CASAC Crisis Intervention Strategies 5 — Questions and Answers
Question 1: A client experiencing alcohol withdrawal develops tremors, diaphoresis, and reports seeing insects on the wall. This presentation indicates:
- Alcohol hallucinosis requiring outpatient monitoring
- Delirium tremens, a life-threatening emergency requiring immediate medical intervention (Correct answer)
- Korsakoff's syndrome requiring nutritional supplementation
- Wernicke's encephalopathy that will resolve with hydration
Correct answer: Delirium tremens, a life-threatening emergency requiring immediate medical intervention
Tremors, diaphoresis, and visual hallucinations together are hallmark signs of delirium tremens, which carries a significant mortality risk and requires emergency medical care.
Question 2: Under the HIPAA Privacy Rule, a counselor may disclose PHI without client authorization in a crisis situation when:
- The client has signed a general consent-to-treat form at intake
- Disclosure is necessary to prevent serious and imminent threat to the client or others (Correct answer)
- The client's insurance company requests records for authorization
- A family member states they are the emergency contact
Correct answer: Disclosure is necessary to prevent serious and imminent threat to the client or others
HIPAA permits disclosure without authorization when needed to prevent or lessen a serious and imminent threat to health or safety, as permitted by law.
Question 3: A peer recovery specialist finds a client unresponsive with a needle nearby. After calling 911, the next action consistent with Good Samaritan law provisions is to:
- Leave the scene to avoid legal liability
- Administer naloxone if available and trained to do so (Correct answer)
- Search the client's belongings to identify the substance used
- Wait for law enforcement before touching the client
Correct answer: Administer naloxone if available and trained to do so
Good Samaritan laws encourage bystander intervention including naloxone administration, and most state provisions protect those who call 911 and provide first aid from prosecution.
Question 4: A crisis counselor is conducting a mental status exam with a client who has been awake for three days using methamphetamine. The MOST critical finding to document is:
- Affect range and appropriateness
- Presence of psychotic features such as paranoid delusions or command hallucinations (Correct answer)
- Insight into the consequences of substance use
- Cognitive distortions related to self-esteem
Correct answer: Presence of psychotic features such as paranoid delusions or command hallucinations
Stimulant-induced psychosis, particularly command hallucinations instructing harm, creates imminent danger and must be documented and acted upon immediately.
Question 5: The Tarasoff duty to warn obligates a counselor to take protective action when a client makes:
- A vague statement of anger toward 'people who wronged me'
- A specific, credible threat against an identifiable third party (Correct answer)
- A generalized wish that someone would 'disappear'
- A passive statement that life would be better without a coworker
Correct answer: A specific, credible threat against an identifiable third party
Tarasoff liability is triggered by a specific, serious threat against an identifiable victim, not vague expressions of frustration or anger.
Question 6: A client in a residential SUD program discloses she has been self-harming (cutting) to manage cravings and emotional pain. The counselor's INITIAL response should be to:
- Immediately transfer the client to an inpatient psychiatric unit
- Explore the function of the self-harm behavior and assess lethality and wound severity (Correct answer)
- Inform the client that self-harm violates program rules and may result in discharge
- Notify the client's family and ask them to take responsibility for monitoring
Correct answer: Explore the function of the self-harm behavior and assess lethality and wound severity
Understanding why the client is self-harming and assessing wound severity and suicidal intent guides appropriate level-of-care decisions and therapeutic response.
Question 7: In Critical Incident Stress Debriefing (CISD) conducted after a group trauma event in a treatment facility, the 'teaching phase' is primarily designed to:
- Elicit the most graphic details of the traumatic event for cathartic processing
- Normalize stress reactions and provide psychoeducation about common trauma responses (Correct answer)
- Identify individuals who require referral for individual therapy
- Establish legal documentation of the incident for liability purposes
Correct answer: Normalize stress reactions and provide psychoeducation about common trauma responses
The teaching phase of CISD normalizes acute stress symptoms and educates participants about expected psychological reactions, reducing stigma and fear.
CASAC Crisis Intervention Strategies 5
A client experiencing alcohol withdrawal develops tremors, diaphoresis, and reports seeing insects on the wall.
This presentation indicates: