinence; treatment history; and evidence of tolerance, dependence, and withdrawal.

Application Exercise 7.2 Learning Objective 7.4: Explain substance use crisis treatment, including relapse and crisis, harm reduction, support groups, couples and family treatment, and cooccurring disorders.

[Q2] Refer to Pearson eTextbook Video Example 7.2. In this role play, the client shares the scope of their substance use. The counselor helps the client begin to identify their goals and talks about safe recovery, including the assistance of a trained physician, as well as the risks of overconsumption. Why is it important to offer psychoeducation with substance use?

[Q2 Model Response] 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Brief interventions and motivational enhancement approaches are two of the highest-ranked, most effective approaches to address substance use disorders and symptoms. It is essential to integrate a crisis model that aligns with these approaches. This allows the counselor to effectively address both the crisis response and the substance use disorders. Psychoeducation is helpful to the client to have information regarding the five stages of change model, information about relapse prevention, treatment options, and the impact of the substance use disorder on the system.

Application Exercise 7.3 Learning Objective 7.6 Identify elements of crisis intervention related to substance use, including safety and self-care, diagnostic considerations during a crisis, and essential substance use–specific crisis intervention skills.

[Q3] Refer to Pearson eTextbook Video Example 7.3. The counselor offers psychoeducation around drinking. How can psychoeducation be essential in the crisis session? When can it be harmful?

[Q3 Model Response] Psychoeducation can be an effective strategy when working with clients in crisis.

Counselors can use education to teach new learning and coping skills, normalize reactions and responses, explore resources, and offer best treatment options.

Psychoeducation may also be harmful. A counselor should never rely on education without involving the client to determine the impact on the client or not take into account the client’s culture.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 7 Test Items Multiple Choice Questions 1. One of the main concerns with nonmedical prescription opiate use is A. withdrawal is more dangerous than with traditional opiates due to purity levels.

B. the ease of which the substances are available from family and friends.

C. overdose can happen much quicker than with heroin due to concentration and potency.

D. relapse prevention is more difficult than with other substances due to addiction potential.

2. All of the following are examples of hallucinogens EXCEPT A. ketamine.

B. mescaline.

C. phencyclidine.

D. codeine.

3. One outcome of the Comprehensive Drug Abuse Prevention and Control Act of 1970 was to A. develop a classification system for all drugs.

B. establish treatment parameters for various treatment placements.

C. identify safe manufacturing practices for drug companies.

D. provide legal guidelines for interstate commerce.

4. What is the fastest way for a drug to reach one’s brain?

A. Injecting into the vein B. Ingesting C. Mucous membrane D. Inhaling 5.

is the psychoactive drug with the highest dependence potential.

A. Caffeine B. LSD C. PCP (smoked) D. Heroin ( IV )

6. The model of addiction holds that clients who develop chronic alcohol dependence and continue drinking or ever return to heavy drinking will likely die.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. biological/genetic B. disease C. neurotransmitter D. multicausal 7. The proper treatment sequence when addressing substance use disorders is A. screening, testing, diagnosis, assessment, treatment placement.

B. assessment, testing, screening, treatment placement, diagnosis.

C. screening, assessment, testing, diagnosis, treatment planning.

D. treatment planning, screening, assessment, testing, diagnosis.

8. The easiest way to screen for potential substance use problems is to A. use the SASSI-3, MAST, or AUDIT screening tools.

B. use the DSM-5-TR. C. use the frequency and amount questions.

D. conduct a clinical interview.

9. Which of the following statements BEST describes the N IAAA's recommended level of daily drinking for men and women?

A. Women and men should consume no more than four drinks a day.

B. Women should consume no more than one drink a day and men no more than two drinks a day.

C. Women should consume no more than two drinks a day and men no more than three drinks a day.

D. No alcohol should be consumed.

10. What is the main purpose of conducting an assessment?

A. Identify the specific condition(s) and a basis for treatment interventions B. Gather clinical data to get an accurate picture of the client's issues C. To assess whether further information is necessary D. To determine whether treatment planning has been beneficial 11. The best tool for use in conducting a clinical assessment is the A. DSM-5-TR or ICD-11.

B. SASSI-3.

C. clinical interview.

D. mental status exam.

12. Counselors must remember that when conducting an assessment 11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. information will continually need to be updated.

B. self-report data may create some inherent bias.

C. counselors must assess level of motivation.

D. All of the above.

13. Which of the following statements best reflects client's reporting of AOD use?

A. Clients tend to over report alcohol consumption.

B. Clients tend to underreport drug use.

C. Clients tend to over report criminal activity.

D. None of the above.

14. The stage of Prochaska and DiClemente's stages of change model proposes that the counselor focus exclusively on using motivation techniques.

A. precontemplation B. contemplation C. maintenance D. preparation 15. Integrating behavioral approaches is most likely to occur during the stage of Prochaska and DiClemente's stages of change model.

A. precontemplation B. contemplation C. action D. preparation 16. All of the following are true for client's dealing with relapse EXCEPT that A. both intrapersonal and interpersonal factors must be examined.

B. counselors should start addressing relapse issues early in the treatment process.

C. relapse often means the client has lost much of the progress made prior to the relapse.

D. relapse most commonly occurs in the first 30 days following treatment.

17. Which of the following would NOT be considered a form of harm reduction?

A. A detoxification program as part of a treatment program B. A needle exchange program at a homeless shelter C. Availability of free condoms at a halfway house D. Free taxi service on New Year's Eve sponsored by MADD 12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

18. An advantage of using an integrated substance abuse and mental health approach when treating clients with co-occurring disorders is A. it significantly lowers rate of relapse.

B. individualized planning and personalization of services.

C. it increases the availability of treatment funding.

D. clients can address concerns quickly.

19. Counselors should be knowledgeable of multicultural competencies. Which of the following is NOT considered one of these competencies?

A. Counselor awareness of own cultural values and biases B. Awareness of client’s worldview C. Intervention strategies that are culturally appropriate D. Understanding that all counseling is multicultural counseling 20. The DSM-5-TR’s reclassification of substance abuse and dependence into the new umbrella term, substance use disorders, was done to address the ambiguity and confusion between the terms A. dependence and addiction.

B. dependence and use.

C. addiction and use.

D. use and comorbidity.

Extended Response Questions 1. Identify and discuss Prochaska and DiClemente's stages of change and why we need to be concerned about client motivation as part of our treatment consideration. What treatment approaches would be appropriate for each stage?

2. A mental health counselor was called to the emergency room to assist with a client who arrived in crisis. Discuss some of the issues the counselor may need to consider to effectively manage this situation.

3. Discuss the differences in classification of substance use disorder in the D SM-5.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 7 Test Answer Key Multiple Choice Answer Key: 1. B (see page 216, section titled Substance Use in Society) 2. D (see page 216, section titled Classification of Drugs) 3. A (see page 216, section titled Classification of Drugs) 4. D (see page 219, section titled The Etiology and Risk Factors of Substance Abuse and Dependence) 5. D (see page 217, section titled Research on Substance Use, Crisis, and Society) 6. B (see page 222, section titled Assessment) 7. C (see page 220, section titled Screening, Assessment, and Diagnosis of Substance Use Disorders) 8. C (see page 220, section titled Screening) 9. A (see page starting 223, section titled Assessment) 10. B (see page starting 223, section titled Assessment) 11. C (see page starting 223, section titled Assessment) 12. D (see page starting 223, section titled Assessment) 13. D (see page starting 223, section titled Assessment) 14. A (see page 226, section titled Assessing a Client’s Readiness to Change) 15. C (see page 226, section titled Assessing a Client’s Readiness to Change) 16. C (see page 226, section titled Assessing a Client’s Readiness to Change) 17. A (see page 238, section titled Harm Reduction) 18. B (see page 230, section titled Substance Use Treatment and Crisis) 19. D (see page 242, section titled Multicultural Perspectives on Substance Use in Crisis) 20. A (see page 225, section titled Diagnosis) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: the five stages of change (precontemplative, contemplative, preparation, action, maintenance); motivational interviewing (MI) as an appropriate technique that focuses on motivation, resiliency, and change; and using the MI strategies of engaging, focusing, evoking, and planning.

2. Model response: Answers will vary, but should include some of the following points: assessment of quantity of use, frequency of use, use in last 30 days, progression of use, route of use; previous attempts to recover, current level of functioning, family 14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

issues, employment history, educational history, mental health history, risk assessment, sexual history, other medication use.

3. Model response: Answers will vary, but should include some of the following points: prior to the DSM-5, there were two main categories: dependence and abuse. The reclassification of the DSM-5 utilizes substance use in order to address the confusion of abuse and dependence. The new classification allows for assessment of severity and progression of use.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter

Learning Objective

Chapter 7

7.1 Understand the Understanding and nature of and importance of Treating substance use in Substance Use society, including Disorders with classification of Clients in Crisis drugs and current research.

Exercises & Quizzes Learning Objective Quiz 7.1 [Q1]

C ACREP Standards— Section 2: Professional Identity 3.F.e, F.3.f,F.5.j, F.5.k F.5.l Section 5. CMHC: 5C2.d, 5C.2.e

blank

7.2 Describe the etiology and risk factors of substance use and dependence.

Learning Objective Quiz 7.2

Section 5: Addiction Counseling 5A.2.c, 5A.2.j

7.3 Articulate procedures for the screening, assessment, and diagnosis of substance use disorders and

Learning Objective Quiz 7.3

F.7.c, F.7.e, F.7.k, F.7.l,

[Q1, Q2, Q3]

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

blank

Application Exercise 7.1

Section 5: Addiction Counseling 5A.1.d, 5A.3.a

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

symptoms, including screening procedures, commonly used assessment instruments, assessment, diagnosis, assessing a client’s readiness to change, and treatment admission and placement processes. blank

7.4 Explain substance use crisis treatment, including relapse and crisis, harm reduction, support groups, couples and family treatment, and cooccurring disorders.

Learning Objective Quiz 7.4

7.5 Explain multicultural perspectives on substance use in crisis situations.

Learning Objective Quiz 7.5

7.6 Identify elements of crisis intervention related to substance use, including safety and self-care, diagnostic considerations during a crisis, and

Learning Objective Quiz 7.6

[Q1, Q2] Application Exercise 7.2

F.3.g Section 5: Addiction Counseling 5A.1.f, 5A.3.c, 5A.3.g

blank

F.2.a, F.2.b, F.2.c, Section 5: Addiction Counseling 5A.2.j

[Q1]

blank

F.2.g, F.5.j, F.5.k, F.5.l, F.5.m, F.7.e,

[Q1, Q2]

Section 5: Addiction Counseling 5A.1.d

Application Exercise 7.3

Section 5. CMHC: 5C.2.b, 5C.2.d, 5C.3b

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

essential substance use– specific crisis intervention skills.

Chapter 8 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by 18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Lisa R. Jackson-Cherry Marymount University

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 8: Intimate Partner Violence and Domestic Violence

1

Learning Outcome Quizzes

1

Application Exercises

10

Test Items

12

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 8: Intimate Partner Violence and Domestic Violence Chapter 8 Learning Outcome Quizzes Learning Objective 8.1: Define and apply the terms intimate partner violence and domestic violence.

[Q1] Physical, sexual, or emotional aggression, violence, or stalking by a former or current opposite- or same-sex intimate partner is the definition of which of the following?

1. Domestic violence 2. Intimate partner violence [correct] 3. Sibling violence 4. Spousal violence [Feedback for Answer Choice 1] The Bureau of Justice Statistics (2019) defines domestic violence as ―violence between spouses, or spousal abuse but can also include cohabitants and nonmarried intimate partners.‖ [Feedback for Correct Answer 2] The terms intimate partner violence (IPV) and domestic violence (DV) have often been used interchangeably, albeit with some error. I PV involves physical, sexual, and emotional aggression, violence, or stalking by a current or former intimate partner (Patra et al., 2018). IPV is an inclusive term that is used to describe violence among opposite- or same-sex couples currently or formerly in a relationship.

[Feedback for Answer Choice 3] Sibling violence is violence against siblings and may or may not fall within the legal definition of domestic violence.

[Feedback for Answer Choice 4] Spousal violence can be a segment of D V but may also fall in the category of IPV depending on the relationship and cohabitation.

[Q2] Violence between spouses, or spousal abuse, can also include cohabitants and nonmarried intimate partners and is a definition of which of the following?

1. Domestic violence [correct] 2. Intimate partner violence 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Sibling violence 4. Spousal violence [Feedback for Correct Answer 1] The Bureau of Justice Statistics (2019) defines domestic violence as ―violence between spouses, or spousal abuse but can also include cohabitants and nonmarried intimate partners.‖ [Feedback for Answer Choice 2] The terms intimate partner violence (IPV) and domestic violence (DV) have often been used interchangeably, albeit with some error. IPV involves physical, sexual, and emotional aggression, violence, or stalking by a current or former intimate partner (Patra et al., 2018). IPV is an inclusive term that is used to describe violence among opposite- or same-sex couples currently or formerly in a relationship.

[Feedback for Answer Choice 3] Sibling violence is violence against siblings and may or may not fall within the legal definition of domestic violence.

[Feedback for Answer Choice 4] Spousal violence can be a segment of D V but may also fall in the category of IPV depending on the relationship and cohabitation.

Learning Objective 8.2: Integrate the cycle of violence into assessment and intervention of individuals in violent relationships.

[Q1] Kanya has reached out to a crisis counselor after her most recent physical incident with her partner. Kanya reports dissociative experiences and says, ―I felt like I was outside my own body, watching myself being hit.‖ She reports being in a state of disbelief over this recent abuse incident. In reviewing Lenore Walker’s cycle of violence, what stage did Kanya experience in this statement?

1. Honeymoon phase 2. Tension building phase 3. Acute battering phase [correct] 4. Bettering phase [Feedback for Answer Choice 1] The honeymoon phase is characterized by loving and repentant behavior from the abusive partner. The abuser may shower the IPV/DV victim with gifts, beg for forgiveness, and promise never to be violent again. During the honeymoon phase, the abusive partner may also use guilt to attempt to persuade the victim into staying in the relationship, using statements such as ―I would be lost without you.‖ This is not the correct answer.

2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] The tension-building phase of the cycle of violence is characterized by mounting pressure and strain in the relationship. The abused partner ―walks on eggshells‖ around the abusive partner, becoming compliant, nurturing, or whatever it takes to keep the abusive partner’s anger from escalating. This phase also involves minor battering incidents. This is not the correct answer.

[Feedback for Correct Answer 3] During an acute battering incident, victims have reported dissociative experiences, such as feeling as though they are outside their own bodies and watching themselves being thrown into a wall, choked, or raped. Following an acute battering incident, many victims enter a state of shock and disbelief. Both partners may make attempts to rationalize the violence. This is the correct answer.

[Feedback for Answer Choice 4] The bettering phase is evident in Walker’s (1980) additional cycle of violence and is characterized by each party making excuses and bettering the situation. This is not the correct answer.

[Q2] Jordyn is a crisis counselor providing training to a group of domestic violence shelter residents. In the scenario for the training, Jordyn gives an example of a person in an abusive relationship who reports they always feel like they are ―walking on eggshells‖ and notices their partner is becoming increasingly irritated and has been throwing things in the house but has not been physically abusive. Jordyn explains this phase is likely referred to as which of the following?

1. Honeymoon phase 2. Tension-building phase [correct] 3. Acute battering phase 4. Bettering phase [Feedback for Answer Choice 1] The honeymoon phase is characterized by loving and repentant behavior from the abusive partner. The abuser may shower the IPV/DV victim with gifts, beg for forgiveness, and promise never to be violent again. During the honeymoon phase, the abusive partner may also use guilt to attempt to persuade the victim into staying in the relationship, using statements such as ―I would be lost without you.‖ This is not the correct answer.

[Feedback for Correct Answer 2] The tension-building phase of the cycle of violence is characterized by mounting pressure and strain in the relationship. The abused partner ―walks on eggshells‖ around the abusive partner, becoming compliant, nurturing, or whatever it takes to 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

keep the abusive partner’s anger from escalating. This phase also involves minor battering incidents. This is the correct answer.

[Feedback for Answer Choice 3] During an acute battering incident, victims have reported dissociative experiences, such as feeling as though they are outside their own bodies and watching themselves being thrown into a wall, choked, or raped. Following an acute battering incident, many victims enter a state of shock and disbelief. Both partners may make attempts to rationalize the violence. This is not the correct answer.

[Feedback for Answer Choice 4] The bettering phase is evident in Walker’s (1980) additional cycle of violence and is characterized by each party making excuses and bettering the situation. This is not the correct answer.

Learning Objective 8.3: Describe how several helpful models can be applied to crisis work in IPV/DV. [Q1] The central component of which of the following models includes the Power and Control Wheel, a visual representation of the most experienced abusive tactics?

1. Duluth model [correct] 2. Contextual model 3. Learned helplessness 4. Ecological theory [Feedback for Correct Answer 1] The Duluth model was developed in 1984 by a group of IPV/DV activists and is based on the actual experiences of female IPV/DV survivors. The central component of the Duluth model is the Power and Control Wheel, which is a visual representation of the most experienced abusive tactics, including economic abuse; using male privilege; using children; minimizing, denying, and blaming; isolation; emotional abuse; intimidation; coercion and threats; and physical and sexual violence.

[Feedback for Answer Choice 2] The contextual model of family stress proposed by Rolling and Brosi (2010) considers the interaction of the stressor event, available resources, an individual’s perception of IPV/DV, the external family context (culture, history, economy, development, and heredity), and the internal family context (family boundaries and rules, understanding of a stressor event, and family values, beliefs, and assumptions). This model allows for in-depth understanding of the victim’s experiences as well as for intervention in multiple domains.

[Feedback for Answer Choice 3] 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Learned helplessness theory has been used to explain why IPV/DV victims remain in abusive relationships. During the tension-building phase of the cycle of violence, the abused partner behaves in an accommodating manner to avoid escalating the abusive partner’s anger. Eventually, the tension builds to an explosive battering incident, and the victim learns that attempts to control the situation were unsuccessful. An IPV/DV client may reach out for help from family, friends, or the police, yet the battering continues.

[Feedback for Answer Choice 4] Ecological theory offers an alternative explanation for why the IPV/DV victim stays in a relationship with an abusive partner. According to ecological theory, the sociocultural system (the ideological and institutional patterns of a culture), the institutional–organizational system (the agencies, policies, programs, and professional groups), the interpersonal system (the victim’s direct interactions with the abusive partner, children, family, and friends), and the individual system (the victim’s perceptions, meanings, and actions) all play roles in the victim’s decision.

Learning Objective 8.4: Understand the common crisis issues of individuals in violent relationships.

[Q1] Common crisis issues that emerge when working with IPV/DV clients include which of the following?

1. Transporting to the E R, establishing immediate safety, and deciding if mandated to report to the police 2. Attending to physical injuries, establishing immediate safety, and reporting to police 3. Attending to physical injuries, connecting to a shelter, and deciding if mandated to report to the police 4. Attending to physical injuries, establishing immediate safety, and deciding if mandated to report to the police [correct] [Feedback for Answer Choice 1] Transportation may be part of the mobile crisis team but it is not a required issue for all situations.

[Feedback for Answer Choice 2] Reporting to police may be required but not in all situations.

[Feedback for Answer Choice 3] Connecting clients to a shelter may be part of the safety plan but it is not the best answer for this question.

[Feedback for Correct Answer 4] 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis counselors should work with IPV/DV clients in crisis to increase perceived options, mobilize resources, and identify sources of continued support after the crisis is stabilized (Greenstone & Leviton, 2011). Common crisis issues that emerge when working with IPV/DV clients include attending to physical injuries, establishing immediate safety, and deciding if mandated to report to the police.

Learning Objective 8.5: Consider and explore special populations in IPV/DV relationships and their needs.

[Q1] As a counselor you are offering training on IPV/DV that includes the prevalence among special populations. Which group or population has the highest rate of IPV/D V and least amount of resources?

1. Disability status 2. Immigrant status 3. Male to female violence 4. Transgender individuals [correct] [Feedback for Answer Choice 1] Controlling for race/ethnicity, age, and S ES, women with disabilities are physically or sexually assaulted at a rate double that of those without a disability (Breiding & Armour, 2015). A victim or perpetrator with a disability is at risk for IPV/ DV, or the disability may be a result of IPV/DV toward the individual. However, this is not the most accurate answer.

[Feedback for Answer Choice 2] In the United States, for immigrant women there is an overall decrease in the use of social and health care services. Language barriers often prevent women in abusive relationships from seeking assistance. Lack of knowledge of available resources, distrust of government agencies, and lack of knowledge of the U.S. legal system may also be barriers to help seeking for immigrant women who experience IPV/DV. Undocumented immigrant victims of IPV/DV may be more hesitant to report IPV/DV due to concerns with deportation. However, this is not the most accurate answer.

[Feedback for Answer Choice 3] Most of the literature, as well as provision of shelters and other resources, have historically focused on women as victims of D V. Although research does support the higher prevalence of women in DV relationships, data also show that men are victims of DV. The National Center for Victims of Crime (2017) approximates one in four men in the United States (25.7% or 29 million) have reported being slapped or pushed/shoved by an intimate partner in their lifetime and one in seven men in the United States (13.8% or 15.6 million) experienced more severe physical abuse resulting in injury.

[Feedback for Correct Answer 4] 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

The National Center for Victims of Crime (2017) reports 4 in 10 lesbian women, 6 in 10 bisexual women, 1 in 4 gay men, and 1 in 3 bisexual men have experienced rape, physical violence, or stalking by an intimate partner. Prevalence in the transgender community is harder to estimate, yet the problem seems to be more pervasive. Approximately 35% of all transgender individuals reported experiencing physical abuse from a partner (James et al., 2016).

Learning Objective 8.6: Describe how to intervene with IPV/DV victims.

[Q1] Paudy is a counselor working in a domestic violence shelter and has a client who has decided to return home where their abuser is also living. As a priority, Paudy needs to implement what type of plan for the client?

1. Harm reduction [correct] 2. Safety 3. Risk assessment 4. Well-being check [Feedback for Correct Answer 1] Harm reduction plans are developed for clients who do not intend to leave the abusive relationship. The goal of the plan is to reduce the amount of harm a victim may encounter by an abuser. Counselors should assess where incidents of violence mainly occur to attempt to avoid those rooms, how to read signs of heightened anger, using code words for children to protect them from danger, using code words to alert neighbors or family members of potential abuse, and arranging an escape bag with necessary items (medications, keys, legal documents) in case the victim must leave immediately.

[Feedback for Answer Choice 2] If a client decided to leave the abuser, the counselor should develop a safety plan with the main goal of keeping the client physically safe, as well as any other vulnerable person living in the home (e.g., children, older adults). The safety plan is tailored to the unique situation of each IPV/DV victim; therefore, gathering concrete and specific information about the victim’s experiences is essential.

[Feedback for Answer Choice 3] A risk assessment should be implemented into the first session before the client leaves the office. Having a risk assessment should be done prior to planning a harm reduction or safety plan as a best practice.

[Feedback for Answer Choice 4] A well-being check may be a call made if the counselor believes the client is in danger but it is not a common call made in most situations.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Learning Objective 8.7: Describe how COVID-19 has impacted persons in IPV/DV relationships.

[Q1] COVID-19 impacted all persons who needed mental health services. Those who were in DV and IPV relationships were impacted and even telehealth posed many obstacles. In the response to the impact to this population, the W HO (2021a) distributed psychoeducation about the pandemic and increased IPV/DV incidents, suggesting the following (but not limited to the following): 1. 1) Reducing exposure to news outlets to 1–2 hours per day; 2) Staying in contact with family and friends by e-mail and text; 3) Maintaining daily routines including physical activities and sleep [correct] 2. 1) Increasing exposure to news outlets to 1–2 hours per day; 2) Staying in contact with family and friends by e-mail and text; 3) Maintaining daily routines including physical activities and sleep 3. 1) Reducing exposure to news outlets to 1–2 hours per day; 2) Limiting contact with family and friends by e-mail and text; 3) Maintaining daily routines including physical activities and sleep 4. 1) Reducing exposure to news outlets to 1–2 hours per day; 2) Staying in contact with family and friends by e-mail and text; 3) Changing daily routines including physical activities and sleep [Feedback for Correct Answer 1] The W HO (2021a) distributed psychoeducation about the pandemic and increased I PV/DV incidents, suggesting: 1) Reducing exposure to news outlets to 1–2 hours per day; 2) Staying in contact with family and friends by e-mail and text; 3) Maintaining daily routines including physical activities and sleep.

[Feedback for Answer Choice 2] Increasing exposure to news outlets to 1–2 hours per day was not a recommendation.

[Feedback for Answer Choice 3] Limiting contact with family and friends by e-mail and text was not a recommendation.

[Feedback for Answer Choice 4] Changing daily routines including physical activities and sleep was not a recommendation.

Learning Objective 8.8: Explain effective IPV/DV perpetrator identification and treatment.

[Q1] 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Which of the following is an intervention used with batterers that involves the collaboration of local councils of service providers in developing a more comprehensive response to IPV/DV incidents, helps victims identify and access multiple available services, of which victims are often not aware; and focuses on advocacy, criminal justice, child services, health care, education, and vocation?

1. Clinical Community Response (CCR) 2. Consultative Community Response (CCR) 3. Correctional Community Response (CCR) 4. Coordinated Community Response (CCR) [correct] [Feedback for Answer Choice 1] This is not the Clinical Community Response (CCR).

[Feedback for Answer Choice 2] This is not the Consultative Community Response (CCR).

[Feedback for Answer Choice 3] This is not the Correctional Community Response (CCR).

[Feedback for Correct Answer 4] One model of attending to the needs of both IPV/DV victims and batterers is a coordinated community response (CCR), which involves the collaboration of local councils of service providers in developing a more comprehensive response to IP V/DV incidents. CCR helps victims identify and access multiple available services, of which victims are often not aware. These services focus on advocacy, criminal justice, child services, health care, education, and vocation.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 8 Application Exercises Application Exercise 8.1 Learning Objective 8.6: Describe how to intervene with IPV/DV victims.

[Q1] As a crisis counselor working with a domestic violence (DV) client who plans to not return home, what are the main elements you would be sure to include in a safety plan?

[Q1 Model Response] A comprehensive assessment and safety plan that meets the needs of the individual client is imperative. If a client decided to leave the abuser, the counselor should develop a safety plan with the main goal of keeping the client physically safe, as well as any other vulnerable persons living in the home (e.g., children, older adults). The safety plan is tailored to the unique situation of each IPV/DV victim; therefore, gathering concrete and specific information about the victim’s experiences is essential. The counselor and client should determine appropriate supports for the client, locations that provide physical safety (e.g., shelters), and whether law enforcement should be contacted. It is also important to emphasize that a safety plan in no way guarantees the safety of the IPV/DV victim. For example, civil protective orders are designed to prevent an abusive partner from having future contact with an IPV/DV victim and can be tailored to meet the victim’s specific needs. A protective order may contribute to an increased sense of safety for many I PV/DV victims.

Application Exercise 8.2 Learning Objective 8.7: Describe how COVID-19 has impacted persons in IPV/DV relationships.

[Q2] COVID-19 impacted virtually all persons who needed or were currently involved in mental health services. Even with telehealth, some groups were impacted more than others, including those in DV and IPV relationships. How did COVID-19 impact this population?

[Q2 Model Response] The increased isolation due to COVID-19 has impacted individuals in IPV/DV situations worldwide to the extent that the W HO (2021a) issued statements regarding the need for a global awareness of social isolation on IPV/DV victims.

Even though their focus is on women and children, it is imperative to extend this awareness to all who are isolated without supports in abusive environments. The decreased ability to seek leave from environments of abuse has been assumed to 10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

increase situations of DV. Pre-pandemic supports such as visiting with family and friends and workplace and educational environments that often provided some form of distancing from an abuser were cut off during most of the pandemic, meaning diminished reprieves from the abuser. Add in the stressors from the pandemic, such as economic changes, and abuse is believed to have increased.

Application Exercise 8.3 Learning Objective 8.8: Explain effective IPV/DV perpetrator identification and treatment.

[Q3] As a counselor who consults with the criminal justice system, you are asked to develop a batterer prevention program targeted at perpetrators identified through the courts with the goal to decrease incidents of DV. What are the main topic areas that should be integrated into this program?

[Q3 Model Response] Batterer intervention programs have three primary goals: (1) ensuring the safety of I PV/DV victims, (2) stopping future acts of partner violence, and (3) increasing offenders’ accountability for their behavior. Batterer intervention programs teach abusive partners to develop empathy for their victims, identify and self-monitor negative thoughts, and identify and interrupt the negative self-talk that often precedes incidents of violence to prevent further abuse. Additionally, batterer intervention programs teach gender equality in relationships and typically teach participants to identify various forms of abuse, recognize and detail the type of abuse they have engaged in, take responsibility for the abuse, and find alternatives to violence, often helping participants learn to develop a nonabusive response to behavior that they might ordinarily respond to in an abusive manner. Although most batterer intervention programs are designed for long-term intervention, counselors should understand the components of these programs and know whether they are available in their community. Understanding the minimizing behaviors perpetrators use can also be a helpful psychoeducation activity for victims.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 8 Test Items Multiple Choice Questions 1. The term ―intimate partner violence‖ describes violence among A. only lesbian or gay couples.

B. only couples who are married or cohabitate.

C. only couples who are sexually intimate.

D. any couple.

2. According to Walker’s Cycle of Violence Theory (1979), the phase is characterized by repentance and expressions of love from the abusive partner.

During this phase, the survivor may feel a range of emotions from love to humiliation.

A. tension building B. acute battering incident C. honeymoon D. recovery 3. According to theory, an abused partner learns through repeated unsuccessful attempts that efforts to control violence in the relationship are ineffective, resulting in passiveness or diminished motivation to respond to violence.

A. constructivist B. ecological C. learned helplessness D. person-centered 4.

theory originated from a study that involved locking dogs in cages and administering electric shocks.

A. Constructivist B. Ecological C. Learned helplessness D. Person-centered

5. The prevalence of IPV/DV among LGBT couples is couples.

in heterosexual

A. less than B. greater than or equal to C. greater among gay male couples and less among lesbian couples than 12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. None of the above.

6. During middle school and high school, females and males report similar rates of dating violence victimization. Approximately percent of students report being hit, slapped, or physically hurt by a partner.

A. 25% females and 15% males B. 50% females and 20% males C. 10% females and 20% males D. 40% females and 20% males 7. All of the following are goals of IPV/DV crisis counseling EXCEPT A. attending to physical injury.

B. establishing immediate safety.

C. reviewing the client’s life history to determine what lead to involvement with an abusive partner.

D. collaborative decision making about reporting abuse to the police.

8. In which of the following situations would a counselor be required to break confidentiality related to IPV/DV? A. IPV/DV is against the law and should always be reported to the police.

B. No children in the household or exposed to IPV/DV. C. The IPV survivor reports suicidal or homicidal ideation.

D. Family members witness the abuse.

9. Violence between spouses, or spousal abuse but can also include cohabitants and nonmarried intimate partners is legally referred to as A. intimate partner violence.

B. domestic violence.

C. spousal abuse.

D. dating violence.

10. Due to the prevalence of IPV/DV, it is generally agreed that screening should occur A. when the counselor or healthcare worker observes signs of physical injury.

B. when a client’s family of origin issues predispose the client to abusive relationships.

C. universally—I PV screening should occur as routinely as screening for suicidal or homicidal ideation.

D. only in the presence of both partners, since both males and females can be considered perpetrators of intimate partner violence.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

11. The prevalence of IPV/DV is highest in which of the following groups?

A. Black; immigrant, and low SES B. White; high SES C. Unmarried women D. Rates of violence are similar across these groups 12. Survivors of IPV/DV frequently experience A. depression.

B. posttraumatic stress disorder.

C. alcohol and drug abuse.

D. All of the above.

13. All of the following are goals of batterer intervention programs EXCEPT A. ensuring the safety of IPV survivors.

B. preventing future acts of intimate partner violence.

C. increasing the abusive partner’s accountability for his or her violent actions.

D. encouraging the abusive partner to contact IPV survivor to express remorse.

14. Which of the following questions or statements should not be included when screening for IPV/DV? A. Please describe the first time your partner was violent toward you.

B. No person deserves to be treated this way. Let’s explore leaving your partner.

C. What does a typical incidence of violence involve?

D. Do you or your partner have access to weapons?

15. A crisis counselor would assist in developing what type of plan for a client who does not intend to leave the abusive relationship.

A. Harm reduction B. Safety plan C. Resource plan D. Separation plan 16. A crisis counselor would assist in developing what type of plan for a client who intends to leave the abusive relationship.

A. Harm reduction B. Safety plan C. Resource plan D. Separation plan 14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

17. IPV/DV have a high rate of misdiagnosis of A. depression and anxiety.

B. ADHD. C. Bipolar.

D. Adjustment.

18. Batterer intervention programs based on assert that IPV/DV includes behaviors that are aimed at maintaining an imbalance of power in a relationship.

A. attachment theory B. feminist informed cognitive behavioral theory C. moral development theory D. person centered theory 19. Common challenges encountered by batterer intervention programs include A. limited financial resources.

B. distinguishing their services from anger management programs.

C. underreporting of IPV. D. All of the above.

20.

can experience IPV/DV. A. Heterosexual married women B. Heterosexual married men C. Gay men in a dating relationship D. All of the above.

Extended Response Questions 1. Describe how you would discuss the pros and cons of reporting IPV to the police with a client who reports being physically injured and raped by her husband.

2. Most experts agree that IPV prevalence rates underestimate the actual prevalence of IPV. Provide an explanation for why IPV is underreported.

Consider the impact of diverse cultural identities on IPV reporting.

3. How is learned helplessness associated with IPV/DV? 4. Choose a multicultural group and describe the unique circumstances a crisis counselor would need to be aware of when working with the person in the group.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 8 Test Answer Key Multiple Choice Answer Key: 1. D (see page 252, section titled Overview of Intimate Partner Violence and Domestic Violence) 2. C (see page 253, section titled Cycle of Violence Theory) 3. C (see page 255, section titled Helpful Models for Understanding IPV/DV) 4. C (see page 255, section titled Helpful Models for Understanding IPV/DV) 5. B (see page 262, section titled LGBTQ+ Violence) 6. A (see page 265, section titled Dating Violence among Adolescents and Young Adults) 7. C (see page 266, section titled Screening for Intimate Partner Violence) 8. C (see page 267, section titled Screening for Intimate Partner Violence) 9. B (see page 252, section titled Overview of Intimate Partner Violence and Domestic Violence) 10. C (see page 266, section titled Screening for Intimate Partner Violence) 11. A (see page 260, section titled Intimate Partner Violence in Special Populations) 12. A (see page 260, section titled Intimate Partner Violence in Special Populations) 13. C (see page 266, section titled Screening for Intimate Partner Violence) 14. B (see page 269, section titled Question Tree Screening Approach) 15. A (see page 271, section titled Harm Reduction Planning) 16. B (see page 271, section titled Safety Planning) 17. A (see page 273, section titled Addressing the Emotional Impact of Intimate Partner Violence) 18. B (see page 276, section titled Batterer Prevention Programs) 19. D (see page 276, section titled Batterer Prevention Programs) 20. D (see page 252, section titled Overview of Intimate Partner Violence and Domestic Violence) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: first, clients’ decision of reporting to police should be assessed as to what is the best solution for the client based on his/her situation. If the client reports sexual assaults, increased violence with use of weapons, children being assaulted, then the client should know the increased risk of self and family. Information about restraining orders and legal issues should be discussed.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Model response: Answers will vary, but should include some of the following points: data for most incidents of IPV/DV are from law enforcement and community clinics.

Incidents reported to counseling centers may not report. Many do not report due to staying in IPV relationships. Males often have a decreased likelihood of reporting.

3. Model response: Answers will vary, but should include some of the following points: the concept of learned helplessness and the thought that no matter how a victim behaves, they cannot accurately predict the abuse of the perpetrator.

4. Model response: Answers will vary, but should include some of the following points: specifics on the groups that often integrate the patriarchal family system, impact of religious/spiritual beliefs, socioeconomic status, disability status, elder abuse and caretakers, dating violence, or immigrant status.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity blank

Chapter 8

8.1 Define and Intimate Partner apply the terms intimate partner Violence and violence and Domestic domestic violence.

Violence

Learning Objective Quiz 8.1 [Q1, Q2]

blank

blank

8.2 Integrate the cycle of violence into assessments and intervention of individuals in violent relationships.

Learning Objective Quiz 8.2

8.3 Describe how several helpful models can be applied to crisis work in IPV/DV.

Learning Objective Quiz 8.3

[Q1, Q2]

blank

Section 5. CMHC: 5C.1.b, 5C.1.c, 5C.3.a, 5C.3b

[Q1]

blank

8.4 Understand the Learning common crisis Objective Quiz issues of

Section 5 Marriage, Couples, and Family Counseling:

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

individuals in violent relationships.

8.4

5F.2.g, 5F.2.i

8.5 Consider and explore special populations in IP V/DV relationships and their needs.

Learning Objective Quiz 8.5

[Q1]

blank

.F.3.g Section 5 CMHC: 5F.2.j

[Q1]

blank

8.6. Describe how Learning to intervene with IP Objective Quiz V/DV victims.

8.6 [Q1] Application Exercise 8.1 blank

F 7.d, .F.3.g Section 5 CMHC: 5C.2.a, 5C.3.a, 5C.3b Section 5 Marriage, Couples, and Family Counseling: 5F.3.a, 5F.3.b, 5F.3.c blank

8.7 Describe how COVID-19 has impacted persons in IPV/DV relationships.

Learning Objective Quiz 8.7 [Q1] Application Exercise 8.2

blank

8.8 Explain effective IPV/DV perpetrator identification and treatment.

Learning Objective Quiz 8.8

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1] Application Exercise 8.3

Chapter 9 Test Item File 19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 9: Sexual Violence

1

Learning Outcome Quizzes

1

Application Exercises

8

Test Items

10

Test Answer Key

15

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 9: Sexual Violence Chapter 9 Learning Outcome Quizzes Learning Objective 9.1: Define and apply key terms and concepts associated with sexual violence.

[Q1] According to the CDC (2014, p. 11), which of the following is ―a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse‖?

1. Sexual intercourse 2. Sexual penetration 3. Sexual molestation 4. Sexual violence [correct] [Feedback for Answer Choice 1] Sexual intercourse may be included in this list if the penetration is not consented but is not the most accurate answer.

[Feedback for Answer Choice 2] Sexual penetration may be included in this list if the penetration is not consented but is not the most accurate answer.

[Feedback for Answer Choice 3] Sexual molestation may be included in this list but is not the most accurate answer.

[Feedback for Correct Answer 4] According to the report, sexual violence is ―a sexual act that is committed or attempted by another person without freely given consent of the victim or against someone who is unable to consent or refuse‖ (CDC, 2014, p. 11). This includes: Completed or attempted forced penetration of a victim; Completed or attempted alcohol/drug-facilitated penetration of a victim; Completed or attempted forced acts in which a victim is made to penetrate a perpetrator or someone else; Completed or attempted alcohol/drug-facilitated acts in which a victim is made to penetrate a perpetrator or someone else; Non-physically forced penetration; Unwanted sexual contact; Noncontact unwanted sexual experiences.

Learning Objective 9.2: Describe demographic and statistical data related to the prevalence of sexual assault and rape.

[Q1] 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

According to the Bureau of Justice Statistics (2019), the legal term for forced sexual intercourse including both psychological coercion that includes same-gender victims as well as the use of drugs and alcohol to perpetrate the act is known as: 1. Sexual violence 2. Sexual molestation 3. Rape [correct] 4. Sexual assault [Feedback for Answer Choice 1] Sexual violence is a crime defined by a wide variety of acts, which include but are not limited to sexual threats, unwanted sexual contact, and rape (Breiding et al., 2014). Sexual violence continues to be an underreported crime. This is not the most accurate answer for this definition.

[Feedback for Answer Choice 2] Sexual molestation often involves unwanted sexual acts but does not include sexual penetration.

[Feedback for Correct Answer 3] According to the Bureau of Justice Statistics (2019), the legal term for forced sexual intercourse including both psychological coercion that includes same-gender victims as well as the use of drugs and alcohol to perpetrate the act is known as rape.

[Feedback for Answer Choice 4] These crimes include attacks or attempted attacks generally involving unwanted sexual contact between victim and offender. Sexual assaults may or may not involve force and include such things as grabbing or fondling. Sexual assault also includes verbal threats. This is not the most accurate answer for this definition.

[Q2] Some states have a law to protect individuals who may be younger than the age of consent but who have consensual sex without the involvement of manipulation or coercion of another individual. These laws are known as which of the following?

1. The age gap provision, close in age exceptions, or the Romeo and Juliet laws [correct] 2. Age of consent laws 3. Labor trafficking 4. Sex trafficking [Feedback for Correct Answer 1] Some states have a law to protect individuals who may be younger than the age of consent but who have consensual sex without the involvement of manipulation or 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

coercion of another individual. These laws are known as age gap provision, close in age exceptions, or the Romeo and Juliet laws.

[Feedback for Answer Choice 2] Age of consent laws vary across states that outline the minimum age a person must be to give consent for consensual sexual activity.

[Feedback for Answer Choice 3] Labor trafficking is the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery.

[Feedback for Answer Choice 4] Sex trafficking is the recruitment, harboring, transportation, provision, obtaining, patronizing, or soliciting of a person for the purpose of a commercial sex act, in which the commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age.

Learning Objective 9.3: Describe the effects of other types of sexual violence, such as sexual harassment, stalking, human trafficking, and with vulnerable school-age children.

[Q1] The Office for Civil Rights (DHHS, 2021) outlines laws that prohibit discrimination based on sex in educational settings. Educational institutions receiving federal funding are responsible for addressing any form of sexual violence or harassment that creates a hostile environment, which includes taking action to eliminate, prevent, and address sexual violence and its effects. According to the U.S. Department of Education (2020b), a hostile environment occurs when ―the conduct is sufficiently serious that it denies or limits a student’s ability to participate in or benefit from the school’s program.‖ What is this law referred to as?

1. Title IX [correct] 2. Title VI 3. Title XI 4. Title X [Feedback for Correct Answer 1] This law is referred to as Title IX .

[Feedback for Answer Choice 2] Title VI is not the correct answer.

[Feedback for Answer Choice 3] Title XI is not the correct answer.

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 4] Title X is not the correct answer.

Learning Objective 9.4: Identify the physical, cognitive-behavioral, and emotional and physiological effects of sexual violence.

[Q1] Burgess and Holmstrom (1974) first coined the term rape trauma syndrome to describe the cluster of symptoms reported by women who were raped. The phase that includes heightened stress level, lasting from several days to multiple weeks, is described as what phase?

1. Chronic phase 2. Disorganization phase 3. Acute phase [correct] 4. Reorganization phase [Feedback for Answer Choice 1] The chronic phase is not part of rape trauma syndrome.

[Feedback for Answer Choice 2] The disorganization phase is not part of rape trauma syndrome.

[Feedback for Correct Answer 3] The phase of the rape trauma syndrome that includes heightened stress level, lasting from several days to multiple weeks, is the acute phase.

[Feedback for Answer Choice 4] The reorganization phase is a longer-term process of integration, during which the victim regains a sense of control over life.

[Q2] Burgess and Holmstrom (1974) first coined the term rape trauma syndrome to describe the cluster of symptoms reported by women who were raped. The phase that includes a longer-term process of integration, during which the victim regains a sense of control over life, is described as what phase?

1. Chronic phase 2. Disorganization phase 3. Acute phase 4. Reorganization phase [correct] [Feedback for Answer Choice 1] The chronic phase is not part of rape trauma syndrome.

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] The disorganization phase is not part of rape trauma syndrome.

[Feedback for Answer Choice 3] The phase of the rape trauma syndrome that includes heightened stress level, lasting from several days to multiple weeks, is the acute phase.

[Feedback for Correct Answer 4] The reorganization phase is a longer-term process of integration, during which the victim regains a sense of control over life.

Learning Objective 9.5: Describe how medical and law enforcement personnel assist individuals who experience sexual violence.

[Q1] The U.S. Department of Justice’s Office on Violence Against Women (2013) developed a national protocol for sexual assaults to recognize the sensitive needs of victims of sexual violence and preserve evidence vital to the successful prosecution of offenders. What is this protocol known as?

1. Sexual assault forensic examinations [correct] 2. Sexual assault nurse evaluators 3. Sexual assault nursing examinations 4. Sexual assault medical examinations [Feedback for Correct Answer 1] The U.S. Department of Justice’s Office on Violence Against Women (2013) developed a national protocol for sexual assault forensic exams (S AFEs) to recognize the sensitive needs of victims of sexual violence and preserve evidence vital to the successful prosecution of offenders.

[Feedback for Answer Choice 2] The U.S. Department of Justice’s Office on Violence Against Women (2013) developed a national protocol for sexual assault forensic exams (SAFEs) to recognize the sensitive needs of victims of sexual violence and preserve evidence vital to the successful prosecution of offenders. Sexual Assault Nurse Examiners (S ANEs) may provide the examination. S ANEs have special training to work with sexual assault victims. However, this is not the accurate answer.

[Feedback for Answer Choice 3] Sexual assault nursing examinations is not the correct answer.

[Feedback for Answer Choice 4] Although sexual assault medical examinations may take place, this is not the correct answer.

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Learning Objective 9.6: Describe and develop skills to treat individuals who experience sexual violence.

[Q1] A systematic set of skills known to be effective in working with victims of recent traumatic events in the immediate intervention, including sexual violence victims, consists of eight essential components. What is this referred to as?

1. Psychiatric First Aid (PFA) 2. Psychological First Aid (PFA) [correct] 3. Counseling First Aid (CFA) 4. Mental Health First Aid (MHFA) [Feedback for Answer Choice 1] Psychiatric First Aid (PFA) is not the correct answer.

[Feedback for Correct Answer 2] Psychological First Aid (PFA) is a systematic set of skills known to be effective in working with victims of recent traumatic events in the immediate intervention, including sexual violence victims, and consists of eight essential components: (1) contact and engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping support, and (8) linkage with collaborative services.

[Feedback for Answer Choice 3] Counseling First Aid (CFA) is not the correct answer.

[Feedback for Answer Choice 4] Mental Health First Aid (MHFA) is not the correct answer.

Learning Objective 9.7: Describe important spiritual, religious, multicultural, disability, and LGBT Q+ issues related to sexual violence and assault.

[Q1] A study conducted by Ahrens et al. (2010) of approximately 100 sexual assault survivors found that the sexual assault survivors who had improved well-being and less depression used what positive coping behaviors?

1. Family 2. Spiritual [correct] 3. Cognitive 4. Interpersonal [Feedback for Answer Choice 1] 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

The study did not conclude findings on family coping behaviors.

[Feedback for Correct Answer 2] Ahrens et al. (2010) conducted a study of approximately 100 sexual assault survivors who reported a belief in God. According to their findings, sexual assault survivors who used positive religious coping behaviors experienced improved wellbeing and less depression than those who used negative religious coping behaviors.

[Feedback for Answer Choice 3] The study did not conclude findings on cognitive coping behaviors.

[Feedback for Answer Choice 4] The study did not conclude findings on interpersonal coping behaviors.

Learning Objective 9.8: Describe and develop skills to treat offenders and perpetrators of sexual violence.

[Q1] A rape in which the rapist that finds pleasure with the torment, anguish, suffering, and pain of the victim and whose main goal is to achieve sexual gratification through inflicting pain is defined as which of the following?

1. Sadistic rape [correct] 2. Anger rape 3. Acquaintance rape 4. Power rape [Feedback for Correct Answer 1] A sadistic rapist finds pleasure with the torment, anguish, suffering, and pain of the victim. The rapist’s main goal is to achieve sexual gratification by inflicting pain on their victim.

[Feedback for Answer Choice 2] The purpose of an anger-motivated rape is to hurt, humiliate, or demean the victim (Groth, 2001). Methods employed by an anger rapist include both physical violence and verbal aggression.

[Feedback for Answer Choice 3] An acquaintance rapist is known by the victim.

[Feedback for Answer Choice 4] A power-motivated rapist may be attempting to validate strength and control in compensation for feelings of inadequacy (Groth, 2001). Like the perpetrator of anger rape, a power rapist finds little sexual gratification with the act; unlike the anger rape perpetrator, however, the power rapist may have fantasized about or planned the event.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 9 Application Exercises Application Exercise 9.1 Learning Objective 9.4: Identify the physical, cognitive-behavioral, and emotional and physiological effects of sexual violence.

[Q1] Refer to Pearson eTextbook Video Example 9.1. Kyle Beach was an N HL player who lived with the experience of sexual assault for over a decade. In the interview, Kyle tells his story, including his personal reactions, the impact of the sexual abuse on his personal life and his relationships, and how he began to heal from the assault.

What were the common reactions he experienced that are often experienced by sexual assault victims?

[Q1 Model Response] In the interview, Kyle reveals he experienced anxiety, severe mood swings, a sense of helplessness, difficulty concentrating, rage, withdrawal, suppression, relationship problems, and ineffective coping skills.

Application Exercise 9.2 Learning Objective 9.4: Identify the physical, cognitive-behavioral, and emotional and physiological effects of sexual violence.

[Q2] You are a crisis counselor training the emergency department staff on the impact of sexual assault on victims. You want to integrate the rape trauma syndrome. What is important for the staff to know about the rape trauma syndrome and what should they integrate when working with patients?

[Q2 Model Response] The rape trauma syndrome is important in order to understand the impact of sexual assault on a victim. During the acute phase of the rape trauma syndrome, the victim experiences a heightened stress level, lasting from several days to multiple weeks.

The reorganization phase is a longer-term process of integration, during which the victim regains a sense of control over their life. Both phases found commonalities consistent with PTSD, including a significant stressor, intrusive thoughts about the sexual assault, and decreased involvement in their environment, sleep disturbances, hypervigilance, guilt, impaired memory, and fears about reoccurrence of the sexual assault. Crisis intervention during the acute phase, and an understanding of the ―normal‖ reactions that victims experience during this phase, can help to decrease the sense of powerlessness one has over personal reactions. Normalizing and educating victims about common reactions and responses at each stage is crucial.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Although most research has focused on females as victims, male victims can also experience these similar responses to rape.

Application Exercise 9.3 Learning Objective 9.6: Describe and develop skills to treat individuals who experience sexual violence.

[Q3] Refer to Figure 9.1, Q-Tree for Identifying the Short-Term Needs of a Survivor of a Sexual Assault. A young adult walks into the crisis center and reports they had been sexually assaulted two days prior. Use the Q-tree to identify the short-term needs related to the recent sexual assault.

[Q3 Model Response] The crisis counselor should utilize the Q-tree to focus on three immediate needs of a sexual assault client: 1) Medical intervention. The crisis counselor should determine if the victim wants to access emergency medical services. The crisis worker should prepare the victim for what they will experience when they arrive in the emergency department and the SAFE examination, even if they do not want to have an examination. 2) Threat and safety. Does the victim perceive continued threats and safety issues? Is the victim willing to make a police report? Request a restraining order? The counselor should also explain the pros and cons of all legal options. 3) Are you mandated to report the incident? If so, be ready to report the incident. What additional services or support does the victim require? Is there a need to refer to longer-term counseling, family therapy, group work, or support groups?

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 9 Test Items Multiple Choice Questions 1. National Organization for Women (N OW) drew attention to the issue of sexual assault by A. developing rape task forces.

B. protesting outside small and large businesses.

C. demanding all women to speak up.

D. None of the above.

2. The prevalence of being the victim of some type of sexual violence in the United States is % for women and % for men A. 34, 20.

B. 25, 25 C. 44, 23.

D. 50, 10.

3. Women with the history of rape before the age of 18 years old are likely to be raped when they are adults.

A. two B. three C. five D. ten 4. Individuals who may lack the capacity to give consent include A. minors.

B. people with mental disabilities.

C. people who may be intoxicated.

D. All of the above.

5. One of the most prevalent acts within the area of sexual assault is A. drug facilitated rape.

B. acquaintance rape.

C. spousal rape.

D. statutory rape.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

times as

6. State statutory rape offenses are typically defined based on A. age of consent, minimum age of the victim, age differential, and the minimum age of a defendant.

B. age of consent but is a misdemeanor.

C. age differential but is a felony.

D. age of the offender.

7. The Bureau of Justice Statistics (2019) defines as forced sexual intercourse including both psychological coercion as well as physical force A. rape B. stalking C. sexual assault D. statutory rape 8. ―Yes means Yes‖ is referred to as A. indecisive decision making.

B. affirmative nonconsent.

C. affirmative consent.

D. No consent.

9. Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature‖ that ―explicitly or implicitly affect an individual’s employment, unreasonably interfere with an individual’s work performance, or create an intimidating, hostile, or offensive work environment is referred to as A. rape.

B. sexual harassment.

C. stalking.

D. sexual assault.

10. Physical reactions to sexual assault can manifest in varying somatic complaints including A. sleep disturbances.

B. hyper alertness.

C. impaired memory.

D. All of the above.

11. Sexual assault victims may experience a wide range of emotions, including A. guilt about surviving the attack.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. self-blame about not being able to stop the attack.

C. anxiety about another attack.

D. All of the above.

12. A sexual assault occurs every

minutes in the United States.

A. 12 B. 30 C. 2 D. 47 13. According to the Bureau of Justice Statistics, repeated unwanted contacts or behaviors that either cause the victim to experience fear or substantial emotional distress or that would cause a reasonable person to experience fear or substantial emotional distress is A. Stalking.

B. sexual harassment.

C. Consensual sex.

D. sexual assault.

14. Spying or tracking through a computer, tracking by GPS, posting personal information publicly, sending unwanted electronic communication, and installing video cameras in places that will violate privacy is known as A. stalking.

B. Cyberstalking.

C. sexual harassment.

D. Consensual sex.

15. According to the U.S. Department of Justice (2022), a crime that involves exploiting a person for labor, services, or commercial sex is A. human sex trafficking.

B. sexual assault.

C. stalking.

D. statutory rape.

16. One of the four key aspects of treating victims of sex trafficking include A. engagement of trauma-informed care.

B. Referral to legal assistance.

C. referral to medical examinations.

D. referral to immigration resources.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

17. Burgess and Holmstrom described two distinct phases of women’s response to sexual assault in the rape trauma syndrome: A. the acute phase and the reorganization phase.

B. the acute phase and the organization phase.

C. the chronic phase and the reorganization phase.

D. the acute phase and the readjustment phase.

18. The phase where the victim experiences a heightened stress level, lasting from several days to multiple weeks is known as the A. acute phase.

B. chronic phase.

C. reorganization phase.

D. readjustment phase.

19. In the rape trauma syndrome, the longer-term process of integration, during which the victim regains a sense of control over life is known as the A. acute phase.

B. chronic phase.

C. reorganization phase.

D. readjustment phase.

20. Approximately 20% of women and 5% of males who have been victims of sexual violence experienced symptoms consistent with A. PTSD. B. borderline.

C. bipolar.

D. persistent grief.

21. The most important aspect when first meeting a sexual assault victim is A. to refer to the hospital immediately.

B. support the victim’s wants and needs.

C. to refer to law enforcement immediately.

D. to refer for sexually transmitted disease screening.

22. The most favorable approach for immediate intervention with sexual violence victims is A. cognitive behavioral approaches.

B. narrative therapies.

C. psychological first aid (PFA).

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. psychodynamic approaches.

Extended Response Questions 1. Define and describe the differences in sexual assault and rape.

2. Describe four types of rape.

3. Discuss the most favorable intervention in the immediate impact for victims of sexual assault and rape and components of the intervention.

4. Discuss two types of long-term mental health treatments for victims of sexual assault and rape.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 9 Test Answer Key Multiple Choice Answer Key: 1. A (see page 286, section titled Sexual Violence, Sexual Assault, and Rape) 2. C (see page 288, section titled Sexual Assault and Rape) 3. A (see page 288, section titled Sexual Assault and Rape) 4. D (see page 288, section titled Consent) 5. B (see page 290, section titled Acquaintance Rape) 6. A (see page 294, section titled Statutory Rape) 7. A (see page 289, section titled Rape) 8. C (see page 290, section titled Affirmative Consent) 9. C (see page 297, section titled Sexual Harassment) 10. D (see page 301, section titled Effects of Sexual Violence) 11. D (see page 301, section titled Effects of Sexual Violence) 12. C (see page 288, section titled Sexual Assault and Rape) 13. B (see page 297, section titled Stalking) 14. B (see page 297, section titled Stalking) 15. A (see page 297, section titled Human Trafficking) 16. A (see page 298, section titled Human Trafficking) 17. A (see page 301, section titled Effects of Sexual Violence) 18. A (see page 301, section titled Effects of Sexual Violence) 19. C (see page 301, section titled Effects of Sexual Violence) 20. A (see page 303, section titled Posttraumatic Stress Disorder) 21. B (see page 307, section titled Sexual Assault and Current Issues) 22. C (see page 310, section titled Short-Term/Immediate Interventions) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: rape being forced sexual intercourse and sexual assaults having varying degrees of sexual contacts and intimidation/coercion.

2. Model response: Answers will vary, but should include some of the following points: acquaintance rape, statutory rape, power rape, anger rape, sadistic rape.

3. Model response: Answers will vary, but should include some of the following points: psychological first aid (PFA). Components of PFA include: (1) contact and 15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

engagement, (2) safety and comfort, (3) stabilization, (4) information gathering, (5) practical assistance, (6) connection with social supports, (7) information on coping support, and (8) linkage with collaborative services.

4. Model response: Answers will vary, but should include some of the following points: Cognitive Behavioral Therapy, Cognitive Processing Therapy, Prolonged Exposure Therapy, EMDR, Anxiety Management, Stress Inoculation, Relaxation, Group therapy.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

Chapter

Learning Objective

Chapter 9

9.1 Define and apply key terms and concepts associated with sexual violence.

Learning Objective Quiz 9.1

9.2 Describe demographic and statistical data related to the prevalence of all forms of sexual violence.

Learning Objective Quiz 9.2

9.3 Describe the effects of other types of sexual violence, such as sexual harassment, stalking, human trafficking, and with vulnerable schoolaged children.

Learning Objective Quiz 9.3

9.4 Identify the physical, cognitive-behavioral, and emotional and

Learning Objective Quiz

C ACREP Standards—Section 2: Professional Identity blank

Sexual Violence

[Q1]

blank

blank

[Q1, Q2]

blank

blank

[Q1]

blank

blank

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Exercises & Quizzes

Learning Objective physiological effects of sexual violence.

C ACREP Standards—Section 2: Professional Identity

9.4 [Q1, Q2] Application Exercise 9.1 Application Exercise 9.2

blank

9.5 Describe how medical and law enforcement personnel assist individuals who experience sexual violence.

Learning Objective Quiz 9.5

9.6 Describe and develop skills to treat individual who experience sexual violence.

Learning Objective Quiz 9.6

Section 5. CMHC: 5C.3.c, 5C.3d, 5C.3.e

[Q1]

blank

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1] Application Exercise 9.1

blank

9.7 Describe important spiritual, religious, multicultural, disability, and LGBTQI+ issues related to sexual violence and assault.

Learning Obje3tive Quiz 9.7

9.8 Describe and develop skills needed to treat offenders and perpetrators of sexual violence.

Learning Objective Quiz 9.8

F.3.g

[Q1]

blank

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 10 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 10: Child Sexual Abuse

1

Learning Outcome Quizzes

1

Application Exercises

8

Test Items

11

Test Answer Key

15

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 10: Child Sexual Abuse Chapter 10 Learning Outcome Quizzes Learning Objective 10.1: Explain the prevalence of child sexual abuse and describe the importance of prevention of child sexual abuse.

[Q1] The most comprehensive collection of child abuse and neglect data, although it does not include incidences of sexual abuse by perpetrators who are not in parental or caregiving roles, is the: 1. Administration for Children and Families 2. Child Protective Services (CPS) 3. Neglect Data System (NCANDS) 4. National Incidence System (NIS) [correct] [Feedback for Answer Choice 1] This is not the most comprehensive collection of child abuse and neglect data.

[Feedback for Answer Choice 2] Most of the sexual abuse cases come to the attention of CPS but this is not the most comprehensive collection of child abuse and neglect data.

[Feedback for Answer Choice 3] Neglect Data System (NCANDS) provides data on neglect but not all incidents of child abuse.

[Feedback for Correct Answer 4] NIS is the most comprehensive collection of child abuse and neglect data, although it does not include incidences of sexual abuse by perpetrators who are not in parental or caregiving roles.

[Q2] Which population is most at risk for child sexual abuse?

1. White children 2. Children with disabilities [correct] 3. Late adolescents 4. Males [Feedback for Answer Choice 1]

1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Race does not appear to be a differentiating characteristic in occurrence of CSA, with consistent rates of CSA victimization in children of all races (U.S. Department of Health and Human Services [D HHS], 2019). White children, however, had a slightly higher proportion of reported sexual abuse at the hands of biological parents than did children of other racial-ethnic backgrounds.

[Feedback for Correct Answer 2] Children with certain disabilities appear more likely to be sexually victimized than other children. Specifically, children who are at increased risk are those who are blind or deaf or who have intellectual disabilities. These groups have an increased prevalence of abuse, may be perceived as having lower credibility in the eyes of adults (Mitra et al., 2013), or may lack the ability to disclose abuse.

[Feedback for Answer Choice 3] The average age of victimization varies, with sources reporting the mean age of onset between 7 and 12 years of age (Trickett, 2006), but national statistics indicate higher rates of substantiated abuse at higher ages—for example, 12 to 15 years of age (Administration for Children and Families, 2020).

[Feedback for Answer Choice 4] Presently in the United States, some sources approximate that 1 in 3 females and 1 in 6 males experienced sexual abuse as children, while others place the total incidence rate at 1 in 10 (Townsend & Rheingold, 2013).

Learning Objective 10.2: Define child sexual abuse and related terms, including statutory rape.

[Q1] A relationship ―between a juvenile and an adult that is illegal under the age of consent statutes, but that does not involve the degree of coercion or manipulation sufficient to qualify under criminal statutes as a forcible sex crime‖ is legally defined as which of the following?

1. Statutory rape [correct] 2. Age of exception 3. Child sexual abuse 4. Age of consent [Feedback for Correct Answer 1] Statutory rape is a relationship ―between a juvenile and an adult that is illegal under the age of consent statutes, but that does not involve the degree of coercion or manipulation sufficient to qualify under criminal statutes as a forcible sex crime.‖ [Feedback for Answer Choice 2] Some states have an age of exception to define what does not meet statutory rape.

However, this is not the correct answer.

2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 3] Definitions of CSA vary across states and advocacy organizations. Broader definitions may include any sexual activity with a minor where consent cannot be or is not granted. However, this is not the correct answer.

[Feedback for Answer Choice 4] Some states have an age of consent to define what does not meet statutory rape.

However, this is not the correct answer.

Learning Objective 10.3: Articulate the cycle of child sexual abuse.

[Q1] As compared with the children of parents who were not subject to CSA in childhood, children whose parents have a history of CSA may experience which of the following?

1. A lower rate of sexual abuse 2. No significant difference in sexual abuse 3. A higher rate of sexual abuse [correct] 4. The same rate of sexual abuse [Feedback for Answer Choice 1] Children whose parents have a history of CSA do not have a lower rate of sexual abuse.

[Feedback for Answer Choice 2] Children whose parents have a history of CSA do have a significant difference in sexual abuse.

[Feedback for Correct Answer 3] As compared with the children of parents who were not subject to CSA in childhood, children whose parents have a history of CSA may experience a higher rate of sexual abuse.

[Feedback for Answer Choice 4] Children whose parents have a history of CSA do not have the same rate of sexual abuse.

Learning Objective 10.4: Identify the signs and symptoms of child sexual abuse.

[Q1] Children who have been sexually abused may experience many behavioral, cognitive, physical, and psychological symptoms and reactions. What is one notably consistent symptom of CSA history across this body of research literature?

1. Substance use [correct] 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Sudden nonparticipation in school activities 3. Crying without provocation 4. Regressive behaviors [Feedback for Correct Answer 1] Children who have been sexually abused may experience many behavioral, cognitive, physical, and psychological symptoms and reactions. One notably consistent symptom of CSA history across this body of research literature is substance use.

[Feedback for Answer Choice 2] Although sudden nonparticipation in school activities is a common symptom, this is not the best answer.

[Feedback for Answer Choice 3] Although crying without provocation is a common symptom, this is not the best answer.

[Feedback for Answer Choice 4] Although regressive behavior is a common symptom, this is not the best answer.

[Q2] Researchers have found that some children who were victims of CSA present without symptoms at the time of their evaluations (Trask et al., 2011). Reasons for these asymptomatic presentations may include narrowness of symptomology being studied, symptoms that have not yet manifested, or children’s perceptions that the C SA was not intolerable, was not threatening, or did not exceed their normal functioning. What do researchers call the tendency of symptoms to present over time and across many phases of lifespan development?

1. PTSD-delayed onset 2. Nonimpact sexual assault 3. Asymptomatic 4. Sleeper effects [correct] [Feedback for Answer Choice 1] Delayed onset of PT SD may be an eventual diagnosis, but this is not the accurate answer.

[Feedback for Answer Choice 2] This is not the name for this tendency.

[Feedback for Answer Choice 3] This is not the name for this tendency.

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 4] Sleeper effects—the tendency of symptoms to present over time and across many phases of lifespan development—tend to be the norm for children who are either symptomatic or asymptomatic for CSA. Learning Objective 10.5: Apply intervention strategies for victims of child sexual abuse, including handling the initial disclosure, collecting information, conducting forensic interviews, reporting, and understanding the future treatment process.

[Q1] The Child Sexual Abuse Interview Protocol (CSAIP) Version 2012 - IV , developed

by Cheung (2012), provides a structured interview process and specific questions to assess CSA. As a summary, the CSAIP has what four main stages?

1. Rapport building, Free narrative account, Questioning, and Closing [correct] 2. Rapport building, Free narrative account, Affirming, and Closing 3. Rapport building, CPS reporting, Questioning, and Closing 4. Rapport building, Free narrative account, Normalization, and Closing [Feedback for Correct Answer 1] The Child Sexual Abuse Interview Protocol (CSAIP) Version 2012 - IV , developed

by Cheung (2012), provides a structured interview process and specific questions to assess CSA. As a summary, the CSAIP has four main stages: Rapport building, Free narrative account, Questioning, and Closing.

[Feedback for Answer Choice 2] Affirming is not one of the stages in the CSAIP. [Feedback for Answer Choice 3] CPS reporting is not one of the stages in the CSAIP. [Feedback for Answer Choice 4] Normalization is not one of the stages in the CSAIP. Learning Objective 10.6: Describe the future treatment process and coping responses of sexually abused youth.

[Q1] Many difficulties exist in identifying evidence-based practices for effectively treating survivors of CSA. However, what is the most effective approach in working with CSA clients?

1. Narrative therapies 2. Cognitive-behavioral therapy (CBT) [correct] 3. Person-centered therapies 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

4. Existential therapies [Feedback for Answer Choice 1] Narrative therapies are not the most effective approach in working with CSA clients.

[Feedback for Correct Answer 2] Cognitive-behavioral therapy (CBT) continues to be the most common approach used in working with CSA clients. CBT approaches have been the most widely used therapies in treating children and adolescents with posttraumatic symptomology (Benuto & O’Donohue, 2015); therefore, such strategies may be most beneficial to children and adolescents who are struggling specifically with posttraumatic stress, anxiety, or depression after being sexually abused.

[Feedback for Answer Choice 3] Person-centered therapies are not the most effective approach in working with CSA clients.

[Feedback for Answer Choice 4] Existential therapies are not the most effective approach in working with CSA clients.

Learning Objective 10.7: Demonstrate an understanding of the characteristics of child sexual abuse perpetrators and treatment of adult and adolescent sex offenders.

[Q1] Unlike sexual assault perpetrators, individuals who sexually abuse children fall along a continuum of motivation for committing the sexual abuse. What type of perpetrator is motivated by compulsive fantasies about their victims and may participate in behaviors that groom their potential targets?

1. Power perpetrators 2. Sadistic perpetrators 3. Manipulative perpetrators [correct] 4. Opportunist perpetrators [Feedback for Answer Choice 1] This type of perpetrator is not called a power perpetrator.

[Feedback for Answer Choice 2] This type of perpetrator is not called a sadistic perpetrator.

[Feedback for Correct Answer 3] Manipulative perpetrators are compulsive and driven by fantasies about their victims and may participate in behaviors that groom their potential targets.

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 4] This type of perpetrator is not called an opportunistic perpetrator.

Learning Objective 10.8: Describe the elements of crisis intervention related to child sexual abuse, including safety and diagnostic considerations during a crisis and essential intervention skills.

[Q1] Counselors working with children who have a history of CSA should be aware that reactions to sexual abuse are very specific to the individual. Some individuals may present with symptoms mimicking anxiety or mood disorders, dissociative disorders, sleep disorders, other physical disorders, and even personality disorders. When considering diagnosis, as a general rule, counselors should do which of the following?

1. Provide an early diagnosis 2. Delay in providing a diagnosis [correct] 3. Provide a rule-out diagnosis 4. Consider a dual diagnosis [Feedback for Answer Choice 1] When considering diagnosis, counselors should NOT provide an early diagnosis in most situations.

[Feedback for Correct Answer 2] Counselors working with children who have a history of CSA should be aware that reactions to sexual abuse are very specific to the individual. Some individuals may present with symptoms mimicking anxiety or mood disorders, dissociative disorders, sleep disorders, or other physical disorders, and even personality disorders. When considering diagnosis, counselors should delay in providing an early diagnosis.

[Feedback for Answer Choice 3] When considering diagnosis, counselors should NOT provide a rule-out diagnosis.

[Feedback for Answer Choice 4] When considering diagnosis, counselors would not provide a dual diagnosis in most situations.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 10 Application Exercises Application Exercise 10.1 Learning Objective 10.4: Identify the signs and symptoms of child sexual abuse.

[Q1] You are providing a training seminar on the reactions and symptoms of child sexual abuse (CSA). What should you share regarding common reactions and symptoms of children who have been sexually abused?

[Q1 Model Response] Children and adolescents who have experienced CSA may respond and react in a variety of ways, ranging from nonresponse to more severe reactions. Given this range of reactions, it is important to view children or adolescents in the context of developmentally appropriate behavior patterns, giving special attention to significant deviations from those norms and from typical developmental behaviors and milestones. Symptoms typically fall into four main categories: (1) Behavioral cues (e.g., Difficulty in walking or sitting; Frequent vomiting; Sexually explicit drawings/writing; Sexual interaction with others; In-depth sexual play with peers; Overt aggression; Sudden nonparticipation in school activities; Crying without provocation; Regressive behaviors) (2) Cognitive cues (e.g., Decreased school performance; Suicidal ideation; More sexual knowledge than is appropriate; Fear of males or fear of females) (3) Physical cues (e.g., Medical issues; Blood or discharge on undergarments; Frequent psychosomatic illnesses; Pregnancy at young age; Sexually transmitted infections at young age) (4) Psychological cues (e.g., Feelings of low self-worth, Depression; Anxiety; Guilt; Shame; Hostility; Flashbacks; Nightmares) Application Exercise 10.2 Learning Objective 10.5: Apply intervention strategies for victims of child sexual abuse, including handling the initial disclosure, collecting information, conducting forensic interviews, reporting, and understanding the future treatment process.

[Q2] Refer to Case Study 10.1, Crisis Intake with a Child Sexual Abuse Client: Eliminating Blame. In this scenario, Justin must make a CPS call due to the suspicion of child sexual abuse. What information do you need to collect for CPS? [Q2 Model Response] The counselor should attempt to gather the following information to relay to the CPS worker: 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.



Reporter’s name, location, and contact information



Child’s name, age, address, and sex



Parents’ names and addresses



Nature and extent of the condition observed



Actions taken by the reporter (e.g., talking with the child)



Identity of alleged perpetrator



Type of abuse



Time frame of the abuse and where the act occurred



Issues of potential risk for the child (e.g., Is the perpetrator in the home? Is there a threat of physical abuse for the child disclosing information? Might the child be kicked out of the home for reporting?)



Are there other children who might be at risk from the alleged perpetrator?

Application Exercise 10.3 Learning Objective 10.5: Apply intervention strategies for victims of child sexual abuse, including handling the initial disclosure, collecting information, conducting forensic interviews, reporting, and understanding the future treatment process.

[Q3] You are supervising a counselor-in-training about the protocol and structure of forensic interviewing. Integrating the Child Sexual Abuse Interview Protocol (CSAIP) provides a comprehensive overview to your supervisees that can be used in an effective forensic interview.

[Q3 Model Response] The Child Sexual Abuse Interview Protocol (CSAIP) Version 2012-IV, developed by Cheung (2012), provides a structured interview process and specific questions to assess CSA. As a summary, the CSAIP has four main stages: Stage 1: Rapport building. This stage starts with an introduction by the interviewers, determination of competency of the child to answer the 4W H questions, expectations, and ground rules.

Stage 2: Free narrative account. By simply asking ―What happened‖ or ―Do you know the reason for seeing me?‖ the child has the freedom to recall the events in their own words without additional prompting, clarifications, or additional questioning.

Stage 3: Questioning. This stage consists of working with both willingly disclosing and reticent children and the use of the 4W H questions (When, Where, Who, What, and How). It is important for counselors to focus on one incident at a time. Focusing on the most recent event or the event that is the most remembered is often the standard practice.

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Stage 4: Closing the interview. This final stage includes confirmation of the name(s) of the perpetrator(s), the type(s) of abuse, and confirmation that no one coerced the child to disclose the abuse.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 10 Test Items Multiple Choice Questions 1. Approximately

% of child sexual abuse is perpetrated by strangers.

A. 10 B. 20 C. 30 D. 40 2. Approximately 1 in

females report being a victim of child sexual abuse.

A. 3 B. 4 C. 5 D. 6 3. Approximately 1 in

males report being a victim of child sexual abuse.

A. 4 B. 5 C. 6 D. 7 4. According to the Child Abuse Prevention and Treatment Act, to be classified as child sexual abuse, a person must be A. at least 4 years older than the child.

B. at least 6 years older than the child.

C. a parent or caretaker of the child.

D. an individual known to the child.

5. When a child makes an initial disclosure it is important that counselors A. do a thorough investigation regarding details of the abuse.

B. use developmentally appropriate tools, like dolls, to have children identify where they have been touched.

C. give children options to help determine who the perpetrator of sexual abuse is.

D. communicate belief of and support for the child.

6.

may be particularly vulnerable to child sexual abuse.

A. Caucasian children and adolescents B. Children and adolescents living below the poverty line 11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C. Children that are below age 12 years D. Children and adolescents with disabilities 7. The most common approach used in working with CSA clients is A. CBT. B. DBT. C. T-SIB. D. REBT. 8. The therapeutic approach that employs eight components including psychoeducation, relaxation and stress management skills, cognitive coping and processing, and conjoint child–parent sessions is known as A. CBT. B. TF-CBT. C. DBT. D. T-SIB. 9.

draws from play and operant therapy techniques and focuses on the psychoeducation and training of parents in the use of play therapy–type strategies to increase the stability, trust, and communication in the parent–child relationship.

A. Parent–child interaction therapy (P CIT) B. T-SIB C. TF-CBT D. DBT

10.

is a therapeutic approach that accesses client memories of traumatic events that trigger any symptoms in the present, and then work to install more adaptive coping processes for trauma triggers that may be experienced in the future.

A. T-SIB B. PCIT C. DBT D. EMDR

11. The least helpful coping skills for children to employ are A. Supports.

B. avoidant.

C. emotional regulation.

D. EMDR. 12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

12. Verbal or psychic denial of the abuse, withdrawal from one’s social network, dissociation, or dissociative forgetting of the abuse are examples of A. avoidant coping skills.

B. approach coping skills.

C. safety coping skills.

D. disclosure.

13. Reaching out to others for support, disclosing the abuse, or discussing the abuse with friends, family, and/or counselors are example of A. avoidant coping skills.

B. approach coping skills.

C. safety coping skills.

D. disclosure.

14. Lanning (2010) identified three behavioral patterns of situational-type perpetrators of sexual abuse: A. regressed, morally indiscriminate, adequate B. regressed, morally discriminate, inadequate C. repressed, morally indiscriminate, inadequate D. regressed, morally indiscriminate, inadequate 15. Offenders driven by a precipitating stressor and may find a readily available child to serve as a sexual substitute for a preferred adult partner are characterized as A. morally discriminate.

B. inadequate.

C. repressed.

D. regressed.

16. Offenders who abuse all or many types of individuals, so the sexual abuse of a child is less a specific preference for children than the result of a sociopathic level are characterized as A. morally indiscriminate.

B. regressed.

C. repressed.

D. inadequate.

17. Offenders who fit are typically perceived as nonmainstream, perhaps with preexisting mental or emotional problems, who may sexually abuse a child out of insecurity or curiosity about sexual behavior A. inadequate.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. morally insufficient.

C. regressed.

D. repressed.

18. Female offenders typically A. are survivors of incestuous relationships with continued psychological problems definition of CSA. B. have multiple victims.

C. are diagnosed as borderline.

D. are from intact families.

19. Crisis counselors must be comfortable in asking questions about A. physical abuse.

B. emotional abuse.

C. parental alienation.

D. sexual abuse and sexual interactions.

20. Children of sexual abuse often show symptoms consistent with the following mental health diagnosis.

A. Acute stress B. Adjustment C. Borderline D. Posttraumatic stress Extended Response Questions 1. What are some of the general warning signs in children that should indicate a clinician needs to consider potential sexual abuse while conceptualizing and/or assessing the client?

2. What is the ―grooming process‖ and how does this psychological trick serve to trap children in colluding in their own abuse?

3. In the moment of disclosure when a child reveals that he or she is being sexually abused, what nonverbal and verbal responses should the crisis counselor provide?

4. What are the child abuse reporting procedures that should be followed when discovery is made that sexual abuse has or might have taken place?

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 10 Test Answer Key Multiple Choice Answer Key: 1. B (see page 334, section titled Prevalence of Child Sexual Abuse) 2. A (see page 334, section titled Prevalence of Child Sexual Abuse) 3. C (see page 334, section titled Prevalence of Child Sexual Abuse) 4. C (see page 336, section titled Definitions of Child Sexual Abuse) 5. D (see page 341, section titled Intervention Strategies for Victims of Child Sexual Abuse) 6. D (see page 336, section titled Prevalence by Race) 7. A (see page 351, section titled Treatment of Survivors of Child Sexual Abuse) 8. B (see page 351, section titled Treatment of Survivors of Child Sexual Abuse) 9. A (see page 352, section titled Treatment of Survivors of Child Sexual Abuse) 10. D (see page 352, section titled Treatment of Survivors of Child Sexual Abuse) 11. B (see page 353, section titled Child Sexual Abuse Coping Strategies and Their Impact on Treatment) 12. A (see page 353, section titled Child Sexual Abuse Coping Strategies and Their Impact on Treatment) 13. B see page 353, section titled Child Sexual Abuse Coping Strategies and Their Impact on Treatment) 14. D (see page 355, section titled Male Perpetrators of Child Sexual Abuse) 15. D (see page 355, section titled Male Perpetrators of Child Sexual Abuse) 16. A (see page 355, section titled Male Perpetrators of Child Sexual Abuse) 17. A (see page 355, section titled Male Perpetrators of Child Sexual Abuse) 18. A (see page 356, section titled Female Perpetrators of Child Sexual Abuse) 19. D (see page 363, section titled Diagnostic Considerations during a Crisis) 20. D (see page 363, section titled Diagnostic Considerations during a Crisis) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: the importance of looking at changes in behaviors (physical, psychological, cognitive) from prior to the alleged abuse (a baseline) to after the alleged abuse while looking at developmentally appropriate behaviors. An extensive list is listed in the chapter. It is also important to look at victims who may not demonstrate symptoms at all depending on the abuse they experienced. Additionally, information regarding medical signs such as difficulty urinating, reported discomfort in the genital 15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

areas, and sexually transmitted diseases may be symptoms to allow for further assessment.

2. Model response: Answers will vary, but should include some of the following points: on the cycle of child sexual abuse and specifically the first stage of enticement, engagement, and entrapment. This stage leads to more frequent and intensity of sexual abuse which often results in suppression of the abuse. In addition, psychological tricks may include threats of harm to family members and pets, threats the child will not be believed, and telling the child they asked for the sexual abuse or they enjoyed the abuse.

3. Model response: Answers will vary, but should include some of the following points: for counselors or adults to respond to the disclosure with informed intention—the intent to do no further psychological harm to the victim with statements that may be perceived as blaming. This includes the verbal and nonverbal responses made directly to survivors as well as the steps taken in the aftermath of the disclosure to respond appropriately. The worst long-term outcomes for clients with histories of CS A are consistently found in those children who met with unsupportive verbal or nonverbal responses following their disclosure of sexual abuse.

4. Model response: Answers will vary, but should include some of the following points: Child Protective Service (CPS) workers will ask the parent’s name and address, nature and extent of the condition observed, actions taken by the reporter (e.g., talking with the child), identity of alleged perpetrator, type of abuse reported, timeframe of the abuse, where the abuse occurred, potential risk for other children, location of the perpetrator in the home, threat of additional abuse for the child disclosing information, reporter’s name, location, and contact information. As much information gathered to be provided to the CPS worker will assist in the protection of the child.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

Chapter

Learning Objective

Chapter 10

10.1 Explain the prevalence of child sexual abuse and describe the importance of prevention of child sexual abuse.

Learning Objective Quiz 10.1

10.2 Define child sexual abuse and related terms including statutory rape.

Learning Objective Quiz 10.2

10.3 Articulate the cycle of child sexual abuse.

Learning Objective Quiz 10.3

Child Sexual Abuse

C AC REP Standards— Section 2: Professional Identity F 7.d, .F.3.g

[Q1, Q2]

blank

blank

[Q1]

blank

blank

[Q1, Q2] blank

10.4 Identify the signs and symptoms of child sexual abuse.

Learning Objective Quiz 10.4

F.3.g

[Q1]

Section 5. CMHC: 5C.3.a, 5C.3b

Application Exercise 10.1

Section 5 School Counseling: 5G.2.g,

Learning Objective

F 7.d

blank

10.5 Apply intervention 17

Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Exercises & Quizzes

Learning Objective

C AC REP Standards— Section 2: Professional Identity

strategies for victims of child sexual abuse, including handling the initial disclosure, collecting information, conducting forensic interviews, reporting, and understanding the future treatment process.

Quiz 10.5

10.6. Describe the future treatment process and coping responses of sexually abused youth.

Learning Objective Quiz 10.6 [Q1]

Section 5. CMHC: 5C.3.a, 5C.3b

10.7 Demonstrate an understanding of the characteristics of child sexual abuse perpetrators and treatment of adult and adolescent sex offenders.

Learning Objective Quiz 10.7

Section 5. CMHC: 5C.3.a, 5C.3b

10.8 Describe the elements of crisis intervention related to child sexual abuse, including safety and diagnostic considerations during a crisis and essential intervention skills.

Learning Objective Quiz 10.8

[Q1] Application Exercise 10.2

Section 5. CMHC: 5C.3.a, 5C.3b

Application Exercise 10.3

blank

F.3.g

blank

[Q1]

blank

[Q1]

F 7.d Section 5. CMHC: 5C.2.d, 5C.3.a, 5C.3b

Chapter 11 Test Item File 18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 11: Military and First Responder Populations

1

Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

17

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 11: Military and First Responder Populations Chapter 11 Learning Outcome Quizzes Learning Objective 11.1: Describe the culture of military personnel and their families.

[Q1] Each phase of military deployment can affect both military service members and their families; therefore, counselors should be aware of each cycle. The military service deployment cycle is divided into which five distinct phases?

1. (1) Pre-deployment, (2) deployment, (3) sustainment, (4) redeployment, and (5) postdeployment [correct] 2. (1) Deployment, (2) pre-deployment, (3) sustainment, (4) redeployment, and (5) postdeployment 3. (1) Pre-deployment, (2) redeployment, (3) sustainment, (4) deployment, and (5) postdeployment 4. (1) Pre-deployment, (2) post-deployment, (3) sustainment, (4) redeployment, and (5) deployment [Feedback for Correct Answer 1] The military service deployment cycle is divided into five distinct phases: (1) predeployment, (2) deployment, (3) sustainment, (4) redeployment, and (5) postdeployment.

[Feedback for Answer Choice 2] The sequence in this answer is not correct.

[Feedback for Answer Choice 3] The sequence in this answer is not correct.

[Feedback for Answer Choice 4] The sequence in this answer is not correct.

Learning Objective 11.2: Describe the impact of war-zone deployments and separation on military personnel.

[Q1] What one factor appears to be a determining factor correlated with increased rates of suicide?

1. Traumatic brain injury (T BI) 2. PTSD 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Relationship strains 4. Separation from the military [correct] [Feedback for Answer Choice 1] TBI is not the factor that appears to be a determining factor correlated with increased rates of suicide.

[Feedback for Answer Choice 2] PTSD is not the factor that appears to be a determining factor correlated with increased rates of suicide.

[Feedback for Answer Choice 3] Relationship strains is not the factor that appears to be a determining factor correlated with increased rates of suicide.

[Feedback for Correct Answer 4] Separation from the military appears to be a determining factor when evaluating increased suicide risk in the military: 26.06 per 100,000 person-years after separating from military service compared with 15.12 per 100,000 person-years for those who did not separate from the military (Kime, 2015). It is possible that many military members who separate from the military may have had preexisting mental health or medical risk factors that contributed to this increased risk. Connection of meaning, purpose, and identification with one’s career may be another reason the link between separation from the military and higher suicide rates was discovered.

Learning Objective 11.3: Explain issues for military families related to deployment.

[Q1] As a counselor, you are working with a 14-year-old whose parent was deployed for a year and was recently reintegrated. The family has been experiencing some adjustments to the parents reunifying. As a crisis counselor, what you should be aware of that may be impacting the client during reintegration of their family member?

1. Abandonment, adjustment to new roles, rejection [correct] 2. Acceptance, adjustment to new roles, rejections 3. Peer alliance, adjustment to new roles, rejections 4. Acceptance, adjustment to new employment, rejections [Feedback for Correct Answer 1] Military family members may struggle with adjusting to new relationships that were developed during deployment. Feelings of abandonment during the prolonged separation may also exist. Unresolved issues may also re-emerge and occur simultaneously with new issues related to readjustment to the new familial dynamic.

Family members may also struggle with negotiating a balance between the support 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

networks formed during deployment and independence. Children within the family may reject, show apathy toward, or have anxiety around the returning family member.

[Feedback for Answer Choice 2] Acceptance is not listed as a stressor for adolescents of a military service member’s reintegration.

[Feedback for Answer Choice 3] Peer alliance is not listed as a stressor for adolescents of military service member’s reintegration.

[Feedback for Answer Choice 4] Adjustment to new employment is not listed as a stressor for adolescents of military service member’s reintegration.

Learning Objective 11.4: Outline crisis intervention as it applies to military service members.

[Q1] You are a crisis counselor doing an assessment with a military veteran. During the assessment, the client says they are also under the care of a primary care physician and psychiatrist for PTSD. You contact the treating physicians and based on the information they provided and your assessment, you determine that a referral for longer-term counseling is an appropriate but missing part of the treatment to address ―the memories of the traumatic events he experienced while deployed‖ that are impacting his level of functioning. You consider a referral to a therapist specializing in which of the following?

1. TF-CBT [correct] 2. Existential therapy 3. DBT 4. T-SIBS [Feedback for Correct Answer 1] TF-CBT is an approach endorsed in clinical practice guidelines by the Veterans Health Administration (2017). These guidelines provide evidence-based practices related to commonly encountered mental health issues within the military population.

TF-CBT involves confronting the memories of the traumatic events and the feared and avoided external situations that remind clients of the events (Creamer et al., 2011).

[Feedback for Answer Choice 2] Another approach is endorsed in clinical practice guidelines by the Veterans Health Administration (2017) and may be a more effective referral.

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 3] Another approach is endorsed in clinical practice guidelines by the Veterans Health Administration (2017) and may be a more effective referral.

[Feedback for Answer Choice 4] Another approach is endorsed in clinical practice guidelines by the Veterans Health Administration (2017) and may be a more effective referral.

Learning Objective 11.5: Describe the special risks that first responders face.

[Q1] First responders are those professionals, either volunteer or paid, who, because of their occupational responsibilities and sworn duties, are the first to respond in a variety of emergency calls from citizens and often to potentially life-threatening situations. First responders consist of which of the following professions?

1. Law enforcement officers, emergency medical services professionals, and chaplains 2. Law enforcement officers, chaplains, and firefighters 3. Law enforcement officers, emergency medical services professionals, and teachers 4. Law enforcement officers, emergency medical services professionals, and firefighters [correct] [Feedback for Answer Choice 1] Chaplains are not considered first responders.

[Feedback for Answer Choice 2] Chaplains are not considered first responders.

[Feedback for Answer Choice 3] Teachers are not considered first responders.

[Feedback for Correct Answer 4] First responders consist of the following professions: Law enforcement officers, emergency medical services professionals, and firefighters.

Learning Objective 11.6: Describe the culture of law enforcement officers and their unique stressors.

[Q1] Law enforcement officers share similar stressors with other first responders.

However, they also have unique stressors such as which of the following?

1. Concern for personal injury or death, increased medical issues, occupational factors, high rates of mental health concerns and suicide 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Concern for personal injury or death, occupational factors, high rates of mental health concerns and suicide [correct] 3. Concern for personal injury or death, salary discrepancies, occupational factors, high rates of mental health concerns and suicide 4. Concern for personal injury or death, religious concerns, high rates of mental health concerns and suicide [Feedback for Answer Choice 1] Increased medical issues were not listed as a factor in the text.

[Feedback for Correct Answer 2] Law enforcement officers share similar stressors with other first responders; however, they also have unique stressors such as concern for personal injury or death, occupational factors, and high rates of mental health concerns and suicide.

[Feedback for Answer Choice 3] Salary discrepancies were not listed as a factor in the text.

[Feedback for Answer Choice 4] Religious concerns were not listed as a factor in the text.

Learning Objective 11.7: Summarize the unique stressors of emergency medical services professionals.

[Q1] Emergency medical services (E MS) professionals vary in training and skills and are permitted to offer medical services according to their provider level. What is the provider level that can provide basic, noninvasive interventions to reduce the mortality of acute emergency responses; can perform all of the duties of EMRs; and has additional skills for patient transport?

1. EMTs [correct] 2. Paramedics 3. Advanced EMTs 4. EMSs [Feedback for Correct Answer 1] EMTs provide basic, noninvasive interventions to reduce the mortality of acute emergency responses; they can perform all of the duties of E MRs and have additional skills for patient transport. EMTs provide the majority of emergency care and, in some locales, are the highest level of patient care and transport available.

[Feedback for Answer Choice 2] Paramedics are allied health professionals who are trained in advanced assessment to formulate a field impression and provide invasive and pharmacological 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

interventions. Paramedics have advanced training and skills and may perform a broad range of interventions for critical and emergency patients.

[Feedback for Answer Choice 3] Advanced EMTs (AEMTs) are trained to perform all the duties of the E MR and EMT and can also conduct limited advanced and pharmacological interventions.

[Feedback for Answer Choice 4] Emergency medical responders (EMRs) provide basic emergency skills for critical patients. They can perform medical interventions while awaiting additional medical providers. EMRs may serve on a transport team but most likely will not be the primary EMS provider.

Learning Objective 11.8: Summarize the unique stressors of firefighters.

[Q1] A study by the National Volunteer Fire Council (2014) found that the suicide ideation rate with professional firefighters was a high as: 1. 1 in 2 2. 1 in 3 3. 1 in 4 [correct] 4. 1 in 5 [Feedback for Answer Choice 1] This is not the correct suicide ideation rate with professional firefighters.

[Feedback for Answer Choice 2] This is not the correct suicide ideation rate with professional firefighters.

[Feedback for Correct Answer 3] A study by the National Volunteer Fire Council (2014) included 800 firefighters to determine levels of suicidal behaviors. Results indicated that one in four professional firefighters and one in five volunteer firefighters considered suicide during their firefighter career.

[Feedback for Answer Choice 4] This is not the correct suicide ideation rate with professional firefighters.

Learning Objective 11.9: Outline crisis intervention as it applies to first responders.

[Q1] An alternative intervention to C ISM/CISD is MANERS psychological first aid, developed by an Australian health agency. MANERS includes which of the following components?

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Maximize exposure; acknowledge the event; normalize the experience; educate as required; restore or refer to professional help; and self-care 2. Minimize exposure; assessment; normalize the experience; educate as required; restore or refer to professional help; and self-care 3. Minimize exposure; acknowledge the event; normalize the experience; evaluation; restore or refer to professional help; and self-care 4. Minimize exposure; acknowledge the event; normalize the experience; educate as required; restore or refer to professional help; and self-care [correct] [Feedback for Answer Choice 1] Maximize exposure is not one of the components.

[Feedback for Answer Choice 2] Assessment is not one of the components.

[Feedback for Answer Choice 3] Evaluation is not one of the components.

[Feedback for Correct Answer 4] MANERS comprises the following components: minimize exposure; acknowledge the event; normalize the experience; educate as required; restore or refer to professional help; and self-care.

[Q2] PFA has become a best-practice model and identifies five imperative phases to be integrated with first responders. What is the phase that includes three main priorities: (a) mandatory medical check-ups every 12 hours; (b) visible spiritual leadership to sustain morale; and (c) information from media outlets?

1. Stabilization stage [correct] 2. Assessment stage 3. Triage stage 4. Communication stage [Feedback for Correct Answer 1] The stabilization phase includes three main priorities: (a) mandatory medical checkups every 12 hours; (b) visible spiritual leadership to sustain morale; and (c) information from media outlets.

[Feedback for Answer Choice 2] This is not the Assessment stage.

[Feedback for Answer Choice 3] This is not the Triage stage.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 4] This is not the Communication stage.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 11 Application Exercises Application Exercise 11.1 Learning Objective 11.1: Describe the culture of military personnel and their families.

[Q1] Refer to Think About It 11.1. You are working with a family seeking counseling prior to the deployment of a family member. You may have only one session to work with the family. What would you discuss to prepare the family for the separation? What questions would be important to ask?

[Q1 Model Response] The following is only a sample of questions. Has there been prior deployments?

What was helpful? What were some issues that came up last time that you all could revisit for pre-planning? What plans for living arrangements are being made while the family member is deployed? What are the challenges they envision they will encounter without the family member (childcare, employment, caregiving to family members, etc.)? Who do they have for support? What events and holidays/special days will be missed? Are there special needs or medical issues of any family members that need to be met?

Application Exercise 11.2 Learning Objective 11.6: Describe the culture of law enforcement officers and their unique stressors.

[Q2] Review the section on stressors of law enforcement officers. Imagine you are working on a stress reduction group training session for law enforcement officers.

What are the main stressors experienced by law enforcement officers you would want to explore in the group?

[Q2 Model Response] Stressors to be included in the discussion with a law enforcement officer should include: 

Deaths and injuries of law enforcement officers



Suicide and suicide ideation



Occupational stressors



Mental health concerns



Secondary traumatic stress 9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.



Separation and retirement

Application Exercise 11.3 Learning Objective 11.9: Outline crisis intervention as it applies to first responders.

[Q3] PFA has been endorsed as a practice model by the Institute of Medicine and is viewed as emotional first aid for first responders. How was PFA integrated with the first responders during Hurricane Katrina?

[Q3 Model Response] PFA identifies five imperative phases to be integrated with first responders: 1. The assessment phase was designed to provide immediate access to mental health services for those first responders at high risk for emotional reactions due to the crisis event. After the devastating impact of Hurricane Katrina, mental health tents were placed directly at recovery and rescue areas for immediate care. Tents were staffed 24/7 with peers and clinical staff trained to work with first responders during disaster incidents. Since first responders wanted to complete the missions and support their team, removing a first responder from the disaster site could cause more traumatic experiences and mental health issues as well as increased guilt in relation to leaving coworkers.

2. The stabilization phase includes three main priorities: (a) mandatory medical check-ups every 12 hours; (b) visible spiritual leadership to sustain morale; and (c) information from media outlets. After Hurricane Katrina media updated information from outside the disaster zones.

3. During the triage phase, first responder performance is assessed hourly and opportunities are provided for regrouping and peer stress intervention.

4. The goal of the communication phase is to provide information and education on perceived stressors and anticipated stressors, as well as information on critical incident stress referrals.

5. The hotline phase includes intense follow-up with first responders to maintain contact and provide assessments and referrals. The hotline phase provided services for family members for several years after the event.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 11 Test Items Multiple Choice Questions 1. A survey by the Iraq and Afghanistan Veterans of America (2020) found that approximately of its members who reported a mental health injury have sought counseling services.

A. One-fourth B. One-half C. Three-quarters D. Two-thirds 2. Which statement best characterizes the current landscape of military service members?

A. Almost all service members are married and have children.

B. Slightly more than half of military service members are married.

C. The current makeup of the military is fairly consistent with historical trends of single males comprising a majority of the military.

D. Slightly more than a quarter of military service members are married.

3. A survey of military dependents seeking counseling services associated with deployment stress indicated A. they are unlikely to and have not used counseling services.

B. a significant majority have used or are likely to use counseling services.

C. most largely talk to fellow military dependents as opposed to counseling services.

D. about half have used or are likely to access counseling services to address these types of issues.

4. A counselor working with service members should consider each of the following elements EXCEPT A. the culture of the military is largely monolithic.

B. there exists significant within and between group differences in the military such as unique cultures in different branches.

C. there is a need to consider the culture of the military when providing counseling to service members.

D. the degree the service member or family member subscribes to aspects of the military culture.

5. The stage of deployment involves partners relying on alternative sources of support and forming new roles and norms for the household.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. pre-deployment B. deployment C. reunification D. redeployment 6. Which statement accurately describes the issues related to deployment in recent conflicts in Afghanistan and Iraq experienced by military service members?

A. The proportion of physical and psychological injuries is about equal.

B. The proportion of physical injuries outstrips psychological issues.

C. The proportion of psychological issues outstrips physical injuries.

D. The proportion of physical and psychological injuries is consistent with previous conflicts.

7.

has been characterized as the ―signature wound‖ of the recent conflicts in Afghanistan and Iraq.

A. Posttraumatic stress disorder B. Adjustment disorder C. Generalized anxiety disorder D. Traumatic brain injury

8. Issues for nondeployed family members experiencing deployment often involves A. increased stress due to the managing tasks of a household and concern for partner.

B. a slight increase in stress through enhanced access via technology to alleviate anxiety.

C. delayed acknowledgement of stress due to the concern for responsibilities at home.

D. increased likelihood of substance abuse for a nondeployed partner due to ineffective coping skills.

9. The concept of ―resilience‖ as it relates to posttraumatic stress disorder involves A. focusing on remediating the symptoms of this disorder once determined to be present.

B. providing information on the disorder prior to deployment to prevent its development.

C. focusing on psychoeducational discussions, enhancing awareness of experiences, and positive emotional experiences and social bonds.

D. All of the above.

10. The approach is commonly used to addressing issues of posttraumatic stress.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

A. psychodynamic B. narrative C. gestalt D. cognitive-behavioral 11. Veterans who have had family members involved in treatment for posttraumatic stress disorder have A. indicated a desire for their inclusion though it has not been demonstrated to be beneficial.

B. not indicated a desire for their inclusion though it has been demonstrated to be beneficial.

C. indicated a desire for their inclusion and it has been demonstrated to be beneficial.

D. not indicated a desire for their inclusion and it has not been indicated to be beneficial.

12. The highest rate of suicide was related to A. separation from the military.

B. active duty.

C. reservists.

D. no separation from the military.

13. The most recent research conducted by the Military Times (2015), found which of the following deployment factors contributed to the highest rate of completed suicides.

A. One deployment B. Two deployments C. More than two deployments D. No deployments 14. The highest rates of suicide occurred among which group of military.

A. Multiple deployments B. Separation from the military C. History of suicidal behavior D. Reservists 15. The main priority of law enforcement is A. crime fighting.

B. safety of the community and personal safety.

C. crime prevention.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. crime solving.

16. The following stressors are evident for law enforcement.

A. Shiftwork B. Exposure to traumatic situations C. Relationship issues D. All of the above.

17. A law enforcement officer dies in the line of duty in A. an average of one death every 60 hours.

B. an average of one death every 60 days.

C. an average of one death every 60 weeks.

D. an average of one death every minute.

18. Law enforcement officers are than the general population to display suicide ideation, behaviors, and PTSD symptoms due to increased exposure to trauma.

A. 2 times more likely B. 4 times more likely C. 6 times more likely D. There is no difference than in the general population 19. EMS professionals report the calls that cause the most stress are incidents involve A. serious injury to children.

B. serious injury or death of a colleague.

C. having a patient die in their care.

D. All of the above.

20. According to the Centers for Disease Control and Prevention (2012), EMS professionals in the United States experience PTSD and suicide ideation than the 3.6% national average for the general public.

A. 2 times greater B. 5 times greater C. 10 times greater D. There is no difference than in the general population 21.

of all EMS professionals reported a line of duty injury, usually due to transport.

A. One in two 14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. One in three C. One in four D. One in five 22. Most line of duty fatalities among fire fighters were attributed to A. sudden cardiac deaths.

B. assaults.

C. injuries on calls.

D. suicides.

23. PFA identifies five imperative phases to be integrated with first responders: A. Assessment phase; stabilization phase; triage phase; communication phase; and hotline phase B. Assessment phase; control phase; triage phase; communication phase; and hotline phase C. Assessment phase; stabilization phase; triage phase; communication phase; and referral phase D. Assessment phase; stabilization phase; control; communication phase; and referral phase 24.

is the most common intervention to decrease the level of stress resulting from emergency calls.

A. Critical incident stress debriefing (CISD) B. Psychological first aid (PFA) C. Cognitive behavioral therapy (CBT) D. First response resiliency program (FRP)

25.

focuses on increasing resiliency skills coupled with a strong social support system to decrease or prevent mental health issues A. Critical incident stress debriefing (CISD) B. Psychological first aid (PFA) C. Cognitive behavioral therapy (CBT) D. First response resiliency program (FRP)

Extended Response Questions 1. Describe how a counselor would intervene from a systemic perspective to support a family who has recently learned that an active-duty family member is being deployed.

2. Describer and apply the concepts outlined in CISD to a shift that lost a law enforcement officer, an EMS, or a firefighter in the line of duty.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Describe what psychological first aid (PFA) identifies as the five imperative phases to be integrated with first responders.

4. Discuss assessment questions that would be assessed with every military member to formulate the appropriate presenting issue and treatment plan essential in forming the presenting issue.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 11 Test Answer Key Multiple Choice Answer Key: 1. C (see page 366, section titled Military Personnel and their Families) 2. B (see page 366, section titled Military Personnel and their Families) 3. D (see page 366, section titled Military Personnel and their Families) 4. A (see page 367, section titled Military Culture) 5. A (see page 369, section titled The Cycle of Deployment) 6. C (see page 369, section titled The Cycle of Deployment) 7. D (see page 370, section titled The Physical and Emotional Effects of War-Zone Deployment) 8. A (see page 372, section titled Familial Stress Associated with Deployment) 9. C (see page 374, section titled Interventions for Posttraumatic Stress Disorder) 10. D (see page 374, section titled Interventions for Posttraumatic Stress Disorder) 11. C (see page 374, section titled Interventions for Posttraumatic Stress Disorder) 12. A (see page 371, section titled Separation from the Military and Mental Health Issues) 13. D (see page 371, section titled Separation from the Military and Mental Health Issues) 14. B (see page 371, section titled Separation from the Military and Mental Health Issues) 15. B (see page 381, section titled Law Enforcement Officers) 16. D (see page 382, section titled Stressors of Law Enforcement Officers) 17. A (see page 382, section titled Deaths and Assaults on Law Enforcement Officers) 18. B (see page 385, section titled Mental Health Concerns: Depression, Anxiety, and Substance Use) 19. D (see page 388, section titled Emergency Medical Services Professionals) 20. C (see page 388, section titled Emergency Medical Services Professionals) 21. C (see page 388, section titled Emergency Medical Services Professionals) 22. A (see page 391, section titled Firefighters) 23. A (see page 392, section titled Psychological First Aid) 24. A (see page 393, section titled Critical Incident Stress Management) 25. D (see page 395, section titled First Responder Resiliency Programs) Feedback for the essay question: 17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Model response: Answers will vary, but should include some of the following points: understanding of the military culture and mission; understanding of the roles of the family members and expectations when deployed; impact of deployment on the family; awareness of supports available and special need of the family; understanding of previous deployments and issues that could assist or need to be addressed for the current deployment. If it is a first deployment, the counselor would also want to assist in preparing for the deployment and what issues could be expected for the couple.

2. Model response: Answers will vary, but should include some of the following points but also relies on reading done in Chapter 12 and applied to this chapter: Introduction Phase: setting the rules and tone of discussion; Fact Phase: discussion of what happened during the crisis from each person’s perspective; Thought Phase: Clients discuss the main emotion and cognition they experienced while going through the crisis; Reaction Phase: Clients discuss the worst part of the crisis; Symptom Phase: Clients describe their symptoms of distress during and after the crisis; Teaching Phase: Teach ways to reduce stressors and the impact of stress; and Re-entry Phase: Counselor answers questions and summarizes comments.

3. Model response: Answers will vary, but should include some of the following points: information on the 5 phases of PFA. (1) assessment phase; (2) stabilization phase; (3) triage phase; (4) communication phase; and (5) hotline phase.

4. Model response: Answers will vary, but should include some of the following points: type of separation from the military, current relationship issues, psychological and physical injuries, exposure and reaction to traumatic events while deployed or at all, and unresolved memories are important questions for crisis counselors to keep in mind when assessing for suicide or homicidal ideation and behaviors.

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter Chapter 11 Military and First Responder Populations

Learning Objective

Exercises & Quizzes

11.1 Describe the culture of military personnel and their families.

Learning Objective Quiz 11.1

C ACREP Standards— Section 2: Professional Identity F.1.d,F.1.e, F.2.c, F.2.e, F.2.h

[Q1] Application Exercise 11.1

blank

11.2 Describe the impact of war-zone deployments and separation on military personnel.

Learning Objective Quiz 11.2

11.3 Explain issues for military families related to deployment.

Learning Objective Quiz 11.3

11.4 Outline crisis intervention as it applies to military service members.

Learning Objective Quiz 11.4

F.3.e, F.3,f, F.7.b, Section 5 CMHC: 5C.2.f

[Q1]

blank

[Q1]

F.3.g, F.3.h, F.1.d,F.1.e, F.2.c, F.2.e, F.2.h Section 5. CMHC: 5C.3.a, 5C.3b

blank

Section 5. CMHC: 5C.3.a, 5C.3b

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

[Q1] blank

11.5 Describe the special risks that first responders face.

Learning Objective Quiz 11.5

11.6 Describe the culture of law enforcement officers and their unique stressors.

Learning Objective Quiz 11.6

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

blank

F.3.g Section 5. CMHC: 5C.3.a, 5C.3b

[Q1] Application Exercise 11.2

blank

11.7 Summarize the unique stressors of emergency medical services professionals.

Learning Objective Quiz 11.7

11.8 Summarize the unique stressors of firefighters.

Learning Objective Quiz 11.8

11.9 Outline crisis intervention as it applies to first responders.

Learning Objective Quiz 10.9

.F.3.g Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

blank

F.3.g Section 5. CMHC: 5C.3.a, 5C.3b

[Q1]

blank

Section 5. CMHC: 5C.3.a, 5C.3b

[Q1, Q2] Application Exercise 11.3

Chapter 12 Test Item File 20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

21 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 12: Emergency Preparedness and Response in the Community and Workplace 1 Learning Outcome Quizzes

1

Application Exercises

9

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 12: Emergency Preparedness and Response in the Community and Workplace Chapter 12 Learning Outcome Quizzes Learning Objective 12.1: Describe the leadership roles in working with multidisciplinary teams in emergency preparedness situations.

[Q1] Multidisciplinary crisis response teams (MCRTs) have various names, including first responder teams, primary and emergency health care teams, school response teams, and community emergency response teams (C ERTs). The hallmark of MCR Ts is that they comprise: 1. Multiple individuals from the medical profession 2. Multiple individuals from first responder populations 3. Multiple faith-based leaders 4. Multiple individuals from different professions [correct] [Feedback for Answer Choice 1] Multidisciplinary crisis response teams (MCRTs) may include medical professionals but also include other professionals.

[Feedback for Answer Choice 2] Multidisciplinary crisis response teams (MCRTs) may include first responder populations but also include other professionals.

[Feedback for Answer Choice 3] Multidisciplinary crisis response teams (MCRTs) may include faith-based leaders but also include other professionals.

[Feedback for Correct Answer 4] The hallmark of MCRTs is that they comprise multiple individuals from different professions, each serving a specific function, who collaborate to provide different perspectives on the crisis or disaster.

Learning Objective 12.2: Outline types of natural disasters, common reactions, and emergency responses.

[Q1] Initially, when a disaster strikes, people experience feelings of shock, fear, panic, confusion, and, possibly, disorientation. Statements such as ―I can’t believe this is happening‖ and ―This can’t be happening‖ are typical. During this initial time of the disaster, people need to know or be assured that: 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Basic survival resources (e.g., safety, food, water) are available [correct] 2. Mental health needs will be addressed 3. Community rebuilding will occur 4. Employment opportunities will be available [Feedback for Correct Answer 1] During this initial time of the disaster, people need to know or be assured that basic survival resources (e.g., safety, food, water) are available.

[Feedback for Answer Choice 2] Mental health may be assessed and in some situations may be a priority, but it is not the most important aspect for the majority of individuals experiencing a disaster in the initial stage.

[Feedback for Answer Choice 3] Rebuilding will be addressed in late stages, but it is not the most important aspect for the majority of individuals experiencing a disaster in the initial stage.

[Feedback for Answer Choice 4] Employment will be addressed in later stages, but it is not the most important aspect for the majority of individuals experiencing a disaster in the initial stage.

[Q2] Everly and Mitchell (2003) proposed that three essential elements need to take place with response teams to prevent panic and chaos immediately following a disaster. What are these three essential elements?

1. Command post, rebuilding, and communication 2. Command post, connections, and risk assessment 3. Command post, connections, and communication [correct] 4. Command post, connections, and safety [Feedback for Answer Choice 1] Rebuilding is not one of the essential elements proposed by Everly and Mitchell (2003).

[Feedback for Answer Choice 2] Risk assessment is not one of the essential elements proposed by Everly and Mitchell (2003).

[Feedback for Correct Answer 3] Everly and Mitchell (2003) proposed that three essential elements need to take place with response teams to prevent panic and chaos immediately following a disaster. First, a command post needs to be established to help people find and 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

recognize one centralized location of leadership and organization in a time of chaos and disarray. Second, people exposed to the disaster must be connected with needed resources. Third, it is essential to communicate with those in need and create an atmosphere in which feelings of helplessness are extinguished.

[Feedback for Answer Choice 4] Safety is not one of the essential elements proposed by Everly and Mitchell (2003).

Learning Objective 12.3: Differentiate between types of terrorism and responses to terrorism.

[Q1] An elevated level of stress is a natural response to a crisis, whether it is a natural disaster, an act of terrorism, or mass destruction. In fact, most of the psychological reactions to natural disasters are the same as the psychological reactions to acts of terrorism. The key difference between natural disasters and terrorism is that with acts of terrorism: 1. There is someone to blame. [correct] 2. A higher power can be blamed.

3. There is nobody to blame.

4. Blaming others is not tolerated.

[Feedback for Correct Answer 1] The key difference between natural disasters and terrorism is that with acts of terrorism, there is someone to blame.

[Feedback for Answer Choice 2] This is not the key difference between natural disasters and terrorism.

[Feedback for Answer Choice 3] This is not the key difference between natural disasters and terrorism.

[Feedback for Answer Choice 4] This is not the key difference between natural disasters and terrorism.

[Q2] Compared with other types of crisis response, some practitioners believe in a gentler approach that allows for open communication, immediate support, focus on the positive, and empowerment. What is this approach?

1. PFA [correct] 2. CISM 3. CISD 4. Defusing 3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 1] While some other approaches of debriefing are seen as intrusive or dictating that individuals need help, PFA is offered to people inquiring how help can be provided.

[Feedback for Answer Choice 2] This approach is not called CISM. [Feedback for Answer Choice 3] This approach is not called CISD. [Feedback for Answer Choice 4] This approach is not called defusing.

[Q3] Which of the following is a phase strategy that is used to reduce the initial stressors and distressful emotions and behaviors along with attempting to prevent further onset of more severe mental and emotional responses (i.e., P TSD symptoms)?

1. PFA 2. CIST 3. CISD [correct] 4. Defusing [Feedback for Answer Choice 1] This approach is not called PFA. [Feedback for Answer Choice 2] This approach is not called C IST. [Feedback for Correct Answer 3] The purpose of CISD is to reduce the initial stressors and distressful emotions and behaviors along with attempting to prevent further onset of more severe mental and emotional responses (i.e., PTSD symptoms). CISD is not therapy; it is a strategy to process an immediate event and to assess the impact of the situation on the individual.

[Feedback for Answer Choice 4] This approach is not called defusing.

[Q4] Imagine you are part of a response team and are facilitating a CISD group of first responders following an incident involving an officer’s line-of-duty death. You are working with the officers from the shift who were on the scene. In the CISD, you begin to explore what parts of the event continue to cause each of them distress.

What phase is this in the CISD? 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Facts phase 2. Reactions phase [correct] 3. Symptoms phase 4. Reentry phase [Feedback for Answer Choice 1] The Facts phase focuses on what happened during the crisis from each person’s perspective.

[Feedback for Correct Answer 2] The Reactions phase is focused on exploring the situation within the event that has caused the clients most distress.

[Feedback for Answer Choice 3] The Symptoms phase focuses on the clients’ symptoms and distress during and after the crisis.

[Feedback for Answer Choice 4] The Reentry phase focuses on the clients’ ability to reenter their role post-crisis.

[Q5] Imagine you are part of a response team and are facilitating a CISD group of first responders following an incident involving an officer’s line-of-duty death. You are working with the officers from the shift who were on the scene. In the CISD, you begin to explore their distress and how the distress is manifesting for each of them.

What phase is this in the CISD? 1. Facts phase 2. Reactions phase 3. Symptoms phase [correct] 4. Reentry phase [Feedback for Answer Choice 1] The Facts phase focuses on what happened during the crisis from each person’s perspective.

[Feedback for Answer Choice 2] The Reactions phase is focused on exploring the situation within the event that has caused the clients most distress.

[Feedback for Correct Answer 3] The Symptoms phase focuses on the clients’ symptoms and distress during and after the crisis.

[Feedback for Answer Choice 4] 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

The Reentry phase focuses on the clients’ ability to reenter their role post-crisis.

[Q6] According to Castellano and Plionis (2006), CISM was successfully implemented during the September 11 aftermath to augment established individual counseling through six components. Because so many senior/superior police officers saw their lower-ranked colleagues die or become devastated by the 9 / 11 attack, specific crisis intervention services and educational seminars were developed and delivered to this senior/superior police officer population. What was this component?

1. Executive leadership program [correct] 2. Hotline 3. Acute traumatic stress group training sessions 4. Acute crisis counseling provided by peer counselors [Feedback for Correct Answer 1] This component was the executive leadership program.

[Feedback for Answer Choice 2] Although telephone crisis hotlines were highly emphasized and used to help those who responded to the 9 / 11 attack, this is not the correct answer.

[Feedback for Answer Choice 3] Although 2-day psychoeducational group sessions helped to decrease isolation, normalize emotions and reactions to the attack, decrease guilt, and increase coping mechanisms, this is not the correct answer.

[Feedback for Answer Choice 4] Although crisis counselors and law enforcement officers with crisis intervention skills provided crisis intervention to law enforcement officers who initially responded to the September 11 terrorist attacks in New York, this is not the correct answer.

Learning Objective 12.4: Describe various types of riots, their impact on a community, and effective interventions.

[Q1] What phase is the final phase when working with a postriot community which emphasizes the rebuilding of the community?

1. Recovery phase [correct] 2. Collaboration phase 3. Community outreach phase 4. Team-building phase [Feedback for Correct Answer 1] 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

The final phase when working with a postriot community which emphasizes the rebuilding of the community is the recovery phase.

[Feedback for Answer Choice 2] The final phase when working with a postriot community which emphasizes the rebuilding of the community is not the collaboration phase.

[Feedback for Answer Choice 3] The final phase when working with a postriot community which emphasizes the rebuilding of the community is not the community outreach phase.

[Feedback for Answer Choice 4] The final phase when working with a postriot community which emphasizes the rebuilding of the community is not the team-building phase.

Learning Objective 12.5: Explain the stages of hostage situations and effective points of intervention.

[Q1] According to Strentz (2018), there are essentially five stages of a hostage situation.

During which stage do hostages suddenly feel like there is no escape from the situation and become paralyzed not only due to threats of physical harm but also due to the severe shock resulting from aggressive actions by the hostage takers?

1. Alarm [correct] 2. Crisis 3. Uncertainty 4. Accommodation [Feedback for Correct Answer 1] During the alarm stage, hostages are confused by the sudden turn of events and feel victimized. They suddenly feel like there is no escape from the situation and become paralyzed not only due to threats of physical harm but also due to the severe shock resulting from aggressive actions by the hostage takers.

[Feedback for Answer Choice 2] During the crisis stage, hostage takers begin to realize the magnitude of the situation and continue to be highly dangerous and volatile but also realize that they must secure their surroundings from authorities and attempts by hostages to escape. The crisis stage also begins the hostage takers’ interactions with the authorities, with the hostage takers frequently making grandiose or ridiculous demands with the expectation that the authorities will meet such demands.

[Feedback for Answer Choice 3] The uncertainty stage has parallel characteristics among the hostage takers, the hostages themselves, and even the hostage negotiators. During this stage, the crisis 7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

stage has either escalated or deescalated, but the situation is not yet under control.

Thoughts of hopelessness (as evident in the crisis stage) are subsiding, but no one knows the outcome of the situation.

[Feedback for Answer Choice 4] The accommodation stage is marked by time standing still and fatigue for both the hostages and the hostage takers. Overall, this stage is somewhat peaceful because dominance over the hostages is established and acts of violence may not be deemed necessary by the hostage takers. Hostages become passive and bored.

They may even experience Stockholm syndrome, a situation in which they develop positive feelings for the hostage takers and negative feelings for the authorities, while hostage takers gain concern and positive feelings for the hostages.

8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 12 Application Exercises Application Exercise 12.1 Learning Objective 12.1: Describe the leadership roles in working with multidisciplinary teams in emergency preparedness situations.

[Q1] Refer to Case Study 12.1, Dealing with a Flood. Phoenix is 50 years old and has lived in rural Missouri alone for the past 30 years, working from home as a graphic designer. Phoenix does not have any family left and rarely talks to anyone except clients. Two years ago, Phoenix’s hearing began to diminish, and now Phoenix has no hearing in their left ear and only 15% of normal hearing capacity in their right ear.

Phoenix’s home and home office are 7 feet under water. Phoenix was rescued by the local fire and rescue unit yesterday evening. You are meeting Phoenix for the first time, just 22 hours after the rescue. As a crisis counselor, what would your priorities be with Phoenix?

[Q1 Model Response] Individuals may not be able to solve large or complex problems until personal safety needs have been met. Providing resources is crucial, such as connecting people with family members and providing them with resources to meet basic needs such as shelter and safety. With Phoenix, assigning him with team members who have special training in hearing different individuals may be needed. Phoenix is in the shelter and currently his basic needs are a priority; these include continued shelter, food, clothing, and safety issues. Working on housing post-shelter will be important.

Since he has no family, connecting him with faith leaders or others in the community may be helpful in the later stages, but starting those connections in the shelter may be a good bridge to the next stages.

Application Exercise 12.2 Learning Objective 12.3: Differentiate between types of terrorism and responses to terrorism.

[Q2] Imagine you are part of a response team and are facilitating a CISD group of firefighters following a fire in the community that took the lives of a family that is known to the firefighters. You are working with the firefighters from the shift who were on the scene battling the fire. In the CISD, as the mental health professional on the team, you are responsible for offering psychoeducation in the teaching phase.

What might be important to include?

[Q2 Model Response]

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Information should center on normal feelings of helplessness, responsibility, guilt, community and individual loss of a family and the grief process, reviewing risk assessment and basic needs to continue a healthy lifestyle (eating, sleeping, not increasing drinking), and referrals to mental health. Determining the relationship to the family for each firefighter would be helpful to assess the impact of the deaths at a more individual level.

Application Exercise 12.3 Learning Objective 12.3: Differentiate between types of terrorism and responses to terrorism.

[Q3] Imagine you are part of a response team and are facilitating a CISD group of first responders following an incident involving an officer’s line-of-duty death. You are working with the officers from the shift who were on the scene. Outline the stages in CISD that you will be implementing.

[Q3 Model Response] The purpose of CISD is to reduce the initial stressors and distressful emotions and behaviors along with attempting to prevent further onset of more severe mental and emotional responses (i.e., PTSD symptoms). CISD is not therapy; it is a strategy to process an immediate event and to assess the impact of the situation on the individual. According to Everly and Mitchell (2003), CISD is structured in its delivery and has the following seven phases: 1. Introduction phase: The counselor sets the rules and tone of the discussion.

2. Facts phase: Clients discuss what happened during the crisis from each person’s perspective.

3. Thoughts phase: Clients discuss the main emotion and cognition experienced while going through the crisis.

4. Reactions phase: Clients discuss the worst part of the crisis.

5. Symptoms phase: Clients describe their symptoms of distress during and after the crisis.

6. Teaching phase: The counselor teaches ways to reduce stressors and the impact of stress.

7. Reentry phase: The counselor answers questions and summarizes comments.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 12 Test Items Multiple Choice Questions 1. The hallmark of teams is that they comprise multiple individuals from different professions, each serving a specific function, who collaborate to provide different perspectives on the crisis or disaster.

A. clinical psychologist B. professional counseling C. social work D. multidisciplinary crisis response 2. Which of the following leadership roles can be found in a multidisciplinary crisis response team?

A. Media liaison B. Mortality liaison C. Both of the above.

D. None of the above.

3. Psychological first aid (PFA) can be used with A. children only.

B. adults only.

C. the elderly only.

D. All of the above.

4. Which of the following statements about psychological first aid (PFA) is NOT true?

A. Psychological first aid (PFA) is grounded in evidence-based research.

B. Psychological first aid (PFA) is less intrusive than critical incident stress management (CISM).

C. Psychological first aid (PFA) is more intrusive than critical incident stress management (CISM).

D. Psychological first aid (PFA) is rooted in the notion that individuals are resilient.

5. A mental health clinician practicing psychological first aid (PFA) would be less likely to A. observe the individual before engaging in counseling.

B. provide practical and realistic resources.

C. allow the individual to detail the trauma and vent.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. empower the individual by letting the individual know that there is hope.

6.

trauma affects a person’s mental and emotional state and requires the person to react to the event in some compensatory manner.

A. Placated B. Collective C. Individual D. Stressful

7. When a disaster strikes, survivors most likely exhibit shock A. when the initial disaster strikes.

B. days after the disaster strikes.

C. months after the disaster strikes.

D. a year after the disaster strikes.

8. When a disaster strikes, survivors most likely exhibit an attitude of moving on A. when the initial disaster strikes.

B. hours after the disaster strikes.

C. days after the disaster strikes.

D. a year after the disaster strikes.

9. When a disaster strikes, mental health clinicians should attempt to reduce the chaos of the disaster A. when the initial disaster strikes.

B. days after the disaster strikes.

C. months after the disaster strikes.

D. a year after the disaster strikes.

10. When a disaster strikes, mental health clinicians should engage in some problem-solving interventions A. when the initial disaster strikes.

B. hours after the disaster strikes.

C. days after the disaster strikes.

D. a year after the disaster strikes.

11. Typical responses to a disaster, such as apathy, feelings of being overwhelmed, depression, irritability, anxiety, agitation, panic, and helplessness are called A. cognitive reactions.

B. physical reactions.

C. emotional reactions.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. behavioral reactions.

12. Typical responses to a disaster such as restlessness, conflicts with others, withdrawal from others, lack of interest in social activities, and increased drug/alcohol use are called A. cognitive reactions.

B. physical reactions.

C. emotional reactions.

D. behavioral reactions.

13. The three essential elements needed to prevent chaos immediately following a disaster include A. connections, communication, and command post.

B. connections, community outreach, and command post.

C. connections, communication, and community outreach.

D. None of the above.

14.

has demonstrated effectiveness for individuals who have experienced a crisis.

A. Psychological first aid (PFA) B. Play therapy C. Eye movement desensitization and reprocessing (EMDR) D. All of the above.

15.

has a specific emphasis on potentiating pairings or venting and debriefing.

A. Psychological first aid (PFA) B. Critical incident stress management (CISM) C. Play therapy D. Eye movement desensitization and reprocessing (E MDR)

16.

is NOT a component in a crisis counseling program (C CP).

A. Assessing strengths B. Creating an open door policy C. Restoring predisaster functioning D. Providing validation

17. In a crisis counseling program (CCP), the term ―accept the face value‖ means A. one must identify not only what the problems are, but also what human and material resources are available.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

B. the key to restoring life to what it was before the disaster is to attempt to reduce the chaos of the disaster.

C. the provision of unconditional positive regard, acceptance, and validation is critical to the growth of disaster victims.

D. one must help clients to reorganize life to accommodate for the impact of the disaster.

18. A ―disturbance of the peace by at least several persons, assembled and acting with a common intent in executing a lawful or unlawful enterprise in a violent and turbulent manner‖ is A. riot.

B. protest.

C. CCP. D. CISM. 19. At least

of hostage takers have a mental or an emotional disorder.

A. 30% B. 40% C. 50% D. 60% 20. During the stage of a typical hostage situation, the hostage taker often becomes suicidal.

A. alarm B. crisis C. accommodation D. resolution 21. During the often feels fatigued.

stage of a typical hostage situation, the hostage taker

A. accommodation B. resolution C. Both of the above.

D. None of the above.

22. During the most traumatized.

stage of a typical hostage situation, hostages would be

A. alarm B. crisis C. accommodation 14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

D. resolution Extended Response Questions 1. What might be some important issues to keep in mind when responding to an earthquake? How might this be different from responding to a school shooting?

2. Describe the essential four stages of a hostage situation. At each stage, what are important things to keep in mind as a mental health clinician?

3. Identify the differences between psychological first aid (PFA) and critical incident stress management (CISM). Also, provide insight into which of these models you prefer and explain why.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 12 Test Answer Key Multiple Choice Answer Key: 1. D (see page 400, section titled Leadership Roles in Multidisciplinary Crisis Response Teams) 2. C (see page 400, section titled Leadership Roles in Multidisciplinary Crisis Response Teams) 3. D (see page 412, section titled Psychological First Aid) 4. B (see page 412, section titled Psychological First Aid) 5. C (see page 412, section titled Psychological First Aid) 6. C (see page 403, section titled Responses to Natural Disasters) 7. D (see page 404, section titled Responses to Natural Disasters) 8. A (see page 404, section titled Responses to Natural Disasters) 9. A (see page 404, section titled Responses to Natural Disasters) 10. B (see page 404, section titled Responses to Natural Disasters) 11. C (see page 407, section titled Responses to Natural Disasters) 12. D (see page 407, section titled Responses to Natural Disasters) 13. A (see page 407, section titled Responses to Natural Disasters) 14. D (see page 412, section titled Interventions after a Disaster or Act of Terrorism) 15. B (see page 414, section titled Critical Incident Stress Debriefing) 16. B (see page 416, section titled Crisis Counseling Program) 17. D (see page 416, section titled Crisis Counseling Program) 18. A (see page 416, section titled Riot) 19. C (see page 418, section titled Hostage Situations) 20. D (see page 418, section titled Hostage Situations) 21. C (see page 419, section titled Hostage Situations) 22. A (see page 419, section titled Hostage Situations) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: discussion on the differences between ―man-made disasters‖ and ―God-made disasters.‖ Often, blame on others in man-made disasters may bring about anger and answers but God-made disasters may impact spiritual and religious beliefs which can impact supports. Earthquake and other God-made disasters may require crisis workers to focus on basic needs of shelter, food, and relocation. In man-made 16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

disasters, such as shooting, crisis workers may need to focus on perceived safety issues as the priority.

2. Model response: Answers will vary, but should include some of the following points: five stages of a hostage situation: (1) alarm, (2) crisis, (3) uncertainty, (4) accommodation, and (5) resolution. Each stage encompasses certain issues for mental health worker in order to understand the issues experienced by a client at each stage. For example, during the crisis stage, victims may form a relationship with the hostage taker and if there are injuries to others, then guilt may be need to be assessed. Information to the victims regarding common reactions for survival strategy may need to be reported to the client.

3. Model response: Answers will vary, but should include some of the following points: PF A: (1) assessment phase; (2) stabilization phase; (3) triage phase; (4) communication phase; and (5) hotline phase.

4. CISM: Introduction Phase: setting the rules and tone of discussion; Fact Phase: discussion of what happened during the crisis from each person’s perspective; Thought Phase: Clients discuss the main emotion and cognition they experienced while going through the crisis; Reaction Phase: Clients discuss the worst part of the crisis; Symptom Phase: Clients describe their symptoms of distress during and after the crisis; Teaching Phase: Teach ways to reduce stressors and the impact of stress; and Reentry Phase: Counselor answers questions and summarizes comments.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

Chapter

Learning Objective

Chapter 12

12.1 Describe the leadership roles in working with multidisciplinary teams in emergency preparedness situations.

Learning Objective Quiz 12.1

12.2 Outline types of natural disasters, common reactions, and emergency responses.

Learning Objective Quiz 12.2

Emergency Preparedness and Response in the Community and Workplace

C ACREP Standards— Section 2: Professional Identity F.1.b, F.1.c Section 5 CMHC: 5C.2.a, 5C.3.d

[Q1]

blank

F.1.b, F.2.g, F.3.g, F.3.h,

[Q1, Q2] Application Exercise 12.1

blank

12.3 Differentiate between types of terrorism and responses to terrorism.

Learning Objective Quiz 12.3

F.2.b, F.2.d, F.2.h,

[Q1, Q2, Q3] Application Exercise 12.2 18

Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

Application Exercise 12.3 blank

12.4 Describe various types of riots, their impact on a community, and effective interventions.

Learning Objective Quiz 12.4

12.5 Explain the stages of hostage situations and effective points of intervention.

Learning Objective Quiz 12.5

F.2.b, F.3.e, F.3.f, F.3.i

[Q1]

blank

F.3.h

[Q1]

Chapter 13 Test Item File

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University 19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 13: Emergency Preparedness and Response in Schools and Universities

1

Learning Outcome Quizzes

1

Application Exercises

8

Test Items

11

Test Answer Key

16

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 13: Emergency Preparedness and Response in Schools and Universities Chapter 13 Learning Outcome Quizzes Learning Objective 13.1: Describe characteristics of school and university crises.

[Q1] The Office of Safe and Drug-Free Schools in the U.S. Department of Education (2017) identified which four phases of a comprehensive school crisis plan?

1. (1) Mitigation and planning; (2) preparedness; (3) response; and (4) recovery 2. (1) Mitigation and prevention; (2) preparedness; (3) reaction; and (4) recovery 3. (1) Mitigation and prevention; (2) preparedness; (3) response; and (4) rebuilding 4. (1) Mitigation and prevention; (2) preparedness; (3) response; and (4) recovery [correct] [Feedback for Answer Choice 1] Planning is not identified as a phase in the school crisis plan.

[Feedback for Answer Choice 2] Reaction is not identified as a phase in the school crisis plan.

[Feedback for Answer Choice 3] Rebuilding is not identified as a phase in the school crisis plan.

[Feedback for Correct Answer 4] The Office of Safe and Drug-Free Schools in the U.S. Department of Education (2017) identified four phases of a comprehensive school crisis plan: (1) mitigation and prevention, which addresses what schools can do to reduce or eliminate risk to life and property; (2) preparedness, which refers to the process of planning for a crisis; (3) response, which refers to the actions taken during a crisis; and (4) recovery, which refers to restoring the school environment after a crisis and includes debriefing strategies.

Learning Objective 13.2: Describe strategies for the mitigation and prevention of school and university crises.

[Q1] Which of the following refers to assessing the dangers in a school and community and identifying strategies to prevent and reduce injury and property damage?

1. Preparedness 2. Response 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

3. Mitigation and prevention [correct] 4. Recovery [Feedback for Answer Choice 1] Preparedness is not the accurate answer.

[Feedback for Answer Choice 2] Response is not the accurate answer.

[Feedback for Correct Answer 3] Assessing the dangers in a school and community and identifying strategies to prevent and reduce injury and property damage is referred to as mitigation and prevention.

[Feedback for Answer Choice 4] Recovery is not the accurate answer.

[Q2] Crime prevention through environmental design (C PTED) is based on a theory of crime prevention that focuses on the design and use of built space to both reduce crime and the fear of crime. Five principles comprise CPTED: 1. Surveillance, physical security, control of visitors, defensible space, and maintenance/management 2. Surveillance, physical security, control of movement, defensible space, and maintenance/management [correct] 3. Surveillance, physical security, control of movement, defensible space, and mitigation 4. Surveillance, physical security, control of security, defensible space, and maintenance/management [Feedback for Answer Choice 1] Control of visitors is not a principle of CPTED. [Feedback for Correct Answer 2] Crime prevention through environmental design (CPTED) is proactive and preventive rather than reactive and designs space and environments for use by legitimate users, thereby reducing the opportunity for crime to occur or for people to fear that a crime will occur. Five principles comprise CPTED: surveillance (i.e., observation of the surrounding environment, illumination), physical security (i.e., design features that withstand intrusion), control of movement (i.e., restricting access to prevent entry and egress of intruders), defensible space (i.e., space should be clearly designated as private, restricted, or open access), and maintenance/management (i.e., areas must be well maintained and orderly).

2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 3] Mitigation is not a principle of CPTED. [Feedback for Answer Choice 4] Control of security is not a principle of CPTED. Learning Objective 13.3: Describe strategies for planning and preparing for school and university crises.

[Q1] One of the most comprehensive models of crisis planning, preparedness, and response developed specifically for schools is PREPaRE. What does PREPaRE stand for?

1. (P) Prevent and prepare, (R) Reaffirm safety and security, (E) Evaluate risk of trauma, (P) Provide interventions, (a)—and (R) Respond to community needs and (E) Examine effectiveness 2. (P) Prevent and prepare, (R) Reaffirm housing, (E) Evaluate risk of trauma, (P) Provide interventions, (a)—and (R) Respond to mental health needs and (E) Examine effectiveness 3. (P) Prevent and prepare, (R) Reaffirm safety and security, (E) Evaluate risk of trauma, (P) Provide interventions, (a)—and (R) Respond to mental health needs and (E) Examine relocation 4. (P) Prevent and prepare, (R) Reaffirm safety and security, (E) Evaluate risk of trauma, (P) Provide interventions, (a)—and (R) Respond to mental health needs and (E) Examine effectiveness [correct] [Feedback for Answer Choice 1] Respond to community needs is not part of the PREPaRE acronym.

[Feedback for Answer Choice 2] Provide housing needs is not part of the PREPaRE acronym.

[Feedback for Answer Choice 3] Examine relocation is not part of the PREPaRE acronym.

[Feedback for Correct Answer 4] PREPaRE stands for: (P) Prevent and prepare, (R) Reaffirm safety and security, (E) Evaluate risk of trauma, (P) Provide interventions, (a)—and (R) Respond to mental health needs and (E) Examine effectiveness.

[Q2] The PREPaRE model suggests that crisis teams respond in which five crisis domains?

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. (1) Prevention, (2) protection, (3) mitigation, (4) response, and (5) recovery [correct] 2. (1) Prevention, (2) privacy, (3) mitigation, (4) response, and (5) recovery 3. (1) Prevention, (2) protection, (3) mitigation, (4) rebuilding, and (5) recovery 4. (1) Prevention, (2) protection, (3) mitigation, (4) response, and (5) building resiliency [Feedback for Correct Answer 1] The PREPaRE model (Brock et al., 2016) is among the most comprehensive models of crisis planning, preparedness, and response developed specifically for schools.

The PREPaRE model suggests that crisis teams respond in five crisis domains: (1) prevention, (2) protection, (3) mitigation, (4) response, and (5) recovery.

[Feedback for Answer Choice 2] Privacy is not one of the five crisis domains.

[Feedback for Answer Choice 3] Rebuilding is not one of the five crisis domains.

[Feedback for Answer Choice 4] Building resiliency is not one of the five crisis domains.

[Q3] Part of preparing for a crisis involves some proactive approaches. On recommendation from the Center for Mental Health in Schools at U CLA (2018) focuses on making academic environments more sensitive to individuals and families coping with trauma. A focus of the framework is to identify local priorities and develop sensitive solutions embedded in the educational context. What is this framework known as?

1. The Trauma and Learning Policy Initiative [correct] 2. The Trauma-Focused Schools 3. Trauma-Informed CBT 4. Complex Trauma Initiative [Feedback for Correct Answer 1] This framework is known as the Trauma and Learning Policy Initiative.

[Feedback for Answer Choice 2] This framework is not known as Trauma-Focused Schools.

[Feedback for Answer Choice 3] This framework is not known as Trauma-Informed CBT. [Feedback for Answer Choice 4] 4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This framework is not known as the Complex Trauma Initiative.

[Q4] When a threat occurs nearby or outside of the school, such as when law enforcement is responding to a nearby emergency; a particular student needs to be located; there is a disturbance in the community near the building; and the threat is not an impending risk but additional caution is warranted, what type of lockdown may be issued?

1. Hard lockdown 2. Soft lockdown [correct] 3. Critical lockdown 4. Minor lockdown [Feedback for Answer Choice 1] A hard lockdown is not typical in this situation.

[Feedback for Correct Answer 2] A soft lockdown may be used when threat occurs nearby or outside of the school, such as when law enforcement is responding to a nearby emergency; a particular student needs to be located; there is a disturbance in the community near the building; and the threat is not an impending risk but additional caution is warranted.

[Feedback for Answer Choice 3] A critical lockdown is not the correct name for this type of lockdown.

[Feedback for Answer Choice 4] A minor lockdown is not the correct name for this type of lockdown.

Learning Objective 13.4: Describe strategies for responding to school and university crises.

[Q1] FEMA outlines many steps and actions to take when responding to a school or university crisis; however, the main goal of any response team is what?

1. Identification of the perpetrator of the crisis 2. Implementation of a relocation plan 3. Evacuation of the location 4. Student safety and simultaneously sending for help from support personnel [correct] [Feedback for Answer Choice 1] Identification of the perpetrator of the crisis is not the most accurate response.

5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Answer Choice 2] Implementation of a relocation plan is not the most accurate response.

[Feedback for Answer Choice 3] Evacuation of the location is not the most accurate response.

[Feedback for Correct Answer 4] FEMA outlines many steps and actions to take when responding to a school or university crisis; however, the main goal of any response team is for student safety and simultaneously send for help from support personnel.

Learning Objective 13.5: Describe strategies for recovery after a school or university crisis.

[Q1] FEMA (2021) cautions that healing and recovery may take months or even years, depending on the traumatic event. Personnel need to understand that healing is a process that will take time. At the same time, the goal of recovery is to return to a stable, precrisis environment that includes which of the following?

1. Return students to the learning environment as quickly as possible [correct] 2. Having students return to after-school activities only 3. Have a planning meeting with parents and school administrators 4. Have a long delay of return to the learning environment [Feedback for Correct Answer 1] The goal of recovery is to return to a stable, precrisis environment that includes having students return to the learning environment as quickly as possible.

[Feedback for Answer Choice 2] Having students return to after-school activities only is not the priority.

[Feedback for Answer Choice 3] Having a planning meeting with parents and school administrators should be scheduled but is not the overall goal or recovery.

[Feedback for Answer Choice 4] Having a long delay of return to the learning environment is not the priority.

Learning Objective 13.6: Describe appropriate responses to crises in university settings, including shelter-in-place procedures and threat assessment teams.

[Q1] Which of the following is NOT recommended by FEMA (2011) in a thunderstorm, lightning, or hurricane shelter-in-place situation?

6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

1. Stand or sit near doors and windows that lead outside [correct] 2. Listen to local watches and warnings about evacuating 3. If you are unable to evacuate, go to a wind-safe room 4. Close doors and windows to the outside [Feedback for Correct Answer 1] People should NOT stand or sit near doors and windows that lead outside.

[Feedback for Answer Choice 2] This is something that FEMA recommends.

[Feedback for Answer Choice 3] This is something that FEMA recommends.

[Feedback for Answer Choice 4] This is something that FEMA recommends.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 13 Application Exercises Application Exercise 13.1 Learning Objective 13.3: Describe strategies for planning and preparing for school and university crises.

[Q1] Crisis plans need to be put in place before a crisis occurs. You are a new school counselor and during the first orientation, you determine there is no written crisis plan. The principal assigns you to chair this task committee to develop a written plan. Using James and Gilliland’s (2017) recommended minimum requirements for a crisis plan, what would be essential to include in the written plan?

[Q1 Model Response] Crisis plans need to be put in place before a crisis occurs. James and Gilliland (2017) recommended the following minimum requirements for a crisis plan: 

Physical requirements: Identify locations for temporary counseling offices. An operations/communications center should be identified where crisis intervention procedures are monitored, needs are assessed, and information for the media is disseminated. Other suggestions include a break room, a first-aid room, and an information center designed to handle media personnel and to facilitate parent communication.



Logistics: Address specific areas that need consideration as an intervention plan is implemented. For example, attention needs to be given to the manner in which on-site and off-site communication will take place. Other logistics that need attention include providing (1) procedural checklists to ensure that the intervention plan is being followed, (2) building plans for emergency personnel, and (3) providing food and drink for crisis personnel.



Crisis response: Prepare a sequential plan for crisis response that includes gathering and verifying the facts, assessing the impact of the crisis to determine what assistance is needed, providing triage assessment to determine who is most in need of immediate attention, providing psychological first aid as a firstorder response, having a model in place, providing crisis intervention, and following through by briefing, debriefing, and demobilizing.

Application Exercise 13.2 Learning Objective 13.3: Describe strategies for planning and preparing for school and university crises.

[Q2] You are a part of an interdisciplinary community crisis team. The principal of a local high school asks to consult with you and the school counseling team to implement 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

some best practices for the beginning of the school year for all faculty and staff on preparation for a crisis. Using the Center for Mental Health in Schools at UCLA (2018) recommendations, what should be integrated into the training?

[Q2 Model Response] The Center for Mental Health in Schools at UCLA (2018) recommends the following steps that could be taken in preparation for a crisis: 

Post on the wall of each classroom an outline of emergency procedures and crisis team information.



At the beginning of each academic year, distribute updated information to all personnel explaining the crisis plan and responsibilities of the crisis team.



Provide in-service training for all staff at the beginning and midpoint of the school year.



Perform disaster/crisis drills (e.g., lockdown, shelter-in-place, evacuation, hurricane, tornado, intruder on campus).

Application Exercise 13.3 Learning Objective 13.3: Describe strategies for planning and preparing for school and university crises.

[Q3] You are providing training for a school district on the types of actions taken during a crisis situation. Your section is to explore the types of lockdowns for protecting students and employees from harm when threats occur, such as an active shooter or unauthorized intruders. Provide the information needed for types of lockdowns.

[Q3 Model Response] Depending on the severity and distance of a nearby threat, a soft lockdown or a hard lockdown may be triggered. A soft lockdown is ordinarily ordered when a threat occurs nearby or outside of the school, such as when law enforcement is responding to a nearby emergency, a particular student needs to be located, or there is a disturbance in the community near the building. Thus, the threat is not an impending risk but additional caution is warranted. During soft lockdowns, people are encouraged to stay inside of rooms and out of hallways and classes and activities may continue. While movement may be allowed within the building, no one should leave the building. A hard lockdown is ordered when threat of a more direct danger occurs and people should remain inside locked rooms, avoid windows and doors, and wait for an all-clear signal to indicate that the danger has passed. While procedures may vary, the following are some best-practice suggestions: 

Immediately close and lock all doors and windows or block doors that cannot be locked. Heavy items should be used to block doors (e.g., file cabinets, 9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

bookcases). Keep doors and windows closed until an all-clear signal has been issued. 

Close all blinds, turn off all lights, and cover all glass in the door to keep people from looking into the room.



Account for all people in the room. Missing or extra students or employees should be reported to administration. This includes extra people in the hallways seeking a safe space. Assist people with disabilities.



Stay near the floor and away from all doors and windows.



Keep quiet; silence all phones and other devices.



A prearranged all-clear signal should be received or an administrator or law enforcement official should appear to end the lockdown. Confirm the identity of anyone who appears to end the lockdown.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 13 Test Items Multiple Choice Questions 1. A school’s response to crisis must A. provide accurate information.

B. provide necessary support and services.

C. prevent additional crises stemming from the initial crisis.

D. All of the above.

2. The U.S. Department of Education’s Office of Safe and Drug-Free Schools (2017) identified four phases of a comprehensive school crisis plan, including all of the following EXCEPT A. mitigation/prevention.

B. preparedness.

C. restoration.

D. response.

3. According to FEMA, in schools.

is an action step for mitigation and prevention

A. knowing the school building B. knowing the community C. conducting regular school safety and security efforts every 5 years D. All of the above.

4. In attempts to secure the building from outside intruders, schools could A. employ a school resource (security) officer.

B. implement a sign-in procedure.

C. keep entrances to the building locked.

D. All of the above.

5.

refers to the physical, aesthetic, and psychological qualities within a school.

A. School climate B. School social structure C. School character D. None of the above.

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

6. School personnel can help foster school climate of safety by A. implementing parenting programs.

B. promoting training in safety precautions.

C. Implementing suicide programs.

D. promoting faculty updates.

7. FEMA refers to the assessment of dangers in a school and community and identifying strategies to prevent and reduce injury and property damage as A. mitigation and prevention.

B. assessment and intervention.

C. mitigation and assessment.

D. assessment and referrals.

8. Crime prevention through environmental design (CPTED) is a crime prevention strategy that uses system design and maintenance to create safer communities and includes the following five principles: A. implemented surveillance, control of movement, physical security, defensible space, and maintenance/management B. implemented surveillance, control of meaning, physical security, defensible space, and maintenance/management C. implemented surveillance, control of movement, physical security, offensive space, and maintenance/management D. mounted surveillance, control of movement, physical security, defensible space, and maintenance/management 9. The crisis team should include the A. principal.

B. school counselor.

C. school security officer.

D. All of the above.

10. All of the following statements regarding crisis teams are TRUE EXCEPT A. the crisis team should be provided with extensive training that is ongoing.

B. crisis teams should meet at the beginning of each school year to review procedures.

C. specific responsibilities should be outlined as each crisis is unfolding.

D. for success, it is critical that the crisis team have the full support of the school administration.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

11. In preparation for a crisis, schools should A. provide in-service training for all school staff at the beginning and midpoint of the year.

B. keep the protocol secretive.

C. do not perform disaster/crisis drills so not to traumatize students.

D. perform crisis drills in the summer.

12. A is designed so that district and school crisis teams, first responders, and other community partners come to the table to evaluate whether written plans would work in an emergency. During this activity, a hypothetical scenario is discussed to assess how school and community partners would respond to the situation.

A. Disaster drill B. Tabletop exercise C. Scenario exercise D. Fire drill 13. A crisis plan A. should not provide exact steps to be taken in the event of a crisis situation.

B. should not inform parents/guardians of the plan prior to any crisis.

C. ensures communications to parents/guardians must be communicated in all languages represented at the school.

D. should provide details of medical facilities in the area.

14. Two things that can put a professional counselor and school or university at risk for legal action: A. (1) not having a written plan for dealing with crises and (2) not following an existing written plan B. (1) not having a verbal plan for dealing with crises and (2) not following an existing written plan C. (1) not having a written plan for dealing with crises and (2) not following a draft plan.

D. (1) not having a written plan for dealing with crises and (2) not following orders from first responders 15. During a lockdown A. nobody is permitted to enter or leave the building.

B. classroom doors are unlocked.

C. all students move to an open space.

D. only administrators move around the building to ensure safety.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

16.

guidelines refer to actions taken immediately to manage an event which may threaten the safety of all parties with the goal of stopping or minimizing the event. An intruder in the building would be an example of a time when these guidelines would be implemented.

A. Emergency B. Crisis C. Disaster D. Lockdown

17. When a threat occurs nearby or outside of the school, such as when law enforcement is responding to a nearby emergency, the school will enact a A. hard lockdown.

B. soft lockdown.

C. postincident support of school critical responses.

D. recovery.

18. The main goal during the phase is to return the school to a stable, precrisis environment and return students to learning as quickly as possible.

A. recovery B. mitigation C. response D. reconstruction 19. During the recovery phase A. school personnel need to keep students, families, and media informed.

B. families and community members must be informed about services provided for students and families at school and in the community.

C. cultural differences should be considered when composing letters or announcements to parents. It may be necessary to provide information in a variety of languages.

D. All of the above.

20. When sending a letter to parents/guardians regarding a crisis, it is important to include A. accurate information.

B. symptoms/reactions children may display.

C. services available for students and parents.

D. All of the above.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

21. In higher education settings, threat assessment teams A. identify individuals whose behavior causes concern or disruption on or off campus affecting students, faculty, and staff.

B. assess whether the identified individual possesses the intent and ability to carry out an attack against the community, and if the individual has taken steps to prepare for the attack.

C. Both of the above.

D. None of the above.

22. University crisis response teams consists of members who are trained to recognize the factors influencing crisis, grief, and stress to help people better cope and are known as A. campus assessment response and evaluation (C ARE) Teams.

B. campus debriefing teams (CDT).

C. critical incident stress debriefing teams (C ISD).

D. Title IX teams.

Extended Response Questions 1. List and discuss the importance of each phase of a comprehensive school crisis plan identified by the U.S. Department of Education’s Office of Safe and Drug– Free Schools (2017).

2. Discuss the roles of the crisis team and describe their responsibilities.

3. What is the purpose of the threat response team (T AT)?

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 13 Test Answer Key Multiple Choice Answer Key: 1. D (see page 426, section titled Characteristics of School and University Crises) 2. C (see page 426, section titled Characteristics of School and University Crises) 3. C (see page 427, section titled Mitigation and Prevention) 4. D (see page 427, section titled Mitigation and Prevention) 5. D (see page 427, section titled Mitigation and Prevention) 6. B (see page 428, section titled Mitigation and Prevention) 7. A (see page 427, section titled Mitigation and Prevention) 8. A (see page 429, section titled Mitigation and Prevention) 9. D (see page 430, section titled Establishing a Crisis Team) 10. C (see page 431, section titled Establishing a Crisis Team) 11. A (see page 431, section titled Establishing a Crisis Team) 12. B (see page 432, section titled Taking Steps to Prepare for a Crisis) 13. C (see page 433, section titled Developing a Written Crisis Plan) 14. A (see page 433, section titled Developing a Written Crisis Plan) 15. A (see page 435, section titled Establishing Lockdown Protocols) 16. A (see page 436, section titled Establishing Lockdown Protocols) 17. B (see page 436, section titled Establishing Lockdown Protocols) 18. A (see page 440, section titled Recovery) 19. D (see page 440, section titled Recovery) 20. D (see page 442, section titled Helping Parents/Guardians) 21. C (see page 453, section titled Threat Assessment Teams) 22. A (see page 453, section titled Campus Assessment Response and Evaluation and Other University Crisis Response Teams) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: the 4 phases are applicable to public and private K–12 schools, community colleges, and public and private colleges and universities and include: (1) mitigation and prevention, which addresses what schools can do to reduce or eliminate risk to life and property; (2) preparedness, which refers to the process of planning for a crisis; (3) response, which refers to the actions taken during the crisis; and (4) recovery, which refers to restoring the school environment after a crisis.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Model response: Answers will vary, but should include some of the following points: (1) Crisis team leader: usually the principal or another administrator; (2) Crisis team leader designee: a person who takes over if the team leader is absent; (3) Offsite manager: a senior staff member without direct student responsibilities who can prepare in-shelter facilities in an evacuation; (4) Security coordinator: a school resource officer, security guard, or other staff member who can work with others to secure the school until law enforcement arrives; (5) Medical responder: usually the school nurse or a staff member with medical training; (6) Communications coordinator: someone who manages the communications until the designated spokesperson takes over. This person may need to work with additional individuals who can translate information to be relayed in all languages represented in the school community; (7) Mental health specialist: a school counselor, psychologist, or social worker who is responsible for providing counseling support and services; (8) Facilities manager: a custodian or building manager who can address utility needs, direct traffic, and provide floor plans to public safety responders.

3. Model response: Answers will vary, but should include some of the following points: The TAT evaluates persons of concern who may pose a potential risk of violence.

The TAT is composed of many persons from various departments across the university. Most TAT’s have a three-step process in threat assessment: (1) Identify individuals whose behavior causes concern or disruption on or off campus affecting students, faculty, or staff; (2) Assess whether the identified individual possesses the intent and ability to carry out an attack against the community, and if the individual has taken steps to prepare for the attack; and (3) Manage the threat posed by the individual, to include disrupting potential plans of attack, mitigating the risk, and implementing strategies to facilitate long-term resolution.

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Chapter Chapter 13 Emergency Preparedness and Response in Schools and Universities

Learning Objective

Exercises & Quizzes

13.1 Describe characteristics of school and university crises.

Learning Objective Quiz 13.1

13.2 Describe strategies for the mitigation and prevention of school and university crises.

Learning Objective Quiz 13.2

13.3 Describe strategies for planning and preparing for school and university crises.

Learning Objective Quiz 13.3

[Q1]

C ACREP Standards— Section 2: Professional Identity F.1.e, F.1., F.1.i, F.2.b, F.2.d, F.2.g, F.2.h Section 5 School Counseling: 5G.2.b, 5G.2.d, 5G.2.e

blank

[Q1, Q2]

F.5.k, F.5.l, F.5.k, F.7.c, F.7.d, F.7.e Section 5 School Counseling: 5G.2.d, 5G.2.e

blank

F.3.e. F.5.k, F.5.l, F.5.k, F.7.c, F.7.d, F.7.e

Section 5 School [Q1, Q2, Q3, Q4] Counseling: 5G.2.d, 5G.2.e Application Exercise 13.1 Application 18

Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

Exercise 13.2 Application Exercise 13.3 blank

13.4 Describe strategies for responding to school and university crises.

Learning Objective Quiz 13.4

13.5 Describe strategies for recovery after a school or university crisis.

Learning Objective Quiz 13.5

13.6 Describe appropriate responses to crises in university settings, including shelter-in-place procedures and threat assessment teams.

Learning Objective Quiz 13.6

F.3.i, F.4.d, Section 5 School Counseling: 5G.2.d, 5G.2.e

[Q1]

blank

F.3.g, F.5.k, Section 5 School Counseling: 5G.2.d, 5G.2.e

[Q1]

blank

F.7.c, F.7.d, F.7.e

[Q1]

Chapter 14 Test Item File

19 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Crisis Assessment, Intervention, and Prevention Fourth Edition Lisa R. Jackson-Cherry Marymount University

Bradley T. Erford Vanderbilt University

Prepared by

Lisa R. Jackson-Cherry Marymount University

20 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

This work is protected by United States copyright laws and is provided solely for the use of instructors in teaching their courses and assessing student learning. Dissemination or sale of any part of this work (including on the World Wide Web) will destroy the integrity of the work and is not permitted.

The work and materials from it should never be made available to students except by instructors using the accompanying text in their classes. All recipients of this work are expected to abide by these restrictions and to honor the intended pedagogical purposes and the needs of other instructors who rely on these materials.

Product Manager: Drew Bennett Content Analyst: Rebecca Fox-Gieg Content Producer: Purnima Narayanan Copyright © 2024, 2018, 2014 by Pearson Education, Inc. or its affiliates. All Rights Reserved. Manufactured in the United States of America. This publication is protected by copyright, and permission should be obtained from the publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise. For information regarding permissions, request forms, and the appropriate contacts within the Pearson Education Global Rights and Permissions department, please visit www.pearsoned.com/permissions/.

PEARSON are exclusive trademarks owned by Pearson Education, Inc. or its affiliates in the U.S. and/or other countries.

Unless otherwise indicated herein, any third-party trademarks, logos, or icons that may appear in this work are the property of their respective owners, and any references to third-party trademarks, logos, icons, or other trade dress are for demonstrative or descriptive purposes only. Such references are not intended to imply any sponsorship, endorsement, authorization, or promotion of Pearson’s products by the owners of such marks, or any relationship between the owner and Pearson Education, Inc., or its affiliates, authors, licensees, or distributors.

ii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Table of Contents

Chapter 14: Counselor Self-Care in Crisis Situations

1

Learning Outcome Quizzes

1

Application Exercises

8

Test Items

11

Test Answer Key

15

iii Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 14: Counselor Self-Care in Crisis Situations Chapter 14 Learning Outcome Quizzes Learning Objective 14.1: Apply counselor self-care assessment and monitor countertransference, burnout, compassion fatigue, and vicarious trauma.

[Q1] Client emotions, behaviors, and issues may stir up unresolved or buried emotions within a counselor, who might then identify too closely with the client, use the counseling relationship to fulfill unmet needs, or ascribe characteristics of significant people and events in their past to their clients. This is known as which of the following?

1. Burnout 2. Countertransference [correct] 3. Vicarious trauma 4. Secondary trauma stress [Feedback for Answer Choice 1] This is not the definition of burnout.

[Feedback for Correct Answer 2] Client emotions, behaviors, and issues may stir up unresolved or buried emotions within a counselor, who might then identify too closely with the client, use the counseling relationship to fulfill unmet needs, or ascribe characteristics of significant people and events in their past to their clients. This is known as countertransference.

[Feedback for Answer Choice 3] This is not the definition of vicarious trauma.

[Feedback for Answer Choice 4] This is not the definition of secondary trauma stress.

[Q2] Counselors can become exhausted both physically and emotionally through overwork, lack of support or over demands from the agency, and an inability to engage in self-care strategies. This stress to social conflict, work overload, and/or a lack of time and other necessary resources can result in which of the following?

1. Burnout [correct] 2. Countertransference 3. Vicarious trauma 4. Secondary trauma stress 1 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 1] Counselors can become exhausted both physically and emotionally through overwork, lack of support or over demands from the agency, and an inability to engage in self-care strategies. This stress to social conflict, work overload, and/or a lack of time and other necessary resources can result in work burnout.

[Feedback for Answer Choice 2] Countertransference may lead to burnout but this is not the most accurate answer.

[Feedback for Answer Choice 3] This stress is not considered vicarious trauma.

[Feedback for Answer Choice 4] This stress is not considered secondary trauma stress.

[Q3] Counselor exposure to client pain and suffering can lead to a sense of being overwhelmed by client stories and differs from burnout. The preoccupation with traumatic client cases and personal identification to a client’s trauma that can create symptoms within the counselor is known as which of the following?

1. Compassion fatigue [correct] 2. Countertransference 3. Vicarious trauma 4. Secondary trauma stress [Feedback for Correct Answer 1] Counselor exposure to client pain and suffering can lead to a sense of being overwhelmed by client stories and differs from burnout. The preoccupation with traumatic client cases and personal identification to a client’s trauma that can create symptoms within the counselor is known as compassion fatigue.

[Feedback for Answer Choice 2] This is not known as countertransference.

[Feedback for Answer Choice 3] This is not known as vicarious trauma.

[Feedback for Answer Choice 4] This is not known as secondary trauma stress.

[Q4] Ravyn is a crisis counselor who works in a rape crisis center. Recently, she has been experiencing a heightened sense of hypervigilance, fear of being the victim of a rape, and is hyperalert of her own safety in the evenings at home. Perhaps the 2 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

empathic constant exposure to her clients’ personal rape traumas is causing her to have similar behaviors and reactions. She may be experiencing which of the following?

1. Compassion fatigue 2. Countertransference 3. Vicarious trauma 4. Secondary trauma stress [correct] [Feedback for Answer Choice 1] This is not considered compassion fatigue.

[Feedback for Answer Choice 2] This is not considered countertransference.

[Feedback for Answer Choice 3] This is not considered vicarious trauma.

[Feedback for Correct Answer 4] Secondary trauma stress refers specifically to behaviors and emotions resulting from exposure to traumatic stories. Essentially, the empathic exposure to another person’s trauma experience affects a counselor’s behavior and reactions. For example, a counselor experiencing secondary traumatic stress might become more irritable or hypervigilant.

[Q5] Hu is a crisis counselor who has been deployed with the International Red Cross, working with refugees and the victims of torture from a war-torn area. Recently, he has not only experienced heightened vigilance and suspicion of his surroundings but also has started to not feel safe with certain groups who are also at the camp. Hu is starting to avoid them and labeling them as bad people based on the stories and what he has observed being the impact of torture on his clients. What may Hu be experiencing?

1. Compassion fatigue 2. Countertransference 3. Vicarious trauma [correct] 4. Secondary trauma stress [Feedback for Answer Choice 1] Compassion fatigue is not the most accurate answer.

[Feedback for Answer Choice 2] Countertransference is not the most accurate answer.

3 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Feedback for Correct Answer 3] Counselors who work with traumatized clients may experience vicarious trauma, which differs from burnout, compassion fatigue, and secondary traumatic stress.

While all are similar constructs and all generate secondary trauma reactions, vicarious trauma additionally affects a counselor’s worldview and sense of self.

Vicarious trauma reactions result from indirect exposure to trauma, such as through extreme or repeated exposure to details of traumatic events.

[Feedback for Answer Choice 4] Secondary trauma stress is not the most accurate answer.

[Q6] Nadin is a crisis counselor who has been deployed with Hu with the International Red Cross, working with refugees and the victims of torture from a war-torn area.

Contrary to Hu, Nadin has been experiencing affirmative thoughts, feelings, and beliefs through hearing her clients’ stories of resiliency and views the clients’ stories as adapting to difficulties in a positive and empowered manner. What may Nadin be experiencing?

1. Compassion satisfaction 2. Compassion resiliency 3. Vicarious trauma bounce back 4. Vicarious resiliency [correct] [Feedback for Answer Choice 1] Compassion satisfaction may be an element involved but it is not the most accurate answer.

[Feedback for Answer Choice 2] Compassion resiliency is not the most accurate answer.

[Feedback for Answer Choice 3] Vicarious trauma bounce back is not the most accurate answer.

[Feedback for Correct Answer 4] While counselors can be affected adversely by trauma work, they can also experience affirmative thoughts, feelings, and beliefs through hearing their clients’ stories of resiliency and adaptation to difficulties in a positive and empowered manner. The capability of clients to deal with trauma and restore their lives was found to be empowering to counselors. Vicarious resiliency can lead to increased hope in one’s ability to cope with problems as well as an increased belief in human empowerment.

Learning Objective 14.2: Describe effective self-care strategies.

4 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

[Q1] Awareness of contextual factors impacting wellness efforts suggests the use of a systemic approach grounded in the values of the counseling profession and infused throughout the curriculum. One potentially useful framework that counselor training programs might consider is the Wellness Model. It is a systemic self-care needs that focuses on which five life tasks?

1. Social, friendship, love, self-direction, and work and leisure 2. Spirituality, friendship, love, medical, and work and leisure 3. Spirituality, friendship, self-direction, medical, and work and leisure 4. Spirituality, friendship, love, self-direction, and work and leisure [correct] [Feedback for Answer Choice 1] Social is not one of the five life tasks.

[Feedback for Answer Choice 2] Medical is not one of the five life tasks.

[Feedback for Answer Choice 3] Medical is not one of the five life tasks.

[Feedback for Correct Answer 4] The Wellness Model focuses on five life tasks: spirituality, friendship, love, selfdirection, and work and leisure.

[Q2] The SMART in the SMART framework stands for which of the following?

1. Specific, Measurable, Attainable, Realistic, and Timely [correct] 2. Specific, Meaningful, Attainable, Realistic, and Timely 3. Specific, Measurable, Accessible, Realistic, and Timely 4. Specific, Measurable, Attainable, Repeated acts, and Timely [Feedback for Correct Answer 1] Supervisors have a variety of strategies available to assist supervisees in developing and maintaining personalized self-care. Self-care plans that demonstrate intentionality and accountability in the form of measurable goals are more likely to be implemented. The SMART in the SMART framework stands for Specific, Measurable, Attainable, Realistic, and Timely.

[Feedback for Answer Choice 2] Meaningful is not one of the elements.

[Feedback for Answer Choice 3] 5 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Accessible is not one of the elements.

[Feedback for Answer Choice 4] Repeated acts is not one of the elements.

[Q3] Supervisors might include such resources as assigned reading in formal supervision contracts. The addition of a reflective component to the assignment might increase the impact of the content, serve to personalize the material for the supervisee, introduce a measure of accountability, and further increase the likelihood that supervisees will follow through with self-care strategies. What is this known as?

1. CBT exercises 2. Meaning making exercises 3. Meditation strategies 4. Bibliotherapy [correct] [Feedback for Answer Choice 1] CBT exercises may be helpful but this is not the correct answer for this question.

[Feedback for Answer Choice 2] Meaning making exercises may be helpful but this is not the correct answer for this question.

[Feedback for Answer Choice 3] Meditation strategies may be helpful but this is not the correct answer for this question.

[Feedback for Correct Answer 4] This is known as bibliotherapy.

Learning Objective 14.3: Build resources available for self-care.

[Q1] Counselors who are committed to self-assessment and maintenance of a healthy mind, body, and spirit are better prepared for the stressors associated with crisis work. Furthermore, ethical best practice requires counselors to engage in all but which of the following?

1. Self-monitoring 2. Appropriately seeking supervision 3. Personal counseling 4. Seeking social connections [correct] [Feedback for Answer Choice 1] 6 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Self-monitoring is an element in best ethical practices.

[Feedback for Answer Choice 2] Appropriately seeking supervision is an element in best ethical practices.

[Feedback for Answer Choice 3] Personal counseling is an element in best ethical practices.

[Feedback for Correct Answer 4] Seeking social connections may be important but is not an element in best ethical practices.

7 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 14 Application Exercises Application Exercise 14.1 Learning Objective 14.1: Apply counselor self-care assessment and monitor countertransference, burnout, compassion fatigue, and vicarious trauma.

[Q1] Refer to Pearson eTextbook Video Example 14.1. In this video, the counselor in training discusses some of the difficulties of being in recovery and encountering a client at a mutual recovery meeting. The senior counselor addresses the need for personal self-care. What options does the counselor in training have to make sure her recovery and self-care is a priority?

[Q1 Model Response] Self-assessment is the process by which counselors self-monitor and maintain selfawareness of their reactions, behaviors, feelings, and thoughts, thereby recognizing how these internal processes affect their sense of self and functioning as helping professionals. A counselor who is unable to attend to internal states is unlikely to be of much help to a client in a crisis; thus, self-awareness and self-care are fundamentally important to best practice. In addition to inner awareness when serving in a disaster context, it is important that counselors also monitor their own crisis-related needs. Self-care is often framed as an essential professional responsibility due to the protective factors it provides for preventing burnout, vicarious traumatization, and so on. Counselors should be mindful of the risks associated with practice and celebrate the rewards associated with helping others; should set clear limits and not overextend themselves; should engage in self-care; should recognize when they are emotionally exhausted and seek support, including counseling; and should avoid emotional isolation. In short, all counselors have an ethical obligation to be mindful of their own health and well-being and to engage in restorative practices. Failure to self-assess and attend to restoration can lead to countertransference, burnout, compassion fatigue, vicarious trauma, and ultimately, to counselor impairment.

Application Exercise 14.2 Learning Objective 14.2: Describe effective self-care strategies.

[Q2] You are providing a workshop on burnout prevention to a mobile crisis team. You want to discuss the differences among compassion fatigue, secondary trauma, vicarious trauma, and vicarious resiliency in order to provide a foundation before conducting an experiential activity with the group. Provide a foundation of this training.

[Q2 Model Response] 8 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Your training should include an explanation of the concepts to include: Compassion fatigue: Counselor exposure to client pain and suffering can lead to a sense of being overwhelmed by client stories; this goes beyond burnout to a condition called compassion fatigue. Compassion fatigue differs from burnout in that burnout is a state of exhaustion caused by the emotional nature of the counseling profession and overwork, whereas compassion fatigue is a preoccupation with traumatic client cases and personal identification with this trauma. Overidentification with trauma creates symptoms within the counselor that are comparable to the symptoms of posttraumatic stress disorder.

Secondary trauma stress: Related to compassion fatigue is secondary traumatic stress. Although these terms are often used interchangeably, secondary traumatic stress refers specifically to behaviors and emotions resulting from exposure to traumatic stories. Essentially, the empathic exposure to another person’s trauma experience affects a counselor’s behavior and reactions. For example, a counselor experiencing secondary traumatic stress might become more irritable or hypervigilant.

Vicarious trauma: Counselors who work with traumatized clients may experience vicarious trauma, which differs from burnout, compassion fatigue, and secondary traumatic stress. While all are similar constructs and all generate secondary trauma reactions, vicarious trauma additionally affects a counselor’s worldview and sense of self (Trippany et al., 2004). Vicarious trauma reactions result from indirect exposure to trauma, such as through extreme or repeated exposure to details of traumatic events.

Vicarious resiliency: While counselors can be affected adversely by trauma work, they can also experience affirmative thoughts, feelings, and beliefs through hearing their clients’ stories of resiliency—adaptation to difficulties in a positive and empowered manner. The capability of clients to deal with trauma and restore their lives was found to be empowering to counselors. Vicarious resiliency can lead to increased hope in one’s ability to cope with problems as well as an increased belief in human empowerment Application Exercise 14.3 Learning Objective 14.2: Describe effective self-care strategies.

[Q3] Refer to Pearson eTextbook Video Example 14.2. In this video, an experienced counselor consults with a colleague about troublesome clients who bring up issues that hit close to home. They discuss burnout and self-care strategies. What self-care strategies do you need to start to think about integrating into your life before experiencing burnout?

[Q3 Model Response]

9 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Self-care strategies may differ depending on the individual person. However, some essential elements to consider would be supervision self-care (i.e., SMART goals, bibliotherapy, orientation, etc.), personal counseling, setting limits and boundaries, and activities that are individualized that may reduce stress and build peace. A person may use the wellness model to integrate the elements of the wellness wheel: spirituality, friendship, love, self-direction, and work and leisure.

10 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 14 Test Items Multiple Choice Questions 1. Self-assessment is the process whereby counselors A. underestimate best practice.

B. react emotionally to challenges.

C. monitor their reactions, behaviors, and feelings.

D. reject internal process.

2. In addition to self-check-ins for mental health monitoring, counselors should also A. ask clients for feedback regarding their performance.

B. conceal stress so that they can continue to be role models.

C. disclose their concerns to clients.

D. debrief with colleagues.

3. Crisis intervention can lead to stress and burnout due to A. the emotionally charged environment.

B. client resiliency.

C. counselor resiliency.

D. wellness training.

4. Counselor James has unresolved grief about his mother’s untimely death at a young age from breast cancer. His new client has come to counseling for help with facing her diagnosis of breast cancer. James begins to cry during the intake session. This is an example of A. consultation.

B. countertransference.

C. transference.

D. resolution therapy.

5.

occurs when counselors exhaust themselves both physically and emotionally over time.

A. Resiliency B. Compassion empathy C. Burnout D. Vicarious trauma

11 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

6. The ―psychological syndrome that involves a prolonged response to chronic interpersonal stressors on the job‖ is A. resiliency.

B. transference.

C. job dissatisfaction.

D. burnout.

7. Secondary traumatic stress refers to A. the ability to cope with primary trauma.

B. behaviors and emotions resulting from trauma stories.

C. cognitive burnout.

D. stress emphasis.

8.

involves a changed worldview and sense of self as a result of work with trauma clients.

A. Burnout B. Secondary traumatic stress C. Compassion fatigue D. Vicarious trauma

9. While burnout is a response to occupational stress, vicarious trauma involves a personal reaction to a client’s experience.

A. behavioral B. affective C. cognitive D. emotional 10.

occurs when counselors experience affirming thoughts, feelings, and beliefs after hearing about clients’ adaptation to difficulties.

A. Vicarious resiliency B. Internal stress C. Vicarious trauma D. Empowerment burnout

11. All of the following are examples of vicarious trauma prevention EXCEPT A. peer supervision.

B. training and education on trauma work.

C. overtime to gain experience working with trauma clients.

D. spirituality.

12 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

12. Counselors working with care.

must be especially intentional about self-

A. the elderly B. adolescents C. a wide spectrum of client issues D. trauma clients 13. The capacity of clients to deal with trauma and restore their lives was found to be to counselors.

A. empowering B. overwhelming C. insignificant D. detrimental 14. Counselor well-being is dependent upon

to engage in self-care.

A. external pressure B. enforced requirements C. intentional choices D. professional organizations 15. Self-care is considered a

factor in the counseling profession.

A. risk B. protective C. transference D. None of the above.

16. Example of issues leading to burnout are A. compensation and hours of work.

B. compensation and working with a large caseload of trauma victims.

C. working with a large caseload of trauma victims and hours of work.

D. working with a large caseload of trauma victims and lack of experience in the field.

17. The Professional Quality of Life Scale (Pro QOL) is a measure of compassion satisfaction and fatigue that provides the counselor with a score for A. compassion satisfaction, burnout, and vicarious trauma.

B. compassion satisfaction, burnout, and secondary traumatic stress.

C. compassion satisfaction, vicarious trauma, and secondary traumatic stress.

D. vicarious trauma, burnout, and secondary traumatic stress.

13 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

18. Secondary traumatic stress is most associated with the concept of A. vicarious trauma.

B. job satisfaction.

C. compassion fatigue.

D. burnout.

19. Vicarious trauma involves a personal client’s experience.

reaction within the counselor to a

A. cognitive B. behavioral C. interpersonal D. intrapersonal 20.

is a new concept used to describe when counselors are affected adversely by trauma work and can experience affirmative thoughts, feelings, and beliefs through hearing their clients’ stories.

A. Positive reinforcement B. Learned helpfulness C. Vicarious resiliency D. Compassion inclusion

Extended Response Questions: 1. Discuss the ethical obligation for engaging in self-assessment and self-care.

2. Define and discuss the differences among burnout, compassion fatigue, and vicarious trauma.

3. Discuss the steps a counselor/agency should take to decrease the vicarious trauma.

14 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter 14 Test Answer Key Multiple Choice Answer Key: 1. D (see page 458, section titled Ongoing Self-Assessment for Counselors) 2. D (see page 458, section titled Ongoing Self-Assessment for Counselors) 3. A (see page 459, section titled Self-Assessment of the Counselor during Crises) 4. B (see page 461, section titled Countertransference) 5. C (see page 461, section titled Burnout) 6. D (see page 461, section titled Burnout) 7. B (see page 463, section titled Compassion Fatigue) 8. D (see page 464, section titled Vicarious Trauma) 9. C (see page 464, section titled Vicarious Trauma) 10. A (see page 466, section titled Vicarious Resiliency) 11. C (see page 464, section titled Vicarious Trauma) 12. D (see page 468, section titled Emphasizing Self-Care in Counselor Training Programs) 13. A (see page 469, section titled Emphasizing Self-Care in Counselor Training Programs) 14. C (see page 469, section titled Emphasizing Self-Care in Counselor Training Programs) 15. B (see page 470, section titled Emphasizing Self-Care in Counselor Training Programs) 16. A (see page 470, section titled Emphasizing Self-Care in Counselor Training Programs) 17. B (see page 463, section titled Burnout) 18. C (see page 463, section titled Burnout) 19. A (see page 464, section titled Vicarious Trauma) 20. C (see page 466, section titled Vicarious Resiliency) Feedback for the essay question: 1. Model response: Answers will vary, but should include some of the following points: should include information on the following: ethical codes are built into professional practice to protect the public. Specifically, ethical codes provide a framework to assist counselors and supervisors in decreasing burnout and vicarious trauma and increasing resiliency, wellness, and sustainability when working with trauma, crisis situations/populations, and difficult clients.

15 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

2. Model response: Answers will vary, but should include some of the following points: Burnout is related to job satisfaction/dissatisfaction. And other chronic interpersonal job related aspects of the position (working conditions). Types of counselors who may experience burnout include well-adjusted counselors, persevering counselors, and disconnected counselors. Compassion fatigue may be experienced after counselors are exposed to client pain and suffering through listening to telling their stories. Compassion fatigue differs from burnout in that burnout is connected to working conditions and compassion fatigue is associated with in identification with the client and their trauma. Vicarious trauma may be experienced when exposure to the trauma stories of the client triggers pervasive alterations in a counselor’s cognitive schema, resulting in disruptions to the counselor’s sense of safety, trust, esteem, control, and intimacy.

3. Model response: Answers will vary, but should include some of the following points: (1) case management specifically limiting the number of trauma clients per week as much as possible; (2) peer supervision, which provides an avenue for debriefing and consultation; (3) agencies assuming responsibility to provide supervision, consultation, staffing, continuing education, and employee benefits, including personal counseling; (4) training and education on trauma work; (5) personal coping mechanisms, which include leisure activities and creative endeavors; and (6) spirituality to facilitate connection and meaning.

16 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

C ACREP Standards Map Source Note for all CACREP Standards: The parts of the CACREP Standards that Pearson reproduces in its Work represent only selected parts of the 2016 CACREP Standards; inclusion of the CACREP Standards in the Pearson Work is in no way intended to imply CACREP endorsement or approval of the Pearson Work. Use of the Pearson Work as a teaching tool does not establish or connote compliance with CACR EP Standards for purposes of determining CACREP accreditation of any education program. The full CACREP standards document can be viewed at http://www.cacrep.org/wp-content/uploads/2015/05/2016-CACREP-Standards.pdf.

The following integrates the 2016 CACREP Standards of Standard 2: Professional Counseling Identity (F1-8) which incudes the core CACREP standards required for all programs.

This document also integrates the following specialty areas in Section 5: Addiction Counseling (5A), Clinical Mental Health Counseling (5C), Marriage, Couple, and Family Counseling (5F), and School Counsling (5G)

Exercises & Quizzes

Chapter

Learning Objective

Chapter 14

14.1 Apply counselor self-care assessment and monitor countertransference, burnout, compassion fatigue, and vicarious trauma.

Learning Objective Quiz 14.1

14.2 Describe effective self-care strategies.

Learning Objective Quiz 14.2

Counselor SelfCare in Crisis Situations

C ACREP Standards— Section 2: Professional Identity F.1.b,F.2.g, F.7.m, F.4.b, F.3.k, F.5.m

[Q1, Q2, Q3, Q4, Q5, Q6] Application Exercise 14.1 F.2.c, F.2.e, F.2.g, F.3.i, F.4.b, F.5.f, F.5.g

[Q1, Q2, Q3] Application Exercise 14.2 Application Exercise 14.3 14.3 Build resources available for self-care.

Learning Objective Quiz 14.3

F.1.b, F.1.d, F.1.k, F.1.l

17 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.

Chapter

Learning Objective

Exercises & Quizzes

C ACREP Standards— Section 2: Professional Identity

[Q1]

18 Copyright © 2024, 2018, 2014 Pearson Education, Inc. All Rights Reserved.