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Yоu аre wоrking аs а crisis sоcial worker in the emergency department at University Hospital in Kansas City. You are part of the on-call behavioral health team that responds to patients experiencing acute psychological distress, trauma, or safety concerns. A 22 year old client, Maya, presents to the emergency department accompanied by her mother. Her mother brought her in after recently learning that Maya was sexually assaulted. Maya did not disclose the assault at the time it occurred, which was approximately six months ago. According to her mother, Maya has “not been herself” for months, becoming increasingly withdrawn, missing work, and struggling to function day to day. Her mother reports growing concern after Maya recently made statements suggesting she “doesn’t see the point in anything anymore.” Maya is a Black woman and a first-generation college graduate who recently started her first full-time job at a marketing firm. She reports nightmares, hypervigilance, and difficulty concentrating. Over the past two weeks, she has missed several days of work, arrived late on others, and reports that her supervisor has noted a decline in the quality of her work. She is currently on a performance improvement plan and is worried about losing her job. Maya discloses passive thoughts of “not wanting to be here anymore,” but does not initially provide more detail. She expresses strong distrust of formal systems, including law enforcement and healthcare, and states that she does not feel safe reporting what happened. She shares that in her past, systems that were supposed to help “only made things worse,” and becomes visibly tense when discussing the idea of involving any formal supports. During the conversation, she avoids eye contact at times, startles easily at noises in the hallway, and struggles to stay focused on your questions. She appears exhausted and emotionally overwhelmed. There is noticeable tension between Maya and her mother, with Maya becoming quiet and guarded when her mother speaks for her. As you listen, you notice that you feel overwhelmed and emotionally impacted by her story. You also find yourself thinking about a close friend from college who experienced a similar situation, and you can feel that memory influencing your emotional reaction in the moment. Assess risk and safety Use Chapter 8 to discuss lethality and suicide risk. Maya has passive thoughts of “not wanting to be here anymore,” so you should explain what additional questions you would ask. Address suicidal ideation, intent, plan, access to means, past attempts, protective factors, and immediate safety needs.
Yоu аre wоrking аs а crisis wоrker in the hospital's emergency department. You are part of the on-call behavioral health team that responds to patients experiencing acute psychological distress, trauma, or safety concerns. A 22-year-old client, Maya, presents to the emergency department accompanied by her mother. Her mother brought her in after recently learning that Maya had been sexually assaulted. Maya did not disclose the assault at the time it occurred, which was approximately six months ago. According to her mother, Maya has “not been herself” for months, becoming increasingly withdrawn, missing work, and struggling to function day to day. Her mother reports growing concern after Maya recently made statements suggesting she “doesn’t see the point in anything anymore.” Maya is a Black woman and a first-generation college graduate who recently started her first full-time job at a marketing firm. She reports nightmares, hypervigilance, and difficulty concentrating. Over the past two weeks, she has missed several days of work, arrived late on others, and reports that her supervisor has noted a decline in the quality of her work. She is currently on a performance improvement plan and is worried about losing her job. Maya discloses passive thoughts of “not wanting to be here anymore,” but does not initially provide more detail. She expresses strong distrust of formal systems, including law enforcement and healthcare, and states that she does not feel safe reporting what happened. She shares that in her past, systems that were supposed to help “only made things worse,” and becomes visibly tense when discussing the idea of involving any formal supports. During the conversation, she avoids eye contact at times, startles easily at noises in the hallway, and struggles to stay focused on your questions. She appears exhausted and emotionally overwhelmed. There is noticeable tension between Maya and her mother, with Maya becoming quiet and guarded when her mother speaks for her. As you listen, you notice that you feel overwhelmed and emotionally impacted by her story. You also find yourself thinking about a close friend from college who experienced a similar situation, and you can feel that memory influencing your emotional reaction in the moment. Apply trauma concepts Use Chapter 7 to explain Maya’s trauma responses. Discuss symptoms such as nightmares, hypervigilance, difficulty concentrating, avoidance, fear, distrust, and physiological arousal. Explain how trauma may affect emotions, thoughts, behavior, work functioning, and relationships.