Counselor Toolbox Podcast

Assessment Tools  ASAM, FARS, LOCUS Counseling CEU courses which include this podcast can be found at https://www.allceus.com/member/cart/index/search?q=patient+placement+criteria Objectives ~ Differentiate between level of care guidelines and patient placement criteria ~ Learn about the Functional Assessment Rating Scale (Required in some states) ~ Learn about the ASAM (Required by most insurers) ~ Learn about the LOCUS (Often an alternate to the ASAM ~ Discuss why these tools are used and how they can benefit clinician and client Patient Placement vs. Level of Care ~ Patient placement criteria suggests a treatment intensity level that meets the needs of the client ~ Level of Care Guidelines are defined by: ~ Insurance Providers ~ State Law (in some states) Why Use Them ~ Provides a biopsychosocial approach to care management ~ Assists in defining potential strengths and obstacles to the recovery process as the client sees them ~ Helps guide treatment planning for ~ Biomedical Issues ~ Cognitive/Emotional/Behavioral Issues ~ Motivational Issues ~ Recovery Environment (including social supports) ~ Assists in providing Specific, Measurable, Achievable, Realistic, Time Limited Goals FARS ~ Functional Assessment Rating Scale ~ Not a placement guideline per se ~ Helps more clearly define anchors for behavioral observations FARS FARS FARS ASAM– Assessment, Reassessment & Discharge ~ Physical ~ Acute Intoxication/Withdrawal Potential ~ Biomedical Conditions ~ Emotional/Cognitive ~ Emotional/Behavioral Conditions ~ Treatment Acceptance/Resistance (Readiness for change) ~ Behavioral ~ Relapse or Continued Use Potential ~ Social/Environmental ~ Recovery Environment ASAM Levels ~ Level .05: Early Intervention (Relapse Prevention) ~ Level I: Outpatient (<9 hours per week) ~ Level II: IOP (9-19 hours per week) ~ Level II.5: PHP (20+ Hours per week) ~ Level 3: Residential ~ Level 4: Medically Managed Intensive Inpatient Services LOCUS Dimensions ~ Risk of Harm ~ 1-Minimal ~ 2-Low ~ 3-Moderate ~ 4-Serious ~ 5-Extreme ~ Functional Status ~ 1-Minimal Impairment ~ 2-Mild Impairment ~ 3-Moderate Impairment ~ 4-Serious Impairment ~ 5-Severe Impairment LOCUS Dimensions ~ Medical, Addictive and Psychiatric Comorbidity ~ 1-No Comorbidity ~ 2-Minor Comorbidity ~ 3-Moderate Comorbidity ~ 4-Major Comorbidity ~ 5-Severe Comorbidity Recovery Environment ~ Level of Stress (A) ~ 1-Low ~ 2-Mild ~ 3-Moderate ~ 4-High ~ 5-Extremely Stressful ~ Level of Support (B) ~ 1-Highly supportive ~ 2-Supportive ~ 3-Limited Support ~ 4-Minimal Support ~ 5-No Support LOCUS Dimensions ~ Treatment and Recovery History ~ 1-Fully Responsive ~ 2-Significant Response ~ 3-Moderate or Equivocal Response ~ 4-Poor Response (goals not achieved or gains not maintained) ~ 5-Negligible Response LOCUS Dimensions ~ Engagement ~ 1-Optimal (Action) ~ 2-Positive (Preparation/Determination) ~ 3-Limited (Contemplation) ~ 4-Minimal (Contemplation) ~ 5-Unengaged (Precontemplation) EXAMPLE Guidelines LOCUS Placement ~ Level 1 LOCUS Placement (up to 3h/week) ~ 1. Risk of Harm – clients with a rating of two or less ~ 2. Functional Status – clients should demonstrate ability to maintain a rating of two or less ~ 3. Co-morbidity – a rating of two or less ~ 4. Recovery Environment – a combined

Medical Error Prevention Understanding Serotonin Syndrome Instructor: Dr. Dawn-Elise Snipes Executive Director: AllCEUs Counselor Education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery CEU course can be found at AllCEUs.com Objectives ~ Define Serotonin Syndrome ~ Explore the drug interactions that often cause serotonin syndrome ~ Explore risk factors for serotonin syndrome ~ Discuss why mental health clinicians need to know about serotonin syndrome ~ Learn about treatment for serotonin syndrome Understanding SOME of the Serotonin Receptors Ways Serotonin is Increased ~ Increase in serotonin synthesis ~ L-Tryptophan (esp. supplementation) ~ Reduction in serotonin breakdown ~ MAOIs: Isocarboxazid (Marplan) and phenelzine (Nardil) ~ Increase serotonin release ~ Amphetamines (ADHD medication, MDMA) ~ Anorectics (appetite suppressants (dexadrine)) ~ Anti-migraine medications such as triptans (Axert, Amerge, Imitrex), carbamazepine (Tegretol) and valproic acid (Depakene) Ways Serotonin is Increased ~ Stimulation of Post Synaptic Receptors ~ Buspirone ~ Lithium ~ Pain medications such as opioid pain medications including codeine (Tylenol with codeine), fentanyl (Duragesic), hydrocodone meperidine (Demerol), oxycodone (Oxycontin, Percocet, Percodan) and tramadol (Ultram). Ways Serotonin is Increased ~ Serotonin Reuptake Inhibitor ~ SSRI Antidepressants (Paxil, Prozax, Zoloft) ~ Ultram (SSRI + mu-receptor activation) ~ Trazadone (SARI: Serotonin Agonist and Reuptake Inhibitor) ~ Tricyclic Antidepressants (i.e. Elavil (amitriptyline), Tofranil (imipramine), and Pamelor (nortriptyline )) ~ Serotonin and norepinephrine reuptake inhibitors (SNRIs), antidepressants such as duloxetine (Cymbalta) and venlafaxine (Effexor) ~ Bupropion (Wellbutrin, Zyban) antidepressant and tobacco-addiction medication. Norepinephrine-dopamine reuptake inhibitor (NDRI)   Other Drugs That Act To Raise Serotonin ~ Illicit drugs, including LSD, Ecstasy, cocaine and amphetamines ~ Herbal supplements, including St. John's wort, ginseng and nutmeg, 5-HTP ~ Over-the-counter cough and cold medications containing dextromethorphan (Delsym, Mucinex DM, others) ~ Anti-nausea medications such as granisetron, metoclopramide (Reglan), droperidol (Inapsine) and ondansetron (Zofran) ~ Linezolid (Zyvox), an antibiotic ~ Ritonavir (Norvir), an anti-retroviral medication used to treat HIV/AIDS http://www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/dxc-20305673 CAN Identify ~ C = Cognitive changes including agitation, confusion, euphoria, insomnia, hypomania and hallucinations ~ A= Autonomic changes including tachycardia, fever, arrhythmias, sweating, dilated pupils ~ N= Neuromuscular changes including tremor, rigidity, incoordination, seizures Other Symptoms ~ Confusion ~ Agitation or restlessness ~ Dilated pupils ~ Headache ~ Changes in blood pressure and/or temperature ~ Nausea and/or vomiting ~ Diarrhea ~ Rapid heart rate ~ Tremor ~ Loss of muscle coordination or twitching muscles ~ Shivering and goose bumps ~ Heavy sweating Life Threatening Stage ~ In severe cases, serotonin syndrome can be life threatening. If you experience any of these symptoms, you or someone with you should seek medical attention immediately: ~ High fever ~ Seizures ~ Irregular heartbeat ~ Unconsciousness Risk Factors ~ There is an increased risk of serotonin syndrome if the person: ~ Recently started taking or increased the dose of a medication kno

Online Counseling Dr. Dawn-Elise Snipes Ph.D., LMHC, LPC-MHSP Charles Snipes IT Director AllCEUs.com & DataTriangle.com Overview ~ History of Online Counseling ~ Reasons for Online Counseling ~ Methods of Online Counseling ~ Ethics of Online Counseling ~ The Business Aspects – Choosing a Virtual Office – Possible Features – How much to charge – Marketing: Making a Place in Cyberspace History ~ 1970s several hospitals linked via video feed to provide doctor-to-doctor consultation ~ 2000 the first independent practitioners started making a name for themselves ~ 21st Century people have begun communicating more by text/IM ~ 2006 several states passed laws indicating that telehealth must be compensated at the same rate as face2face ~ 2010 – The majority of insurers are compensating for telehealth services – Florida created a state-certification for e-therapy. Reasons ~ Access experts on a particular problem worldwide (must be licensed in the state of practice and the state where the client resides) ~ Often more cost effective for the practitioner and the patient ~ Provides a degree of anonymity making many people feel more at ease ~ Enduring record ~ Many of the youth of today prefer etherapy…You lived on the phone as a teen, they live on their iphone or text. ~ An adjunct to traditional therapy Methods /Ethics / Cultural Appropriateness ~ Phone – Benefits – Drawbacks ~ Text/IM – Benefits – Drawbacks ~ Video – Benefits – Drawbacks ~ Email – Benefits – Drawbacks Ethics ~ Who and Where ~ Verifying identity ~ Assessment ~ Treatment Issues – Addictions – Anxiety – Depression – Bipolar – OCD – PTSD Ethics- Informed Consent ~ Verifying Identity ~ Who will have access to the information ~ How to handle power or internet outtages ~ How to handle mental health emergencies ~ How to schedule and reschedule ~ Payment policies – Fees – What shows up on credit card – Alternate payment methods (checks / money orders) ~ Releases of information ~ Information Security and Risks ~ Methods for protecting privacy (clearing cache / deleting recent history, etc.) Ethics ~ Handling disinhibition – Suicidal threats – Flaming – Repeated calls/texts/emails ~ Information about expected response time for – Text – Email The Business Aspects ~ Choosing a Virtual Office – Virtual office vs. a web presence – Partnering with someone else vs. Independent Office  Advertising/Marketing  Commissions  HIPAA  Payment Business Aspects cont… ~ Possible Features – Web presence – Interactive online appointment book – Fillable assessment and intake forms – Secure IM/Text chat (imbedded or downloadable) – Secure email – Secure video chat (imbedded or downloadable) – Instant services Business Aspects ~ How much to charge ~ Marketing: Making a Place in Cyberspace – SEO optimization – HTML vs. Blog or CMS – Designing your website (colors, usability) – Finding a niche Online Therapists and Social Networks ~ Keep your personal social networks separate from your clinical / practice network ~ Add clients only to your clinical network if you have one ~ Know whatever you say / put out there can possibly be seen and interpreted personally

Online Counseling Business Practices 2 Hours Dr. Dawn-Elise Snipes, PhD, LPC-MHSM, LMHC Executive Director: AllCEUs Counselor Education Host: Counselor Toolbox Objectives ~ Provide information about website development ~ Discuss search engine optimization ~ Identify ways to attract clients and market ~ Review methods for accepting payment and setting appointments Website Development ~ Website development services. ~ TherapySites.com ~ Wix.com ~ Choose your domain name ~ GoDaddy.com ~ Domains.google.com ~ Any other site where you can purchase a domain ~ Identify who is going to do all your IT stuff ~ Identify your web host (where your website will “live”) Web Development ~ Video and Other Client Services ~ Must provide a BAA..Just having HIPAA compliant standards is not enough. ~ Video (required for insurance reimbursement) ~ As of 2017 some companies which offer this service include… ~ Vsee ~ Thera-link ~ Luxsci ~ Email ~ SMS/Chat programs Choosing the Format for Your Website ~ WordPress ~ Blog type format ~ Easily updated ~ Very little programming knowledge needed ~ Purchase pre-constructed themes ~ HTML ~ Purchase pre-constructed themes ~ Cannot be updated on the fly (static presence) ~ Must use software on your computer or login to the website host to modify your website Site Development ~ Keep it clean. Less is more ~ Review other well ranked similar sites for ideas ~ Use relevant (optimized) pictures ~ Pay attention to the tone your colors set ~ Get 3 friends to review ~ Target visual zones using the 1-Mississippi test ~ Figure out what your customers want and ask your beta testers to find it Required Content ~ Home page (your “lobby”) ~ About Us ~ Why would a client want to choose you ~ What is your approach ~ Hours and location (link to Google, yahoo maps) ~ Services and Fees ~ What you offer ~ Cost of services ~ Insurances accepted (in or out of network) Content cont… ~ Policies ~ Informed consent ~ HIPPA/HITECH policies ~ Emergency after-hours number and/or procedure ~ Contact us ~ Phone number ~ Secure email form (with disclaimer) ~ Mailing and physical address Content cont… ~ General information and articles ~ Provide useful content ~ Become an affiliate of companies who offer related products (books, biofeedback devices, essential oils…) ~ Use descriptive links to direct people to useful self-help and support websites SEO Optimization ~ Page key word density ~ Pay attention to current search engine optimization trends (i.e. what Google, yahoo and other search engines like and don’t like) ~ Don’t gray out a list of random key words ~ Try to focus on less than 30 key words ~ Use metatags and descriptions. ~ Google “keyword selector” or “Keyword picker” to find current tools ~ Pay attention to page titles ~ Provide frequently updated, relevant, UNIQUE content SEO Cont. ~ For more information ~ https://moz.com/beginners-guide-to-seo ~ Google “overview SEO” for the most up to date articles ~ Hire a consultant Marketing ~ Twitter ~ Instagram ~ Pinterest ~ Google AdWords ~ Facebook Advertising ~ Facebook Page ~ Facebook Group ~ United Way Information and Referral ~ Specialty Organizations (PTSD, Addiction, etc) ~ Psychology Today Payment ~ Paypal ~ Invoice ~ Prior to purchase ~ Credit Cards ~ Merchant Accounts (Stripe, Autorize.net, etc) ~ Paypal ~ Insurance ~ In Network ~ Out of Network

Improving Cultural Competence SAMHSA TIP 59 Part 3 Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Review elements which constitute a culture ~ Define and explore the drug culture ~ Define and explore the recovery culture for addictions ~ 12-Step ~ SMART ~ Celebrate Recovery ~ Define and explore the culture of Mental Health Recovery ~ Theorize about the struggles clients experience when becoming acculturated to the recovery culture ~ Hypothesize interventions and methods which can help clients embrace the recovery culture   Worldview, Values, and Traditions ~ Culture can be seen as ~ A frame through which one looks at the world ~ A repertoire of beliefs and practices that can be used as needed ~ A narrative or story explaining who people are and why they do what they do ~ A set of instructions defining different aspects of values and traditions ~ A series of boundaries that use values and traditions to delineate one group of people from another Continuum of Cultural Competence ~ Stage 1. Cultural Destructiveness ~ Organizational and Individual Level: Negates the relevance of culture in the delivery of behavioral health services, holding a myopic view of “effective” treatment. (Abstinence, Harm Reduction, Happiness) ~ Stage 2. Cultural Incapacity ~ Organizational and Individual Level: Expects clients to conform to generalized services. Ignores the relevance of culture while using the dominant client population and/or culture as the norm for assessment, treatment planning, and determination of services. (Therapy Groups, 12-Step Based Treatment) Continuum cont… ~ Stage 3. Cultural Blindness ~ Organizational and Individual Level: At this stage, counselors uphold the belief that there are no essential differences among individuals across cultural groups—that everyone has trauma, mood, self-esteem and coping deficits which are causing the current state ~ Stage 4. Cultural Precompetence ~ Organizational Level: Have a basic understanding of and appreciation for the importance of sociocultural factors in the delivery of care. Counselors acknowledge a need for more training specific to the populations they serve. Continuum cont… ~ Stage 5. Cultural Competence and Proficiency ~ Organizational Level: Organizations are aware of the importance of integrating services that are congruent with diverse populations. Recognize the vital need to adopt culturally responsive practices. Cultural Identity ~ Cultural identity describes an individual's affiliation or identification with a particular group or groups. ~ Cultural identity arises through the interaction of individuals and culture(s) over the life cycle. ~ Cultural identities are not static; they develop and change across stages of the life cycle. ~ People reevaluate their cultural identities and sometimes resist, rebel, or reformulate them over time. (Remember High School; Midlife “crisis”) Acculturation ~ There are many forces at work that pressure a person to alter his or her cultural identity to conform to the mainstream culture's concept of a “proper” identity. ~ People may feel conflicted about their identities—wanting to fit in with the mainstream culture while also wanting to retain the values of their culture of origin. (Religion) ~ Sorting through these conflicting cultural expectations and forging a comfortable identity can be an important part of the recovery process ~ Many studies have found that increased acculturation are associated with higher rates of substance use disorders and mental health issues Culturally Responsive Practice ~ Culturally re

Improving Cultural Competence SAMHSA TIP 59 Part 2 Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC Executive Director: AllCEUs.com Counselor education Podcast Host: Counselor Toolbox, Happiness Isn’t Brain Surgery Objectives ~ Define “Clinical Worldview” ~ Discuss how clinical worldview impacts treatment, case formulation and rapport development ~ Explore questions to consider when developing the case formulation and treatment plan ~ Learn how mapping the client’s cultural views and influences can help clinicians (and clients) develop insights into current struggles and clarify culturally relevant goals Worldview: The cultural lens of counseling ~ The term “worldview” refers to a set of assumptions that guide how one sees, thinks about, experiences, and interprets the world. ~ Shaped by significant relationships, the individual's environment and life experiences ~ Influences ~ Values, attitudes, beliefs, and behaviors ~ Concept of time ~ Definition of family ~ Organization of priorities and responsibilities ~ Orientation to self/ family/community ~ Religious or spiritual beliefs ~ Ideas about success ~ Etc. Clinical World View ~ Influenced by education, clinical training, and work experiences ~ Counseling culture reflects ~ Counseling theories (Psychoanalytic, Humanistic, CBT) ~ Techniques and modalities (Individual, group, TAC) ~ General office practices. (Privacy, punctuality, Assessment/Intake) ~ This worldview and their personal cultural worldview shapes the counselor's beliefs pertaining to: ~ The nature of wellness, illness, and healing ~ Interviewing skills and behavior ~ Diagnostic impressions and prognosis. Clinical World View ~ This worldview, coupled with their personal cultural worldview, ~ It influences ~ the definition of normal versus abnormal behavior ~ the determination of treatment priorities ~ the means of intervention ~ the definitions of successful outcomes Cultural Awareness and Nonmalfeasance ~ Counselors must engage in self-exploration, critical thinking, and clinical supervision to understand ~ their clinical abilities and limitations regarding the services that they are able to provide, ~ the populations that they can serve ~ the treatment issues that they have sufficient training to address. ~ Cultural competence requires an ability to assess accurately one's clinical and cultural limitations, skills, and expertise. ~ Counselors risk providing services beyond their expertise if they lack awareness and knowledge of the influence of cultural groups on client–counselor relationships, clinical presentation, and the treatment process or if they minimize, ignore, or avoid viewing treatment in a cultural context. ~ Tennessee House Bill 1840 LEARN at Intake ~ Listen to each client from his or her cultural perspective, including perception of the problem and treatment preferences ~ Explain the overall purpose of the interview and intake process. ~ Acknowledge client concerns and discuss the probable differences between you and your clients. Take time to understand each client's explanatory model of illness and health. ~ Recommend a course of action through collaboration with the client including how much involvement he or she has in the planning process ~ Negotiate a treatment plan that weaves the client's cultural norms and lifeways into treatment goals, objectives, and steps. RESPECT Clients ~ Respect—Understand and reflect how respect is shown within given cultural groups through verbal and nonverbal communications. ~ Explanatory model—Devote to understanding how clients perceive their presenting problems issues, their origin, impact and treatment ~ Sociocu

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 identi

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 they a

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 they

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 perspective ~    Qu

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