Counselor Toolbox Podcast

Tips for Individual and Group Counseling Instructor: Dr. Dawn-Elise Snipes LPC-MHSP, LMHC Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Objectives • Review techniques to start and facilitate individual sessions • Learn ways to facilitate • Process groups • Random and planned psychoeducational groups General • How you start and manage individual and group sessions depends largely on • the counselor’s theoretical approach • the personal characteristics of the client (age, cognitive functioning, distracting factors, presenting issue) Individual Sessions • The first session— • Develop rapport/empower the client • Ask the client what he or she hopes to accomplish • Share your understanding of his/her situation to make sure you are on the same page • Ask the client to prioritize which problem he/she wants to address first/which is most important • Ask the client what he/she thinks might be helpful to approach the issue • Share your theoretical approach and, based on the client’s responses, outline a proposal for the next steps. Individual Sessions • Subsequent sessions • Humanistic approaches • Acknowledge that people have within themselves the answers to improving their own lives. • Recognize and respect the ability of human beings to employ reason, science, intuition, and creativity as tools for the achievement of goals. • Don’t get unnecessarily side tracked. Stay on the issue at hand. • Assert that wellness and health is best achieved through personal growth. • Strategies • Begin by summarizing what was covered in the last session • Ask the client to share what has happened in the past week, emphasize positive changes and explore stuck points/challenges • Use socratic questioning to draw connections between the last weeks events, current presenting issues and current skills Individual Sessions • Subsequent sessions • Humanistic approaches • Acknowledge that people have within themselves the answers to improving their own lives. • Recognize and respect the ability of human beings to employ reason, science, intuition, and creativity as tools for the achievement of goals. • Assert that wellness and health is best achieved through personal growth. • Strategies • Begin by summarizing what was covered in the last session • Ask the client to share what has happened in the past week, emphasize positive changes and explore stuck points/challenges • Use socratic questioning to draw connections between the last weeks events, current presenting issues and current skills Individual Sessions • Subsequent sessions • Cognitive Approaches • Assert that issues are caused by unhelpful thoughts and/or unhelpful behaviors. • Seek to identify those thoughts and behaviors and help the client become more mindful of how these things impact their mood. • Strategies • Cognitive approaches tend to be much more structured. • Begin by summarizing what was covered in the last session • Review homework • Ask the client to share what has happened in the past week, emphasize positive changes and explore stuck points/challenges • Help client identify and address unhelpful thoughts and behaviors perpetuating stuck points. Group Sessions • Process Groups • Psychoeducational Groups • Structured • Unstructured Group Sessions • Process Groups • Central to the group process is the opportunity for members to talk as openly as they possibly can about their interactions and experiences of each other as well as any aspects of the group experience that may come to mind. (microcosm) • Can be an excellent adjunct to psychoeducational groups which teach knowledge and skills. • Process groups translate and generalize those skills to practice “How did it feel last week when you…” “What came up for you when…” • Techniques • Theme your modules (abandonment, grief and loss, shame and guilt, mothers/fathers empowerment, etc.) • Consider choosing a book to give structure (Seeking Safety, Toxic Parents, Growing Up with a Borderline Parent, Journey to Recovery) •

Models of Treatment for Co-Occurring Disorders Dr. Dawn-Elise Snipes PhD, LMHC Executive Director, AllCEUs.com Learner Objectives ~ Identify the most common settings for co-occurring disorders treatment ~ Differentiate between the levels of treatment from intervention to residential level IV. ~ Identify specific characteristics of treatment in problem solving courts, jails Settings ~ Health Departments and Social Services ~ Behavioral Healthcare Centers ~ Private Practice Offices ~ Hospitals ~ Schools ~ Jails Prevention ~ Averting problems before they begin through modifying risk and protective factors in the following domains: ~ Individual ~ Family ~ School ~ Community ~ Examples ~ Educating children about drugs and their effects ~ Improving communication among families ~ Ensuring children are able to engage in school ~ Improving community stability, organization and attachment. Intervention ~ Providing resources to prevent worsening of addiction or other biopsychosocial issues that could lead to addiction. ~ Methods ~ Psychoeducational groups and classes ~ Early identification of persons with risk factors for mental health, stress related or substance abuse issues ~ Frequency: Once per week ~ Setting: ~ School ~ Church ~ Community Center ~ Clinic ~ Home ~ Online/phone Outpatient ~ Individual and group counseling sessions ~ Frequency: 1 to 3 times per week ~ Setting: ~ Clinic ~ School ~ Online/Telephone ~ Home ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses Intensive Outpatient ~ Individual and group counseling sessions ~ Frequency: 3 to 5 times per week for a minimum of 3 hours per day ~ Setting: ~ Clinic ~ Online ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses Partial Hospitalization ~ Individual and group counseling sessions ~ Frequency: Daily ~ Setting: Clinic (Patient sleeps off campus) ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses Short-Term Residential ~ Individual and group counseling sessions ~ Frequency: Daily for up to 60 days ~ Setting: Clinic (Patient sleeps on campus) ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses Long Term Residential ~ Individual and group counseling sessions ~ Frequency: Daily for up to 1 year ~ Setting: Clinic (Patient sleeps on campus) ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses ~ Medication management ~ Establishment of wrap around services Criminal Justice ~ Individual and group counseling sessions ~ Frequency: Daily ~ Setting ~ Jail ~ Intensive outpatient as with problem solving courts ~ Issues ~ Coping skills ~ Maladaptive emotions/reactions; thoughts and/or behaviors ~ Relationship and interpersonal issues ~ Past traumas and losses ~ Changing criminogenic thinking ~ Reintegration services Case Management and linkages with wrap around services Job and life skills Problem Solving Courts ~ Created to assist consumers whose illegal behaviors are thought to be a result of an underlying substance abuse or mental health issue. ~ Involve ~ Weekly monitoring by the court ~ Daily contact with a counselor ~ Provision of sanctions based on noncompliance ~ Progression through phases based on demonstrated improvements in behaviors, reactions and relationships Summary ~ Consumers should be placed in the least restrictive environment ~ There are benefits and drawbacks to all levels of care ~ Outpatient ~ Intensive outpatient ~ Short term residential ~ Long term residential ~ Problem solving courts have demonstrated much success

Abuse and Neglect Indicators Training Protecting Children, Elders and Adults with Disabilities Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery Objectives • Define terms related to sexual, physical, mental and financial abuse and neglect of children and adults • Identify signs of abuse or neglect in the victim as well as in the caregivers • Learn about mandatory reporting • Identify resources for the most up-to-date reporting guidelines Definitions • Definition of a child • A Person less than 18 years old • Definition of an elder • Person 60 years AND SUFFERING from infirmities or aging as manifested by: • advanced age (75 years or older) OR • organic brain damage (delirium, dementia) OR • other physical, mental, or emotional dysfunction in which person’s ability to care for self is impaired Definitions of a Caretaker • PARENT (Biological, foster or adoptive) • ADULT HOUSEHOLD MEMBER(found in the home continually) • ANOTHER ADULT( entrusted with; assumed responsibility) • ANOTHER CHILD (employee or volunteer of daycare, private school, agency, camp, similar facility) Disabled Adult • A person 18 years or older AND suffers from a condition of physical or mental incapacitation due to: • developmental disability • organic brain damage • mental illness • one or more physical and/or mental limitations that substantially restrict the ability to function in activities of daily life (ADLs) ABUSE • Non-accidental infliction of physical or psychological injury or sexual abuse by parent, adult household member, or other person responsible for care of child • Non-accidental action by a relative, caregiver or household member which causes or reasonably be expected to cause, physical or psychological injury or sexual abuse. • Actively encouraging another person to commit an injurious act upon an elderly person or disabled adult NEGLECT • Failure/omission by a caretaker to provide the care, supervision, services or protection necessary to maintain physical and mental health Note: This may include witnessing domestic violence or illicit drug use • Repeated or single act of carelessness that causes or can be expected to cause serious physical, psychological injury, sexual abuse or substantial risk of death THREATENED HARM • SITUATION, CIRCUMSTANCES, or BEHAVIOR which lead person to have reasonable cause to suspect abuse or neglect has occurred or may occur in the immediate future if no intervention is provided. SELF NEGLECT • OMISSION or FAILURE of elderly or disabled person to maintain their own physical/mental health which is deemed essential for his/her well-being. • This may include not taking medication as prescribed and substance abuse EXPLOITATION • May or may not stand in a position of trust and confidence to the victim, and • Acts knowingly, by deception or intimidation, and • knows or should know the victim lacks capacity to consent, and • Intends to temporarily or permanently deprive the victim of funds, assets or property for the benefit of someone other than the victim Physical Abuse Physical Abuse – Type • Burning • Beating • Kicking • Punching/Slapping • Shaking (especially infants) • Misuse of medication • Approximately 24 states have specific reporting procedures for cases of suspected substance-exposed infants. • Standard reporting procedures apply in those states that statutorily define infant drug exposure as child abuse and neglect but have no specific reporting procedures for substance-exposed infants Physical Indicators • Unexplained Bruises/Welts on face, lips, mouth, torso, back, buttocks, thighs • In various stages of healing, clustered, forming regular patterns, reflecting shape of object used • On several different surface areas, regularly appear after absence, weekend or vacation • Unexplained burns (soles, palms, back, buttocks) • Immersion burns (sock like, glove-like, doughnut shaped on b

Domestic Violence Dr. Dawn-Elise Snipes, PhD, LMHC Objectives ~ Review the extent of the problem ~ Identify risk factors for violence ~ Review practice guidelines for working with survivors of DV ~ Identify primary, secondary and tertiary interventions ~ Explore components of an effective routine DV screening program Statistics ~ 2-4 million women battered each year ~ 20-30% lifetime risk for a woman to be battered ~ 1,500 women murdered/year by partners ~ 20-30% of women seen in medical setting may be abuse victims ~ 5-6% prevalence of elder mistreatment (1.8 million) ~ 1,100 childhood deaths from abuse each year ~ 140,000 childhood injuries from abuse each year ~ 1.7 million reports of child abuse each year ~ 250,000-450,000 cases of child sexual abuse/year ~ 16 percent of adult women report a history of sexual abuse by a family member Economic Costs Acute medical care for injuries or neglect, and their complications ~ medical complications from injuries with enduring effects ~ mental health and substance abuse care for victims, perpetrators and families ~ inappropriate medical care for unrecognized mental health problems (“distressed high utilizers”) Criminal justice system ~ intervening, arrests, prosecution, incarceration, etc. Legal system ~ separation, divorce, custody disputes, protection orders, etc. Social welfare organizations ~ emergency shelters, housing, foster care, etc. Impediments to work ~ absenteeism or poor productivity Practice Guidelines ~ Implement routine, universal screening ~ in all health care settings ~ for all females 12 years of age and older ~ Skills to foster an environment that facilitates disclosure: ~ how to ask the question ~ how to respond ~ what to document ~ your legal obligations ~ Screening strategies and initial responses ~ respond to the needs of all women ~ take into account differences based on diversity ~ Use reflective practice to examine how your own beliefs, values, and experiences influence the practice of screening Educational Guidelines ~ Mandatory educational programs in the workplace designed to increase: ~ knowledge and skills ~ foster awareness and sensitivity about abuse ~ Curricula incorporate content on abuse in a systematic manner Organizational Recommendations Develop policies and procedures ~ supporting routine universal screening & initial response Work with the community at a systems level to improve collaboration and integration of services between sectors Practice implementation requires: ~ adequate planning, resources, administrative support ~ appropriate facilitation ~ an assessment of organizational readiness and barriers ~ involvement of all members ~ dedication of a qualified single point of contact ~ ongoing opportunities for discussion and education ~ opportunities for reflection Definition ~ Woman abuse is: ~ the intentional and systematic use of tactics to establish and maintain power and control over the thoughts, beliefs and conduct of a woman through the inducement of fear and/or dependency ~ The tactics include: ~ emotional, financial, physical and sexual abuse, as well as, intimidation, isolation, threats, using the children and using social status and privilege Primary Prevention ~ Prevents disorders before they occur ~ May include such activities as: ~ educating patients about the domestic violence ~ teaching parents about appropriate discipline ~ educating children about respect and appropriate assertiveness ~ recognizing and referring patients at-risk for perpetrating abuse ~ assessing potentially over-stressed caregivers ~ advising middle-aged parents about the need to plan for future care needs of dependent, impaired adult children ~ making routine inquiries about: ~ any violence in the home ~ presence of stressors ~ availability of firearms Other Prevention Types ~ Secondary prevention ~ involves such efforts as making patients aware of physician interest in hearing about abuse ~ screening for all forms of victimization, psychiatric disorde

Life Skills Instructor; Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery Objectives ~ Review common life skills Communication Skills ~ Types ~ Written ~ Nonverbal ~ Oral Communication Skills ~ Assertiveness ~ Being open in expressing wishes, thoughts and feelings and encouraging others to do likewise. ~ Listening to the views of others and responding appropriately, whether in agreement with those views or not. ~ Accepting responsibilities and being able to delegate to others. ~ Regularly expressing appreciation of others for what they have done or are doing. ~ Being able to admit to mistakes and apologize. ~ Maintaining self-control. ~ Behaving as an equal to others, respecting that their opinions and needs are equally important to yours. Communication Skills ~ 6 main characteristics of assertiveness ~ Eye contact: demonstrates interest, shows sincerity ~ Body posture: congruent body language will improve the significance of the message ~ Gestures: appropriate gestures help to add emphasis ~ Voice: a level, well modulated tone is more convincing and acceptable, and is not intimidating ~ Timing: use your judgement to maximize receptivity and impact ~ Content: how, where and when you choose to comment is probably more important than WHAT you say ~ Use of “I” statements Communication Skills ~ Conflict management and dialectics ~ We respond to conflicts based on our perceptions of the situation, not necessarily to an objective review of the facts. Our perceptions are influenced by our life experiences, culture, values, and beliefs. ~ Conflicts trigger strong emotions. If you aren’t comfortable with your emotions or able to manage them in times of stress, you won’t be able to resolve conflict successfully. ~ Conflicts are an opportunity for growth. When you’re able to resolve conflict in a relationship, it builds trust. You can feel secure knowing your relationship can survive challenges and disagreements. Communication Skills ~ Conflict management and dialectics ~ Skills ~ Get the facts ~ Empathize with the other person/try to understand their feelings and point of view ~ Be respectful and objective in communications ~ Be aware of verbal and nonverbal cues of increasing frustration ~ Identify triggers for conflict ~ Seek compromise/embrace dialectics ~ Win/lose ~ Competent/incompetent ~ Right/wrong ~ Be creative Communication Skills ~ Negotiating ~ Stages ~ Preparation ~ Discussion ~ Clarification of goals ~ Negotiate towards a Win-Win outcome ~ Agreement ~ Implementation of a course of action ~ Creating a win/win ~ Saying No, Asking for something Communication Skills ~ Interviewing ~ Dress for the job ~ Listen more than you talk ~ Ask questions more than you tell ~ Answer questions asked of you ~ Use proper language ~ Speak confidently and clearly ~ Don’t be too cocky ~ Express optimism, enthusiasm and gratitude ~ Research and rehearse potential interview questions ~ Re-read the job description prior to the interview ~ Research the company Communication Skills ~ Giving criticism ~ State the problem objectively ~ Phrase it in terms of how the solution can be helpful to the person. ~ Your paperwork has been very late. You are an excellent employee. Getting your paperwork in on time will go a long way to helping you get a raise/promotion etc. ~ Ask how you can help ~ Is there something that has changed that is causing the problem, or something I can help with? Communication Skills ~ Handling criticism ~ Listen to hear what the critic is saying ~ Separate the criticism from the self ~ Don’t be defensive. Often the person is trying to help you. Thank the commenter for his criticism, acknowledge his point without being defensive (Separate criticism from abuse though) ~ Ask open ended questions for clarification ~ Admit your mistakes. ~ Take what is useful and leave the rest. (Sometimes it is about them) ~ Look at criticism as a challenge to do better. ~ Work on your self-est

Recovery Oriented System of Care and Service Coordination Recovery Oriented Systems of Care ~ Affirms the real potential for permanent resolution of behavioral health problems ~ Offers solutions to behavioral health problems on a community and cultural level ~ Shift away from risk management and relapse prevention toward encouraging clients to self-define goals and take responsibility for achieving them ~ A shift from emergency room/acute care model to one of sustained recovery management which include wrap-around recovery support services Recovery Oriented Systems of Care ~ Emphasis on ~ Post-treatment monitoring ~ Stage-appropriate recovery education ~ Peer recovery coaching ~ Assertive linkages to recovery communities ~ Early re-intervention ~ Maintaining functional ability in all life activities ~ Recovery in illness instead of recovery from illness Recovery Oriented Systems of Care ~ Goals ~ Foster health and resilience activities ~ Increase permanent housing and sense home/belonging ~ Ensure gainful employment and access to education to provide a sense of purpose ~ Enhance communities by increasing availability of necessary supports from and for peers/family/community ~ Reduce barriers to social inclusion ~ Counselor functions ~ Identify gaps in services ~ Identifying emerging trends and needs ~ Monitor system effectiveness Recovery Oriented Systems of Care ~ Guiding principles of Recovery emerges from hope and is… ~ Person-centered – self-efficacy, self-direction ~ Non-linear, and occurs via many pathways (methods) ~ Holistic – mind, body, spirit, community ~ Supported by peers and allies (counselors/case workers) ~ Supported through relationships and social networks (family, peers, faith groups, community) ~ Culturally based and influenced ~ Supported by addressing trauma ~ Based on respect of individual, family and community strengths and responsibilities Recovery Oriented Systems of Care ~ 3 core components ~ Collaborative decision making /individual empowerment ~ Continuity of services and supports ~ No wrong door ~ Services available as long as needed ~ Service quality and responsiveness ~ Evidence based ~ Developmentally and culturally appropriate ~ Gender specific ~ Trauma informed ~ Family focused ~ Stage appropriate Recovery Management ~ Treatment does not need to be voluntary, but success depends on personal engagement ~ Full recovery often comes from episodic, nonlinear treatment ~ Previous treatment and relapse is not indicative of poor prognosis ~ Relapse is viewed as evidence of the severity of the condition rather than a cause for discharge ~ Recovery management is a time-sustained, recovery focused collaboration between consumers and service providers with the goal of stabilizing and managing the ebb and flow of co-occurring disorders until full recovery is achieved or self-management is possible. Recovery Management ~ Spans 3 phases ~ Prerecovery identification and engagement ~ Recovery initiation and stabilization ~ Recovery maintenance Service Coordination ~ Encompasses administrative, clinical and evaluative activities that bring the client , treatment services, community agencies and other resources together to focus on needs identified in the recovery plan ~ Service coordination includes: ~ Case management ~ Collaboration with client and SOs ~ Coordination of treatment and referral services to address issues contributing to and caused by addictive behaviors ~ Liaison activities with community resources ~ Ongoing evaluation of treatment progress and client needs ~ Client Advocacy Service Coordination ~ Tasks ~ Initiating and collaborating with referral source “warm referral” ~ Obtain, review and interpret all relevant screening, assessment and treatment planning information ~ Confirm client eligibility for admission and continued readiness for change ~ Completing necessary administrative procedures for admission ~ Coordinating all treatment activities with services provided to the client by o

Milestones of Child Development: Addressing (and Preventing) Stuck Points Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Identify the major psycho-social milestones for each age group ~ Learn about things that may thwart development ~ Identify protective factors for healthy development ~ Conceptualize behaviors as goal-driven in order to better understand their purpose and provide appropriate redirection Infancy Milestones ~ Age 0-1 years ~ Children master the use of their hands (0-6 months) ~ Start crawling ~ Respond to familiar words ~ Discover their voices ~ Rely on parents for comfort and to meet basic needs ~ Cognitive (Piaget): Object permanence ~ Develop Trust (Erickson) ~ Secure attachment to caregiver ~ In self to properly interpret signals and get needs met Infancy and Attachment ~ Attachment ~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security. ~ The quality of the infant-parent attachment is a powerful predictor of a child’s later social and emotional outcome ~ Determined by the caregiver’s response to the infant when the infant’s attachment system is ‘activated’ ~ Beginning at six months old, infants come to anticipate caregivers’ responses to their distress and shape their own behaviors accordingly (eg, developing strategies for dealing with distress when in the presence of that caregiver) ~ Sensitive, Responsive, Loving = Secure ~ Insensitive, Rejecting or Inconsistent = Insecure Attachment cont… ~ Continues through childhood, but formative attachment relationships developed in infancy ~ Effects of Secure Attachment ~ Learn basic trust, which serves as a basis for all future emotional relationships ~ Develop fulfilling intimate relationships ~ Maintain emotional balance ~ Feel confident and good about themselves ~ Enjoy being with others ~ Rebound from disappointment and loss ~ Share their feelings and seek support Attachment Cont… ~ Effects of Secure Attachment cont… ~ Explore the environment with feelings of safety and security, which leads to healthy intellectual and social development ~ Develop the ability to control behavior, which results in effective management of impulses and emotions ~ Create a foundation for the development of identity, which includes a sense of capability, self-worth, and a balance between dependence and independence ~ Establish a moral framework that leads to empathy, compassion, and conscience ~ Generate a core set of beliefs ~ Provide a defense against stress and trauma Infancy Developmental Stuck Points ~ Interferences ~ Child does not have basic food, shelter, safety, love needs met ~ Manifestations ~ Inability to trust self or others ~ Reliance on others to tell them what they need ~ Lack of a sense of worthiness for basics ~ Discomfort with and craving of attention ~ Irritability/anxiety ~ Establishment/Re-Establishment of Trust and Attachment ~ Consistency ~ Care: Understanding and ensuring basic needs are met ~ Compassion: Being calm and accepting of the child’s emotions and needs ~ Providing compassionate redirection: Add. Don’t just subtract Toddlers 2-3 Years ~ Developmental Task: ~ Psychosocial: Autonomy vs. Shame & Doubt (Erickson) ~ Personal control over physical skills and body (potty training and “no”) ~ Cognitive: Preoperational (Through age 7) ~ Think about things symbolically (Doll can “be” Mom) / Pretend play ~ Begin to understand the concept of past and future ~ Continue to develop secure attachments Toddlers 2-3 Years Stuck Points ~ Interferences ~ Overly permissive or overly strict parents ~ Lack of praise for exploration and experimentation ~ Manifestations ~ Low self-esteem/need for external validation ~ Lack of motivation ~ Establishment/Re-Establishment ~ Encourage child to explore and experiment ~ Praise child for trying even if he fails ~ Reassur

Milestones of Child Development: Addressing (and Preventing) Stuck Points Instructor: Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Counseling CEUs and Specialty Certificates Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Identify the major psycho-social milestones for each age group ~ Learn about things that may thwart development ~ Identify protective factors for healthy development ~ Conceptualize behaviors as goal-driven in order to better understand their purpose and provide appropriate redirection Infancy Milestones ~ Age 0-1 years ~ Children master the use of their hands (0-6 months) ~ Start crawling ~ Respond to familiar words ~ Discover their voices ~ Rely on parents for comfort and to meet basic needs ~ Cognitive (Piaget): Object permanence ~ Develop Trust (Erickson) ~ Secure attachment to caregiver ~ In self to properly interpret signals and get needs met Infancy and Attachment ~ Attachment ~ Attachment is the quality of the relationship with the caregiver characterized by trust, safety and security. ~ The quality of the infant-parent attachment is a powerful predictor of a child’s later social and emotional outcome ~ Determined by the caregiver’s response to the infant when the infant’s attachment system is ‘activated’ ~ Beginning at six months old, infants come to anticipate caregivers’ responses to their distress and shape their own behaviors accordingly (eg, developing strategies for dealing with distress when in the presence of that caregiver) ~ Sensitive, Responsive, Loving = Secure ~ Insensitive, Rejecting or Inconsistent = Insecure Attachment cont… ~ Continues through childhood, but formative attachment relationships developed in infancy ~ Effects of Secure Attachment ~ Learn basic trust, which serves as a basis for all future emotional relationships ~ Develop fulfilling intimate relationships ~ Maintain emotional balance ~ Feel confident and good about themselves ~ Enjoy being with others ~ Rebound from disappointment and loss ~ Share their feelings and seek support Attachment Cont… ~ Effects of Secure Attachment cont… ~ Explore the environment with feelings of safety and security, which leads to healthy intellectual and social development ~ Develop the ability to control behavior, which results in effective management of impulses and emotions ~ Create a foundation for the development of identity, which includes a sense of capability, self-worth, and a balance between dependence and independence ~ Establish a moral framework that leads to empathy, compassion, and conscience ~ Generate a core set of beliefs ~ Provide a defense against stress and trauma Infancy Developmental Stuck Points ~ Interferences ~ Child does not have basic food, shelter, safety, love needs met ~ Manifestations ~ Inability to trust self or others ~ Reliance on others to tell them what they need ~ Lack of a sense of worthiness for basics ~ Discomfort with and craving of attention ~ Irritability/anxiety ~ Establishment/Re-Establishment of Trust and Attachment ~ Consistency ~ Care: Understanding and ensuring basic needs are met ~ Compassion: Being calm and accepting of the child’s emotions and needs ~ Providing compassionate redirection: Add. Don’t just subtract Toddlers 2-3 Years ~ Developmental Task: ~ Psychosocial: Autonomy vs. Shame & Doubt (Erickson) ~ Personal control over physical skills and body (potty training and “no”) ~ Cognitive: Preoperational (Through age 7) ~ Think about things symbolically (Doll can “be” Mom) / Pretend play ~ Begin to understand the concept of past and future ~ Continue to develop secure attachments Toddlers 2-3 Years Stuck Points ~ Interferences ~ Overly permissive or overly strict parents ~ Lack of praise for exploration and experimentation ~ Manifestations ~ Low self-esteem/need for external validation ~ Lack of motivation ~ Establishment/Re-Establishment ~ Encourage child to explore and experiment ~ Praise child for trying even if he fails ~ Reassur

Documentation Review Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review Addiction Counselor Certification Training (400 Hours) $149 Documenting the Treatment Process ~ The client record is the most important tool to ensure continuity of care ~ Documentation contributes to service delivery by: ~ Reducing replication of services ~ Presenting a cohesive longitudinal record of clinically meaningful information ~ Ensuring reimbursement for services ~ Assists in guarding against malpractice ~ What was done ~ By whom ~ Were they adequately credentialed Purposes of Clinical Documentation ~ Records professional services ~ Intake ~ Differential diagnosis ~ Placement criteria used in decision making ~ Treatment and other services provided ~ Response to treatment interventions ~ Referral services and outcome ~ Clinical course ~ Reassessment and treatment plan reviews ~ Records compliance with state, accreditation and payor requirements ~ Ease transition to other programs and to referral resources ~ Prevent duplication of information gathering when possible Purposes of Clinical Documentation ~ Facilitates Quality Assurance ~ Documenting the appropriateness, clinical necessity and effectiveness of treatment ~ Substantiating the need for further assessment and testing ~ Support termination or transfer of services ~ Identifying problems with service delivery by providing data to support corrective actions ~ Adding to methods to improve and assure quality of care ~ Providing information that is used in policy development, program planning and research ~ Providing data for use in planning professional development activities. ~ Fosters communication and collaboration between multidisciplinary team members Documentation: CFR 42 part 2 ~ Confidentiality of Alcohol and Drug Abuse Patient Records ~ 42 CFR Part 2 applies to all records relating to the identity, diagnosis, prognosis, or treatment of any patient in a substance abuse program in the US ~ Prohibition, data that would identify a patient as suffering from a SUD or undergoing SUD treatment ~ 42 CFR Part 2 allows for disclosure ~ where the state mandates child-abuse-and neglect reporting ~ when cause of death is being reported ~ with the existence of a valid court order Documentation – Release of Information ~ A written consent form requires ten elements (42 C.F.R. § 2.31(a); 45 C.F.R. § 164.508(c)): ~ 1. the names of the programs making the disclosure ~ 2. the name of the individual or organization that will receive the disclosure ~ 3. the name of the patient who is the subject of the disclosure ~ 4. the specific purpose or need for the disclosure ~ 5. a description of how much and what kind of information will be disclosed ~ 6. a patient’s right to revoke the consent in writing and the exceptions ~ 7. the program’s ability to condition treatment, payment, enrollment, or eligibility of benefits on the patient agreeing to sign the consent ~ 8. the date or condition when the consent expires if not previously revoked ~ 9. the signature of the patient (and/or other authorized person) ~ 10. the date on which the consent is assigned ~ When used in the criminal-justice setting, expiration of the consent may be conditioned upon the completion of, or termination from, a program Documentation – Information Sharing ~ Information can be shared within an agency on a need to know basis with person on the treatment team ~ Information sharing can be done ~ With a release ~ To the client ~ Under specific circumstances ~ Agencies generally have policies for who is allowed to release information ~ Clients have the right to review and amend their records ~ If request to view or amend the record is denied, a written explanation must be provided to the client HIPAA and HITECH Act ~ Protects insurance coverage of workers when they change or lose their job ~ Safeguards the privacy of information ~ Combats waste in healthcare delivery ~ Simplifies administration

Diagnosis Dr. Dawn-Elise Snipes PhD, LPC-MHSP Podcast Host: Addiction Counselor Exam Review and Counselor Toolbox Objectives ~ Review the criteria for substance use disorder ~ Discuss substance induced disorders ~ Learn mnemonics to identify signs of intoxication and withdrawal as well as mental health symptoms Diagnosis and the DSM ~ The Diagnostic and Statistical Manual is created to ~ facilitate communication between and within professions regarding mental health and substance use disorders ~ Improve interrater reliability regarding diagnosis ~ Improve sharing of information about client presentation and needs ICD-10 ~ International Classification of Disease is used for diagnosis (like the DSM) Diagnosis of Substance Use Disorders ~ The DSM V recognizes 10 separate classes of drugs ~ Alcohol ~ Inhalants ~ Opioids ~ Sedatives ~ Hypnotics/Barbiturates ~ Anxiolytics ~ Stimulants ~ Caffeine ~ Tobacco ~ Cannabis ~ Hallucinogens ~ Other/Unknown substances SUD Diagnosis ~ Although how each types of drug acts in the brain differs, they all activate the brain’s reward system ~ Two groups of substance disorders ~ Substance use ~ Substance induced SUD Diagnosis ~ Diagnosis ~ Using in larger amounts or for longer than intended ~ Wanting to cut down or stop but failing ~ Spending increased time getting, using or recovering from use ~ Cravings and urges ~ Neglecting work, school, family, social obligations because of use ~ Continue to use even when it causes problems in relationships ~ Giving up important social, occupational, recreational activities because of use ~ Using in risky situations ~ Continuing to use despite knowing that it is making a physical or psychological problem worse ~ Tolerance ~ Withdrawal Diagnosis of Substance Use Disorders ~ SUD severity is dependent on how many symptoms are present ~ 2-3 symptoms = Mild ~ 4-5 = Moderate ~ More than 5 severe ~ Qualifiers ~ In early remission ~ In sustained remission ~ On maintenance therapy ~ In a controlled environment Substance Induced vs. Mental Illness Dx ~ Substance induced means that the current presenting symptoms are likely the result of use of a substance not an underlying (pre-existing) mental disorder ~ Concurrent mental disorders can (and often do) occur Substance-Induced Disorder Diagnosis ~ Result from effects of the use of a substance ~ Intoxication ~ Withdrawal ~ Anxiety or depressive disorders ~ Bipolar and related disorders ~ Psychotic disorders (hallucinations, delusions) ~ Sleep disorders ~ Sexual dysfunctions ~ Neurocognitive disorders ~ The teeter-totter principle helps predict symptoms in the withdrawal period (Polysubstance complicates things) Depressants ~ Alcohol, Sedative, Hypnotic, or Anxiolytic Intoxication (SAM'S GIN) Slurred Speech Attention impairment Memory impairment Stupor or coma or death Gait unsteady Incoordination Nystagmus Depressants ~ Alcohol, Sedative, Hypnotic, or Anxioloytic Intoxication Withdrawal (PAST NITES) Psychomotor agitation Anxiety Seizures (Grand-Mal) Transient hallucinations Nausea or vomiting Insomnia Tremor increased (hand) Excitability-autonomic (Increased HR and BP) Sweating (diaphoresis) Stimulants ~ Amphetamine/Cocaine Intoxication (A CODE BLUE) Agitation or retardation (psychomotor) Cardiac (tachycardia or bradycardia) Opening of the pupil Diaphoresis (or chills) Encephalopathic-like changes (seizures, confusion, dyskinesias, dystonias, or coma) Blood pressure (elevated or lowered) Loss of stomach content Unstable muscle-associated changes (diaphramatic, cardiac, and skeletal) i.e., muscle weakness, respiratory depression, arrhythmias Evidence of weight loss Stimulants Amphetamine/Cocaine Withdrawal (D-PANTS) Depression (suicidal) P -Psychomotor agitation or retardation A -Appetite increases N -Nightmares (vivid, unpleasant dreams) T -Tiredness (fatigue) S -Sleep (hypersomnia or insomnia) Cannabis and Hallucinogens Hallucinogen Intoxication (DISTORT) Disoriented (blurred) vision Incoordination Sweating Tachycardia Op

Addressing Adult ADHD Dr. Dawn-Elise Snipes AllCEUs.com Counselor Education Podcast Hots: Counselor Toolbox, Addiction Counselor Exam Review, Happiness Isn’t Brain Surgery Objectives ~ Identify current points to remember about ADHD ~ Learn how to help motivate a person with ADHD ~ Identify ways to get someone with ADHD started even without motivation ~ Review treatment goals for clients ~ Identify interventions that can help people reach treatment goals ~ Explore an activity to help clients develop their action plan. Note ~ While boys are diagnosed with ADD three times more often than girls, this is likely because, in girls, the disorder typically presents as the “inattentive” or “dreamy” type (staring out windows or drifting off midconversation), as opposed to the “hyperactive” type. ~ Giftedness and ADHD often co-occur ~ The brains of people who are gifted operate faster than non-gifted leading to ~ Interrupting ~ Movement Things to Remember ~ ADHD is not a character flaw ~ ADHD recovery is a team effort ~ ADHD often responds well to medication ~ Pills do not give skills ~ Keep an inventory of things the person does right ~ People with ADHD find it hard to demonstrate what they know to someone else Things to Remember ~ Motivation is essential (ED) ~ The importance of a task and the rewards of completing it don’t motivate a person with ADHD to get things done ~ Embracing his deeply held values or things that are important to him can help an individual with ADHD get things done and stay focused. (JFK) ~ Competition can help. Even if it is only against self ~ Improved sense of competence also helps Motivation Prompts ~ What excites you or recharges your batteries? ~ Think about a time in your past when completing a similar type of task wasn’t so hard. What was different? Can you bring some of those elements into the situation now? ~ How can you break this task down into three pieces so it feels more manageable? ~ How will you reward yourself when you complete this? ~ What needs to change to turn this “should” into a “want”? ~ What are you good at? Motivation ~ What self-talk do you notice that you can let go of? ~ What about this task is important or meaningful to you? ~ When is the best time for you to do this task? ~ What support do you have to get this task done? ~ What obstacles are preventing you from completing this task? Which of these can you eliminate now? ~ How can you make this task fun, interesting, or enjoyable? Motivation ~ See the goal ~ People with ADHD forget the purpose of their tasks, so they are uninspired to finish them. ~ Imagining the negative consequences of not doing something is not a potent motivator ~ Imagine how great it will feel to get to your goal works better and add visual reminders of the goal—including daily creative visualization. ~ Hint: Put a medication reminder app on his phone to remind him each morning to do his creative visualization for handling that issue Motivation ~ Envision the end result. ~ Instead of: You need to get these applications done for college ~ Try: Think how awesome it will be when you get in college and can finally start learning the stuff that is important to you! ~ Try: How great will it feel when you have been accepted to college and can see how your hard work paid off? Get Started (Even Unmotivated) ~ Get started ~ Create urgency ~ Keep a list of must-dos (bills, dishes, homework) ~ Work with a buddy ~ Reward yourself ~ Start with the goal of good enough ~ Work during peak times Goals ~ For each goal ask ~ How has this issue caused you problems to identify specific goal targets ~ How will your life be improved when this is resolved to help the person visulaize Goals ~ Chronic lateness ~ Be on time to work/appointments 90% of the time ~ Difficulty controlling anger and low frustration tolerance ~ Reduce anger episodes to less than 1/day ~ Reduce intensity of anger episodes from a 5 to a 2 90% of the time Goals ~ Forgetfulness ~ Improve memory by reducing “f

Assessment Review for the Addiction Counselor Certification Exam Dr. Dawn-Elise Snipes, PhD, LPC-MHSP Podcast Host: Counselor Toolbox and Addiction Counselor Exam Review 12 Assessment Steps ~ Engage ~ Get authorizations and gather information from collateral sources ~ Screen for co-occurring disorders ~ Determine the severity of mental and SUDs ~ Determine appropriate level of care ~ Determine diagnoses ~ Determine disability and functional impairment ~ Identify strengths and supports ~ Identify cultural and linguistic needs and supports ~ Identify additional problem areas (medical, housing, education…) ~ Determine readiness for change ~ Plan treatment Assessment ~ Screening determines the possible presence. ~ Assessment ~ Is an ongoing process ~ Determines the nature and severity ~ Develops specific treatment recommendations ~ Surveys client strengths and resources for addressing “life problems.” (wrap-around) ~ Substance Abuse Assessment Foci ~ Historical and situational factors contributing to or triggering use ~ Patterns of use ~ Common signs and symptoms ~ Consequences of use Assessment ~ Examines the context(s) in which the disorder(s) manifest ~ Explores reciprocal interactions of… ~ Family/marital life ~ Social support/interpersonal functioning ~ Physical health needs ~ Spirituality ~ Employment ~ Financial issues ~ Legal issues ~ Other issues which may impact treatment (transportation, childcare) Assessment ~ Explores reciprocal interactions cont… ~ Gender, cultural, linguistic issues ~ Readiness for change ~ Relapse risk ~ Recovery support ~ Special life circumstances (single parent) ~ Medical conditions ~ Client centered—respecting ~ The client’s perceptions of his problems ~ Goals he wishes to accomplish ~ Strengths he has Assessment Instruments ~ Forms ~ Standardized interviews ~ Limits interviewer to a script ~ Requires limited training ~ Collects the same information on all clients ~ Structured interviews ~ Probing questions can be asked ~ Requires additional training/knowledge ~ Self-administered tests/questionnaires ~ Require some motivation and reading ability on the client’s part ~ Standardized instruments have: ~ Reliability ~ Validity information Assessments ~ Sources of information (with written consent) ~ Personal reports ~ Family ~ Other professionals/prior treatment experiences ~ May be the most objective resource ~ Employment history ~ Criminal records ~ Drug tests ~ Collateral information gathered should be confirmed to the extent possible ~ Accurate assessment requires the coherent integration of multiple sources of information to avoid under- or over-estimation of the problem. Drug Testing in SUD Treatment ~ Drug testing is ~ Part of the initial assessment ~ Used to identify drugs to make most appropriate treatment recommendations ~ Screen to prevent adverse effects of prescribed medications ~ Component of the treatment plan ~ Way to monitor use of substance and compliance with medications ~ Method to assess efficacy of treatment ~ Method to document abstinence for legal matters, disability, custody etc. ~ Drug testing cannot replace an assessment to diagnose a substance use disorder. Drug Testing in SUD Treatment ~ Drug Testing ~ Can accurately reveal drugs in the system ~ Time frame for detection is limited ~ Dependable for identifying frequent users ~ Less accurate for infrequent or binge users Types of Drug Tests ~ Breathalizer (hours) ~ Urine (up to a month) ~ On-site ~ Gas chromatograph ~ Can produce false positives ~ Saliva (past day) ~ Sweat and hair ~ drug use patterns over periods of time ~ Cannot discriminate between recent and past drug use ~ Not able to identify use within past 3-8 days ~ Blood Risk Assessment ~ One of the most important functions at both screening and assessment ~ Presence of any risk warning signs ~ Requires immediate referral (detox, CST, ER) ~ Screening and assessment are inappropriate ~ Assess for: ~ Intoxication ~ Substance toxicity ~ Withdrawal ~ Aggression/dan

Animal Assisted Therapy Dr. Dawn-Elise Snipes Podcast Host: Happiness Isn’t Brain Surgery, The Addiction Counselor Exam Review Objectives ~ Define Animal Assisted Therapy ~ Explore the research around animal assisted therapy ~ Review some general cautions Definitions ~ Animal Assisted Activities/Pet-Therapy ~ Integration of animals into activities to facilitate motivation, education and recreation, encouraging casual interaction without following a specific set of criteria or goals ~ Animal Assisted Therapy ~ Intentional and therapeutic, whereby the animal’s role is integral in assisting with mental health, speech, occupational therapy or physical therapy goals, and augments cognitive, physical, social and/or emotional well-being General Benefits ~ Reduced blood pressure ~ Release of oxytocin ~ Increase in understanding of UPR (3 legged dog, one eyed cat, blind horse) ~ Biofeedback/Mindfulness ~ Stress reduction and laughter ~ Increased physical activity ~ Consistency and clear communication ~ Decrease learned helplessness behaviors and increase a sense of control over self and environment General Benefits ~ Act as a bridge by which therapists can reach patients who are withdrawn, uncooperative, and uncommunicative ~ Participants interacting with the animals were more inclined to smile and demonstrate pleasure, and were more sociable and relaxed with other participants ~ More sensitive issues can be rendered less incendiary when an animal is involved ~ A multisensory aspect is also available when an animal is involved; increasing the level of attention and interest of the client who is active or struggles with focus or concentration Which Animals Can Be used ~ Any Animals… ~ Fish ~ Guinea Pigs ~ Dogs ~ Cats ~ Rabbits ~ Horses ~ Dolphin… Hippotherapy (Equine) ~ Using horse movement to compliment therapy ~ Self-awareness ~ Developing trust and respect ~ Meeting/Join Up (understanding the prey/predator relationship) ~ Petting ~ Feeding ~ Addressing personalization/exploring dialectics ~ Going into a barn or trailer ~ Bonding/relaxation ~ Confidence ~ Acceptance (despite being different) ~ Choosing animals with differences ~ Highlighting unique animal pairs (donkey and goat) Farm Animals ~ The diversity of a farm experience offers much stimulation, and provides the basis for creative and varied interventions, such as providing the client with opportunities to practice ~ Nurturing activities ~ Organizational skills ~ Perspective taking ~ Problem solving Dogs ~ A “dog’s social life is organized around dominance-subordinance relationships” ~ Dogs are expected to obey commands and offer clients what is often referred to as “unconditional acceptance” (Brewster vs. Duke) ~ Difference in the children’s response during sessions, including more laughing, increased eye contact, communication with the dog, and a desire to connect through feeding the animal dog treats ~ Teaching people positive dog training techniques could help them understand ~ Clear communication ~ Relationship development (trust, respect, nurturance and termination) ~ Empathy ~ Perspective-taking ~ Delayed gratification ~ The connection between behaviors and consequences in a non-threatening manner Cats ~ “Cat socialization toward is based on ~ “Give and take” ~ Mutuality/reciprocity ~ Respect for their independent nature ~ In contrast to human-horse or human-dog relationships. Chandler (2005) listed the following attributes for felines in therapy: ~ Quietness and calmness ~ Level of comfort with being touched ~ Motivation to be around people ~ Playful cats offer lighthearted moments which can act as an “icebreaker” Techniques ~ Teach the client how to direct the animal, and then collaboratively problem-solve when confronted with an obstacle to promote self-monitoring, mindfulness, and to empower the client and encourage generalization to daily life situations, among other things. ~ Parenting (consistency and clear communication) ~ Communicating with a spouse or boss ~ G

Supporting Student Wellness Dr. Dawn-Elise Snipes, Director AllCEUs.com Addiction Counselor Certification Training $149 Unlimited Continuing Education $59 Podcast Host: Counselor Toolbox Objectives ~ General guidelines for supporting student mental health ~ Specific information regarding student athletes ~ Explore some information relevant to students regarding alcohol and drug use and disordered eating ~ Identify the basics for early crisis intervention ~ One in every 12 U.S. college students makes a suicide plan, according to National Data on Campus Suicide and Depression. ~ One in four adults experience mental illness in a given year, according to the National Alliance on Mental Illness. ~ In 2015 students were asked if they worried their food would run out before they had money to buy more. Nearly a quarter (22 percent) of undergraduate students answered yes to this question ~ 32 percent of female students reported experiencing sexual assault within their lifetime Association of American Universities survey ~ CDC finds sharp increases in three sexually transmitted diseases, and young adults account for a majority of these cases. (11/3/2016) ~ 30–70% of those seeking treatment for an eating disorder receive medical treatment for weight loss, indicating that individuals with eating disorders are much more likely to receive treatment for a perceived weight problem than mental health treatment for an eating disorder. ~ 4.4–5.9% of teens enter college with a pre–existing, untreated eating disorder General ~ Find a “champion” who will support the student well-being initiative ~ Promote positive behaviors and benefits of health promotion ~ Demonstrate a genuine interest in student success (academics, extracurricular, athletics etc) ~ Engage athletic trainers, directors of residence life and resident assistants, house moms/dads, professors and apartment managers General ~ Communicate about the consequences of not seeking help and the benefits of early intervention ~ Normalize/destigmatize mental health issues ~ Due to strong cohesion of certain groups, understanding and addressing group (athletics, sorority/fraternity) norms about health and safety behavior an important educational strategy ~ Train peer health educators ~ Be aware of high stress times: Rush, Try-outs, midterms, finals, before breaks, after breaks ~ Be alert to signs of hazing and have a clear policy and procedure for handling hazing reports Student Athletes ~ Just because student-athletes are generally a healthy population does not mean that they are immune to mental health issues. ~ Because of this perception, student-athletes may be even more reluctant than a non-athlete student to seek help. ~ Pressures related to scholarships, academic and athletic performance and being in the spotlight (good and bad attention), reaction to injury, overtraining add to student athlete’s stressors. ~ Key people influencing student-athlete decision-making are coaches, teammates, and parents. Student Athletes ~ Programing for student-athletes must consider timing issues, such as differences in alcohol use, dieting, workout schedule, and time availability in the off-season compared to the competitive season ~ Student-athletes may experience an increase in anxiety when exposed to a new coaching style and/or team ~ Coaches need to be particularly responsive and careful with depressed student-athletes as they may interpret interactions and communication more negatively than intended ~ Establish a practice of following up with student-athletes who suffer career-ending injury or otherwise are disconnected from the team Alcohol Awareness ~ Alcohol use inhibits absorption of nutrients and diminishes protein synthesis, resulting in decreased muscle growth. ~ Alcohol causes dehydration and slows down the body’s ability to heal. ~ Alcohol negatively impacts sleep, which can result in decreasing the body’s natural production of human growth hormone (HGH) and may compromise muscle repair and

Screening Review Instructor: Dr. Dawn-Elise Snipes Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery & The Addiction Counselor Exam Review Objectives ~ Review key skills for engagement ~ Discuss factors impacting engagement ~ Define screening ~ Explore how to do a screening ~ Identify types of screening instruments Engagement, Screening and Assessment ~ Demonstrate verbal and nonverbal skills to establish rapport and promote engagement ~ Discuss with clients the rationale, purpose and procedures associated with screening and assessment ~ Assess clients immediate needs including detoxification ~ Administer evidence based screening and assessment instruments to determine client strengths and needs ~ Obtain relevant history to establish eligibility and appropriateness of services ~ Screen for physical needs, medical conditions, co-occurring mental health issues ~ Interpret results of screening and assessment and integrate information to formulate a diagnostic impression and determine appropriate course of action ~ Develop a written integrated summary to support diagnostic impressions Engagement ~ Establish rapport and an effective working alliance in which the client feels heard and understood ~ Respectful ~ Nonjudgmental ~ Attentive ~ Motivate and engage the client in identified service needs ~ Engagement puts the clinician in the best position to negotiate with the client about what to do and how to do it. ~ Engaged clients are more likely to ~ Participate willingly ~ Be treatment compliant ~ Successfully complete treatment Engagement ~ Create a welcoming environment ~ Pleasant physical environment sensitive to ~ Age ~ Gender ~ Disability ~ Sexual orientation ~ Religion ~ Socioeconomic status Factors Impacting Engagement ~ Stigma ~ About the diagnoses ~ About help seeking ~ Expectations ~ About the effectiveness of treatment ~ About one’s role/power in the treatment process ~ About the treatment process itself ~ Likeableness ~ Client’s social skills ~ Client’s attentiveness ~ Client’s attractiveness Factors Impacting Engagement ~ First Impression ~ Professional presentation ~ Promptness ~ Courtesy ~ Smooth handling of paperwork ~ Environment ~ Calm, clean, comfortable ~ Not too formal or informal ~ Avoids interruptions ~ Provides appropriate privacy Goals of the Initial Interview ~ Establish trust and develop rapport ~ Be empathetic ~ Convey warmth and respect ~ Explore client strengths and skills ~ Facilitate client’s understanding of rationale, purpose and procedures of the screening and assessment process ~ Explore the client’s problems and expectations regarding treatment and recovery ~ Determine whether a further assessment is needed Screening ~ The process by which the counselor, client and SOs review the current situation, symptoms and collateral information to determine the probability of a problem ~ Used by all types of human service personnel to determine eligibility and appropriateness of services and needed referrals ~ Screening helps determine the immediacy of need ~ Must be a transparent process ~ Requires informed consent ~ Identification of early warning signs helps provide early intervention services and/or resources Screening ~ Screening is the first opportunity to engage the client in the therapeutic relationship and treatment process ~ Sometimes, based on observation or other circumstances people may be referred directly for assessment. ~ The client’s internal motivation is the primary reason for engaging in treatment. ~ Internal motivation may be fleeting, so rapid engagement is vital. Screening ~ Successful screening should be ~ Brief ~ Conducted in a variety of settings by a range of professionals on persons deemed to be at risk ~ A collaboration among a multidisciplinary team ~ Sensitive to racial, cultural, socioeconomic and gender related concerns ~ Developed from information gathered from multiple sources when possible Screening ~ Assess signs and symptoms of intoxication and withdr