Counselor Toolbox Podcast

Improving Cultural Competence SAMHSA TIP 59 Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery On-Demand Counseling CEUs are available at https://www.allceus.com/member/cart/index/product/id/684/c/ Objectives ~ Define assumptions about cultural competence ~ Define Race, Ethnicity and Culture ~ Explore the problems with limited cultural competence Assumptions ~ Assumption 1: Counselors will not be able to sustain culturally responsive treatment without the organization's commitment to it. ~ Assumption 2: An understanding of race, ethnicity, and culture (including one's own) is necessary to appreciate the diversity of human dynamics and to treat all clients effectively ~ Assumption 3: Incorporating cultural competence into treatment improves therapeutic decision-making and offers alternate ways to define and plan a treatment program that is firmly directed toward progress and recovery ~ Assumption 4: Consideration of culture is important at all levels of operation—individual, programmatic, and organizational ~ Assumption 5: Culturally congruent interventions cannot be successfully applied when generated outside a community or without community participation. ~ Assumption 6: Public advocacy of culturally responsive practices can increase trust among the community, agency, and staff. Cultural Identification ~ Not all clients identify with or desire to connect with their cultures ~ Culturally responsive services offer clients a chance to explore the impact of culture, acculturation, discrimination, and bias, and how these impacts relate to or affect their mental and physical health. ~ The Affordable Care Act, (HHS 2011b) necessitates enhanced culturally responsive services and cultural competence among providers. Problems with Limited Cultural Competence ~ Limited cultural competence is a significant barrier that can translate to: ~ Ineffective provider–consumer communication ~ Delays in appropriate treatment and level of care ~ Misdiagnosis ~ Lower rates of treatment compliance ~ Clients feeling misunderstood ~ Clients feeling judged ~ Clinicians making inappropriate treatment recommendations ~ Poorer outcome Culturally Responsive Practice ~ Culturally responsive practice reminds counselors that a client's worldview shapes his or her: ~ Perspectives (How things “should be,” What goals to strive for) ~ Beliefs (ex. Just world, why things happen) ~ Behaviors surrounding addictive behaviors (Alcohol, illicit drugs, sex, gambling, eating disorders) ~ Beliefs about illness and health (East vs. West, God’s punishment vs Natural progression) ~ Seeking help (Airing “dirty laundry,” participation in face to face vs virtual treatment, LEO/Military, elderly) ~ Counseling expectations (LEO/Military, criminally involved) ~ Communication (Openness, methods) Continuum of Cultural Competence ~ Stage 1. Cultural Destructiveness ~ Organizational Level: At best, the behavioral health organization negates the relevance of culture in the delivery of behavioral health services. ~ Individual Level: Counselors can also operate from this stance, holding a myopic view of “effective” treatment. ~ Stage 2. Cultural Incapacity ~ Organizational Level: Organizational culture may be biased, and clients may view them as oppressive. An agency functioning at cultural incapacity expects clients to conform to generalized services ~ Individual Level: Counselors ignore the relevance of culture while using the dominant client population and/or culture as the norm for assessment, treatment planning, and

Using Technology Based Tools in Behavioral Health Best Practices for Improving Access Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Counseling CEUs are available for this podcast at https://www.allceus.com/member/cart/index/search?q=etherapy Objectives ~    Explore the benefits and drawbacks to technology assisted counseling ~    Learn about some of the different technology tools available ~    Identify ways technology can be used in your practice to enhance client success and be culturally responsive Why Use It ~    Mobile devices are becoming universal in our culture. ~    The use of electronic media and information technologies in behavioral health treatment is rapidly gaining acceptance. ~    Technology allows alternative models of care to be offered to clients with specific needs that limit their ability or interest in participating in more conventional settings ~    Privacy ~    ADD/ADHD ~    Pain ~    Time ~    Technology-assisted care (TAC) can reach many people otherwise unable to access services Why Use It ~    Useful in a wide variety of settings, including ~    The home ~    Community organizations ~    Schools ~    Emergency rooms ~    Healthcare providers' offices ~    Via mobile devices and online social networks. Why Use It ~    TAC is often accessible on demand at the user's convenience, thus reducing barriers to access. ~    Travel/transportation ~    Time ~    Childcare ~    Some reduced cost can be passed on to the client ~    Facilitates coordination of services and care management between providers ~    Millennials grew up communicating through chat and are most comfortable with those modalities Why Use It–Adolescents ~    Several studies underscore the acceptability and appeal to youths of computer-delivered interventions ~    Significant barriers to adolescents' participation in addiction treatment may be addressed by internet-based addiction services ~    Many youths report interactive computer learning environments preferable to traditional learning environments, in that computer-based learning allows them to solve problems actively and independently and receive individualized feedback Why Use It – Elderly/Aging ~    A growing body of research has highlighted the utility of technology for health promotion among aging populations ~    Computerized tools designed to enhance cognitive skills through exercises that target problem solving, attention, memory, and abstract reasoning have been shown to have promise in populations with SMI as well as among individuals with substance use disorders Why Use It ~    Meet the needs of the adult learner ~    Provide more comprehensive services (“Clinician Extenders”) ~    Individual patients can participate in online, moderated forums/groups ~    All patients can access web or app based exercises, activities and videos outside of “session” ~    May encourage clients to reach out more often (i.e. watch a video or review a forum in the middle of the night) ~    Many online support forums are free and maintained by someone else. (Similar to support group meetings facilitated by churches, crisis centers etc.) Downside ~    Lack of nonverbals, even in video chat ~    Lack of immediate feedback when done asynchronously (forums, online activities) ~    Asynchronous interaction needs to be addressed in patient responsibilities and regularly reviewed for appropriateness. ~    Clients who do not type well may fine text-based interventions frustrating.

Disaster Planning: An Ethical Obligation Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox & Happiness Isn’t Brain Surgery This course is available on-demand here: https://www.allceus.com/member/cart/index/search?q=Risk+and+Disaster+Management or as part of our Recovery Residence Administrator Training Program https://www.allceus.com/member/cart/index/product/id/619/c/ Objectives ~    Rationale and Process for Disaster Planning ~    Preparing for Disaster ~    Continuity Planning ~    Management of Prescription Medications ~    Testing the Plan Rationale ~    Disaster planning can save lives, minimize injury and emotional trauma, protect property and operational capability, and prevent or reduce interruptions in treatment. ~    The behavioral health treatment program has a special obligation to prepare for disasters because it provides essential services. ~    By their nature, disasters have an impact on behavioral health: ~    Most people who experience a disaster, whether  as a victim or responder, will have some type of psychological, physical, cognitive, and/or emotional response to the event. Most reactions are normal responses to severely abnormal circumstances. (American Medical Association, 2005, p. 2) Rationale ~    Disaster planning can prepare the program for continuing to provide the services to its existing clientele in order to prevent: ~    Relapse ~    Medical and psychological consequences for prematurely discontinuing medically managed detox or crisis stabilization ~    Homelessness if clients are in a residential facility ~    Client destabilization due to lack of access to medications prescribed and/or administered by the agency (antipsychotic injections, prescription refills, methadone) ~    Exacerbation of problems in at-risk populations as a result of lack of access to support Rationale ~    Disaster Planning can help mitigate psychological issues in the community by providing services to new clients (Katrina) ~    Aid to other programs ~    Rapid response to influx of clients from other agencies or areas Types of Disasters ~    Your facility is incapacitated or destroyed (fire, building flood, sink hole) but other facilities remain open and clients are in their homes ~    Your facility and others are incapacitated and clients are in shelters (Hurricane, blizzard, fires). ~    Your facility is functional in the aftermath of a natural disaster in which your patients are in shelters. (City-wide flood). ~    When the program must cease provision of nonessential services due to a sudden reduction in resources, infrastructure, or available personnel due to illness or diversion of resources. Health department can provide a copy of the local Hazard Identification and Risk Assessment (HIRA) Continuity Planning ~    Requires a program’s personnel to consider the threats that could adversely affect essential functions; ~    Determine the personnel, vital information (e.g., patient medical records including prescription records), and other resources required to continue those essential functions; ~    Develop plans for providing essential functions onsite or at alternate locations if needed ~    Make advance arrangements for obtaining the resources necessary to support essential functions throughout the disaster and recovery phases ~    Plan for the safety of all personnel during these periods. Planning cont… ~    In its initial work, the disaster planning team conducts or gathers, from partner agencies in the community, a hazard id

This course is available on-demand here: https://www.allceus.com/member/cart/index/search?q=Risk+and+Disaster+Management or as part of our Recovery Residence Administrator Training Program https://www.allceus.com/member/cart/index/product/id/619/c/ Objectives What is Risk ~    The combination of the probability of an event and it’s consequences Benefits of Risk Management ~    Provides a framework for consistent, quality services ~    Improves decision making, planning and prioritization ~    Contributes to efficient use/allocation of resources ~    Protects and enhances assets including reputation Types of Financial Repercussions ~    Suits against the agency for: ~    Medical bills ~    Lost wages / earning capacity ~    Pain and suffering ~    Emotional distress and loss of ability to enjoy life ~    Property damage ~    Wrongful death ~    Punitive damages if there was negligence ~    Loss of funding ~    Loss of license ~    Loss of reputation (client base) Classifying Risk ~    Consequences ~    High: Financial impact is likely to exceed Z;  Significant impact on the organizations ability to operate. ~    Medium: Financial impact is between Y and Z and will have a moderate impact on operational abilities (layoffs?) ~    Low: Financial impact is less than Y and will have a low impact on ability to operate. Probability ~    High: 25% chance it will happen in a 12-month period ~    Medium: 25% change it will happen in a 10 year period ~    Low: Less than 2% chance of occurrence or Not likely to occur in a 10 year period Multiple Types of Risk ~    Strategic and Financial  (Keep $$ coming in) ~    Organizational Objectives ~    Cash Flow ~    Service Market ~    Legal and Regulatory Issues ~    Employee Risk (Maintain Efficient Workforce/Reduce Turnover) ~    Workers Compensation ~    Termination ~    Burnout ~    Injury or Victimization Types of Risk cont… ~    Technology Risk (Regulatory and Legal Compliance) ~    HIPAA/HITECH compliance ~    Meaningful use ~    Data Breach ~    Disaster (Data failure) ~    Patient Safety Risk Management (Regulatory and Safety Compliance) ~    Physical Environment ~    Interpersonal ~    Client/Client ~    Client/Staff ~    Destabilization Common Suits Against Therapists for Patient Safety Issues ~    Boundary violations ~    Inappropriate or excessive self-disclosure ~    Dual Relationships ~    Using techniques without proper training (or licensure) ~    Deliberately using incorrect diagnosis to get insurance coverage or other funding ~    Inadequate documentation (paybacks) ~    Wrongful death ~    Breach of confidentiality Common Suits Against Agencies ~    Sexual Harassment ~    Environment of Care (Safety) ~    Improper billing practices ~    Billing for services not provided ~    Unbundling ~    Waiving copays and deductibles ~    https://www.hollandhart.com/waiving-copays-and-deductibles ~    http://cbsbilling.net/ioi-copay.html ~    http://www.hcpro.com/REV-46459-2477/Beware-of-waiving-copays-and-deductibles.html ~    https://www.webpt.com/blog/post/legal-compliance-one-more-reason-to-collect-patient-deductibles-and-copays ~    Therapist malpractice ~    Wrongful termination / Civil rights General Questions ~    Based on information provided from other resources, managers should conduct analyses to determine potential risks. The analysis should identify:

Confidentiality, HIPAA and HITECH Brought to you by AllCEUs.com Instructor: Dr. Dawn-Elise Snipes An on-demand CEU course will be available for this class at allceus.com Objectives ~ Review HIPAA and HITECH regulations as they pertain to maintaining confidentiality and security of PHI ~ Encourage critical assessment of your work practices for compliance. ~ Get through the presentation with all of you staying awake  Business Associates ~ A person or entity that performs certain functions or activities that involve the use or disclosure of PHI on behalf of, or provides services to, a covered entity. ~ Business associate functions and activities include: ~ Billing, claims processing, administration, benefit management ~ Data analysis, processing or administration ~ Utilization review & quality assurance ~ ISPs are NOT business associates ~ Software vendors providing EHR systems and providers of virtual offices and email services will clearly qualify as business associates Requirements for PHI ~ Risk analysis (Required) of the potential risks and vulnerabilities to the confidentiality, integrity, and availability. ~ Risk management (Required). Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with §164.306(a). ~ Sanction policy (Required). Apply appropriate sanctions to workforce members who fail to comply with the security policies. ~ Information system activity review (Required). Regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports. Workforce Security ~ Ensure that all members of its workforce have appropriate access to ePHI, and prevent those who do not from obtaining access to electronic PHI. ~ Implement procedures for the authorization and/or supervision of workforce members who work with ePHI or in locations where it might be accessed. ~ Implement procedures to determine that the access of a workforce member to ePHI is appropriate. ~ Implement procedures for terminating access to ePHI when the employment of, or other arrangement with, a workforce member ends or changes. Information Access Management ~ Implement written policies and procedures for authorizing access to ePHI ~ Implement policies and procedures for granting access to ePHI, for example, through access to a workstation, transaction, program, process, or other mechanism. ~ Implement policies and procedures that establish, document, review, and modify a user's right of access to a workstation, transaction, program, or process. ~ Virtual workstations ~ Key cards ~ Passwords Security Awareness and Training ~ Training for all members of its workforce (including management) ~ Periodic security updates. ~ Procedures for guarding against, detecting, and reporting malicious software. ~ Procedures for monitoring log-in attempts and reporting discrepancies. ~ Procedures for creating, changing, and safeguarding passwords. Contingency Plan ~ Establish (and implement as needed) policies and procedures for responding to a disaster that damages systems that contain electronic PHI. ~ Data backup plan (Required). ~ Disaster recovery plan including procedures to enable continuation of critical business processes for protection of the security of ePHI while operating in emergency mode (Required). ~ Implement procedures for periodic testing and revision of contingency plans. Facility Access Controls ~ Limit physical access to its electronic information systems and the facility or facilities in which th

Confidentiality, HIPAA and HITECH Brought to you by AllCEUs.com Instructor: Dr. Dawn-Elise Snipes An on-demand CEU course will be available for this class at allceus.com Objectives ~ Review HIPAA and HITECH regulations as they pertain to maintaining confidentiality and security of PHI ~ Encourage critical assessment of your work practices for compliance. ~ Get through the presentation with all of you staying awake  Business Associates ~ A person or entity that performs certain functions or activities that involve the use or disclosure of PHI on behalf of, or provides services to, a covered entity. ~ Business associate functions and activities include: ~ Billing, claims processing, administration, benefit management ~ Data analysis, processing or administration ~ Utilization review & quality assurance ~ ISPs are NOT business associates ~ Software vendors providing EHR systems and providers of virtual offices and email services will clearly qualify as business associates Requirements for PHI ~ Risk analysis (Required) of the potential risks and vulnerabilities to the confidentiality, integrity, and availability. ~ Risk management (Required). Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with §164.306(a). ~ Sanction policy (Required). Apply appropriate sanctions to workforce members who fail to comply with the security policies. ~ Information system activity review (Required). Regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports. Workforce Security ~ Ensure that all members of its workforce have appropriate access to ePHI, and prevent those who do not from obtaining access to electronic PHI. ~ Implement procedures for the authorization and/or supervision of workforce members who work with ePHI or in locations where it might be accessed. ~ Implement procedures to determine that the access of a workforce member to ePHI is appropriate. ~ Implement procedures for terminating access to ePHI when the employment of, or other arrangement with, a workforce member ends or changes. Information Access Management ~ Implement written policies and procedures for authorizing access to ePHI ~ Implement policies and procedures for granting access to ePHI, for example, through access to a workstation, transaction, program, process, or other mechanism. ~ Implement policies and procedures that establish, document, review, and modify a user's right of access to a workstation, transaction, program, or process. ~ Virtual workstations ~ Key cards ~ Passwords Security Awareness and Training ~ Training for all members of its workforce (including management) ~ Periodic security updates. ~ Procedures for guarding against, detecting, and reporting malicious software. ~ Procedures for monitoring log-in attempts and reporting discrepancies. ~ Procedures for creating, changing, and safeguarding passwords. Contingency Plan ~ Establish (and implement as needed) policies and procedures for responding to a disaster that damages systems that contain electronic PHI. ~ Data backup plan (Required). ~ Disaster recovery plan including procedures to enable continuation of critical business processes for protection of the security of ePHI while operating in emergency mode (Required). ~ Implement procedures for periodic testing and revision of contingency plans. Facility Access Controls ~ Limit physical access to its electronic information systems and the facility or facilities in which t

CBT:  Irrational Thoughts Understanding and Addressing Them Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Counseling CEUs for this presentation are available at https://www.allceus.com/member/cart/index/product/id/497/c/ Objectives ~ Define Thinking Errors ~ Explore the different types of thinking errors ~ Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure ~ Identify ways to ~ Increase awareness of thinking errors ~ Address thinking errors ~ Address basic fears Why I Care/How It Impacts Recovery ~ Thinking errors, or stinkin’ thinkin’ plays a large part in keeping people miserable ~ Addiction, depression, anxiety, anger and guilt often stem or are made worse by faulty thinking ~ Addressing these thought patterns will help you: ~ Not make a mountain out of a molehill ~ Focus on the things you can change ~ Identify and eliminate thought patterns that are keeping you stuck What are Thinking Errors ~ Cognitive Distortions take a thought and manipulate it to ~ Fulfil your expectations of a situation ~ Conform to your current head space (negative begets negative) ~ Irrational Thoughts are beliefs/thoughts that you may hold that ~ Are usually extreme (I must have love and approval from everyone all the time) ~ Are unrealistic ~ Create feelings of failure, inadequacy, disempowerment A Note About Irrationality ~ The origins of most beliefs were rational and helpful given: ~ The information the person had at the time ~ The cognitive development (ability to process that information) ~ “Irrationality” or unhelpfulness of thoughts comes when those beliefs are: ~ Perpetuated without examination ~ Continue to be held despite causing harm to the person Sometimes it is more productive for clients to think of these thoughts as “unhelpful” instead of “irrational.” Irrational Beliefs ~ If I make a mistake, it means that I am incompetent. ~ When somebody disagrees with me, it is a personal attack. ~ I must be liked by all people. ~ My true value depends on what others think of me. ~ If I am not in a relationship, I am completely alone. ~ Success and failure are black and white.  There is no gray. Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure Irrational Beliefs ~ Nothing ever turns out the way you want it to. ~ If the outcome was not perfect, it was a complete failure. ~ If something bad happens, it is my fault. ~ The past always repeats itself. ~ If it was true then, it must be true now. Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure Irrational Thoughts Quick Help ~ What is upsetting me? ~ Why is this upsetting me? ~ What are the FACTS for and against this belief ~ Am I reacting based on facts or feelings? ~ What cognitive distortions am I using? ~ What irrational thoughts am I using? ABC-DEF ~ Activating Event (What happened) ~ Beliefs ~ Obvious ~ Negative self-talk//Past tapes ~ Consequences ~ Dispute Irrational Thoughts ~ Evaluate the Most Productive Outcome ~ Is this worth my energy? ~ How can I best use my energy to deal with or let go of the situation? Constructive Self Talk ~ Use self-talk constructively to challenge that statement. An effective challenge will make you feel better (less tense, anxious, panicky) ~ What is the evidence ~ What is so awful

Cognitive Distortions: Understanding and Addressing Them Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs A direct link to the CEU course is  https://www.allceus.com/member/cart/index/product/id/520/c/ Objectives ~    Define Thinking Errors ~    Explore the different types of thinking errors ~    Cognitive distortions ~    Irrational Thoughts ~    Evaluate how thinking errors can play into our basic fears: Rejection, isolation, the unknown, loss of control, failure ~    Identify ways to ~    Increase awareness of thinking errors ~    Address thinking errors ~    Address basic fears Why I Care/How It Impacts Recovery ~    Thinking errors, or stinkin’ thinkin’ plays a large part in keeping people miserable ~    Addiction, depression, anxiety, anger and guilt often stem or are made worse by faulty thinking ~    Addressing these thought patterns will help clients: ~    Not make a mountain out of a molehill ~    Focus on the things they can change ~    Identify and eliminate thought patterns that are keeping them stuck What are Thinking Errors ~    Cognitive Distortions take a thought and manipulate it to ~    Fulfil people’s expectations of a situation ~    Conform to their current head space (negative sees negative) ~    Irrational Thoughts are beliefs/thoughts that you may hold that ~    Are usually extreme (I must have love and approval from everyone all the time) ~    Are unrealistic ~    Create feelings of failure, inadequacy, disempowerment Causes of Thinking Errors ~    Information-processing shortcuts ~    Using outdated, dichotomous schemas ~    Mental noise ~    The brain's limited information processing capacity ~    Age ~    Crisis Causes of Thinking Errors ~    Emotional causes ~    I feel bad, therefore it must be bad ~    Moral causes ~    It was the right thing to do ~    Social causes ~    Everyone is doing it Impact of Thinking Errors (Fight or Flee) ~    Emotional upset ~    Depression ~    Anxiety ~    Behavioral ~    Withdrawal ~    Addictions ~    Sleep problems/changes ~    Eating changes ~    Physical ~    Stress-related illnesses ~    Headaches ~    GI Distress ~    Social ~    Irritability/impatience ~    Withdrawal Thinking Errors & Interventions ~    Emotional Reasoning –Feelings are not facts ~    Learn to effectively identify feelings and separate facts ~    I am terrified ~    About what are you terrified? ~    What is the evidence that you are in danger now? ~    In what ways is this similar to other situations? ~    How have you dealt with those situations? ~    Develop distress tolerance skills ~    Develop emotional regulation skills Thinking Errors & Interventions ~    Cognitive Bias/Negativity/Mental Filter– Focus on the negatives and worry about the future ~    Questions ~    What is the benefit to focusing on the negative? ~    What are the positives to this situation? ~    What are all the facts? ~    Coin toss activity Thinking Errors & Interventions ~    Disqualifying or minimizing the positive ~    Questions ~    Would you minimize this if it was your best friend’s experience? ~    What is scary about accepting the positive? ~    Sometimes we disqualify the positive because it fails to meet someone else’s standards, might that be true here? ~    Availability Heuristic: Remembering what is most prominent in your mind ~    Questions ~    What are the facts Thinking Errors & Interventions ~    Egocentrism– My perspective is the only perspecti

Behavior Modification, Goal Setting and Avoiding Common Traps Presented by: Dr. Dawn-Elise Snipes Executive Director, AllCEUs Host: Counselor Toolbox A direct link to the CEU course is https://www.allceus.com/member/cart/index/product/id/29/c/ Objectives ~    Define behavior modification ~    Explore how behavior modification can be useful in practice ~    Learn basic behavior modification terms: ~    Unconditioned stimulus and response ~    Conditioned stimulus and response ~    Discriminitive stimuli ~    Learned helplessness Why Do I Care ~    Change means doing something different or modifying a response ~    That response can be a neurochemical one (stress response) or an overt behavioral one (smoking) ~    Behavior modification principles will help you understand some of the reasons people act/react the way they do ~    By understanding what causes and motivates people’s behavior we can better address their issues ~    The focus on observable, measurable conditions to the exclusion of cognitive interpretation underscores the mind-body connection Definition ~    Behavior modification in its truest form is concerned only with observable, measurable behaviors, stimuli and reinforcement ~    Emotions, interpretations and mental processes have no bearing How can this be useful in practice ~    Traditional (strict) behavior modification can be quite useful in simplifying stimulus/reaction ~    Integrating the cognitive interpretations (labels) can help people in identifying and addressing what is causing their “distress” (Behaviorists would refer to excitatory response) ~    Understanding what causes feelings can also give people a greater sense of empowerment. Example ~    Puppies learn appropriate behavior through reinforcement and correction ~    Puppy 1 tackles puppy 2  threat ~    Puppy 2 responds by tackling puppy 1  counter threat ~    Both puppies get a surge of adrenaline ~    The puppy that dominates receives a dopamine surge that reinforces the prior behaviors — do that again. ~    If Puppy 1 plays too rough, then puppy 2 will either become more aggressive or leave. ~    Either way, puppy 1s behavior is punished. Example 2 ~    Humans have learned to label certain internal experiences with feeling words (angry, scared, happy) ~    Sally goes to a pet store ~    A puppy comes out, sits in her lap and puts is head on her leg ~    This contact (we know from studies) usually causes the release of dopamine and oxytocin –both reward chemicals ~    Sally calls this “happy” ~    If Sally had previously had a threatening experience with a dog, when she saw it, her body would likely respond by secreting adrenaline, kicking off the fight or flight reaction.  Sally would label this as “fear” Points ~    The brain receives signals and, based on prior learning (conditioning), responds with either: ~    Fight/Anger or Flee/Fear (adrenaline/norepinepherine) ~    No reaction/neutral ~    Pleasure/Happy/Do this again (Dopamine/norepinephrine/Serotonin/GABA/Oxytocin?) ~    Humans label these different chemical responses with feeling words. ~    The same response can be labeled differently by two different people (fear vs. exhilaration) Points ~    People with anxiety, anger or resultant depression may need to: ~    Recondition  X is not actually a threat (anymore) ~    Relabel ~    Excited vs. terrified ~    Stressed vs. hungry ~    Helpless/anxious vs. fat ~    ACT approach– X is causing me to have the feeling that… ~    In American culture we often use nonfeeling words to describe emotional states. ~    Part

Pharmacology of  Opiates Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counseling Continuing Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Counseling and social work CEUs are available on Demand for this podcast at https://www.allceus.com/member/cart/index/search?q=opiates Objectives ~    Examine the following for opiates ~    Types of drugs ~    The short and long term effect on the person ~    Symptoms of intoxication and withdrawal ~    Detoxification issues ~    Current state of abuse ~    Recommended treatments Side Note ~    Method of administration greatly effects the intensity and duration of onset for various drugs ~    Oral (slowest) ~    Inhalation/Snorting ~    Inhalation/Smoking ~    Injection ~    Rectal suppository ~    Skin patches Opiates ~    Types of Drugs: Analgesic (pain killer); CNS Depressant How they Work ~    Body naturally produces opiate-like substance Endogenous opioids ~    Regulate pain perception ~    Hunger ~    Mood ~    “Runners High” How they Work ~    Opiates bind to the same receptors but are 50-1000 times stronger and… ~    Reduce GABA (which regulates dopamine and anxiety)  increase in Dopamine   pleasure and possible energy & focus (norepinephrine (increased arousal from decreased GABA)) ~    Increase available serotonin levels (reduced anxiety/depression, improved pain tolerance) Neurotransmitter Review ~    Dopamine ~    Pleasure ~    Energy, focus, motivation (norepinepherine) ~    Reduced GABA ~    Increased anxiety  HPA Axis activation  energy ~    Increased anxiety during detox (warming a cold bath) Opiates ~    Tolerance starts to develop in 5-7 days ~    Tolerance reversal also  starts in only a few days ~    Short term impact (up to 5 hours) ~    Depends heavily on: ~    The dose ~    The route of administration ~    Previous exposure Opiates ~    Short term impact (up to 5 hours) ~    Psychological: Euphoria, feeling of well-being, relaxation, drowsiness, sedation, disconnectedness, delirium. ~    Physiological: Analgesia, depressed heart rate and respiration depression, constipation, flushing of the skin, sweating, pupils fixed and constricted, diminished reflexes Opiates ~    Complications and Side Effects ~    Medical complications among abusers arise primarily from adulterants and in non-sterile injecting practices ~    Include skin, lung and brain abscesses, collapsed veins, endocarditis, hepatitis, HIV/AIDS, death Opiates ~    Complications and Side Effects ~    Alcohol or depressants such as benzodiazepines, hypnotics, and antihistamines increase the CNS effects of opiates ~    Sedation/drowsiness ~    Decreased motor skills. ~    Respiratory depression, hypotension Opiates ~    Potentiation: Combining 2 drugs because one intensifies the other:  Antihistamine + narcotic intensifies its effect, there by cutting down on the amount of the narcotic needed. ~    Synergism: Two drugs taken together that are similar in action  effect out of proportion to that of each drug taken separately, 1+1= 5 Opiates ~    Long term impact ~    Vein collapse ~    Depression ~    Brain changes/damage ~    Reduction of the production of natural pain killers Opiates ~    Symptoms of intoxication ~    Constricted pupils ~    Sleepiness or extreme relaxation ~    Agitation ~    Scratching and picking ~    20-25% of people get opiate itch. (remember that antihistamines potentiate opiates) O

Triggers and Cravings CEUs are available on demand for this podcast at https://www.allceus.com/member/cart/index/product/id/19/c/ Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs.com Objectives ~    Define a trigger ~    Discuss the function of triggers ~    Explore triggers for mental health symptoms ~    Explore how triggers lead to cravings and obsessive thinking ~    Explore the concept of stimulus generalization What is a trigger ~    Physical or cognitive stimulus ~    Which causes a physical or cognitive reaction ~    To either repeat (pleasure) or avoid (pain) the stimulus ~    Any pleasurable stimulus is associated with elevated dopamine levels ~    Any painful or distressing stimuli trigger the fight or flight reaction What is a Trigger ~    The same trigger can be positive or negative depending on the: ~    Frequency of the reinforcement/punishment ~    Intensity of the reinforcement/punishment Goals ~    Trigger ~    Competing response (IMPROVE, ACCEPTS) ~    Eliminate/counter condition trigger ~    Approaches ~    Continue the chain: ~     Trigger Depression  Coping Skills (competing response) ~    Break the chain ~    Eliminate the trigger (cognitive distortions, low self-esteem) ~    Eliminate the negative aspects of the trigger (bridge, Kenny, source of resentment or determination) Unconditioned triggers ~    Purpose: Generally survival ~    Sight—bright sun, something (ball, fist) headed to your face, inability to access caregiver ~    Sound—loud noise, heartbeat ~    Smell—pleasant, noxious ~    Touch— pain, temperature, hugs ~    Taste— Pleasant or noxious Conditioned Triggers ~    Conditioned triggers are things that in themselves have no meaning to the person. ~    Sight— Bottle, Snow ~    Sound—Music, Sirens ~    Smell—Smoke, Brownies ~    Touch— Hot stove, wool sweater ~    Taste— Coffee, Reeses ice cream ~    Thought– Lice, Thanksgiving Where do they come from? ~    Learned ~    Experience (Trial and error) ~    Positive/Reward: ~    Brownies  Positive feelings ~    Get good sleep  More energy, better mood ~    Negative: ~    Brownies  Blood sugar crash and upset stomach ~    Getting good sleep  Less time with friends Where do they come from? ~    Learned ~    Observation ~    Positive/Rewarding ~    Dad drinks after a hard day  gets less angry ~    Dad exercises after a hard day  gets less angry ~    Negative/Punishing ~    Dad drinks after a hard day  gets a hangover, grumpy the next day ~    Dad exercises after a hard day  cant move tomorrow and cranky Where do they come from? ~    Learned ~    Education ~    Positive: ~    Mindfulness increases awareness and reduces stress ~    Sunlight increases vitamin D and improves mood ~    Negative: ~    Mindfulness is exasperating with monkey mind ~    Sunlight increases chances of skin cancer Trigger to Obsession/Compulsion ~    Trigger ~    Pleasure—I really want to do that again because it makes me happy or eliminates pain ~    Smell brownies cant wait for them to be done ~    New relationship & cant wait to see them again ~    Gambling can’t wait to get that big win again ~    Trigger actual or memory of pain/distress hopelessness, helplessness  intensification of depression/anxiety/anger or escape Why Do I Care ~    Knowing triggers for the behavior to be eliminated will prevent the client fro

Using Groups to Address Anger, Anxiety, Depression and Addiction Presented by: Dr. Dawn-Elise Snipes  Executive Director, AllCEUs Podcast Host: Counselor Toolbox & Happiness isn’t Brain Surgery Author: Journey to Recovery (2015) & Happiness Isn’t Brain Surgery (2017) Objectives Review the benefits of groups Identify the modalities for group goals for psychoeducational and skills groups addressing anger, anxiety, addiction and depression Explore activities that can be used to enhance group engagement Benefits of Group Cost effective Peer feedback and support Development of interpersonal skills Reduce isolation and “uniqueness” Many observers Modalities for Group Face-to-face Web-meeting Video Chat Asynchronous Psychoeducational/skills video Group participation by responding to questions on a discussion board and receiving feedback from group members and the clinician HIPAA, HITECH and 42 CFR Part 2 all apply TRANSDIAGNOSTIC GROUPS Awareness Learn about anger, anxiety, depression and addiction and their symptoms Learn about the Mind-Body Connection Potential causes of symptoms Effects of symptoms Interventions for symptoms Have clients identify Their symptoms What changed which causes or worsens the symptom How they have dealt with the symptom in the past Impact of the symptom on them Awareness Negative Triggers Those things that cause or worsen the symptom Hungry Angry Lonely Tired False Evidence Appearing Real People Places Things Times (of day, anniversaries, holidays) Which ones can be avoided or prevented? Identify three ways to deal with the unavoidable ones Awareness Positive Triggers Those things that remind you to use your new tools How can you add those to your environment? Sights Sounds Smells Social Environment Awareness Vulnerabilities Explain the concept of vulnerabilities Identify the most common vulnerabilities Emotional (guilt, envy, depression, anxiety, anger) Mental (negativity, unhelpful thoughts, fogginess) Physical (pain, exhaustion, illness, medication) Social (stressful people/environments; abandonment fears) Environmental (too chaotic/quiet; disorganized, dark…) Awareness Mindfulness and Vulnerability Prevention Learn about mindfulness Purpose Benefits Methods Anchored Scan 3 minute thoughts 3 minute observations Difference from meditation Awareness Help clients brainstorm interventions and develop a plan for becoming more mindful of strengths and needs in order to: Prevent vulnerabilities (home, work, family/social gatherings) Mitigate vulnerabilities Prevent unnecessary distress Mitigate unavoidable distress Awareness Goal Identification:  What is most important to focus your energy on so you can be happy?  // What does happiness/recovery look like to you? What 5 things are important to you? What 5 relationships are important to you and what do you want them to look like? What 5 personal growth goals are important to you? What are your top 5 values that support your goals Distress Tolerance Clients with mood or addictive disorders tend to Get stuck in the unpleasant emotion Impulsively act to eliminate/escape from distress Distress tolerance skills help them learn that urges and feelings: Come in waves Do not have to be acted upon Can be tolerated Can help them practice to pause to make choices which will keep them using their energy to move toward their goals Bee metaphor Distress Tolerance Address Distress

Group Therapy (TIP 41) Chapter 6&7 Leadership Skills & Common Errors Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Module 6 Objectives Objectives: ~ Discuss the characteristics of group leaders. ~ Describe concepts and techniques for conducting substance abuse treatment group therapy. Leaders Choose ~ How much leadership to exercise ~ How to structure the group ~ When to intervene ~ How to effect a successful intervention ~ How to manage the group’s collective anxiety ~ How to resolve other issues Personal Qualities of Leaders ~ Constancy ~ Active listening ~ Firm identity ~ Confidence ~ Spontaneity ~ Integrity ~ Trust ~ Humor ~ Empathy ◦ Communicates respect and acceptance ◦ Encourages ◦ Is knowledgeable ◦ Compliments ◦ Tells less; listens more ◦ Gently persuades ◦ Provides support Leading Groups ~ Leaders vary therapeutic styles to meet the needs of clients. ~ Leaders model behavior. ~ Leaders are sensitive to ethical issues: •Overriding group agreement •Informing clients of options •Preventing enmeshment •Acting in each client’s best interest Leading Groups (cont.) ~ Leaders improve motivation when: ◦ Members are engaged at the appropriate stage of change. ◦ Members receive support for change efforts. ◦ The leader explores choices and consequences with members. ◦ The leader communicates care and concern for members. ◦ The leader points out members’ competencies. ◦ Positive changes are noted in and encouraged by the group. Leading Groups (cont.) ~ Leaders work with, not against, resistance. ~ Leaders protect against boundary violations. ~ Leaders maintain a safe, therapeutic setting: •Emotional aspects of safety •Substance use •Boundaries and physical contact ~ Leaders help cool down affect. ~ Leaders encourage communication within the group. Interventions ~ Connect with other people. ~ Discover connections between substance use and thoughts and feelings. ~ Understand attempts to regulate feelings and relationships. ~ Build coping skills. ~ Perceive the effect of substance use on life. ~ Notice inconsistencies among thoughts, feelings, and behavior. ~ Perceive discrepancies. Avoid a Leader-Centered Group ~ Build skills in members; avoid doing for the group what it can do for itself. ~ Encourage group members to learn the skills necessary to support and encourage one another. ~ Refrain from overresponsibility for clients. Clients should be allowed to struggle with what is facing them. Confrontation ~ Can have an adverse effect on the therapeutic alliance and process. ~ Can point out inconsistencies such as disconnects between behaviors and stated goals. ~ Can help clients see and accept reality, so they can change accordingly. Transference & Countertransference ~ Transference. Clients project parts of important past relationships into present relationships. ~ Countertransference. The other person projects emotional response to a group member’s transference: ◦ Feelings of having been there ◦ Feelings of helplessness when the leader/other person is more invested in the treatment than the client is are ◦ Feelings of incompetence because of unfamiliarity with culture and jargon Resistance ~ Resistance arises to protect the client from the pain of change. ~ Resistance is an opportunity to understand something important for the client or the group. ~ Resistance indicates the proposed solutions are less rewarding/appealing than the old behaviors or there is a fear

Group Therapy (TIP 41) Chapters 3-5 Stages of Treatment and Process Issues Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC, NCC Executive Director, AllCEUs Module 3 Goal and Objectives Goal: Provide an overview of how to match clients with groups, depending on clients’ readiness to change and their ethnic and cultural experiences. Objectives: ~ Match clients with substance abuse treatment groups. ~ Assess clients’ readiness to participate in group therapy. ~ Determine clients’ needs for specialized groups. Matching Clients With Groups ~ The client’s characteristics, needs, preferences, and stage of recovery ~ The program’s resources ~ The client’s ethnic and cultural experiences Clients Who May Be Inappropriate ~ Clients who refuse to participate ~ Clients who cannot honor group agreements ~ Clients in the throes of a life crisis ~ Clients who cannot control impulses ~ Clients whose defenses would clash with the dynamics of the group ~ Clients who experience severe internal discomfort in groups Primary Placement Considerations ~ Women ~ Adolescents ~ Level of interpersonal functioning ~ Motivation to abstain (if an addiction group) ~ Stage of recovery ~ Expectation of success Preparing the Group for New Members ~ Integrate new clients into the group slowly, letting them set their own pace. ~ Be aware of signs of transference and countertransference between ◦ Clinician and clients ◦ Clients and other clients ~ Watch for signs of increased participation and comfort Module 4 Goal and Objectives Objectives: ~ Distinguish the differences between fixed and revolving membership groups. ~ Prepare clients for groups. ~ Describe the tasks for each of the three phases of group development. Fixed Membership Groups ~ Members are prepared and stay together for a long time. ~ Membership is stable. ~ Groups are either: ◦ Time limited. Members participate in a specified number of sessions and start and finish together. ◦ Ongoing. New members fill vacancies in a group that continues over a long period. Revolving Membership Groups ~ New members enter a group when they become ready for its services. ~ Groups must adjust to frequent, unpredictable changes. ~ Groups are either: ◦ Time limited. Member attends a specified number of sessions, starting and finishing at his or her own pace. ◦ Ongoing. Member remains until he or she has accomplished his or her specified goals. Pregroup Interviews ~ Begin as early as the initial contact between the client and the program. ~ Strive to: •Form a therapeutic alliance between the leader  and the client. •Reach consensus on what is to be accomplished  in therapy. •Educate the client about group therapy. •Allay anxiety related to joining a group. •Explain the group agreement. Preparation Meetings ~ Explain how group interactions compare with those in self-help groups. ~ Emphasize that each person may be at a slightly different place in recovery ~ Let new members know they may be tempted to leave the group at times. ~ Recognize and address clients’ therapeutic hopes. Group Agreements ~ Establish the expectations that group members have for one another, the leader, and the group. ~ Require that group members entering a long-term fixed membership group commit to the group. ~ Inspire clients to accept the basic rules and increase their determination and ability to succeed. Elements in a Group Agreement ~ Communicating grounds for exclusion ~ Confidentiality ~ Physical contact ~ Use of mood-altering substances ~ Contact outside the group ~

Group Therapy (TIP 41) Chapter 1 Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUsTraining Objectives ~ Goal: ◦ Provide an overview of group therapy used in substance abuse treatment. ~ Objectives: ◦ Discuss the use of group therapy in substance abuse treatment. ◦ Define five group therapy models used in substance abuse treatment. ◦ Explain the advantages of group therapy. ◦ Modify group therapy to treat substance abuse Group Therapy in Treatment ~ Supports members in times of pain and trouble. ~ Enriches members with insight and guidance. ~ Is a natural ally with addiction treatment. ~ Has trained leaders. ~ Produces healing or recovery from substance abuse Group Therapy in Treatment cont… ~ Can address factors associated with addiction ◦ Depression ◦ Anxiety ◦ Anger ◦ Shame ◦ Temporary cognitive impairment ◦ Character pathology ◦ Medication Management ◦ Pain Management Advantages of Groups ~ Provide positive peer support for abstinence and positive action ~ Reduce isolation ~ Enable members to witness the recovery of others. ~ Allow members to see how others deal with similar problems. Advantages of Groups (cont.) ~ Provide information to clients who are new to recovery. ~ Provide feedback on group members’ values and abilities. ~ Offer family-like experiences. ~ Encourage, coach, support, and reinforce. Advantages of Groups (cont.) ~ Allow a single treatment professional to help a number of clients at the same time ~ Can add needed structure and discipline ~ Instill hope, a sense that “If he can make it, so can I.” ~ Support and provide encouragement to one another outside the group setting. Summary ~ Group therapy is not individual therapy done with an audience ~ Group therapy is not a mutual support group ~ Group therapy is designed to help people develop and practice knowledge and skills in a microcosm ~ Group therapy also aids patients in learning how to develop healthy, supportive relationships Module 2 Goal and Objectives Goal: Provide details about the group therapy models used in substance abuse treatment. Objectives: ~ Explain the stages of change. ~ Discuss the three specialized group therapy models used in substance abuse treatment. Training Stages of Change ~ Precontemplation ~ Contemplation ~ Preparation ~ Action ~ Maintenance ~ Recurrence Variable Factors for Groups ~ Group or leader focus ~ Specificity of the group agenda ~ Heterogeneity or homogeneity of group members ~ Open-ended or determinate duration of treatment ~ Level of leader activity ~ Duration of treatment and length of each session ~ Arrangement of room ~ Characteristics of the individuals Psychoeducational Groups ~ Assist individuals in every stage of change ~ Help clients learn about ◦ Their disorders ◦ Treatment options ◦ Other resources ~ Provide family members with an understanding of the person in recovery. Psychoeducational Groups ~ Educate about a disorder or teach a skill or tool ~ Work to engage clients in the discussion ~ Prompt clients to relate what they learn to their own issues (disorders, goals, challenges, successes) ~ Are highly structured and often follow a manual or curriculum.  Teach  Apply  Practice Basic Teaching Skills ~ Components of Learning ◦ Capture (acquire knowledge)  Auditory/Kinesthetic/Visual  Global/Sequential ◦ Conceptualization (Relating to building blocks) ◦ Caring (Motivation) Psychoeducational  Tec