CASAC Crisis Intervention Strategies 4 — Questions and Answers
Question 1: A client in opiate withdrawal becomes agitated and threatens to leave the detox unit against medical advice. What is the counselor's FIRST priority?
- Immediately call security to restrain the client
- Engage the client calmly and explore their concerns about staying (Correct answer)
- Document the AMA refusal and notify the physician
- Administer a PRN sedative per protocol
Correct answer: Engage the client calmly and explore their concerns about staying
Therapeutic engagement that addresses the client's concerns is the first step to de-escalate the situation and encourage voluntary cooperation.
Question 2: Which lethality assessment tool is specifically designed to evaluate suicide risk in substance-using populations by incorporating substance use factors?
- Beck Scale for Suicidal Ideation (BSS)
- Columbia Suicide Severity Rating Scale (C-SSRS) (Correct answer)
- Modified SAD PERSONS scale
- Reasons for Living Inventory
Correct answer: Columbia Suicide Severity Rating Scale (C-SSRS)
The C-SSRS is widely validated and recommended across clinical settings, including substance abuse treatment, because it assesses ideation intensity, behavior, and intent comprehensively.
Question 3: A client discloses that their domestic partner destroys their medications when angry. In crisis intervention, this pattern is BEST classified as:
- Situational crisis related to financial stress (Correct answer)
- Dispositional crisis stemming from lack of information
- Maturational crisis linked to developmental transitions
- Psychiatric emergency requiring involuntary hospitalization
Correct answer: Situational crisis related to financial stress
Domestic violence that disrupts treatment is a situational crisis because it arises from an external, identifiable event rather than a developmental or psychiatric cause.
Question 4: During a crisis call, a client says 'I've already taken the pills.' The counselor's immediate action should be to:
- Ask the client to describe their feelings in detail before acting
- Dispatch emergency services while keeping the client on the line (Correct answer)
- Consult with a supervisor before contacting emergency services
- Encourage the client to induce vomiting and call back
Correct answer: Dispatch emergency services while keeping the client on the line
A completed overdose is a medical emergency; dispatching EMS immediately while maintaining verbal contact is the only appropriate response.
Question 5: The ABC Model of Crisis Intervention focuses on Affect, Behavior, and Cognition. In the 'C' step, the counselor's goal is to:
- Conduct a comprehensive biopsychosocial assessment
- Help the client reframe distorted thinking that is maintaining the crisis (Correct answer)
- Connect the client with community resources and referrals
- Confirm the safety plan has been signed by the client
Correct answer: Help the client reframe distorted thinking that is maintaining the crisis
In the ABC model, the Cognition step targets irrational or distorted beliefs that amplify the crisis state so the client can regain cognitive control.
Question 6: A counselor working in a community recovery center receives a text from a client stating 'goodbye everyone.' The counselor cannot reach the client by phone. The MOST appropriate next step is to:
- Wait 30 minutes and attempt to call again before escalating
- Send a wellness check request through local law enforcement (Correct answer)
- Post a supportive message in the group chat and monitor responses
- Notify the client's sponsor and ask them to check in
Correct answer: Send a wellness check request through local law enforcement
A 'goodbye' message with no response constitutes an imminent threat; requesting a law enforcement wellness check is the only action that ensures immediate physical safety.
Question 7: Which principle of Motivational Interviewing is MOST applicable when a client in crisis is ambivalent about accepting help?
- Confronting denial directly to break through resistance
- Rolling with resistance by exploring the ambivalence non-judgmentally (Correct answer)
- Providing expert advice on the consequences of refusing treatment
- Using strategic self-disclosure to model vulnerability
Correct answer: Rolling with resistance by exploring the ambivalence non-judgmentally
Rolling with resistance avoids power struggles and keeps the client engaged by acknowledging their ambivalence rather than confronting it.
CASAC Crisis Intervention Strategies 4
A client in opiate withdrawal becomes agitated and threatens to leave the detox unit against medical advice.
What is the counselor's FIRST priority?