Counselor Toolbox Podcast

Increasing Case Management Effectiveness Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director, AllCEUs Counseling Continuing Education Host: Counselor Toolbox and Case Management Toolbox Podcasts Objectives – Identify the benefits of case management – Explore the impact of ineffective “standard” treatment – Identify goals of the case manager – Review the research identifying the most helpful factors in case management – Review assessment areas – Explore common needs of CM clients – Describe characteristics of effective care plans Intro – CM can be defined as a “coordinated integrated approach to service delivery, ongoing supportive care and help to access resources for living and functioning in the community” Why Case Management – Frequent users of healthcare services are a small group of patients with multiple chronic conditions and psychosocial and mental health comorbidities accounting for a high number of healthcare visits – Frequent use of services is often considered a symptom of gaps in accessibility and coordination of care. – These patients are more at risk for incapacity, poorer quality of life and mortality. – Case management (CM) is the most frequently implemented intervention to improve care for frequent users of healthcare services and to reduce healthcare usage and cost – CM interventions resulted in decreases in ED use and cost, a better use of appropriate existing resources, and a reduction in social problems such as homelessness and drug and alcohol abuse Impact of Ineffective Treatment – Treatment dropout – Continued illness – Work impairment – Financial problems – Relationship impairment – Impaired parenting – Stress related health problems – Development of (additional) mood issues Case Example – John has a substance use disorder, major depressive disorder and hepatitis C. He doesn’t know how to afford his medication for hepatitis or his depression, has a history of suicidal ideation and has a history of relapse. Currently he is living in a local motel. He recently lost his job and got a DUI. – Counselors review your provider administration manual. Most insurers offer care/case management programs. – http://www.aetna.com/healthcare-professionals/documents-forms/bh-provider-manual.pdf Goals – Increase/maintain client engagement/motivation by: – Improving health literacy – Identifying and addressing obstacles (payors, transportation, language/literacy, childcare) – Identifying and enhancing strengths – Serving as a healthcare guide – Providing support and encouragement – Reducing symptoms – Reducing the burden on caregivers thereby improving the psychosocial environment (emotional support, social support, domestic help, insurance, transitional services) – Increasing confidence in caregivers and clients for self-management Helpful Factors in Case Management – Helpful Factors – Access to medical, social and community resources – Calm and trusted case manager – Case manager with strong relationships to referral sources – Effective communication between CM and treating clinician(s) via a unified treatment strategy – Multidisciplinary care plan – Life skills coaching – Frequent contacts with care provider – Regular review of the care plan with the client – Assistance with healthcare navigation – Patient education/Health literacy enhancement – Coordination and prioritization of care Assessment Areas: Client and Caregiver – Emotional needs – Cognitive functioning – Physical complaints – Sleep – Current physicians, medications, diagnoses and treatment plans – Motivation – Knowledge about the condition – Health literacy – Access to safe housing – Access to healthy meals – Ability to p

406 -Biopsychosocial Impact of Addiction and Mental Disorders on the Individual - Examine the biological (physical) impact of addiction and mental health issues on the individual - Examine the psychological impact of addiction and mental health issues on the individual - Examine the social impact of addiction and mental health issues on the individual - Identify interventions in each area.

004 -Health Coaching in Case Management Health Coaching Case Management Toolbox Podcast Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Continuing Education Host: Case Management Toolbox Podcast & Counselor Toolbox Podcast CEUs can be earned for this podcast here: https://www.allceus.com/member/cart/index/product/id/1125/c/ Objectives – Explain what health coaching is – Differentiate it from counseling or medical practice – Describe different skills a health coach needs – Discuss how to develop an individualized service plan Give a man a fish, he eats for a day. Teach a man to fish, he eats for a lifetime. Overview of Health Coaching – Health coaches: – Providing self-management support – Educate clients – Bridge the gap between clinician and patient – Help patients navigate the health care system – Offering support and encouragement Health Coaching Research – Significant improvements in one or more of the following – Nutrition – Physical activity – Weight management – Exercise frequency – Perceived social support – Patient engagement and “activation” – Medication adherence – Common features of effective programs are goal setting, motivational interviewing, and collaboration with health care providers – The Care Transitions Intervention is a widely-used coaching method that imparts skills, tools and confidence to patients and family caregivers as they move from hospital to home.13 It is focused on “four pillars”: – Having an effective, understandable management strategy – Overcoming barriers to follow-up appointments, – Knowing how to recognize and respond to worsening signs and symptoms – Using a personal health record to identify and record 30-day goals, health information and key questions to be shared with the physician at upcoming health care encounters. Goal Attainment Scaling Educate Clients – Help clients learn where to find reliable, valid information about their concerns or conditions – Help clients learn how to evaluate that information – Educate clients about the impact of nutrition, sleep, exercise, sunlight, relaxation, thoughts and mood on their condition and their goals – Teach clients about SMART Goals – Teach clients about motivational enhancement Patient Centered Care: Engagement & Rapport – Employ a person centered model – Respect for client as an individual (UPR) – Respect for client’s preferences for goals and interventions – Collaborative approach providing choice and self-determination – Coordination and integration of care – Validation, support, encouragement, empathy – Involvement of social supports Enhancing Motivation – Emotional (How will this help client be happier-) – Mental (How does this make sense to the client-) – Physical (How can this improve the client’s health and energy-) – Social (How will it enhance important relationships- Who is supportive of this change-) – Environmental (What things can be placed in the environment to enhance motivation) – Spiritual (In what ways does this change help the client live more in harmony with personal values and feel a greater sense of connection-) Motivational Techniques (ROADS) – Reflective Listening – Open Questions – Affirmations of Self-efficacy and Optimism – Develop Discrepancy – Summarizing Adult Learning Theory – Provide explanations of why specific concepts are being taught – Ensure learning that is connected to their health goals (make room for meaning) – Use self-assessments to assess different levels of prior experience and education – Remember prior learning will be the filter with which they conceptualize new information – Use multiple methods of instruction (auditory, visual, kinesthetic) – Ensure acces

405-Social Work Considerations for Addressing Chronic Conditions Treatment for persons with chronic conditions requires use of many strategies outside of traditional emotion or cognition focused counseling to educate, motivate and empower clients to take charge of their condition. ~ It is beneficial to educate the client as well as the family/support system about the condition, effects of the condition, expectations for improvement and benefits and drawbacks of possible interventions. CEUs can be earned for this presentatino at allceus.com or australia.allceus.com

NCMHCE Crisis Assessment--Learn multiple mnemonics to help you remember what to look for in your scenario assessments. CEUs are available for this at allceus.com

Learn how to teach a model to help clients implement psychological flexibility in episode 404 of Counselor Toolbox Podcast. CEUs are available at allceus.com and Australia.allceus.com

Childhood obesity contributes to a range of physical and mental health issues. Identify ways counselors and social workers can work with students, families and communities to address this growing crisis. CEUs are available at allceus.com and Australia.allceus.com

NCMHCE Assessment Review Part 3 Brought to you by AllCEUs.com Counselor Continuing Education Unlimited CEUs $59/month or $99/year Live Webinars as low as $4/hour Addiction Counselor Certificate Training $149 Assessment – Categories of information – Presenting issue – Mental Status Exam – Emotional – Behavioral – Physical – Personality – Coping Skills – Family of Origin – Culture – Social Supports and interpersonal relationships – Environment live and work – Developmental stage – Activities of daily living and ability for independence – Motivation Assessment – Categories of Information – Emotional Signs and symptoms – Degree of emotional control – Ability to feel and express a range of emotions – Emotional appropriateness – Emotional issues which may be a focus of clinical attention – Anger – Anxiety – Depression – Grief – Guilt Assessment – Categories of information – Psychiatric signs – Looking for diagnostic criteria for disorders – Affective, behavioral/physical, cognitive, social indicators of mood disorders – Changes in thinking behavior associated with cognitive impairments – Signs of a substance use disorder – Discussing with client – Exacerbating factors and triggers – Mitigating factors and effective interventions Assessment – Categories of information – Medical and Physical Symptoms and Issues – Consider the possibility that symptoms are caused by a medical condition and refer for an evaluation – Evaluate current medications and consider medication side effects – Is the client intoxicated or in withdrawal from a substance – Vegetative symptoms: Persistent problems with appetite, weight control, sleep, energy, sexual desire and function Assessment – Categories of information – Medical and Physical Symptoms and Issues – Somatoform Disorders: Physical symptoms with no detectable physiological cause – Includes pain disorder and body dysmorphic disorder – When tests and physical exams do not support the patient’s symptoms consider malingering of factitious disorders Assessment – Categories of information – Personality Traits – Patterns of behavior, thinking and perception that are pervasive can indicate a personality style such as aggressive, addictive, Type A or co-dependent or a personality disorder such as antisocial, histrionic, or borderline – Ego functioning – Self regulation/impulse control/frustration tolerance – Defense mechanisms – Healthy use limits dysphoric emotions without significantly disrupting a persons life Assessment – Categories of information – Coping skills – Coping abilities, resources and deficits – Current coping strategies that are and are not effective – Ways the client has responded to similar problems in the past (adaptive and maladaptive) – Specific individual characteristics that impact coping ability such as developmental level, cognitive functioning, locus of control and sense of self-efficacy – Family of Origin – Cultural background – Socioeconomic background Assessment – Categories of information – Interpersonal Relationships and Social Supports – Type, quality and effectiveness of current relationships – If isolated, evaluate for voluntary withdrawal, poor social skills, alienation, shyness/social anxiety, substance misuse or compulsive behaviors, low self-esteem, PTSD – Capacity for healthy interpersonal relationships (boundaries) Assessment – Categories of information – Social Roles and Role Functioning – Each role holds a set of role expectations – What roles does the person fulfill (child, parent, spouse, employee, friend…) – Is there role ambiguity or role

Help Parents of Children with Autism Better Engage and Communicate with Their Children. Move from a deficits based to a differences based approach to interaction. Describe the unique interpersonal needs of people with autism spectrum disorders. Identify characteristics necessary to form secure attachments. List at least 5 practices that caregivers and teachers can use to improve connection with children on the autism spectrum. CEUs are available for this course at allceus.com or Australia.allceus.com

NCMHCE Exam Review Podcast Assessment Part 2 Brought to you by Counselor Toolbox Podcast and AllCEUs.com Counselor Continuing Education where you can get Unlimited on demand CEUs for $59 or unlimited live webinars for $40 Objectives ~ Define assessment ~ Review acronyms to help you remember what to look for when assessing for a problem. What is Assessment ~ Assessment is the process of gathering, analyzing and integrating information into a comprehensive picture that describes ~ The nature, frequency, intensity and duration of the client’s problems ~ The roles the client, significant others and the environment/community play in the current issues ~ The functioning of the client and significant others ~ Client motivation to address presenting issues ~ Resources needed to resolve problems and effectively participate in treatment. Presenting Issue ~ Represents the problems that are foremost in the client’s mind ~ Denial of any problems may also provide information into client insight, judgement and motivation Evaluating the presenting issue ~ When did it begin? ~ What makes it worse? Better? ~ How often does it occur and to what intensity? ~ If the client is reporting multiple symptoms, assess the above for each and identify which symptom presented first. ~ What are the antecedents of (triggers/precipitants) the problem? ~ How do you feel when the problem occurs? What are you thinking? ~ Describe what happens right after the problem (reinforcers), habitual responses. Stressors ~ What stressors are occurring and what is their frequency, intensity and duration? ~ How does the client deal with the stressors? ~ Are the stressors impacting the course of the presenting problem? Emotional Range ~ Emotional control (dysregulation or flattening) can impact the client’s health, relationships and functioning at work or school. ~ People who avoid dealing with emotions may develop depression, anger or anxiety ~ People who experience dysregulation may also develop depression, anger or anxiety ~ Trauma-induced changes in emotional range may also impact the client’s ability to function ~ Remember that affect is the current, transient state. Always assess affect. Mood Disorders ~ When the client presents with mood symptoms, inquire about ~ Previous episodes of the same symptoms ~ How he or she has dealt with them before ~ If there was a previous episode, was there full remission? Depression ~ What to look for ~ Anhedonia ~ Dysphoria ~ Sleep changes ~ Appetite changes ~ Changes in psychomotor behavior ~ Reduction in libido ~ Reduced energy ~ Nonverbals indicating any of the above ~ Highly self-critical ~ Cognitive distortions ~ Hopelessness/pessimism ~ Irritability ~ Guilt/shame ~ Difficulty concentrating ~ Withdrawal from relationships Depression Mnemonic A SAD FACES ~ A = Appetite (Weight Change) ~ S = Sleep (Insomnia / Hypersomnia) ~ A = Anhedonia ~ D = Dysphoria ~ F = Fatigue ~ A = Agitation / Retardation ~ C = Concentration Diminished ~ E = Esteem (Low) / Guilt ~ S = Suicide / Thoughts of Death Mania ~ What to look for ~ Elevated mood ~ Grandiosity ~ Irritability/aggression ~ Pressured speech ~ Flight of ideas ~ Restlessness ~ Hypersexuality ~ Impulsivity ~ Limited insight ~ Poor concentration ~ Impatience ~ Gregariousness ~ Provocativeness Mania Mnemonic DIG FAST ~ Distractibility ~ Indiscretion ~ Grandiosity ~ Flight of ideas ~ Activity increase ~ Sleep deficit ~ Talkativeness Anxiety ~ What to look for ~ Irritability/edginess ~ Uneasiness/worry ~ Panic ~ Hypervigilance ~ Psychomotor agitation/Nervous habits ~ Nonverbals indicative of worry ~ Ruminating ~ Persistent worrying about a variety of things ~ Difficulty concentrating ~ Withdrawal from relationships ~ Highly critical of self ~ Sleep problems ~ Clinginess/dependency Anxiety Mnemonic: Worry WARTS ~ Worry ~ Worn out ~ Absentminded ~ Restless ~ Touchy ~ Sleepless PTSD ~ What to look for: ~ Exposure to a traumatic event ~ Re-Experiencing (Dreams, memories, flashbacks) ~ Avoidance of re

Learn about the impact of historical trauma and cultural issues to which clinicians must be responsive in order to provide effective, ethical care to American Indians and Alaskan Natives. CEUs are available for this podcast at allceus.com and Australia.allceus.com.

NCMHCE Review Part 3 Assessmemt Brought to you by AllCEUs.com Counselor Continuing Education Unlimited CEUs $59/month or $99/year Live Webinars as low as $4/hour Addiction Counselor Certificate Training $149 Assessment ~ Categories of information ~ Presenting issue ~ Mental Status Exam ~ Emotional ~ Behavioral ~ Physical ~ Personality ~ Coping Skills ~ Family of Origin ~ Culture ~ Social Supports and interpersonal relationships ~ Environment live and work ~ Developmental stage ~ Activities of daily living and ability for independence ~ Motivation Assessment ~ Categories of Information ~ Emotional Signs and symptoms ~ Degree of emotional control ~ Ability to feel and express a range of emotions ~ Emotional appropriateness ~ Emotional issues which may be a focus of clinical attention ~ Anger ~ Anxiety ~ Depression ~ Grief ~ Guilt Assessment ~ Categories of information ~ Psychiatric signs ~ Looking for diagnostic criteria for disorders ~ Affective, behavioral/physical, cognitive, social indicators of mood disorders ~ Changes in thinking behavior associated with cognitive impairments ~ Signs of a substance use disorder ~ Discussing with client ~ Exacerbating factors and triggers ~ Mitigating factors and effective interventions Assessment ~ Categories of information ~ Medical and Physical Symptoms and Issues ~ Consider the possibility that symptoms are caused by a medical condition and refer for an evaluation ~ Evaluate current medications and consider medication side effects ~ Is the client intoxicated or in withdrawal from a substance ~ Vegetative symptoms: Persistent problems with appetite, weight control, sleep, energy, sexual desire and function Assessment ~ Categories of information ~ Medical and Physical Symptoms and Issues ~ Somatoform Disorders: Physical symptoms with no detectable physiological cause ~ Includes pain disorder and body dysmorphic disorder ~ When tests and physical exams do not support the patient’s symptoms consider malingering of factitious disorders Assessment ~ Categories of information ~ Personality Traits ~ Patterns of behavior, thinking and perception that are pervasive can indicate a personality style such as aggressive, addictive, Type A or co-dependent or a personality disorder such as antisocial, histrionic, or borderline ~ Ego functioning ~ Self regulation/impulse control/frustration tolerance ~ Defense mechanisms ~ Healthy use limits dysphoric emotions without significantly disrupting a persons life Assessment ~ Categories of information ~ Coping skills ~ Coping abilities, resources and deficits ~ Current coping strategies that are and are not effective ~ Ways the client has responded to similar problems in the past (adaptive and maladaptive) ~ Specific individual characteristics that impact coping ability such as developmental level, cognitive functioning, locus of control and sense of self-efficacy ~ Family of Origin ~ Cultural background ~ Socioeconomic background Assessment ~ Categories of information ~ Interpersonal Relationships and Social Supports ~ Type, quality and effectiveness of current relationships ~ If isolated, evaluate for voluntary withdrawal, poor social skills, alienation, shyness/social anxiety, substance misuse or compulsive behaviors, low self-esteem, PTSD ~ Capacity for healthy interpersonal relationships (boundaries) Assessment ~ Categories of information ~ Social Roles and Role Functioning ~ Each role holds a set of role expectations ~ What roles does the person fulfill (child, parent, spouse, employee, friend…) ~ Is there role ambiguity or role conflict (parent/friend; parent/employee) ~ Has there been a loss of an important role (empty nest, divorce) ~ Is the client overwhelmed or ambivalent about the responsibilities associated with a role (parenting, employee, spouse) ~ Are client’s normal dependency/affiliation needs being met in an appropriate way (boundaries) ~ Is the client being victimized/manipulating or victimizing/manipulating someone else Assessment ~ Cate

Groups are extremely cost effective. This series of 24 groups provides the foundation for clients to address issues underlying anxiety, anger and depression and begin living a happier life. CEUs are available for this podcast at allceus.com and Australia.allceus.com.

Improving Health Literacy Case Management Toolbox Podcast Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director, AllCEUs Counseling CEUs Objectives ~ Define health literacy ~ Explain why health literacy is important ~ Explore health literacy in a recovery oriented system of care ~ Identify at least 5 ways to improve health literacy What is a ROSC ~ Recovery-Oriented Systems of Care (ROSC) is a coordinated network of community-based resources that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve improved health, wellness, and quality of life ~ In order to access and benefit from these services, people must have a high level of health literacy ~ Case Managers and clinicians can work together in communities to identify ~ Needs and resources to prevent health and mental health issues ~ Needs and resources to recover from health and mental health issues What is Health Literacy ~ Health literacy is the degree to which individuals can obtain, process, and understand basic health information to make appropriate health decisions. ~ Includes math skills to manage levels, understand risks, measure medication, understand nutrition labels and even manage insurance. ~ Includes general health information about requirements for good health including exercise, sleep, nutrition and regular checkups as well as ways to prevent or mitigate common risk factors for disease ~ Only 12 percent of adults have proficient health literacy, or the skills needed to manage their health and prevent disease. What is Health Literacy ~ Health literacy (what a person needs to know and how to help them understand and use that information) is dependent on: ~ Communication skills of lay persons and professionals ~ Lay and professional knowledge of health topics ~ Demands of the situation/context ~ Health literacy affects people's ability to: ~ Find information and services ~ Communicate their needs and preferences and respond to information and services ~ Process the meaning and usefulness of the information and services ~ Understand the choices and consequences of the information and services ~ Decide which information and services they need and take action Health Literacy Skills ~ Anyone who provides health information and services needs health literacy skills to ~ Help people find information and services ~ Effectively communicate information about health promotion and conditions to people of varying ages, cultures and cognitive abilities.(teach back) ~ Understand what people are explicitly and implicitly asking for ~ Decide which information and services work best for different situations and people so they can act Health Literate Services ~ A Health Literate Case Manager or Clinician ~ Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement ~ Has a high level of health literacy ~ Works with clients in the design, implementation, and evaluation of the service plan ~ Uses health literacy strategies in communications and confirms understanding ~ Provides easy access to health information and services ~ Designs and distributes print, audiovisual, and social media content that is easy to understand and act on. ~ Regularly addresses health literacy in high-risk situations, including care transitions and medication changes ~ Communicates clearly what services are available free and cost Health Literate Services ~ A Health Literate Case Manager or Clinician ~ Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement ~ Evaluate client understanding of the condition, treatment options, and services available at admission ~ Evaluate client’s understanding of general health and wellness behaviors ~ Assess client’s ability to seek out, obtain and use health-related information ~ Ensure clients understand what evaluations are asking of them ~ Identify obstacles to client health literacy and set goals for improvem

Learn how to increase motivation and participation when facilitating group as well as common group leadership errors and what to do about them. CEUs are available for this podcast at allceus.com and Australia.allceus.com.