Full Course Description

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High Risk Clients: Effectively Handle Five of the Most Critical Scenarios You’ll Face as a Clinician

Program Information

Outline

• Client Assessment: Ask the Right Questions
  • Conduct comprehensive assessments
    • Mini mental status exam
    • Lethality assessment: Suicide and homicide
    • Substance use assessment
    • Trauma assessment
  • Tips and strategies for eliciting the right information
• The Suicidal Client: More than 13 Reasons Why
  • High-risk populations—who is most at risk?
  • Implicit and explicit expressions of suicidal ideation and intent
  • Self-injurious behavior and suicidal ideation
  • Suicide assessment and interviews: Ideation, plans, means, intent
  • What do I do now? —Disposition & safety planning
    • Why “No-Harm Contracts” are harmful
    • Breaking client confidentiality
    • When in doubt, do what?
  • Hospitalization process
  • After the ER: When clients are not admitted
  • Case studies:
    • Michelle—Teenagers experiencing suicidal ideation
    • William—The intersection of substance use, mental illness and suicidality
• The Violent Client: Manage Dangerous Situations
  • Dealing with our fears: Clinicians’ safety concerns
  • When the clinician is the target
  • When others are the target
  • De-escalation techniques
  • Preventative planning
    • Office layout
    • Keeping good boundaries
    • Police involvement before a crisis
  • Safety planning
  • When to call 911
  • Hospitalization process
  • Duty to warn
  • Case studies:
    • George—Handle a violent client
    • Dale—Practice Duty to Warn
• The Addicted Client: What ALL Clinicians Need to Know
  • How misdiagnosis harms clients
  • Signs of intoxication
  • Imminent risk: Signs and symptoms of overdose
  • Identify withdrawal syndromes
  • Accurate diagnosis and treatment matching
  • Drug basics that clinicians should know:
    • Opioids and the opioid crisis (heroin, fentanyl and emerging drugs)
    • Stimulants (cocaine, “bath salts,” methamphetamine)
    • Cannabinoids (“shatter,” spice)
    • Other chemicals (DXM, “Special K,” Ayahuasca)
  • When and how to refer to a higher level of care
  • Case studies:
    • Percy—Opioid crisis in the waiting room
    • Cathy—Bipolar Disorder? Think again
• The Traumatized Client: Help Without Hurting
  • Recognize trauma in clients
  • The risk of misdiagnosis
  • Dangers of improper treatment
  • Strategies for trauma-informed care
    • First and foremost: Safety inside and outside the clinic
    • The role of mindfulness
    • Go slow…but go
  • Understand Levels of Safety
  • Triune Brain Model and trauma
  • Bereavement: Not always trauma
  • The intersection of trauma, mental health, substance abuse and medical problems
  • Case studies:
    • Brian—Trauma missed
    • Mick—“How deep can I bury this?”
• Medical vs. Psychiatric Problems: Limiting Harm
  • “What Could Kill the Patient First?”
  • Collaborative care with primary physician
  • Medical emergencies that present with psychological symptoms
  • Signs and symptoms: Limit client harm by recognizing a medical emergency
    • Medication-Related Disorders
    • Traumatic Brain Injury (TBI)
    • Neurocognitive Disorders
    • Other Neurological Illnesses
  • Case studies:
    • Steven and the Zombies—Organic disorders
    • “Granny has schizophrenia!”
• High Risk Clinicians: After the Crisis
  • Protect your license and manage liability
  • Documentation: What you need to know
  • Debriefing and supervision
  • Vicarious trauma
  • Addressing compassion fatigue
  • Case study:
    • Dave and me

• Limitations and Potential Risks

  • Limited controlled studies
  • Seek supervision when necessary
  • Weigh out risk of intervening versus not intervening

Objectives

1. Complete a comprehensive mental health assessment that encompasses a multitude of clinical concerns including mental status, lethality, substance abuse and trauma.
2. Determine signs of and risk factors for suicidal ideation in clients and effectively respond in order to ensure the safety of the client.
3. Assess indicators of substance intoxication, withdrawal and overdose in clients and create protocol for responding appropriately.
4. Assess for risk of violence in a clinical setting and develop skills to effectively and safely intervene during an acute crisis.
5. Examine ways in which client responses to trauma are often misdiagnosed as mental health disorders and consider the clinical implications of this.
6. Create accurate and comprehensive documentation of clinical crises to protect all.

Copyright : 18/04/2018

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Suicide Assessment and Intervention: Assess Suicidal Ideation and Effectively Intervene in Crisis Situations with Confidence, Composure and Sensitivity

Program Information

Objectives

1. Assess individuals at risk of suicide with a clinical approach that identifies both explicit and implicit expressions of suicidal thought.
2. Ascertain key indicators of imminent suicide and develop a strategy for determining when and how to hospitalize clients.
3. Formulate a CBT and DBT oriented case conceptualization that addresses how to effectively work with specific populations including veterans and the elderly.
4. Employ a collaborative safety approach to help clients survive a suicidal crisis while avoiding the pitfalls of suicide contracting and the false sense of security and decreased clinical vigilance that can accompany their use.
5. Develop communication strategies that convey your compassion and support and strengthen the therapeutic alliance.
6. Design a multi-systemic approach that reduces access to lethal means and incorporates the suicidal person’s social connections into their safety plan.

Outline

Suicide: Who, When, How and Where

• Addiction recovery
• Trauma-informed care
• Populations with multiple risk factors
• Suicide attempt survivors – learning from their experience
• Upstream clinical practices: reaching people before the point of crisis

Elicit Key Information from Suicidal Clients: Assessment and Level of Risk

• Implicit and explicit expressions of suicidal thoughts
• Communicating caring: Language to impart compassion and avoid stigma
• Suicide risk assessment
  • SAFE-T
  • PATH WARM
  • Ideation, plan, means, intent
  • Level of risk

Formulate Treatment Plans that Help Clients Regulate Emotions and Make Them Feel Valued and Connected

• Collaborative safety planning (or “Why Suicide Contracting is Dead”)
• Proactive approaches to decrease the likelihood of suicidal despair
• Multi-system approaches – support systems
• Evidence-based treatments:
  • Cognitive Behavioral Therapy
    • Cognitive restructuring strategies
    • Emotional regulation exercises
    • Behavioral Activation
  • Dialectical Behavior Therapy
    • How to organize a skills training group
    • Tips for phone coaching
  • Relapse prevention plans
  • Reduce access to lethal means
  • Working with specific populations: veterans, the elderly

Confidently Handle Crisis Situations

• Conduct a behavioral chain analysis
• Validating reasons for suicide
• Identify reasons for living
• Use distress tolerance and CBT skills to manage a crisis
• When and how to hospitalize

Suicide Grief Support and Innovative Suicide-Specific Care

• Implement Suicide Grief Support
  • Understand the unique nature of suicide grief
  • Peer-based support: Connect clients to other survivors of loss
  • Access and Reclaim compassion
    • Somatic resourcing
    • Remembered resources
    • Assess clients self-talk

ReInvest in a Life Worth Living: Rekindle the Desires of the Heart

• The PIE of life – brainstorm possibilities of growth
• Cultivate social connection and re-engagement
  • Support and grief groups
  • Toxic people
  • Working with families impacted by loss
• Choice and perspective
• Foster gratitude and a spirit of contentment after loss
• Measurements of Post-Traumatic Growth

Please Note: PESI is not affiliated or associated with Marsha M. Linehan, PhD, ABPP, or her organizations.

Copyright : 08/06/2018

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