0930am

CHCCCS009 New unit

I was late

Discussing coming units...

Some heavy topics coming up – trigger warning.

- Group agreement review

To make your learning in this class fun and safe, what things are important for you?

• Be open
  
• Be confident to answer questions
  
• Feel welcome
  
• Friendly
  
• Show respect
  
• Help each other — especially with technology :-)
  
• Teamwork
  
• Confidential
  
• Compassionate

- What we will cover

Safety briefing

- What will I learn?

1. Identify imminent crisis situations
   
2. Address immediate safety concerns
   
3. Provide referral for crisis intervention support
   
4. Care for self

- Definition of crisis

“A crisis occurs when a stressful life event overwhelms an individual’s ability to cope effectively in the face of a perceived challenge or threat” – (Auerbach and Kilmann, 1997)

- Characteristics of a crisis

psychological comfort and normal coping mechanisms are disrupted

a persons usual way of coping fails to help resolve the situation

the distress due to the crisis may for a period of time cause the individual to be impaired in some way i.e. feeling unable to cope, being highly emotional, or becoming isolated.

It's not helpful to compare one person's suffering to another.

What coping mechanisms do you have when going through a crisis?

- What is a crisis?

• any event that could lead to an unstable and dangerous situation
  
• a major negative change to the safety, security, mental, physical or emotional well-being
  
• individual reaction to an event or experience
  
• is often, although not always, sudden
  
• it is a crisis if the person thinks it is a crisis!

If a client thinks they are going through a crisis and it is overwhelming for them, it's not up to us to judge whether it is or not.

A person that has not many coping mechanisms is likely to feel overwhelmed when going through a crisis.

- Different type of crisis

Developmental crisis - associated with normal life transitions e.g. adolescence, old age

Situational crisis - Events out of the ordinary and out of people’s control e.g. car accident, family death

Complex Crisis – these crisis are not a part of everyday life and are usually very difficult to cope with. They include severe trauma such as violent personal assault, natural or man-made disasters. The trauma often directly affects individuals as well as their immediate and extended support networks i.e. September 11, the boxing-day tsunami, Hurricane Katrina.

- Complex Crisis

Complex crises are also those associated with serious mental illness. The stress associated with the crisis can itself increase the intensity and frequency of the mental illness.

- Crisis or emergency?

How would you define the difference between a crisis and emergency?”

- Crisis v emergency

An emergency is a life threatening situation that requires and immediate response i.e. overdoses.

A crisis occurs when an individual becomes aware of obstacles to life goals. In both a crisis and an emergency, expert professional help may be required.

A crisis may turn into an emergency. It depends upon the context and circumstances as to whether a client’s situation may be considered a crisis or emergency, therefore careful and thorough assessment of each individual’s circumstances are crucial.

Ant: We are not to stay in a state of stress or distress.

- Crisis situations

• Potential suicide
  
• Threats to harm others
  
• Domestic and family violence
  
• Abuse, including child abuse
  
• Received threats
  
• Self-Harm
  
• Exacerbation of serious mental illnesses

- Different types of crisis

Duration of crisis:

Being in a state of crisis is time limited, generally 4-6 weeks. It is characterised by a sudden increase in stress and tension. The person tries and fails to cope with issues and becomes receptive to assistance. Work is done to resolve the issue but crisis intervention alone may not address deeper issues. Longer term intervention may still be required to sustain well being.

Longer term intervention may be needed for people who have been exposed to:

• Sexually assault
  
• Domestic violence

Some people are able to cope with crisis better than others because of what they have already overcome.

Some people struggle with crisis worse than others due to other issues in their past life.

- Signs of crisis

DIRECT AND INDIRECT SIGNS THAT SOMEONE IS EXPERIENCING OR IS AT RISK OF CRISIS CAN INCLUDE:

• having bruises, burns, sprains, dislocations, bites or cuts
  
• wearing long-sleeved clothes on hot days in an attempt to hide bruising or a self-harm injury
  
• having unexplained chronic gastrointestinal symptoms
  
• having unexplained chronic pain
  
• becoming less interested in appearance and hygiene.
  
• having headaches, cognitive problems or hearing loss

- Counsellor responsibilities

WHAT ARE YOUR RESPONSIBILITIES IN A CRISIS?

If a client is experiencing a crisis, you have a responsibility to:

• support the person to the best of your ability within the scope of your work role
  
• work ethically and maintain professional boundaries
  
• recognise any potential limitations you may have, such as lack of experience or expertise or a conflict of interest
  
• meet your legal obligations by following your organisation's procedures, policies and codes of practice.

- Crisis intervention

Crisis intervention is the term used to define the response mode by support workers to a critical incident. This crisis could be an event such as a death or injury, or an emotional state such as extreme distress or suicidal intentions.

When responding to a crisis, support workers should:

• Define the problem
  
• Make sure the person and others are safe
  
• Assess their own ability to manage the situation
  
• Get assistance if necessary
  
• Give support
  
• Look at alternatives
  
• Get commitment from the person for any interventions
  
• Make plans

- Signs of a difficult time

WHICH OF THE FOLLOWING SIGNS MAY INDICATE A PERSON IS HAVING A DIFFICULT TIME?

[ ] Feeling resilient
[X] Feeling lonely
[X] Feeling overwhelmed and finding it hard to cope with everyday things and tasks
[X] Using alcohol or drugs to cope with feelings
[X] Feeling tearful and wanting to cry all the time
[X] Having suicidal thoughts
[ ] Maintaining a healthy lifestyle
[X] Experiencing 'brain fog', finding it hard to think clearly and losing concentration
[ ] Nurturing support systems
[X] Lacking energy or feeling tired all the time
[X] Feeling angry or short tempered
[X] Feeling that no one understands you
[X] Withdrawing from others and usual activities
[X] Changes to sleeping or eating patterns
[ ] Feeling happy and at peace
[X] Feeling irritable, restless or agitated

Ant: the earlier we can discover a potential crisis, the better.

- Recognising and responding to signs

Working in crisis intervention, there will always be potential safety issues to look out for, some of which will be serious and some of them less so.

In any case, it is vital that you recognise and respond to any signs of trouble as soon as possible.

The time it takes you to react to a safety issue will have real and serious consequences for others; in extreme cases, it could even be the difference between life and death.

- Spot Safety Signs

RECOGNISE SIGNS INDICATING SAFETY ISSUES FOR PEOPLE

There may be a number of reasons that a person is at risk of harm.

They may be at risk of self-harm or at risk of harm from a family member, neighbour or someone else.

They may be living in a domestic violence situation or experiencing abuse from outside the family.

Assessing risk is difficult because human behaviour is complex; people may be reluctant to make full disclosure of their situation and the circumstances leading to harm can be complicated.

Why would people not open up and talk about their issues they are going through?

11:11am

Break time to 11:35am

[I caught up on the following because I missed as I was in court hearing on phone (divorce)]

We've covered, Valid reasons why people don't open up

...Continuing on with PowerPoint slides

Ant: We'll leave "Potential suicide" part as we will come back to it later on.

Ant: Some of the things we will understand about suicide is the risk factors and steps we will need to take. Ant wants us to be confident to sit with someone with risk of suicide.

Ant: What words may we use or phrases to help clients to reach positive step to seek out?

Ant: Thank them to take the step and that they are very brave. That life can sometimes be very overwhelming and we need support from other people – we are meant to seek help.

Ant: Let them know that it shows real strength for them to reach out for help.

Ant: We need to listen empathetically about their details of their current situation.

Ant: What time of skills could you use?

Ant: One way to express empathy, is to use the formula: "Sounds like you are feeling... because of ..."

Ant: Cooperation – working with clients is important. Acknowledge that clients are experts of their own lives. Our role is to help them some of the barriers in their life. Even if we don't agree with the client's values or beliefs. Understand what is important for them. You don't have to understand, but you can validate.

Ant: Active listening is being present, showing interest and respect. Microskills are very important.

Ant: Open questions are handy... What kind of questions can we ask more if a client is under crisis? For the most part we will be asking more open questions, but if they are going under crisis, we may have to be more direct with the client using closed questions like, "Are you contemplating suicide?"

Ant: We will look more specifically about suicide later on...

[11:52am back from divorce hearing]

- Self care

• Remember to do something
  nice for yourself and look
  after yourself.
• Today’s topics have been
  difficult, so let's finish class
  sharing something you are
  looking forward to doing in the
  next week.

Ant: At the end of the session sit and distinguish the difference from the client and personal life. Get some separation from the clients and personal life. Come up with 2 or 3 things that are different. As sad and terrible the client's story may be, it isn't our story! We need to create a boundary and separation.

- Helpful doc for assessments

{opine}DOC{opine} Document: The Learner Resource Guide 2020

- A crisis is

An acute disruption of psychological homeostasis rt which one’s usual coping mechanisms fall and there exists evidence of distress and functional impairment It usually involves a hazardous or traumatic event, a vulnerable or unbalanced state, a preop«tat«g factor or trigger, an active crisis state based on the person's perception of them *1 a crisis
A person who is in crisis is likely to experience high levels of stress

Ant: Two branches of how people cope under stress

Fight or Flight state

Wind down state

AI:

- (AI) ANS response to stress

The Autonomic Nervous System (ANS) manages the body's involuntary functions and plays a key role in responding to stress through two main branches: the sympathetic and parasympathetic nervous systems.

Sympathetic Nervous System: Activates the "Fight or Flight" response during stress, preparing the body to confront or escape threats. This activation results in increased heart rate, elevated blood pressure, and enhanced alertness, providing a burst of energy for immediate action.

Parasympathetic Nervous System: Promotes the "Wind Down" or "Rest and Digest" state after the threat passes, helping the body to relax and recover. It lowers heart rate, reduces blood pressure, and facilitates digestion, ensuring the body conserves energy and maintains balance.

The ANS responses to stress demonstrate the body's ability to mobilize for immediate survival through the sympathetic nervous system and then return to a state of equilibrium through the parasympathetic nervous system, ensuring long-term health and well-being.

Ant: Pre-frontal cortex shuts down when we get overly distressed.

Why?

To act intellectually to make very quick decisions to save self.
Animals don't have pre-frontal cortex – they are always acting institutionally.

Brain is in the motto of "better be safe than sorry".

AI:

When we become overly distressed, the prefrontal cortex (PFC), the brain region responsible for higher-order functions like decision-making, problem-solving, and regulating emotions, can become less effective. This is largely due to the body's evolutionary response to stress, prioritized by the need for immediate survival over complex thought processes. Here's why this happens:

Overwhelming Stress Response
During high levels of stress, the body prioritizes immediate survival through the activation of the "fight or flight" response, managed by the sympathetic nervous system. This response leads to the release of stress hormones like adrenaline and cortisol, preparing the body to react swiftly to a threat.

Resource Redistribution
To facilitate this rapid reaction, the body redistribits resources away from functions deemed non-essential in the immediate context of survival. The PFC's activities, which involve thoughtful decision-making and emotional regulation, are resource-intensive and are temporarily downgraded to redirect energy towards more critical survival functions, such as increased heart rate and alertness.

Prefrontal Cortex Inhibition
The release of cortisol can inhibit the functioning of the PFC. High levels of cortisol can impair synaptic regulation, decrease the formation of new neurons (neurogenesis), and even lead to atrophy in some regions of the brain over prolonged periods of stress. This reduction in functionality of the PFC leads to difficulties in thinking clearly, making decisions, and regulating emotions effectively during extreme stress.

Evolutionary Perspective
From an evolutionary standpoint, this mechanism makes sense. In situations of acute stress, especially those that our ancestors might have faced, such as immediate physical threats, quick and decisive action could mean the difference between life and death. The time it takes for complex decision-making or emotional regulation could be a luxury not afforded in such critical moments.

Conclusion
Thus, the shutting down of the prefrontal cortex under extreme distress is a protective, evolutionary response designed to prioritize rapid reaction to threats. While beneficial in short-term, high-stress situations, chronic activation of this response due to prolonged stress can lead to significant negative impacts on cognitive function, emotional well-being, and overall health.

Leni: Resignation Syndrome

Resignation Syndrome is a severe psychological condition predominantly affecting refugee children, characterized by a catatonic state where individuals become unresponsive, immobile, and mute, retreating from the external world. This syndrome is believed to stem from extreme psychological trauma and stress, particularly amid uncertainties over asylum status and fears of deportation. Diagnosis requires excluding other conditions, focusing on the individual's psychological and social circumstances. Treatment centers on ensuring a safe environment, nutritional support, and psychological care, with recovery closely tied to improvements in the individual’s life situation. Resignation Syndrome underscores the critical need for mental health support among refugee and displaced populations.

Ant: The brain sends blood to arms and legs to be stronger and faster to save our lives and why we get butterflies, need to go to the toilet, chest pain, etc...

--

12:38 break to 13:05

13:10pm

Resource learning guide...

What happens to our bodies when going through stress or distress.

(Page 2 image) + muscle tension (around neck, legs)

To move out of this state, help client with their breathing and help them relax their muscles.

Ant: Our breath is what regulates our autonomic nervous system.

- Breathing technique 4 7 8

Ant: what do you experience when breathing out after holding breath?

Ant: Progressive muscle relaxation

- Potential suicide

Will cover later...

(Page 4)

- Threats of harm

To self

and others

- Self harm

Self-harm is when someone intentionally....

Forms of self-harm include:

• Unexplained injuries
  
• ...
  
• Digital self-harm or self-cyberbullying is when teenagers create

- Received threats

(page 5)

- Abuse

Abuse includes child abuse

- Abuse including child abuse

Abuse is the improper usage or treatment of an entity, often to unfairly or improperly gain benefit. Abuse can come in many forms, such as physical or verbal maltreatment, injury, assault, violation, rape, unjust practices, crimes, or other types of aggression.
Child abuse is an act or set of acts that will result in serious harm or risk of harm, including physical or emotional abuse, exploitation or death, inflicted by a parent, caregiver, or another person who has responsOlity for the chid. If a caregiver farts to act and it results in senous harm or risk of harm, it is also considered chid abuse.

- Signs

• Bruises, cuts or scars, or bums
• marks left by a gag (or some form of restraint)
• imprint injuries (e.g... marks shaped like fingers, thumbs, hands, belts or sticks)
• eye injuries, broken bones, sprains, abrasions or scrapes
• vaginal or rectal pain
• abrasions, bleeding or bruising in the genital area
• incontinence in someone who was previously toiet-trained

...

1401pm

Start getting acquainted with the resource document.

---end of class---