NCMHCE Exam Review: Assessing Dangerousness, Abuse, and Crisis Intervention in Clinical Practice

This podcast episode, part of the NCMHCE exam review series, provides a comprehensive overview of assessing dangerousness and various forms of abuse, crucial for counseling professionals. Dr. Snipes outlines the characteristics of a dangerousness assessment, emphasizing the need to identify the cause of a crisis and the probability of a client harming someone. Key factors associated with a high risk for violence are discussed, including male gender, alcohol abuse, a history of violence or antisocial behavior, recent provocation, and diagnoses such as substance use disorder, schizophrenia, personality disorders, mania, or intermittent explosive disorder. The episode also details the criteria for a counselor's "duty to warn": a reasonably identifiable victim, a credible threat, and imminent danger, stressing the importance of breaching confidentiality only when these conditions are met and divulging only necessary information.

The presentation then delves into specific types of abuse, providing indicators and intervention strategies for domestic violence, child abuse, and elder abuse. For domestic violence, signs like injuries at various stages of healing, symptoms of depression or anxiety, vague somatic complaints, and an over-dependence on a partner are highlighted. Child abuse indicators include sudden behavioral changes, regression, overly sexualized behavior, and a caregiver's unconcern or false explanations for injuries. Elder abuse can manifest through physical injuries, fear of the caregiver, and financial exploitation. A critical distinction is made regarding mandatory reporting, which is emphasized as a legal and ethical imperative for child and elder abuse in every state.

Practical insights and recommendations for clinicians are a core component. For dangerousness, strategies include providing a calm environment, allowing clients to vent, building self-esteem, exploring non-violent options, mobilizing support systems, and making "no violence" contracts. In cases where composure cannot be regained, voluntary or involuntary commitment may be necessary. For abuse victims, interventions focus on ensuring medical treatment, developing escape plans, challenging denial, and referring to support groups. For perpetrators, the emphasis is on breaking through denial, teaching anger management, and providing referrals. The podcast also offers guidance for handling crisis calls from non-clients, prioritizing obtaining identifying information and ensuring the caller's immediate safety.

Broader implications underscore the ethical and legal responsibilities of counselors, particularly the delicate balance between confidentiality and the duty to protect. The episode stresses the necessity of ongoing professional education, especially in complex areas like domestic violence, to ensure safe and effective practice. Through a vignette analysis concerning a client with Acute Stress Disorder, Dr. Snipes demonstrates how to apply diagnostic criteria, identify appropriate referrals (e.g., psychiatrist for medication), and monitor progress by tracking relevant symptoms and daily functioning, reinforcing the practical application of these critical assessment and intervention skills for the NCMHCE exam and clinical practice.

The first thing you want to do is try to identify the cause of the crisis and the probability the client will hurt someone.

Our duty to warn comes in if there's a reasonably identifiable victim and a credible threat of imminent danger.

If those criteria are met you need to contact law enforcement and the intended victim but divulge only the information necessary.

A lot of times when people are in crisis it is an opportunity for them to grow but when they're in crisis they're feeling out of control and they're feeling overwhelmed.

You want to see various injuries in various stages of healing... that's an indication of domestic violence.

It is imperative that you get continuing professional education on how to handle that in the safest way to prevent retaliation by the perpetrator against the victim when they get home.

Mandatory reporting in every state abuse reporting is mandatory and to the best of my knowledge abuse reporting for children and elders or disabled adults is mandatory in every state.

A lot of elders feel a lot of shame surrounding any abuse they may be experiencing and/or they may feel like they deserve it because they are a burden on the caregiver.

It's imperative for clinicians to be prepared for dealing with clients who may be violent or in abusive situations.

When you hear rape you're looking probably for acute stress or post-traumatic stress.