Counselor Toolbox Podcast

Relapse is a return to a state of prior functioning. People can relapse from both mental health and addiction issues. Relapse from one increases the likelihood of relapse from the other in people with co-occurring disorders. Identify ways to prevent relapse. CEUs are available at allceus.com and Australia.allceus.com

By understanding the function of symptoms we can: Normalize the behavior and identify alternate ways to meet that same need or address the issue. CEUs are available for this presentation at allceus.com and Australia.allceus.com.

Trauma can cause the HPA-Axis or the threat response system to get stuck in overdrive. Learn why this happens and what can be done about it. CEUs are available for this episode at allceus.com and Australia.allceus.com

Case Management Toolbox Podcast Sponsored in part by AllCEUs Continuing Education I’m your host, Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Case Management CEUs are available for these podcasts at allceus.com/CaseManagement Case Management for Mental Health Best Practices Case Management Toolbox Podcast Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC AllCEUs Continuing Education Host: Counselor Toolbox & Case Management Toolbox Podcasts Objectives ~ Review what a Mental Health Case Manager does (or a counselor if the client does not qualify for case management services) ~ Identify common issues clients with mental health diagnoses have and ways to address them What Does a MH Case Manager Do? ~ Serve as the single point of contact ~ Facilitate patient engagement ~ Screen patients for common mental health and substance abuse disorders and identify necessary services to aid in achieving their optimal level of recovery ~ Provide patient education about common mental health and substance abuse disorders and the available treatment options. ~ Provide education to clients and stakeholders about the utility/effectiveness of wrap-around services for goal attainment ~ Housing ~ Supplemental Nutrition Assistance ~ Transportation ~ Employment/Education ~ Financial counseling What Does a MH Case Manager Do? ~ Participate in regularly scheduled (usually weekly) caseload consultation with the team and communicate resulting service recommendations to the patient’s team. ~ Consultations focus on patients new to the caseload and those who are not improving as expected under the current treatment plan. ~ Regularly meet with key team members to determine which benchmarks they are most interested in and identify barriers to care ~ Track patient follow-up, clinical outcomes including treatment adherence, medication side effects, changes in clinical symptoms and effectiveness of treatment. ~ Document in-person and telephone encounters in the EHR and use the system to identify and re-engage patients. What Does a MH Case Manager Do? ~ Document patient progress and service recommendations in EHR and other required systems to be shared with other treating providers. ~ Facilitate treatment plan changes for patients who are not improving as expected or who have reached maximal gains in consultation with the treatment team ~ Facilitate referrals for clinically indicated services within and outside of the organization(e.g., housing, vocational rehabilitation, legal assistance, substance abuse treatment, clubhouse/day treatment). ~ Follow up with client and referral services to ensure effective linkages. ~ Develop and complete relapse prevention plans with patients at admission and review those plans with those who have achieved their treatment goals and being discharged Common Issues ~ Medication Access ~ Medication Effectiveness ~ Medication Compliance (Physical and psychotropic) ~ Side effects ~ Forgetting ~ Counseling Access ~ Cost ~ Transportation Common Issues ~ Counseling Effectiveness ~ Rapport ~ Approach ~ Support System ~ Education regarding how to help the individual ~ Respite care ~ Counseling to deal with grief or other issues ~ Child/respite care ~ Respite care for a child or adult with significant illness ~ Childcare so parent can attend counseling, seek employment ~ Parenting education or assistance (i.e. child with Autism or ADHD; parent with SUD and DCF plan) Common Issues ~ Housing ~ Affordability ~ Safety ~ Nutrition ~ Affording ~ Shopping ~ Cooking ~ Activities of Daily Living ~ Paying bills (financial counseling or power of atty) ~ Hygiene Common Issues ~ Meaningful Engagement ~ Supported Employment ~ Paid employment for persons with developmental disabilities who, without long-term support, are unlikely to succeed in a regular job. ~ Supported employment facilitates competitive work in integrated work settings for individuals with the most severe disabilities who need ongoing support services in order to perform their job. ~ Supported e

NCMHCE Review Part 2 Screening 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 Screening Questions — Anxiety ~ Do you worry about a lot of things most of the time? ~ Do you worry about specific things like germs or getting into a car accident a lot? ~ Do you get so worked up that you cannot eat or sleep? Screening –PTSD ~ Have you been in really bad situations in which you had no control? ~ Have you been in terrifying situations? ~ Do you ever have memories of those situations that disrupt your day? ~ Do you startle really easily? ~ Do you find yourself being irritable and pessimistic? Anger ~ Do you often get angry? ~ When you get angry, do you feel like you are ready to explode? ~ Do you think you are more irritable than other people? Screening Questions — Depression ~ Do you feel pleasure or happiness on a regular basis? ~ Have your sleep patterns changed? ~ How is your appetite? ~ Do you often feel guilty? ~ How is your energy throughout the day? ADHD ~ Do you have difficulty finishing tasks? ~ Do you have difficulty getting organized? ~ Do you have difficulty if you have to sit still for a long time? ~ Do you have difficulty staying focused and filtering out distractions ~ Do you have difficulty waiting your turn or not interrupting? OCD ~ Do you sometimes have thoughts you cannot get out of your head? ~ How much time do these thoughts take up on average each day? ~ Do you ever feel like you have to do something over and over or something bad is going to happen? ~ How much time do you spend each day doing these things? Delusions and Hallucinations ~ Have you ever thought that people could read your mind or control your thoughts? ~ Have you ever felt like your mind was playing tricks on you? ~ Do you ever see or hear things that other people cannot see or hear? ~ Do you ever have difficulty knowing if you are awake or dreaming? Eating Disorders ~ How would you describe your eating habits? ~ Do you have any concerns about your weight? ~ How do you maintain your weight? Impulsivity ~ Do you ever find yourself doing things without really thinking about the consequences first? ~ Do you ever do things you know you shouldn’t but just cannot seem to stop yourself? ~ Do you buy things that you really don’t need just because they are there? Mania ~ Have you ever had so much energy that you couldn’t sit still ~ Have you ever found yourself not needing sleep or needing much less than usual? ~ Do you have times when you talk a lot more than usual and your brain seems to be going really quickly? Substance Misuse ~ Have you been bothered by “using medicines or drugs without a doctor’s prescription, or in greater amounts or longer than prescribed? ~ Have you used more than intended or spent more time engaging in an activity than intended? ~ Have you spend more time planning, engaging in or recovering from the use of the substance or activity? ~ Have you given up or had difficulty in significant areas of your life as a result of use of the substance or engaging in the activity. ~ CAGE ~ Cutting Down ~ Annoyed ~ Guilt ~ Eye Opener Summary ~ It is important to screen for a variety of issues ~ Know the diagnostic criteria for the most common mental illnesses ~ Many disorders have overlapping symptoms ~ Anxiety, PTSD, ADHD, Bipolar and Depression for example ~ Psychiatry.org has multiple free Cross Cutting Symptom Measures to be aware of ~ Screening just gives you a launch pad to help guide the in-depth biopsychosocial assessment Test Taking Tip ~ First Priority is identifying the diagnoses for everyone in the scenario. ~ Don’t try to be too broad. ~ If the scenario is about someone who recently underwent a traumatic event and the question asks for what to evaluate to support a provisional diagnosis, think about what you would assess for a provisional PTSD/ASD diagnosis, not a blanket evaluation f

Objectives Why Holistic? ~ 30% to 40% of patients with major depressive disorder (MDD) do not respond sufficiently to usual antidepressant treatment ~ Even under optimal treatment conditions, only one-third of patients achieve remission ~ Among patients who fail to respond to two pharmacologic interventions, remission rates with the next antidepressant are as low as 12% ~ A patient becomes less likely to respond clinically with each additional nonresponse to antidepressant treatment

NCMHCE Review Part 1 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 Mental Status Exam ~ Evaluation of a clients current mental functioning ~ Combined with other information to arrive at formal diagnosis ~ Behavioral Aspects ~ Physical characteristics (ethnicity, cleanliness, weight, dress–age and setting appropriateness) ~ Communication barriers ~ Alertness ~ Movement and activity (tension, perseverative movements, non-goal-directed behaviors, itching/picking) ~ Facial expressions and continuity with words ~ Eye contact ~ Speech patterns (articulation, stuttering, mumbling, baby-talk, use of cultural dialects) ~ Attitude toward therapist Mental Status Exam ~ Mood and Affect ~ Mood: How they feel most days ~ Affect is more variable— How do they feel right now or at a specific time ~ Type, quality, appropriateness ~ Bland—nothing affects him may indicate dementia ~ Affective flattening is a negative symptom of schizophrenia Mental Status Exam ~ Flow of Thought ~ Spontaneous or only in response to questions ~ Incoherent rambling: Intoxication ~ Common in mania or schizophrenia ~ Flight of ideas ~ Tangential speech (answers unrelated to questions) ~ Loose associations (I got up and it was sunny today. I had oatmeal for breakfast. My dog died last Thursday) Mental Status Exam ~ Flow of speech ~ Rate of speech: pressured (hypomania) or too slow (depression or intoxication) ~ Suicidal/Homicidal Ideation and risk for violence Mental Status Exam ~ Cognitive Aspects ~ Thought content (logical, deluded) ~ Perception (Accurate, hallucinations) ~ Consciousness and cognition ~ Awareness of, ability to process and communicate information and attention span ~ Orientation to person, place, time and situation, also may include familiar object identification and other people identification Mental Status Exam ~ Cognitive Aspects ~ Language comprehension and fluency ~ Memory ~ Types ~ Immediate (5-10 seconds) ~ Short Term (5-10 minutes) ~ Long Term – ability to provide autobiographical hx ~ Deficit Indicators ~ Dementia ~ Amnesia ~ Mental disorder due to a medical condition (stroke, chronic fatigue) ~ Substance Induced Mental Disorder (Korsakoff’s Syndrome) ~ Depression ~ Anxiety Mental Status Exam ~ Cognitive Aspects ~ General Intelligence ~ Poor intelligence despite a good educational background can indicate a neurological problem ~ Must consider age, education level, culture and degree of depression and anxiety when assessing performance (29% of Americans can’t name the vice president) ~ Abstract Thinking: Interpret a proverb ~ Don’t count your chickens before they hatch Mental Status Exam ~ Insight and Judgement ~ Insight about problem severity and what needs to happen ~ Poor insight is associated with cognitive disorders, depression, psychosis and mania. ~ Poor judgement is often associated with mania, hypomania or FASD Summary ~ A mental status exam should be done at admission to aid in assessment and treatment plan development ~ A mini mental status exam should be done at each contact. ~ Orientation to person, place, purpose and time ~ Sign in ~ Thought content and perception ~ What were 2 things you got out of group/session ~ Fund of information / memory ~ How did you apply the tools/homework from last week ~ Future plans ~ What do you plan to do over the next week to improve your recovery ~ Mood ~ What is your mood? Happy Anxious Angry/Irritable Depressed ~ Judgement ~ If you start having a bad day, what will you do? Test Taking Tip ~ For ethics related questions your best guess is the answer that is best for the client. ~ When eliminating response options, eliminate answers which: ~ Don’t answer the whole question ~ Are true, but not relevant to the presenting problems and situation ~ Use extreme words like always or must ~ Represent a common misconception or a lay-persons view ~ Chec

Case Management and Counseling Ethics and Scope of Practice Case Management Toolbox Podcast Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC Executive Director: AllCEUs Continuing Education Host: Counselor Toolbox Podcast & Case Management Toolbox Podcast Objectives ~ Explain the scope of practice and code of ethics for case managers ~ Compare and contrast the code of ethics and scope of practice for case managers to that of Rehabilitation and Mental Health Counselors and Social Workers Scope of Practice ~ CM ensure that the treatment team has provided education about the injury/disease/condition ~ CM provides information to the team and the client and family regarding available resources and benefits ~ Identify clinical, psychosocial, financial, operational and/or environmental issues which may need to be addressed to ensure quality care and reimbursement ~ CM will use assessment complimentary tools that identify risks associated with client needs ~ CM and client will develop a plan of care that matches the patients needs, preferences and available resources ~ CM will help sequence and organize the implementation of services to ensure efficient, effective care delivery Scope of Practice ~ CM documentation focuses on acquisition and utilization of resources as they pertain to reducing risk and enhancing treatment delivery. ~ Risks include ~ Early termination/sporadic participation ~ Ineffective treatment (i.e. for someone who is hearing impaired or has limited literacy) ~ Worsening of symptoms due to medication noncompliance ~ Additional complications due to difficulty with ADLs ~ Readmission Scope of Practice ~ CM and Counselors will identify available community resources and advocate for the resolution of gaps in services and/or problems in process implementation ~ CM and Counselors ensure all elements of the transition plan are communicated to all stakeholders as appropriate. ~ CM and Counselors will track avoidable delays and identify and communicate opportunities for improvement ~ CM and Counselors will proactively prevent denials based on medical necessity by documenting relevant information and educating key stakeholders Ethical Principles of Counseling and CM ~ Beneficence ~ Act in the best interest of the client. Includes advocacy. ~ Nonmalfesance ~ Do no harm ~ Fidelity ~ Be faithful to your word ~ Justice ~ Ensure clients receive equal and fair treatment ~ Autonomy ~ Empower clients for success Public Interest ~ Place the public interest above your own at all times (B, N, J) ~ False billing leads to higher insurance rates and loss of trust in the profession ~ Continuing to work while “burned out” or psychologically unavailable can harm clients and negatively impact perception of the profession ~ Report/address known misconduct ~ Make referrals when other providers are more appropriate due to case content or caseload ~ As a client advocate identify options and provide choices Respect Rights and Inherent Dignity ~ Respect Rights and Inherent Dignity of All Clients (B, N, J, A) ~ Do not make decisions for clients which they can make for themselves ~ Advocate for client empowerment and autonomy ~ Respect the cultural values and personal preferences of clients ~ Inform clients about confidentiality restrictions Maintain Objectivity ~ Maintain Objectivity with Clients ~ Is able to clearly articulate reasoning behind recommendations ~ Avoids making referrals to “preferred” vendors ~ Respects their cultural values and perspectives ~ Does not impose their own values or perspectives ~ Is aware of and addresses any transference or countertransference issues ~ Regularly self-evaluates performance ~ Avoids any dual relationships Dual Relationships ~ Can exist between the case manager or counselor and ~ Client ~ Payor (insurance, state contract) ~ Employer (of the professional or client) ~ Friend/Relative (of the professional or client) ~ Other entities Act with Integrity and Fidelity ~ Act with Integrity and Fidelity with Client

Learn about pathological gambling with Dr. Daniel Kaufmann

Preventing Vulnerabilities Pain Management. Pain is inevitable. It impacts your Mood, Thoughts, Behaviors, Relationships, Addressing pain will help reduce related, Anxiety, Depression, Anger. Pain management requires a comprehensive approach addressing, Physical causes of pain, Mood, Social supports, Sleep.

The Interaction Between Neurotransmitters, Thoughts & Emotion Objectives Learn about your central control center, the brain What role does it play in Emotions Thoughts Physical Reactionsl Sensations How things can go wrong How to fix those things Summary After a hard day, you often want to relax and “veg” This is the brain sending out […]

Internal Family Systems Theory Dr. Dawn-Elise Snipes Purchase CEU class for this podcast at: https://www.allceus.com/member/cart/index/product/id/1034/c/ Objectives ~ Define Internal Family Systems Theory ~ Identify when it is used ~ Explore guiding principles ~ For more information and training programs in IFS, go to https://www.selfleadership.org/ Overview ~ IFS was developed in the 1990s by family therapist […]

Objectives Identify symptoms of anxiety in children Review common misdiagnoses Explain how children’s developmental stage impacts their fears Propose interventions to help children deal with anxiety

Define closed, open and single-session groups Explore the benefits and challenges for each Discuss necessary skills for managing open-ended groups

Positive self talk helps you feel empowered and good about being the best you that you can be. Feelings of empowerment reduce feelings of helplessness and hopelessness and can protect against depression, anxiety and a host of stress related illnesses. CEUs are available for this podcast at allceus.com/counselortoolbox or in Australia at australia.allceus.com/counselortoolbox .