Triage Assessment System
The triage assessment system (TAS) for crisis intervention provides a framework for understanding clients’ reactions during a cri- sis. This model integrates research from a variety of sources and presumes that reactions to crisis events are seen in three domains: (1) affective, (2) behavioral, and (3) cognitive. Clinicians assess clients’ reactions along all three domains. This point is critical because failure to assess each domain can result in a collapse in the resolution of the crisis and lead to additional problem. The TAS guides clinicians in the identification of the complex interaction among the three domains and helps prevent protracted mental health concerns.
The TAS uses Crow’s work on emotions associated with crises and research on primary emotions as the foundation for identifying affective reactions clients experience when in crisis. These reactions are (1) anger/hostility, (2) anxiety/fear, and (3) sadness/melancholy. The expres- sion of these feelings can range from negligible to extremely severe; however, uncom- fortable levels of emotions are more characteristic reactions of people who are experiencing a crisis.
Assessing clients’emotional reactions is generally straightforward. It is relatively uncom- plicated to determine whether clients are angry, afraid, or sad. However, often clients express a combination of these feelings, bouncing from one to another and back again. We suggest that determining the emotion most frequently expressed identifies the primary affective reac- tion. If others are present, these are considered as secondary or tertiary.
Clients’ behavioral reactions can be assessed as (1) immobility, (2) avoidance, and (3) approach. Immobility is defined as being stuck, or unable to sustain any consistent attempt to resolve the crisis. Avoidance is defined as an active attempt to escape or bypass problems associated with the crisis. In contrast, approach reactions are those that are active attempts to resolve problems result- ing from the crisis.
In the cognitive domains, reactions are (1) transgression, (2) threat, and (3) loss. Transgression is seen as a “demeaning offense against me and mine”. The perception of the event is that it is happening primarily in the present. Threat, on the other hand, is viewed as potential, that is, something that will occur in the future. The perception is that an impending catastrophe is approaching. The perception of loss is that it occurred in the past and is irrevocable. Clients’ perceptions, whether accurate or not, are used in the assessment of cognitive reactions. The areas of clients’ lives that are perceived to be affected by the crisis include (1) physical, such as health, shelter, safety; (2) psychological/self-concept, such as identity and emotional well-being; (3) social rela- tionships, such as with family, friends, coworkers; and (4) moral/spiritual, such as per- sonal integrity, values, and belief system. Clients can perceive a transgression, threat, or loss in each of these life dimensions.
The TAS has been operationalized through the development of the Triage Assess- ment Form: Crisis Intervention. The Appen- dix contains a copy of the form. This form adds a severity scale to each domain that allows crisis workers to rate the severity of clients’ reactions in each domain.
Reactions are rated on a scale of 1 to 10 with 10 the most severe reaction. A “rule out” process is the most efficient strategy to determine the severity of each reaction. We suggest beginning with 10 and going down the scale until finding a characteristic that meets the severity of reaction in that domain. This strategy of ruling out characteristics is the most rapid and accurate way to assess severity.
