Counselor Toolbox Podcast

Summary - As we move toward a capitated model of healthcare, prevention will become increasingly important. - Prevention activities - Can be started as early as the prenatal period - Can be integrated into school curricula - Are more effective if presented in multiple settings and formats - Need to be tailored to the age, abilities and culture of the recipients

419 -13 Useful Brief Interventions Instructor: Dr. Dawn-Elise Snipes, PhD, LPC-MHSP, LMHC CEUs are available at allceus.com/counselortoolbox Objectives ~ Review the benefits of brief interventions ~ Identify the goals of brief interventions ~ Explore 13 brief interventions that can be used with most clients Benefits ~ Reduce no-show ~ Increase treatment engagement ~ Increase compliance […]

Learn about how visible and invisible disabilities can impact PACER: ~ Physical Health ~ Affect ~ Cognitions ~ Environment and Economic Well-being ~ Relationships and Recreation and what you can do to minimize the negative impact.

Summary ~ Working with people with cognitive impairment can be frustrating ~ It is important not to confuse chronological age with communicative age ~ KISS ~ Eliminate distractions ~ Don’t expect short-term memory ~ Use pictures, lists, storyboards ~ Spaced retrieval training has shown effectiveness in improving memory in people with cognitive impairments ~ Many people with a FASD will present in mental health practices without a FASD diagnosis. ~ Many clients who misuse alcohol and/or try to self detox can precipitate a cognitive impairment through ~ Thiamine deficiency ~ Stroke ~ Conduct ongoing assessments for cognitive impairments

Objectives - Define MAT - Explore barriers to treatment What is Our Goal - Help people - Reduce symptoms of depression and anxiety - Agitation - Sleep disruption - Anhedonia - Fatigue - Feelings of worthlessness and guilt - Stay alive (not overdose or commit suicide) - Be relatively pain free (bidirectional with depression and anxiety) - Be independent - Improve interpersonal relationships - Be financially secure - Be “productive” members of society to their ability

Summary ~ Strengthen the motivation to change throughout the change process. ~ Identify high-risk situations ~ Develop coping strategies and skills to avoid high-risk situations and to deal with them when they are unavoidable. ~ Recognize and implement changes to the environment and lifestyle to minimize the frequency of high-risk situations and to strengthen commitment to change.

- Motivation is dynamic, influenced by multiple types of motivation including emotional, cognitive, social, environmental - Motivational Interviewing increases client’s hope and enhances treatment participation - 3 critical elements of motivation: Ability, willingness and readiness - 5 elements of motivational approaches - The FRAMES approach - Decisional balance exercises - Discrepancies between personal goals and current behavior - Flexible pacing - Personal contact with clients in treatment

Summary ~ Online therapy is becoming increasingly mainstream ~ There are many advantages such as convenience, cost effectiveness and accessibility ~ Things to consider when choosing an office are your particular skill set, your target population, how tech savvy you are and how much you want to spend ~ Building an online practice is no faster than a face-to-face one, but there are things you can do to speed up the process.

Summary - Conflict is inevitable - Violence prevention involves - Creating an environment that supports open communication and respect - Maintaining self awareness of stressors and our impact on others - Maintaining awareness of other’s reactions, behaviors and stressors - Educating staff and clients regarding effective conflict resolution strategies - Minimizing triggers for conflict - Being willing to learn from conflict

Summary - Trauma impacts the person biopsychosocially - Behavioral interventions can help them prevent and address avoidance and hypervigilance - Cognitive interventions can help them - Understand the function of their symptoms to choose effective ways of dealing with them - Address unhelpful cognitions about the trauma, themselves and the world - Reduce chronic stress to help the HPA-Axis rebalance and recover - Assist in integrating the trauma narrative so it is not a “loose end.”

Objectives - Learn about bariatric surgery - Explore reasons for the surgery and increase in popularity - Identify the psychosocial outcomes of bariatric surgery - Identify common presenting issues in persons seeking bariatric surgery - Explore current recommendations for assessment protocols and presurgical preparation for bariatric surgery - Identify postoperative mental and physical health issues which may occur and need to be addressed Types of Bariatric Surgery - Bariatric surgeries all aim to make the stomach smaller so it can hold less food through removal, banding or bypassing. - Some surgeries also bypass part of the small intestine which inhibits calorie as well as nutrient absorption

NCMHCE Exam Review Dangerousness and Abuse Dr. Dawn-Elise Snipes PhD, LPC-MHSP Executive Director, AllCEUs Counseling Education Host: Counselor Toolbox Podcast Objectives – Identify the characteristics of a dangerousness assessment – Identify factors associated with a high risk for violence – Identify steps in preventing danger to others – Review special cases – Domestic violence – Child Abuse – Elder Abuse – Substance Abuse – Eating Disorders – Emergency calls from nonclients Dangerousness Assessment – Identify the cause of the crisis – Determine the probability the client will hurt someone – Gather information using a mental status exam – Ask the client about a history of violence and current plans – Asses the client’s support system Factors Associated with a High Risk – Male – Alcohol use – History of violence or threats of violence – Antisocial behavior – History of child abuse – Recent provocation – Diagnoses: Substance use disorder, delirium, schizophrenia, mania, personality disorders, intermittent explosive disorder – Agitation – Loud or abusive speech – Poor impulse control – Emotional lability Duty to Warn – Must involve a reasonably identifiable victim and a credible threat of imminent danger – Contact law enforcement and the intended victim – Divulge only information necessary: You name, the client’s name and the threat (Diagnosis and other information is not necessary and still protected) – Inform the client ahead of time if appropriate Immediate Intervention – Provide a calm, controlled environment – Allow the client to vent feelings – Build self-esteem – Explore options for addressing the issue – Mobilize support – Help client understand the cause of the crisis* – Make a no violence contract – Ensure the client is calm prior to leaving – If client is unable to regain composure, encourage voluntary commitment – Use involuntary commitment as a last resort Domestic Violence – Indicators – Injuries at various stages of healing – Depression, anxiety, insomnia, nightmares, ASD – Vague somatic complaints – Complaints of relationship issues – Over-dependence on partner – History of substance abuse – Behavioral problems in children – If kids in the house, assess for child abuse DV Intervention – Use open ended questions – “How did you get that bruise” instead of “Did your spouse do this to you-” – If the perpetrator is present, assess for substance abuse – For victim – Get medical treatment as needed – Help victim protect herself—referral, escape plan – Challenge victim’s denial and self blame – Help client understand the situation (cycle of violence) and their options – Support group referral DV Intervention – For Perpetrator – Break through denial – Get commitment to a no-violence contract – Teach anger management skills – Support group referral Child Abuse Indicators – In Children – Sudden change in behavior – Excessive clinginess – Regression – Suicidal behavior – Antisocial behavior – Fear of adults – Overly sexualized behavior – Sleep disturbances – Childhood pregnancy or STD – School problems – In Adults – Unconcerned about child’s injuries – Provides false explanations – Conceals injuries – Uses harsh discipline – Has overly high expectations for the child – Was abused as a child – Extremely jealous or overprotective – Lacks social support outside the family Child Abuse Interventions – Mandatory reporting – Medical treatment – Ensure safety – Mobilize family support systems – Refer parents to

Summary - Enhancing adolescent development means - Preventing adverse childhood experiences - Ensuring adequate growth and development - Enhancing protective factors in the person, home, school and community - Strategies include - Involving community groups, rec centers, businesses in providing opportunities for youth recreation and leadership - Working with schools to adjust curriculum to teach skills necessary for success including resiliency skills, health literacy and mental health promotion - Ensuring families have access to the resources they need to create a safe and nurturing environment - Involving youth in identifying problems, challenges, gaps in resources and incentives for participation

Summary - Burnout work environments are a reality - Burnout does not have to be - Burnout causes problems in - Health - Mental Health - Relationships - Work environment and employee retention - Ability to provide client services - Develop resilience and identifying the sources and interventions for your burnout

Summary Resources - 100 Day Kit for Families - Age appropriate autism materials - Building Our Future: Educating Students on the Autism Spectrum - Autism Information for Social Workers and Counselors - Supporting Appropriate Behavior in Students with Asperger’s - Next Steps: A Guide For Families New To Autism - Puberty and Children on the Autism Spectrum - Transition-Preparing_for_a_Lifetime - Growing Up Together (For School-Aged Peers) - Growing Up Together (For Middle School-Aged Peers)