تصمیم‌گیری در شرایط اضطراری رفتاری: کسب مهارت در ارزیابی و مدیریت بیماران پرخطر

Nearly every clinician will eventually have to face a “behavioral emergency”—a situation in which a client is at risk of suicide, violence, or becoming the victim of violence. Yet few clinicians have been trained to deal with the life-or-death judgments that are required in the stress of these moments. This practical, comprehensive book is designed to help practitioners make good decisions under difficult conditions. It straightforwardly addresses such vital topics as how to assess efficiently, how to think clearly under pressure, and how to prepare effectively for emergencies. "In this volume, I describe a model for acquiring skill and attaining competence in evaluating and managing behavioral emergencies. The model involves having a knowledge base as described in the book by Kleespies (2009), but beyond that it requires considerably more. Thus, it involves learning a decision-making strategy that is suited to intense, high-pressure, time-limited conditions such as those that can occur when patients may be at imminent risk of life-threatening behavior. It involves a gradated type of stress training (SET or stress exposure training) that enables the clinician-in-training to avoid becoming overwhelmed and allows him or her to gain key emergency-related experiences. These experiences prime the clinician to be able to quickly "size up" future crises and emergencies and respond to them more rapidly and effectively. The gradated approach to training further allows the clinician to begin to see these high-pressure situations as challenges that can be managed rather than as anxiety-provoking situations that seem beyond his or her capability. As noted in various places in this volume, behavioral emergencies force clinicians to confront what can be life-and-death decisions. If there is a negative outcome, serious clinical, ethical, legal, and professional questions can be raised about the management of the case. As pointed out, there have been numerous calls to action to improve the training of mental health clinicians in suicide risk assessment and intervention. These calls have largely gone unheeded (Schmitz et al., 2012). There is little reason to think that training in the evaluation and management of potential patient violence is appreciably better. In this vein, is it not time for professional psychology to embrace training and competence in such a critical area of practice as the assessment and management of patient life-threatening behaviors?"--Book. (PsycINFO Database Record (c) 2014 APA, all rights reserved) When a client or patient presents who is suicidal, potentially violent, and/or at risk of being victimized, this is considered a behavioral emergency, a situation that requires immediate response. The goal of this book is to help clinicians increase their ability to manage stress and decrease its negative impact when making decisions about the assessment and care of these patients. The author presents models for decision making and stress training, guidance for teaching how to evaluate and manage behavioral emergencies, decision support tools, and a discussion of legal and ethical considerations. This very practical approach to required competency will be a valuable resource for psychologists and any other mental health professionals who work in a clinical setting. It is the only known work that advocates for a decision-making model appropriate to the circumstances in which behavioral emergencies often occur. The book is presented by the author as a companion to his earlier book, Behavioral Emergencies: An Evidence-Based Resource for Evaluating and Managing Risk of Suicide, Violence, and Victimization. Contents Preface Acknowledgments Introduction Chapter 1 Evaluating and Managing Behavioral Emergencies and Crises: An Overview Chapter 2 Decision Making Under Stress: Theoretical and Empirical Bases Chapter 3 Training to Reduce Stress in Dealing With Behavioral Emergencies Chapter 4 Mental Practice for Decision Making During Behavioral Emergencies Chapter 5 The Use of Decision-Support Tools in Behavioral Emergencies Chapter 6 Training for Decision Making With Experience Near or Actual Behavioral Emergencies Chapter 7 The Stress of Legal and Ethical Issues in High-Risk Cases Chapter 8 Coping With the Emotional Aftermath of Negative Events Afterword References Index About the Author This practical, comprehensive book is designed to help mental health practitioners make good decisions when they consider a client to be at imminent risk of suicide, violence toward others, or interpersonal victimization. It addresses straightforwardly such vital topics as how to assess efficiently, how to think clearly under pressure, and how to prepare effectively for emergencies. When a client or patient presents who is suicidal, potentially violent, and/or at risk of being victimized, this is considered a behavioural emergency, a situation that requires immediate response. The goal of this book is to help clinicians increase their ability to manage stress and decrease its negative impact when making decisions about the assessment and care of these patients.