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Since I am uncertain what path within counseling I will be going, I am including the ACA Code of Ethics as it is a "comprehensive overview of values for counselors in general, and is the code of ethics adhered to by the Texas Counseling Association."

American Counseling Association, (2014). 2014 ACA Code of Ethics.

https://www.counseling.org/resources/aca-code-of- ethics.pdf

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Reflecting on cultural competence and making efforts to improve understanding of cultural differences can help a counselor deliver more responsive and effective services to people from diverse backgrounds.

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My name is Nikki Stroud. Crisis and Trauma is the first class I have taken as I work towards a Masters degree in Mental Health and Wellness.

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The American Counseling Association Center for Practice, Policy, and Research is responsible for providing access to, and interpretation of, the American Counseling Association Code of Ethics.

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American Counseling Association | A professional home for counselors

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Counseling work is governed by public policy. TCA keeps you informed and up to date on rules, statutes and public policies related to professional counseling here in Texas and at the federal level.

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Be in the know! TCA offers numerous professional development and educational opportunities throughout the year, including two large conferences and statewide division as well as chapter learning and networking events. TCA also sends alerts when new rules and policies are proposed by regulatory boards. Sign up for our email list to have TCA event updates, CE opportunities, and policy updates sent straight to your inbox.

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Be in the know! TCA offers numerous professional development and educational opportunities throughout the year, including two large conferences and statewide division as well as chapter learning and networking events. TCA also sends alerts when new rules and policies are proposed by regulatory boards.

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Offers information on key laws and resources for Texans living with a mental health diagnosis. This page provides information on both resources and contacts that can help when looking for mental health services in the state. Additionally, this page includes a summary of laws by topic that may impact individuals living with mental illness.

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Find information on key laws and resources for Texans living with a mental health diagnosis. This page provides information on both resources and contacts that can help when looking for mental health services in the state. Additionally, this page includes a summary of laws by topic that may impact individuals living with mental illness. This section is not intended to be used for legal advice.
On This Page:
Resources

Contacts for Urgent Services

Contacts for Non-Urgent Services

The first step when seeking help for non-emergency mental health or substance use challenges is to find local services. Call the local referral line for confidential help 24 hours a day, 7 days a week.

File a Complaint

To file a complaint with the U.S. Department of Justice (DOJ):

(800) 514-0301 (voice)

(800) 514-0383 (TTY)

Additional Resources

State and Federal Law

Patient's Rights

( Texas Health and Safety Code, Chapter 576)

A person living with mental illness has the rights, benefits, responsibilities, and privileges guaranteed by the constitution. A patient of an institution has:

the right to register and vote at an election;

the right to acquire, use, and dispose of property, including contractual rights;

the right to sue and be sued;

all rights relating to the grant, use, and revocation of a license, permit, privilege, or benefit under law;

the right to religious freedom; and

all rights relating to domestic relations.

Providing court-ordered, emergency, or voluntary mental health services to a person is not a determination or adjudication of mental incompetency and does not limit the person's rights as a citizen, or the person's property rights or legal capacity. A person is presumed mentally competent unless a court has determined otherwise.

An individual who is a patient in an inpatient mental health facility has the right to:

receive visitors;

communicate with a person outside the facility by telephone or mail; and

communicate by telephone or mail with legal counsel, the state agency, the courts, and the state attorney general.

A patient must be informed in writing, at the time of admission and discharge at an inpatient facility, of the existence, purpose, telephone number, and address of the protection and advocacy system in Texas under the Protection and Advocacy for Mentally Ill Individuals Act of 1986.

A patient receiving mental health services has the right to:

appropriate treatment in the least restrictive appropriate setting available;

not receive unnecessary or excessive medication;

refuse to participate in a research program;

an individualized treatment plan and to participate in developing the plan; and

a humane treatment environment that provides reasonable protection from harm and appropriate privacy for personal needs.

A person may not administer a psychoactive medication to a patient receiving voluntary or involuntary mental health services who refuses unless:

the patient is having a medication-related emergency;

the patient is younger than 16 years of age, or the patient is younger than 18 years of age and is a patient admitted for voluntary mental health services, and the parent, managing conservator, or guardian consents to the administration on behalf of the patient; or

the refusing patient's representative authorized by law to consent on their behalf has consented to the administration.

A patient receiving inpatient mental health services is entitled to obtain at the patient's cost an independent psychiatric, psychological, or medical examination or evaluation by a psychiatrist, physician, or no physician mental health professional chosen by the patient. The facility administrator allows the patient to obtain the examination or evaluation at any time.

If the patient is a minor, the minor and the minor's parent, legal guardian, or conservator is entitled to obtain the examination or evaluation. The cost of the examination or evaluation will be billed by the professional who performed the examination or evaluation to the person responsible for payment of the minor's treatment.

Least Restrictive Appropriate Setting for Treatment

( Texas Health and Safety Code, Section 571.004)

The least restrictive appropriate setting for the treatment of a patient is the treatment setting that:

is available;

provides the patient with the greatest probability of improvement or cure; and

is no more restrictive of the patient's physical or social liberties than is necessary to provide the most effective treatment and to protect adequately against any danger the patient poses to themselves or others.

Continuing Care Plan

( Texas Health and Safety Code, Section 574.081(c))

The physician responsible for a patient's treatment will prepare a continuing care plan for a patient scheduled to be furloughed or discharged unless the patient does not require continuing care.

The plan must address the patient's mental health and physical needs, including:

the need for outpatient mental health services following furlough or discharge; and

the need for sufficient psychoactive medication on furlough or discharge to last until the patient can see a physician.

The physician shall deliver the plan and other appropriate information to the community center or other provider that will deliver the services if:

the services are provided by:

a community center or other provider that serves the county in which the patient will reside and that has been designated to perform continuing care services; or

any other provider that agrees to accept the referral; and

the provision of care by the center or provider is appropriate.

A patient who is to be discharged may refuse the continuing care services.

Guardianship

( Texas Probate Code, Sections 770A and 770(b))

The guardian of an adult may expend funds of the guardianship as provided by court order to care for and maintain an individual who has been determined to be incapacitated. The guardian may apply for residential care and services on behalf of a person who has decision-making ability if the person agrees. The guardian must report the condition of the person to the court at regular intervals, at least annually, unless the court orders more frequent reports. If the person is receiving residential care in a public or private care facility, the guardian must include in any report to the court a statement as to the necessity for continued care in the facility.

A guardian may not voluntarily admit an incapacitated person to a public or private in-patient psychiatric or residential facility for care and treatment. If care and treatment in a psychiatric or a residential facility are necessary, the person or the person's guardian may apply to a court to commit the person or transport the ward to an inpatient mental health facility for a preliminary examination.

A guardian of a person younger than 16 years of age may voluntarily admit an incapacitated person to a public or private inpatient psychiatric facility for care and treatment. A guardian of a person may voluntarily admit an incapacitated person to a residential care facility for emergency care or respite care.

Read more about State and Federal Laws for Guardianship.

Disease Management

( Health and Safety Code, Section 533.0354)

A local mental health authority (LMHA) must ensure the provision of assessment services, crisis services, and intensive and comprehensive services using disease management practices for adults with bipolar disorder, schizophrenia, or clinically severe depression and for children with serious emotional illnesses. The LMHA must ensure that individuals are engaged with treatment services that are:

ongoing and matched to the needs of the individual in type, duration, and intensity;

focused on a process of recovery designed to allow the individual to progress through levels of service;

guided by evidence-based protocols and a strength-based paradigm of service; and

monitored by a system that holds the local authority accountable for specific outcomes, while allowing flexibility to maximize local resources.

An LMHA ensures the provision of assessment services, crisis services, and intensive and comprehensive services using disease management practices for children with serious emotional, behavioral, or mental disturbance and adults with severe mental illness who are experiencing significant functional impairment due to a mental health disorder that is defined by the DSM-5, including:

major depressive disorder, including single episode or recurrent major depressive disorder;

post-traumatic stress disorder;

schizoaffective disorder, including bipolar and depressive types;

obsessive-compulsive disorder;

anxiety disorder;

attention deficit disorder;

delusional disorder;

bulimia nervosa, anorexia nervosa, or other eating disorders not otherwise specified; or

any other diagnosed mental health disorder.

Each LMHA is required to incorporate jail diversion strategies into the disease management practices for managing adults with schizophrenia and bipolar disorder to reduce the involvement of those client populations with the criminal justice system.

Court-ordered Mental Health Services

( Texas Health and Safety Code, Sections 574.004 and 574.102)

An attorney representing a proposed patient during a hearing for court-ordered mental health services must interview the proposed patient within a reasonable time before the date of the hearing.

The attorney must thoroughly discuss with the proposed patient the law and facts of the case, their options, and the grounds on which the court-ordered mental health services are being sought. A court-appointed attorney must also inform the proposed patient that they may obtain personal legal counsel at their own expense instead of accepting the court-appointed counsel.

Before a hearing, the attorney must:

review the application filed for court-ordered mental health services, the certificates of medical examination for mental illness, and the relevant medical records;

interview supporting witnesses and other witnesses who will testify at the hearing; and

explore the least restrictive treatment alternatives to court-ordered inpatient mental health services.

The attorney must discuss with the proposed patient:

the procedures for appeal, release, and discharge if the court orders participation in mental health services; and

other rights the proposed patient may have during the period of the court's order.

Minors

( Texas Health and Safety Code, Section 572.004)

Minors (under age 18) may not refuse psychoactive medication authorized by a parent or guardian, or discharge themselves from a voluntary mental health facility if guardian or parent objects.

Restraints and Seclusion

( Texas Health and Safety Code, Chapter 322)

A person may not administer to a resident of an inpatient facility a restraint that:

obstructs the resident's airway, including a procedure that places anything in, on, or over the resident's mouth or nose;

impairs the resident's breathing by putting pressure on the torso; or

interferes with the resident's ability to communicate.

The executive commissioner of the Health and Human Services Commission (HHSC) will ensure that each resident at a facility and the resident's legally authorized representative are notified of the rules and policies related to restraints and seclusion.

A facility may not discharge or otherwise retaliate against:

an employee, client, resident, or other person because they files a complaint, present a grievance, or otherwise provide in good faith information relating to the misuse of restraint or seclusion at the facility; or

a client or resident of the facility because someone on their behalf files a complaint, presents a grievance, or otherwise provides in good faith information relating to the misuse of restraint or seclusion at the facility.

Detaining a Mental Health Patient

( Texas Health and Safety Code, Section 573.021)

A peace officer, without a warrant, may take a person into custody, regardless of the age of the person, if the officer:

has reason to believe and does believe that:

the person is a person with mental illness; and

because of that mental illness there is a substantial risk of serious harm to the person or to others unless they are immediately restrained; and

believes that there is not sufficient time to obtain a warrant before taking the person into custody.

A peace officer who takes a person into custody must immediately:

transport the person to:

the nearest appropriate inpatient mental health facility; or

a mental health facility deemed suitable by the LMHA, if an appropriate inpatient mental health facility is not available; or

transfer the person to emergency medical services personnel of an emergency medical services provider.

A jail or similar detention facility may not be deemed suitable except in an extreme emergency.

A physician shall examine the person as soon as possible within 12 hours after the time the person is brought into a facility by the peace officer or transported for emergency detention by the person's guardian.

A person may be admitted to a facility for emergency detention only if the physician who conducted the preliminary examination of the person makes a written statement that:

is acceptable to the facility;

states that after a preliminary examination it is the physician's opinion that:

the person is a person with mental illness;

the person evidences a substantial risk of serious harm to themselves or to others;

the described risk of harm is imminent unless the person is immediately restrained; and

emergency detention is the least restrictive means by which the necessary restraint may be accomplished; and

includes:

a description of the nature of the person's mental illness

a specific description of the risk of harm the person evidences that may be demonstrated either by the person's behavior or by evidence of severe emotional distress and deterioration in the person's mental condition to the extent that the person cannot remain at liberty; and

the specific detailed information from which the physician formed the opinion.

A person transported by a peace officer for emergency detention, or detained will be released on completion of the preliminary examination unless the person is admitted to a facility.

This same individual has the right to:

a reasonable opportunity to communicate with and retain an attorney;

a reasonable opportunity to communicate with a relative or other responsible person who has a proper interest in the person's welfare;

be advised of the location of detention, the reasons for the detention, and the fact that the detention could result in a longer period of involuntary commitment;

be transported to a location if the person is not admitted for emergency detention, unless the person is arrested or objects;

be released from a facility; and

be advised that communications with a mental health professional may be used in proceedings for further detention.

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Find information on key laws and resources for Texans living with a mental health diagnosis. This page provides information on both resources and contacts that can help when looking for mental health services in the state. Additionally, this page includes a summary of laws by topic that may impact individuals living with mental illness.

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The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.

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SAMHSA - The Substance Abuse Mental Health Services Administration

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SAMHSA - Substance Abuse and Mental Health Services Administration

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SAMHSA.gov, Substance Abuse and Mental Health Services Administration

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2-1-1 Texas | 2-1-1 Texas - Connecting People and Services

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2-1-1 Texas | Texas Health And Human Services Commission

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Find Help A search term is required to find resources for food, health, housing, and more Enter Search Term enter search term 211 Administrative Entities 211 Lead Agencies 311 Services 3D Printing 911 Services AARP Tax Aide Program Sites Abandoned Building Inspection Abandoned Shopping Cart Removal Abandoned Vehicle Reporting/Removal Abortion Services Absentee Ballots Abused

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State of Texas, DFPS, Texas Department of Family and Protective Services, HHSC

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Texas Department of Family and Protective Services (DFPS)

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The mission of the Texas Department of Family and Protective Services (DFPS) is to protect the unprotected -- children, elderly, and people with disabilities -- from abuse, neglect, and exploitation.

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One personal goal that I feel like I'm already beginning to achieve is learning more about myself and also becoming a more empathetic person by learning more about what other people go through. One of my very favorite quotes by Ram Dass is “We are all just walking each other home.” Personally, I just want to help everyone I possibly can and make sure everyone I meet feels seen and heard.

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A professional goal is to get really good at helping others by earning a license to be an LPC. At first, I was set on working virtually, but I’m not really sure where I want to end up. I’m ok with just learning for now. I have been told by those who sit on the other side of my desk that I should be a counselor because they feel better when they leave. I want to learn all that I can to give the best care. I have never felt that helping others felt forced, which tells me I’m doing something right. It comes as naturally to me as reading a book!

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I'd like to take in everything I possibly can from this course. I’m very lucky that I’m in a situation where my children are fairly self-sufficient and I’m able to take my time reading and learning all that is presented to me in coursework. I am really enjoying learning. Since I've started this class, I've been able to sleep better because my mind is busy. I also like the added bonus of my kids being able to see me as a learner who works hard to achieve her goals.

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King. (2020). Encounters with Ram Dass. Encounters With Ram Dass. Retrieved February 3, 2023, from https://ramdasslove.org/

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Skip to Main Content

It looks like you're using Internet Explorer 11 or older. This website works best with modern browsers such as the latest versions of Chrome, Firefox, Safari, and Edge. If you continue with this browser, you may see unexpected results.

What is Cultural Competence?

To date, there is no one definition of cultural competence as definitions have evolved from diverse perspectives, interests and needs. One definition is known as the Cross Framework, which defines cultural competence as a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations ( Cross et al., 1989).

Being culturally competent is a continual process that involves an ongoing critical examination of one's attitudes, awareness, knowledge and skills in order to negotiate cross-cultural differences to complete tasks and/or create positive living, learning and working environments ( NC State University Office for Institutional Equity and Diversity).

Cultural competence encompasses:

being aware of one's own world view

developing positive attitudes towards cultural differences

gaining knowledge of different cultural practices and world views

developing skills for communication and interaction across cultures

Source: NC State, Office for Institutional Equity and Diversity

Cultural Competence and Humility Resources: Books

What is Cultural Humility?

The concept of cultural humility was developed by Melanie Tervalon and Jann Murray-Garcia in 1998 to address inequities in the healthcare field. It is now used in many fields, including education, public health, social work, and library science, to increase the quality of interactions between workers and their diverse community members. Cultural humility goes beyond the concept of cultural competence to include:

1. A personal lifelong commitment to self-evaluation and self-critique

2. Recognition of power dynamics and imbalances, a desire to fix those power imbalances and to develop partnerships with people and groups who advocate for others

3. Institutional accountability (Tervalon & Murray-Garcia, 1998)

Resources on The Haudenosaunee

The Haudenosaunee Confederacy (a.k.a. Iroquois or Five Nations Confederacy) encompasses the sovereign Mohawk, Oneida, Onondaga, Cayuga, Seneca, and later the Tuscarora nations. Haudenosaunee means "people who build" or "people of the longhouse." The Mohawk are the Keepers of the Eastern Door, the Onondaga are the Keepers of the Central Fire, and the Seneca are the Keepers of the Western Door .

Cultural Competence and Humility Resources: Videos

Cultural Competence and Humility Resources: Podcasts

These podcasts seek to break cultural barriers and invite listeners to hear real human stories. These podcasts fight against the dehumanization of people from other backgrounds and cultures, and they do it through storytelling.

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Research Guides: FYS 101: Cultural Competence & Humility

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I enjoyed being able to "meet" everyone. I'm glad that we as a class collectively have many different backgrounds that allow us to come together and appreciate the varying perspectives. I liked being able to get an idea of where people are in their educational journey, and get to know them a bit since many of us will probably be alongside each other through this degree. This exercise was a good base to see how much I have to learn as well!

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https://docs.google.com/document/d/1whLlUpM-wOJF_plk1ZH_tcoysvpz5pzVmpzTnTk3IRc/edit

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Introduction and Assessing Prior Knowledge

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This article discusses a path in counseling that I am very interested in- bibliotherapy!

Leung, W. (2022, December 24). Therapeutic literature can have positive effects on mental health, says doctor; Practice known as bibliotherapy prescribes poetry, fiction, to help patients with symptoms of anxiety or depression. Globe & Mail [Toronto, Canada], A15. https://link-gale-com.easydb.angelo.edu/apps/doc/A731050420/HWRC?u=txshracd2485&sid=bookmark-HWRC&xid=be00b400

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I found this project to be extremely engaging and meaningful. I learned more from looking at different resources, trying to put the pieces together for myself, than I could have from taking it from one textbook. I read many different things, falling down a rabbit hole of information in a positive way. I hope that in future classes I get to go deeper in these areas. I find myself applying concepts to life and feel I'm already gaining a better understanding of people.

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Stroud Reference Guide for Mental Health Disorders

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This is a well written article that very simply explains depression, anxiety, and how addiction can come into that. Most importantly it goes into the necessity to address the underlying issues that brought about the depression and anxiety in the first place. I feel that several people in my life suffer within the triangle of these three.

Koezler. (2022, October 6). How Depression, Anxiety and Addiction Go Together and Why it Matters - Drug Rehab Options. Drug Rehab Options. Retrieved January 29, 2023, from https://rehabs.com/pro-talk/how-depression-anxiety-and-addiction-go-together-and-why-it-matters/

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The most staggering statistic that I've read regarding mental health goes like this: more than 50% of people in America will experience a mental illness at some point in their lives. This data comes from a study led by Harvard Medical School and the National Institute of Mental Health (NIMH).

Take a moment to let that sink in. Then ask yourself, how much do we really know about these conditions that impact most of us at some point in our lives? Mental health issues are not "side issues." On the contrary, they affect millions of Americans every single day.

National Depression Screening Day takes place on October 5th this year, and World Mental Health Day follows on October 10th. Now is the perfect time to focus in on depression and anxiety, two interrelated mental and emotional health conditions that often precipitate addiction.

Depression and Anxiety By the Numbers

According to a 2017 study published in the journal Psychiatric Services, more than 8.3 million American adults have depression and anxiety. Plus, the 2016 Surgeon General's report on addiction notes that over 27 million people were abusing drugs and over 66 million were abusing alcohol in 2015.

Depression, anxiety, and addiction are on the rise, and they're all interconnected. But before we talk about why depression and anxiety contribute to drug addiction, let's define these terms.

Defining Depression and Anxiety

Traditional textbook definitions of depression and anxiety describe symptoms, not causes.

If you Google "depression," you'll get this: "A mental health disorder characterized by persistently depressed mood." If you search for "anxiety," you'll find this: "A mental health disorder characterized by feelings of worry, anxiety, or fear." These definitions are accurate, but they're not exactly illuminating. They don't reveal the root causes.

We like to define depression as " anger turned inward." This definition is just three words long, but it gets straight to the heart of the matter. Depression is anger you haven't allowed yourself to feel or express. While depression manifests as sadness or numb apathy, it starts off as anger.

Likewise, we define anxiety as " emotional energy bouncing back and forth, trapped between internal walls." Anxiety is the sensation you get when you refuse to feel your "off-limits" emotions, such as hurt and anger.

We teach a framework that clarifies the relationship between depression, anxiety, and addiction. It's called the "Anger-Hurt-Loving" model, and it points the way forward to healing.

Depression, Anxiety, and Addiction

The Anger-Hurt-Loving model peels back the curtain and allows us a glimpse of what's usually driving addictive behaviors: untreated mental and emotional health issues. The model is key to understanding anger and addiction as well.

Here's what it looks like:

Here's an explanation of how it works:

Behind every feeling of anger, there is an underlying hurt. We get angry when something we can't tolerate is present, or something that we need is absent. Either way, the reason we're angry is because a part of us is hurting.

However, many of us were socialized not to feel or express our anger, so we push it down and inward. The first diagonal line in the model represents how we cut ourselves off from the feeling of anger. As you now know, anger turned inward becomes depression.

Now we've refused to feel our anger, chances are we don't want to feel our hurts, either. (Who wants to feel hurt? It hurts!) So we cut ourselves off from that uncomfortable felt experience as well, hence the second diagonal line on the model.

Since we're not feeling our hurt or our anger, our emotional energy - that is, the up-and-down arrows in the model - is bouncing back and forth between our internal walls.

And what do we call emotional energy bouncing back and forth? That's right, anxiety.

Similarly, we define panic as the "acceleration of anxiety." If anxiety is an emotional jog, then panic is a sprint.

How Addiction Plays In

So now we're depressed, anxious, and at the point of panic. We feel terrible, and we're desperate to feel good. And sometimes the bar isn't even that high; we're just desperate for a break from feeling quite so bad! We want to avoid our feelings of stress, anxiety, and panic, so we turn to substances. We use because we feel bad, not because we are bad.

Fortunately, there is another option. As you see in the model, when you allow yourself to feel your feelings instead of stuffing them, you move toward healing.

The best way to sum up the core message of the Anger-Hurt-Loving Model is this: When you apply love to the parts of yourself that hurt, you heal.

You may be thinking, Wait a minute, what about my medications? Don't they help me to heal too?

The Role of Medications in Healing

While self-medication with illegal substances is fraught with danger, taking legally prescribed medications such as SSRIs for depression and anxiety can do a world of good. Prescription medications can improve and stabilize people with mood disorders ... up to a point.

(Important note of clarification: we're not speaking about antipsychotic medications here, as those are a different class of medication with different protocols.)

In the short-term, medication for depression may well be the perfect fit. But for the long term, it's important to address the root causes, not just alleviate symptoms.

Of course we want to help people feel better. Of course we want to provide crisis care. But we also want to give people the tools they need to recover from depression and anxiety.

We typically suggest that people maintain their current medications and dosages as they begin addressing the underlying core issues. Once they've had some time to work with a therapist, they can discern if a lower dose is warranted. We often find that chronic mental health issues diminish in intensity - or even disappear altogether! - as people learn to apply love to the parts of themselves that hurt.

How to Treat Depression and Anxiety for Recovery

What's really behind your mood swings, your depression, your anxiety? It's time to find out. It's time to treat your mental health conditions, rather than simply medicating them and hoping they'll go away.

As you now know, lasting recovery from substance abuse means addressing and healing the underlying core issues that caused the depression and anxiety in the first place. So give yourself the tools and support you need to work with the anger and hurt you've held at bay. Maybe that means outpatient therapy. Maybe it means choosing inpatient treatment for depression. Everyone is different, but no one should have to go it alone.

If you're afraid to try and afraid to feel, don't be. In offering yourself this compassion and care, you'll find that you are much stronger than you know.

As author, speaker, and recovering everything Anne Lamott wrote:

"Hope begins in the dark, the stubborn hope that if you just show up and try to do the right thing, the dawn will come. You wait and watch and work: you don't give up."
Images Courtesy of iStock

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How Depression, Anxiety and Addiction Go Together and Why it Matters - Drug Rehab Options

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The most staggering statistic that I've read regarding mental health goes like this: more than 50% of people in America will experience a mental illness at some point in their lives. This data comes from a study led by Harvard Medical School and the National Institute of Mental Health (NIMH).

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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This work was meaningful because of the application of our studies to the documentaries viewed. It also makes me want to carry it forward and continue on with evaluating non-fiction works that I encounter, to determine, what disorder may be coming into play with individuals, and be able to see how trauma can make people do things that they normally wouldn't. I also learned just how impactful therapy can be, and that there are options for treatment, it doesn't have to be just one way. Individuals need to be able to have a say in their treatment plan to work through their trauma in a way that is comfortable for them.

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This is a great resource with lots of information that I can appreciate for use while I am at school working.

Introduction. (2018, February 1). In The National Child Traumatic Stress Network. https://www.nctsn.org/trauma-informed-care/secondary-traumatic-stress/introduction

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The National Child Traumatic Stress Network

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Understanding Who is at Risk

The development of secondary traumatic stress is recognized as a common occupational hazard for professionals working with traumatized children. Studies show that from 6% to 26% of therapists working with traumatized populations, and up to 50% of child welfare workers, are at high risk for secondary traumatic stress or the related conditions of PTSD and vicarious trauma. Any professional who works directly with traumatized children, and is in a position to hear the recounting of traumatic experiences, is at risk for secondary traumatic stress. That being said, risk appears to be greater among women and among individuals who are highly empathetic by nature or have unresolved personal trauma. Risk is also higher for professionals who carry a heavy caseload of traumatized children; are socially or organizationally isolated; or feel professionally compromised due to inadequate training. Protecting against the development of secondary traumatic stress includes factors such as longer duration of professional experience and the use of evidence-based practices in the course of providing care.

Clearly, client care can be compromised if the therapist is emotionally depleted or cognitively affected by secondary trauma. Some traumatized professionals, believing they can no longer be of service to their clients, end up leaving their jobs or the serving field altogether. Several studies have shown that the development of secondary traumatic stress often predicts that the helping professional will eventually leave the field for another type of work.

Strategies for Prevention and Intervention

A multidimensional approach to prevention and intervention-involving the individual, supervisors, and organizational policy-will yield the most positive outcomes for those affected by secondary traumatic stress. The most important strategy for preventing the development of secondary traumatic stress is the triad of psychoeducation, skills training, and supervision. As workers gain knowledge and awareness of the hazards of indirect trauma exposure, they become empowered to explore and utilize prevention strategies to both reduce their risk and increase their resiliency to secondary stress. Preventive strategies may include self-report assessments, participation in self-care groups in the workplace, caseload balancing, use of flextime scheduling, and use of the self-care accountability buddy system. Proper rest, nutrition, exercise, and stress reduction activities are also important in preventing secondary traumatic stress.

Although evidence regarding the effectiveness of interventions in secondary traumatic stress is limited, cognitive-behavioral strategies and mindfulness-based methods are emerging as best practices. In addition, caseload management, training, reflective supervision, and peer supervision or external group processing have been shown to reduce the impact of secondary traumatic stress. Many organizations make referrals for formal intervention from outside providers such as individual therapists or Employee Assistance Programs. External group supervision services may be especially important in cases of disasters or community violence where a large number of staff have been affected.

Strategies to Build Resiliency and Address STS

Provide adequate clinical supervision, including reflective supervision

Maintain trauma caseload balance

Support workplace self-care groups

Enhance the physical safety of staff

Offer flextime scheduling

Incorporate STS training into EBP training for clinical staff

Create external partnerships with STS intervention providers

Train organizational leaders and non-clinical staff on STS

Train organizational leaders on organizational implementation and assessment

Provide ongoing assessment of staff risk and resiliency

Use supervision to address STS

Increase self-awareness of STS

Maintain healthy work-life balance

Exercise and good nutrition

Practice self-care

Stay connected

Develop and implement plans to increase personal wellness and resilience

Continue individual training on risk reduction and self-care

Use Employee Assistance Programs or counseling services as needed

Participate in a self-care accountability buddy system

Worker Resiliency in Trauma-Informed Systems: Essential Elements

Both preventive and interventional strategies for secondary traumatic stress should be implemented as part of an organizational risk-management policy or task force that recognizes the scope and consequences of the condition. The following concepts are essential for creating a trauma-informed system that will adequately address secondary traumatic stress. Specifically, the trauma-informed system must:

Recognize the impact of secondary trauma on the workforce

Recognize that exposure to trauma is a risk of the job of serving traumatized children and families

Understand that trauma can shape the culture of organizations in the same way that trauma shapes the world view of individuals

Understand that a traumatized organization is less likely to effectively identify its clients' past trauma or mitigate or prevent future trauma

Develop the capacity to translate trauma-related knowledge into meaningful action, policy, and improvements in practices

Be integrated into direct services, programs, policies, and procedures, staff development and training, and other activities directed at secondary traumatic stress

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The development of secondary traumatic stress is recognized as a common occupational hazard for professionals working with traumatized children. Studies show that from 6% to 26% of therapists working with traumatized populations, and up to 50% of child welfare workers, are at high risk for secondary traumatic stress or the related conditions of PTSD and vicarious trauma.

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This online course was helpful not only as an introduction to being a provider during a disaster, but also provided helpful ideas of how to better evaluate the behavior of individuals that may be experiencing their own stressful or traumatic experiences not related to an area disaster. I learned how very important it is to just evaluate people and their behavior. This applies to me in my position as a librarian because students often come to the library to have a quiet place. While not always the case, students may need a quiet place because they are going through something, and the stressors of the classroom become too much. I appreciate knowing how to better assist students with the knowledge gained through this course.

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As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with:

300+ FREE CE certificates

50+ speakers

200+ online webinars

90,000+ members

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery. Both PFA and SPR were developed by the National Center for PTSD and the National Child Traumatic Stress Network, as well as other individuals involved in coordinating and participating in disaster response and recovery.

PFA and SPR intervention strategies are intended for use with children, adolescents, parents and caretakers, families, and adults who are survivors or witnesses exposed to disaster or terrorism. PFA and SPR can also be provided to first responders and other disaster relief workers.

While grounded in the same foundations of disaster response and recovery, there are several differences between PFA and SPR.

Psychological First Aid (PFA) Online is 5-hour interactive online course that helps participants learn the core actions of PFA and describes ways to apply them in different post-disaster scenarios and with different survivor needs. This course also covers provider well-being before, during, and after disasters. This course is relevant for new providers who are wanting to be oriented to PFA, as well as for seasoned practitioners who want a review of the PFA concepts.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Skills for Psychological Recovery (SPR) is a 5-hour interactive course designed for providers to help survivors gain skills to manage distress and cope with post-disaster stress and adversity. This course is for individuals who want to learn about using SPR, learning the goals and rationale of each core skill, delivering SPR, and supporting survivors in the aftermath of a disaster or traumatic event.
This 5-hour interactive online training offers certificate of completion with 5 CEs upon completion.

Los Primeros Auxilios Psicológicos constituyen un enfoque modular basado en la evidencia y cuyo objetivo es ayudar a niños, adolescentes, adultos y familias a afrontar las consecuencias inmediatas de desastres o actos de terrorismo. En este curso en línea, Rosaura Orengo-Aguayo, PhD, ha adaptado el entrenamiento de PFA en un formato de 3 horas, en Español. Luego de ver este curso en línea, los participantes recibirán 3 créditos de educación continua.

Destrezas para la Recuperación Psicológica (SPR por sus siglas en inglés) es un curso de 3.5 horas diseñado para que los proveedores ayuden a los sobrevivientes a adquirir destrezas para manejar la angustia y afrontar el estrés y la adversidad luego de un desastre. Este curso es para personas que desean aprender sobre el uso de SPR, conocer los objetivos y la justificación para cada destreza básica, brindar SPR y brindar apoyo a los sobrevivientes después de un desastre o evento traumático. Luego de ver este curso en línea, los participantes recibirán 3.5 créditos de educación continua.

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learn: psychological first aid (pfa) and skills for psychological recovery (spr)

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Learn: Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR)

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As part of the National Child Traumatic Stress Network (NCTSN), the Learning Center for Child and Adolescent Trauma offers Free Online Education with: 300+ FREE CE certificates 50+ speakers 200+ online webinars 90,000+ members Psychological First Aid (PFA) and Skills for Psychological Recovery (SPR) are promising practices for disaster behavioral health response and recovery.

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Our group worked extremely well together. Although the project only required a few sources, we came together from so many directions that we ended up with 17. I like that we were able to discover that there are so many reliable sources in this area. My first thoughts on this project were that it may be difficult to find content on such a specific area, but it really wasn't. We discovered together that there is always somewhere to turn for more resources, no matter how specific the situations of an individual may be.

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I enjoyed this project because I feel that the process was very meaningful. I found it exciting to go through the entire process, of being introduced to the issues with Melynda, then breaking them down, and from there being able to really put the puzzle together of the underlying issues she was having. It makes me look forward to doing this more, and being able to help people in important ways, with even more information to help in the process. It also brings up for me the fact that this is already something I do, but I've never used the path of putting down on paper to see how it all works together.

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http://dustinkmacdonald.com/abc-model-of-crisis-intervention/#Suicide_Intervention

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A simple model of crisis intervention is the ABC Model. A number of crisis intervention models use this same three step process. Essentially, it involves establishing a relationship (A), understanding the problem (B), and taking action (C).

This model uses Achieving Rapport, Boiling down the Problem and Contracting for Action. You can see a video of this post here.

Brief History of the ABC Model

In the 1980s, the Alberta Model was designed by a team of suicidologists who were responding to a spike in the suicide rate caused by a bottoming out in the economy. In addition to developing the CPR Risk Assessment they also developed the ABC Model of Crisis Intervention dictated below.

Achieving rapport describes the emotional and physical aspects used to establish a connection with the suicidal person you're working with. This involved physical safety, emotional connection and good rapport.

Physical ways that you can establish rapport include:

Ensuring there is no obstacles between yourself and the suicidal person (e.g. chairs, tables); rapport is improved when there is nothing between you

Solid eye contact; when you look at someone rather than looking away it establishes that you're able to talk openly about suicide

Orienting your body towards someone; this is a subconscious cue that you think positively of that person

Keeping your arms uncrossed and legs open; Crossed-arms and legs pressed together are signs of anxiety or dislike

Emotionally, you can establish safety and comfort through the following:

Validate what the person is saying.

Use empathy statements, which are statements that highlight an emotion while responding. For instance, if someone says that they've had a fight with their wife, and that it keeps happening you might say "It sounds like you're feeling really frustrated." This captures the emotion underlying the experience and is an important part of helping someone feel understood.

Use a calm, even voice-tone - don't speak too quickly and don't cut off the other person

Avoid judgement such as "why" questions. Instead ask "How come?"

When rapport is established, the suicidal person will be comfortable and able to express themselves.

Boiling Down the Problem

The next step in the ABC Model of Crisis Intervention is boiling down the problem. This involves a careful mix of open and closed questions to make sure that you fully understand what is making the person suicidal. You can start by asking them what they think is the source of their suicidal pain.

Suicidal thoughts are often the result of events that overwhelm a person's personal coping methods. These methods can be different for every person and so it is unwise to assume that something isn't an issue for the suicidal person unless you've spoken to them about it.

For example, a student who has never failed a test before could become suicidal over a perceived threat to their Ivy League college hopes based on failing a test, while another student may have had many ups and downs and therefore has learned to cope with this loss.

Contracting for Action

When you feel that you have a good understanding of the suicidal person's problems, it's important to work with them to implement some long-term changes. If you think back to the CPR Model, we need to assess whether the person is Low Risk, Medium Risk or High Risk.

Contracting for action means developing plans with the client that they can do within the next 24 hours (or another short period) in order to ensure their safety.

When the suicidal person is low risk, your role should be to help with any practical referrals and building up their support network. For instance, someone who is having financial issues, referral to debt counselling would be helpful. Exploring the person's resources to see if there are those they can rely on who they may not be seeing will also be helpful.

Emotional support is most important at this stage so that the person feels comfortable expressing themselves without feeling judged or stigmatized.

When the suicidal person is medium risk, it's important to work collaboratively. Getting the suicidal person to agree to more comprehensive support will be easier if they know that you care. Taking steps to reduce risk by encouraging the person to remove access to suicide methods is also important.

Ensure that you follow up with the person to make certain that they've taken advantage of the referrals. By checking in with them frequently and continuing to assess their suicide risk (even on a simple 1-10 scale) will help you tell if their suicidal risk is being reduced.

When the suicidal person is high risk, it's important to take immediate steps to reduce that risk. You should be directive with the person, taking immediate steps to guarantee their safety. This will involve checking for suicide attempts in progress, referrals that you make with the suicidal person and possible hospitalization if they don't think they can remain safe throughout the night.

In order to assess for immediate risk, you should ask questions like, "Are you in danger?", "Have you taken anything tonight?", "Have you done anything tonight to hurt or kill yourself?" If the person admits that yes, they have, than it's important to get details and make the call to 911 if necessary.

If not, you should explore what they can do to ensure their safety. This may involve calling a crisis line if they don't feel safe, calling 911 or going to a hospital emergency room or staying with you (or someone else they can rely on) to keep them safe.

Further Reading

The book Crisis Intervention Strategies, 7th Edition provides a review of the ABC Model of Crisis Intervention and other basic and advanced crisis intervention skills. I also provide a number of crisis intervention articles in this area.

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ABC Model of Crisis Intervention - Dustin K MacDonald

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Updated for 2018! See below. A simple model of crisis intervention is the ABC Model. A number of crisis intervention models use this same three step process. Essentially, it involves establishing a relationship (A), understanding the problem (B), and taking action (C). This model uses Achieving Rapport, Boiling down the Problem and Contracting for Action....

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Important Texas resource to have on hand.

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District Safety Teams - Safe & Supportive School Program

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Midlothian ISD Campus Threat Assessment Template

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Midlothian ISD Campus Threat Assessment Template

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Midlothian ISD Campus Threat Assessment Template

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Midlothian ISD. (2022). Campus threat assessment template.

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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Midlothian ISD Case Management Plan- Threat Assessment Team

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Midlothian ISD Case Management Plan- Threat Assessment Team

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Midlothian ISD. (n.d.) Case management plan threat assessment team.

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Create a new document and edit with others at the same time -- from your computer, phone or tablet. Get stuff done with or without an internet connection. Use Docs to edit Word files. Free from Google.

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These slides help provide information what could be done in a school district to conduct a risk assessment and referral process.

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The 988 Suicide & Crisis Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States.

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Skip to main content

We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

988

¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!
Haga clic aquí para obtener información sobre cómo acceder a todos los servicios en español.

Conocer más

Stock photo by iStock.

The 988 Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week in the United States. We're committed to improving crisis services and advancing suicide prevention by empowering individuals, advancing professional best practices, and building awareness.

About The Lifeline

Anyone could be struggling with suicide. Find more specific resources below.

I'm Struggling With Individuals with Neurodivergence

We understand that every struggle is different. Experience the stories of people like you, and how they overcame crisis to find hope and recovery.
read stories of hope & recovery

First, you'll hear an automated message featuring additional options while your call is routed to your local 988 Lifeline network crisis center.

We'll play you a little music while we connect you to a skilled, trained crisis worker.

A trained crisis worker at your local center will answer the phone.

This person will listen to you, understand how your problem is affecting you, provide support, and get you the help you need.

988 Lifeline Center calls are free and confidential, and we're available 24/7.

Show What Happens When You Call The Lifeline

Everyone Plays A Role In Suicide Prevention

Get in touch

Call the Lifeline

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Skip to main content We can all help prevent suicide. The 988 Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States. 988 ¡Los servicios de texto y chat de 988 Lifeline ya están disponibles en español!

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Suicide and Crisis Center of North Texas

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Suicide and Crisis Center of North Texas

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The crisis line is staffed by trained, caring volunteers who are available to talk and listen. Services are free and confidential.

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The crisis line is staffed by trained, caring volunteers who are available to talk and listen. Our services are free and confidential.

To speak to a Suicide and Crisis Center volunteer, please call (214) 828-1000. You may also call the National Suicide Prevention Lifeline at (800) 273-TALK (8255).

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24-hour Crisis Line - Suicide & Crisis Center of North Texas

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The crisis line is staffed by trained, caring volunteers who are available to talk and listen. Our services are free and confidential. To speak to a Suicide and Crisis Center volunteer, please call (214) 828-1000. You may also call the National Suicide Prevention Lifeline at (800) 273-TALK (8255).

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Crisis Text Line serves anyone, in any type of crisis, providing access to free, 24/7 support via mediums people already use and trust.

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Crisis Text Line | Text HOME To 741741 free, 24/7 Crisis Counseling

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Crisis Text Line provides free, 24/7 support via text message. We're here for everything: anxiety, depression, suicide, school. Text HOME to 741741.

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Substance Abuse and Mental Health Services Administration. (2017) Improving cultural competence quick guide for clinicians.

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APA is an organization of psychiatrists working together to ensure humane care and effective treatment for all persons with mental illness, including substance use disorders.

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Anxiety and Depression Association of America

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Anxiety and Depression Association of America

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Provides an informative resource for the public and professionals. It explains GAD, along with providing symptoms, treatments, and tips for managing anxiety and stress. Users can search for a therapist, as well as join a free mental health peer-to-peer support community. A reading list provides research focused mental health books focusing on anxiety and depression.

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Athletes will continue to work hard, push themselves, and make their bodies do things many of us...

Join us May 2nd live for a follow-up to our Best Practice CBT Practice for Tinnitus Distress.

Two years ago, I was diagnosed with Generalized Anxiety Disorder. This condition controlled my...

Find Help. Learn More. Support ADAA.

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Helpful Anxiety Resources | Anxiety and Depression

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Athletes will continue to work hard, push themselves, and make their bodies do things many of us... Join us May 2nd live for a follow-up to our Best Practice CBT Practice for Tinnitus Distress. Two years ago, I was diagnosed with Generalized Anxiety Disorder. This condition controlled my... Find Help.

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NIMH provides users with lots of important content on one page including an overview of schizophrenia, explanation on onset and symptoms, risk factors, treatments and therapies, resources for help, and a learn more option, providing printable brochures and other shareable resources.

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National Institute of Mental Health (NIMH)

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Learn about schizophrenia, including onset & symptoms, risk factors, treatments and therapies, how to help a loved one, & resources for more information.

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The NEDA website provides users with a great starting point for looking for help for those with eating disorders.  The help and support page offers screening tools, a help line, resources for free and low cost support, and information on dealing with recovery and relapse.

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NEDA Resources

NEDA offers support options to individuals and loved ones affected by eating disorders to provide them with support throughout the treatment and recovery process. These programs are not replacements for professional help, and are designed and operated with the aid of NEDA Clinical Advisors to be used as a helping hand while navigating eating disorders recovery.

These listed resources are for your reference only and are not recommendations. We have listed resources based on information provided to us by each resource. We do not confirm the accuracy of the information given to us by any resource. NEDA is a nonprofit organization and does not endorse or recommend any particular resource, nor do we make any judgment about the quality of care given by any resource. NEDA is not responsible for any damages arising from the conduct of any resource listed on the site.
Click the button below to add yourself to our treatment provider listing. New registrations will be reviewed within 7-10 business days.

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NEDA Resources NEDA offers support options to individuals and loved ones affected by eating disorders to provide them with support throughout the treatment and recovery process. These programs are not replacements for professional help, and are designed and operated with the aid of NEDA Clinical Advisors to be used as a helping hand while navigating eating disorders recovery.

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