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NCMHCE Dangerousness and Abuse

NCMHCE Dangerousness and Abuse

Update: 2019-07-19


NCMHCE Exam Review

Dangerousness and Abuse

Dr. Dawn-Elise Snipes PhD, LPC-MHSP

Executive Director, AllCEUs Counseling Education

Host: Counselor Toolbox Podcast


– Identify the characteristics of a dangerousness assessment

– Identify factors associated with a high risk for violence

– Identify steps in preventing danger to others

– Review special cases

– Domestic violence

– Child Abuse

– Elder Abuse

– Substance Abuse

– Eating Disorders

– Emergency calls from nonclients

Dangerousness Assessment

– Identify the cause of the crisis

– Determine the probability the client will hurt someone

– Gather information using a mental status exam

– Ask the client about a history of violence and current plans

– Asses the client’s support system

Factors Associated with a High Risk

– Male

– Alcohol use

– History of violence or threats of violence

– Antisocial behavior

– History of child abuse

– Recent provocation

– Diagnoses: Substance use disorder, delirium, schizophrenia, mania, personality disorders, intermittent explosive disorder

– Agitation

– Loud or abusive speech

– Poor impulse control

– Emotional lability

Duty to Warn

– Must involve a reasonably identifiable victim and a credible threat of imminent danger

– Contact law enforcement and the intended victim

– Divulge only information necessary: You name, the client’s name and the threat (Diagnosis and other information is not necessary and still protected)

– Inform the client ahead of time if appropriate

Immediate Intervention

– Provide a calm, controlled environment

– Allow the client to vent feelings

– Build self-esteem

– Explore options for addressing the issue

– Mobilize support

– Help client understand the cause of the crisis*

– Make a no violence contract

– Ensure the client is calm prior to leaving

– If client is unable to regain composure, encourage voluntary commitment

– Use involuntary commitment as a last resort

Domestic Violence

– Indicators

– Injuries at various stages of healing

– Depression, anxiety, insomnia, nightmares, ASD

– Vague somatic complaints

– Complaints of relationship issues

– Over-dependence on partner

– History of substance abuse

– Behavioral problems in children

– If kids in the house, assess for child abuse

DV Intervention

– Use open ended questions

– “How did you get that bruise” instead of “Did your spouse do this to you-”

– If the perpetrator is present, assess for substance abuse

– For victim

– Get medical treatment as needed

– Help victim protect herself—referral, escape plan

– Challenge victim’s denial and self blame

– Help client understand the situation (cycle of violence) and their options

– Support group referral

DV Intervention

– For Perpetrator

– Break through denial

– Get commitment to a no-violence contract

– Teach anger management skills

– Support group referral

Child Abuse Indicators

– In Children

– Sudden change in behavior

– Excessive clinginess

– Regression

– Suicidal behavior

– Antisocial behavior

– Fear of adults

– Overly sexualized behavior

– Sleep disturbances

– Childhood pregnancy or STD

– School problems

– In Adults

– Unconcerned about child’s injuries

– Provides false explanations

– Conceals injuries

– Uses harsh discipline

– Has overly high expectations for the child

– Was abused as a child

– Extremely jealous or overprotective

– Lacks social support outside the family

Child Abuse Interventions

– Mandatory reporting

– Medical treatment

– Ensure safety

– Mobilize family support systems

– Refer parents to support groups

– Clarify events that caused the crisis

– Build self esteem, reduce shame and self-blame

– Support and validate positive behaviors in the parents

– Teach parenting skills or refer

– Increase parent’s understanding of the triggers and dynamics of abuse

Elder Abuse

– Mandatory Reporting

– You see the abuse

– The client tells you of abuse

– You observe physical injuries that clearly indicate abuse

– Caregiver won’t let you see client alone

– Client appears afraid of caregiver

– Types of Abuse

– Emotional

– Financial

– Physical incl. neglect

– Sexual

Elder Abuse Interventions

– Get medical assistance

– Mobilize support system and resources

– Be empathetic and validating

– Explore events leading up to the current crisis

– Help clients and caregivers identify alternate coping strategies an resources which could prevent future problems

Severe Eating Disorder or Addiction

– Conduct a mental status exam

– Assess the client’s support system

– Encourage voluntary commitment or involuntary if needed

– After the crisis is stabilized, proceed with treatment

– Refer the client to a physician for medical evaluation

– Consider involving a dietician and psychiatrist

– Instill hope

Crisis Call from a Non-Client

– Get the phone number and address of the caller

– Assess the caller’s level of crisis and ability for self-management

– Be directive and advocate for steps to ensure the caller’s safety

– Consider offering an appointment as soon as possible


– It is imperative for clinicians to be prepared for dealing with clients who may be violent or in abusive situations

– Know your ethical imperatives regarding mandatory reporting.

– Get additional training on safety practices for working with victims of abuse

– If confronted with a call from someone who is in crisis but not your client, it is your responsibility to provide initial triage and assist the individual in getting to safety.

Test Taking Tips

– Sally is a 25 year old graduate student who was recently raped. She was referred to you by victim services. Her father, a doctor, whom she is estranged from calls your office wondering how Sally is doing

– What information do you need to make a diagnosis

Test Taking Tips

– What are possible diagnoses

– GAD, ASD, PTSD, MDD, Adjustment Disorder

– What information do you need to make a diagnosis

Test Taking Tips

– You determine that Sally has Acute Stress Disorder.

– Which of the following would be appropriate referrals

Test Taking Tips

– You determine that Sally has Acute Stress Disorder.

– Which of the following would be appropriate to monitor progress-









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NCMHCE Dangerousness and Abuse

NCMHCE Dangerousness and Abuse

Charles Snipes