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Triage Assessment: the Triage Assessment System

Janice Pazar, RN, MS, NCC

The University of Memphis

Memphis, TN

Purpose: Provide participants an opportunity to explore their own approach to crisis assessment, become informed about the process and methods used in the Triage Assessment System, and compare and contrast their own approach with the Triage Assessment System.

Methods: Group participation by sharing experiences and reflection on their own approach to crisis assessment. Instruction and practice in the use of the Triage Assessment System. Integration and evaluation of the TAS through group discussion.

Materials: Participant Handouts summarizing the Triage Assessment Model, Triage Assessment Rating and Scoring Criteria, and the Triage Assessment System Practice Rating Form. Videotaped scenarios of three different levels of a domestic violence crisis situation for use in practice ratings.

Summary of the Triage Assessment System:

The Triage Assessment Model (Myer, R.,A., Williams, R. C., Otten, A. J., & Schmidt, A. E., 1992) assumes individual reactions are unique and situational. Crisis workers assess crisis reactions in three domains: affective (feeling) , behavioral (doing), and cognitive (thinking). Assessment of the affective domain determines the primary reaction, which may be anger, fear, or melancholy. Behavioral reactions include approach, avoidance, or immobility (fight, flight, or freeze). Cognitive reactions refer to the client's perception of the event. Individuals may perceive transgressions of their rights being violated, threats of potential for harm, or an experience of irretrievable loss. These perceptions may occur in any domain of life: physical, psychological, social, environmental, values and beliefs.

To accomplish a triage rating, the affective, behavioral, and cognitive domain responses are each rated on a scale of 1 to 10 using criteria to mark escalating severity of impairment. A total TAS score, therefore, may be between 3 and 30, with 3 being no impairment and 30 being the most severe score possible. Affective rating criteria include stability or lability of mood, congruence of affect to situation, and degree of effort required to maintain volitional control of affect. Behavioral ratings consider the level of impairment in performance of activities of daily living, effectiveness and adaptability of coping behaviors, and potential for harm to self and others. Ratings of cognitive impairment consider the individual's ability to focus and concentrate, problem-solve and make decisions. The presence of confusion, perceptions not matched by reality, and limited control over intrusive thoughts rate higher severity scores on the cognitive scale.

Recommended for further reading:

James, R. K. & Gilliland, B. E. (2001). Crisis intervention strategies. Belmont, CA: Wadsworth.

Myer, R. A. (2001). Assessment for crisis intervention: A triage assessment model. Belmont, CA: Wadsworth.

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