Crisis Counseling, Therapy & Advocacy Services
The following model can be found in the Canadian Health Care System within their delivery of psychological services. Crisis counseling, therapy and advocacy services are provided by Christina Kennedy, Counselor and Public Health Nurse, who is a counselor and case manager for many high-risk individuals. Christina utilizes the
DSM-IV
as an urgent assessment of global functioning for these severely at-risk clients. The immediate development of trust occurs through support groups and individual counseling, as a result of creating a safe environment.
The DSM's Axis V becomes particularly useful to assess social and occupational disorders in crisis clients and to track progress in rehabilitation, utilizing the Global Assessment of Functioning. For example, many of our clients are homeless, without food, and at grave risk, with severe psychological issues. At the same time, as described on Axis III of the DSM, Christina targets the extent of the multiple health and mental health problems that burden this population.
Utilizing Axes IV and V extensively emphasizes clients' developing assertiveness skills and knowledge of their own empowerment. The empowerment model is especially useful with this population, who have been denied access to health care and are in need of the skills necessary to access many services within our community. (An empowerment model is used in San Francisco, primarily with drug and alcohol clients, battered women, and others who have suffered abuse.)
Obviously, Christina Kennedy does not provide all of the therapy herself. She helps screen clients, too, looking at their special needs and thereby selectively connecting clients with other skilled Zona Seca counselors and therapists. The supportive linkages that follow are utilized to stabilize our clients and facilitate the achieving of their goals. These strategies are presented in order of importance for basic survival:
Crisis Counseling
Suicidal ideation
runs rampant in despairing individuals.
Despair complicated by co-occurring mental illness may manifest in self-mutilation
Immediate stabilization is essential, and, if necessary, a 51/50 designation to prevent suicide.
Hospital Care
Hospital care must often be provided first.
Coordination between the hospital's Social Worker, physicians, home health agencies, and Zona Seca, however, is more protective of client health, after hospital care, to maintain the client during the recuperative phase.
Community medical services then may be utilized as a secondary measure, such as Meals on Wheels and Home Health Nursing.
Medical Care
Homeless clients suffer from multiple severe health crises.
Hepatitis C
and
TB
, as well as other diseases caused by viruses, are nearly epidemic among the homeless.
Coordination with Public Health and with medical doctors is essential.
Psychiatric Care
Mental Health
services become essential to distressed clients.
Schizophrenia
and paranoia are not uncommon in these cases.
Alcohol and drugs exacerbate panic disorder and severe
depression
,as well as
related disorders
.
Food
Malnutrition ravages many of these needy people.
Assessment of malnutrition and weight is crucial to the health of our clients, whose daily diet needs to be monitored; because malnutrition, coupled with disease, can cause the client to deteriorate very rapidly.
Also, because many have neither knowledge or information about food sources, preventive education that addresses
nutrition
is included within the counseling.
Shelter
Temporary emergency shelter may prevent untimely death.
Appropriate permanent housing remains a vital necessity.
Culture
Interventions are culturally specific in that the strategies respect client cultural backgrounds.
Veterans
Viet Nam or Desert Storm veterans have difficulty securing Vietnam benefits.
Disabled and non-disabled widows of veterans often require help to secure benefits.
Out of frustration with "the system," one veteran we know has turned to entrepreneural initiatives and alternative medicine to relieve his own personal
struggles with PTSD
(Post Traumatic Stress Disorder).
Group Support/Individual Therapy and Families
Peer groups for specialized needs provide essential support (e.g., recreational YMCA groups).
Specialized groups may include,
A.A.
, Depressives Anonymous, Adult Survivors of Incest,
Children of Alcoholics
, and so forth.
Individual therapy before and after group calms confusion and answers questions.
In helping high-risk persons, families, friends, and significant others are included in groups.
In-depth Therapy
Retention runs high in those who desire therapeutic intervention.
Long-term therapy is necessary to resolve pain of origin. (Please see "Time.")
It takes a very experienced chemical dependency counselor to
recognize and help drug abusers
.
Transportation
Transportation must often be arranged to help clients meet doctors' appointments.
Bus transportation can be accessed when an application indicating client disability is made to the transit line. The transit line will then allow a reduced payment per ticket.
Grief
Many kinds of loss plague homeless and
despairing
clients.
Severely troubled populations witness severe abuse, and even death, in their environment.
Grief counseling addresses these acute and chronic issues.
Legal
Alcoholics, drug addicts, and the homeless too often become embroiled with the police.
Ignorance of the law and lack of knowledge about basic rights hurts these persons further.
Most can be educated about the legal support systems available to them, taught about their rights, and trained in assertiveness skills.
Referrals can be made to legal aid for cases such as
DUI
, for instance.
Social Security Benefits
Those who have lost SSI benefits and Medi-Cal become truly "down and out."
These despairing and hungry individuals are given assistance in managing appeal and re-appeal processes.
Twelve Step Programs
AA
, NA, and other 12-Step Anonymous Programs address addiction concerns.
Many persons are referred for temporary and permanent sponsors.
Spiritual longings may also be resolved through
12-Step Meetings
.
Probation Department
Coordination of various supportive services including probationary advocacy betters the client's probationary status.
Sometimes probationary requirements are complicated by DUI and other
drinking-driver
related issues.
Environmental Pressers (Stressors)
Caregivers role model the use of cognitive skills as they share with their clients the concepts of assertion theory.
Our clients are encouraged to state their needs, to know their legal rights, and to assess immediately when they are being abused, either emotionally or physically.
Learning Disabilities
Many of our clients suffer from
ADD & ADHD
.
Clients therefore must be assisted in areas of skills building and accessing services that address learning disabilities.
Time
Caregivers must understand that many clients who come from histories of extreme abuse often require years, and not merely several sessions, to be able to reach higher levels of global functioning.
Updated * 15 November 1997
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