Clinical Mental Health Counseling, Class 2
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Ethics & Legal Considerations, Evidenced-Based Programs, DSM-5 Fundamentals, Mental Status Exam
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Clinical Mental Health Counseling, Class 2
- 1. Course: CED 5972 Presenter: John Grady, LPC, LCADC, ACS, CCS, NCC Class Two
- 2. *
- 3. * *Intro selves * Q’s for the class * Ethics & Legal Considerations * DSM-5: Fundamentals & Classification System * Article Discussion Half-Time! (or go right through) *WHODAS 2.0 *Global Assessment of Functioning (no long used) *Mental Status Exam (MSE) components *Tx Team Meeting Exercise
- 4. * *How far along are you in the Counseling program? *What licensure are you pursuing? *What are your strengths? *What are your favorite accomplishments?
- 5. * *What did you find most useful from last week’s class? *Does the DSM-5 adhere more to the Medical Model or the Wellness Model? *How does the answer affect your view of diagnosing clients as part of their treatment? * What subjects are you interested in (for your article presentation)? *Any remaining questions regarding the many career paths you may wish to pursue?
- 6. * *As we discuss our topics, please sign up for your article presentation date…
- 7. Ethical & Legal Considerations *ACA Code of Ethics *Influenced by 5 moral principles *2014: 9 sections *Ethics Support: Erin T. Shifflett; 800-347-6647; ethics@counseling.org *Using Evidenced-Based Practices *ACA Ethics - C.7.b.: Scientific basis for Tx * Boundaries of Competence (C.2.a) *Law & Legal Regulations: Governing Entities, Clinical Practice *Ethics: Decision Making, Professionalism *Legal resources: *American Bar Association *Legal Action Center *ACA Risk Management Service (legal): Anne Marie Wheeler * Referred after speaking to Ethics support *Conflicts – Ethics vs. Laws *ACA Ethics – I.1.c
- 8. * * Substance Abuse and Mental Health Services Administration (SAMHSA) webguide: Evidence-Based Practices (EBP) *http://www.samhsa.gov/ebp-web-guide *SAMHSA’s National Registry of Evidence-Based Programs & Practices *http://www.samhsa.gov/nrepp *Cognitive Behavioral Therapy (CBT) *Motivational Interviewing (MI) *Effective Child Therapy *http://effectivechildtherapy.org/ *For Professionals & Educators *CBT, Family Therapy, *Offers specific EB Tx Programs summaries w/links to additional info
- 9. * *DSM-5: The World Standard for evaluation & assessment. *International Classification of Diseases, 10th Rev. (ICD-10) codes *ACA Ethics: Diagnosis of Mental Disorders – E.5 *“Essential Features”/”Prototype Method” to establish Dx *Use to generate additional exploration *Mental Disorder defined *Physical Conditions & Disorders *Can directly impact mental Dx or the management of mental disorder *Psycho-social & Environmental Problems *May be independent of mental disorder or caused by it *ICD-10 Z codes (used by DSM-5)
- 12. * 5 Axis system of previous editions: Eliminated * All mental, personality, physical disorders are recorded in the same place *Principal Dx first *Reflects the Dx most responsible for current evaluation *Provisional Dx *Unspecified Dx; Other Specified Dx *Consider “The D’s” *Specifiers; subtypes; severity
- 14. *
- 15. * * What is a meta-analysis? * What are some symptoms of PTSD? * What is a “bona fide” treatment for PTSD? * What was the conclusion? * How do the results of such studies compare to your clinical experiences working with clients? *Which have more impact on your clinical estimation of client needs? *Or, if you have yet to work with clients, how do you think your decisions will be affected by studies vs. professional experiences?
- 16. Please Return in 10 minutes…
- 17. * *World Health Organization Disability Assessment Schedule, Version 2.0 *Replaces the Global Assessment of Functioning (GAF) of previous versions *Generic assessment for health and disability *6 Domains of Functioning *12 and 36-item versions, covering previous month *Scoring: 0-100 * 0=no disability *100= full disability *Weighted towards physical abilities *Review Manual
- 19. * *In use from DSM-III-TR through DSM IV-TR *100 point scale *Reflected overall occupational, psychological, & social functioning *Did not consider physical limitations or environmental problems *Subjective in nature – was useful for tracking changes in patients level of functioning over time GAF
- 20. * *Appearance: *Posture, clothes, grooming, gait *Behavior: *Mannerisms, gestures, expressions *Psychomotor activity (rate of movement) *E.g. Talking speed, fidgeting, repetitive movements *Eye contact, ability to follow discussion, compulsions *Attitude: *Cooperative, hostile, open, defensive, apathetic *Secretive, evasive, disinterested, focused
- 21. *What mental status exam (MSE) information – Appearance, Behavior, Attitude – did you observe? *Bonus Q: How do you feel about Paul’s absolute refusal to provide judicious self-disclosures (especially about family)?
- 22. *Summary *Key info to remember: *Ethical & Legal considerations *DSM-5 Classification System *Upcoming responsibilities: *TIP 59: Chapters 2&3 * http://store.samhsa.gov/product/TIP-59-Improving- Cultural-Competence/SMA15-4849 *STEP Notes Guidelines webpage: http://www.ncda.org/aws/NCDA/pt/sd/news_article/88604 /_PARENT/layout_details_cc/false
- 23. * America Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. Diamond, R. J. (2009). Instant psychopharmacology, 3rd ed. New York, NY: W.W. Norton & Company. Jongsma, A. E., Peterson, L.M., & Bruce, T.J. (2014). The complete adult psychotherapy treatment planner (5th ed.). New York, NY: Wiley. Morrison, J. (2014). DSM-5 made easy: The clinician’s guide to diagnosis. New York, NY: The Guilford Press. Preston, J., & Johnson, J. (2015). Clinical psychopharmacology made ridiculously simple (8th ed.). Miami, FL: MedMaster, Inc.
Editor's Notes
- ACA Code – influenced by Kitchener’s 5 moral principles * Autonomy: concept of independence & ability to make one’s own decisions * Justice: treating each person fairly * Beneficence: doing good, or doing what is client’s best interest * Nonmaleficence: do no harm * Fidelity: loyalty; faithfulness; honoring commitments Sections: The Counseling Relationship; Confidentiality and Privacy; Professional Responsibility; Relationships with other Professionals; Evaluation, Assessment, and Interpretation; Supervision, Training, and Teaching; Research and Publication; Distance counseling, technology, and social media; Resolving ethical issues --- Ethics – C.7.b: Use techniques/procedures/modalities that are grounded in theory or have empirical or scientific foundation --- C.2.a: Boundaries of Competence: Practice w/in boundaries of competence based on 1) education, 2) training, 3), supervised experienced, 4) state and national professional credentials, and 5) appropriate professional experience --- Laws: More prescriptive than ethical standards; greater sanctions/consequences Governing entities: Courts; Fed/State agencies Clinical Practice: Location & type; other professionals Decision making: ethical codes; ethical training; supervision; consultation Professionalism: licensing board; professional organization; colleagues --- Legal Action Center: Fights discrimination vs. persons with Hx of addiction, illness, criminal behavior --- I.1.c: Make known commitment to Code of Ethics and attempt to resolve conflict; if cannot, acting w/in client’s best interests, adhere to the requirements of the law
- CBT: Guides clients to modify dysfunctional cognition and behavioral patterns associated with presenting problems --- MI: Conversational approach that helps clients address ambivalence to change --- Key components: Accurate empathy, Avoid arguments Adjust to resistance (not opposing directly) Empower self-efficacy & optimism Develop discrepancy between client goals/values and current behaviors
- ICD-10: Copywrited by World Health Organization (WHO) - a coding of diseases, signs and symptoms, external causes of disease, etc. - October 1, 2015 – new compliance date (according to CMS – Medicaid and Medicare) - New features: expanded injury codes; greater specificity - affects Dx and inpatient procedure for all covered by HIPAA --- ACA Ethics & Dx – E.5: Proper Dx; Cultural Sensitivity; Hx and Social Prejudice in Dxing of pathology; Refraining from Dx --- Essential Features/Prototypes: Compare data from current client to a “picture” of how we interpret various mental or behavioral disorders (which is based on experience, clinical intuition, study of diagnostic criteria) * Scale – how ideally does your client match the Dx you are considering? Use scale of 1-5 * Consider Jongsma’s “Diagnostic Suggestions” category to explore DSM 5 criteria --- Mental Disorder: A collection of symptoms, which can be behavioral or psychological, that causes a person disability or distress in social, personal, or occupational functioning --- Zcodes: conditions, not mental disorders, but require clinical attention
- 5 axis system: Recorded biopsychosocial assessment of clients Axis 1: Principal Disorder requiring immediate attention Axis 2: Personality Disorder Axis 3: Medical or neurological disorder Axis 4: Psychosocial stressors Axis 5: Level of Functioning (GAF) --- Provisional Dx: One believes that Dx is appropriate but sufficient Hx has not been attained - could be due to limited contact with client - could be that symptoms are anticipated with continued ct. contact - could be that lab tests have yet to confirm medical condition or SA --- Unspecified Dx: Ct. doesn’t fully meet Dx criteria (based on self-report denial of important symptoms) – reasons are not specified -- Other specified: Same as unspecified, but reasons are specified (e.g. duration of Sx shorter than required) --- The D’s: Differential Dx: Alternative disorders when evaluating symptoms (e.g. SA, general medical disorders) Distress or Disability: Challenges are severe enough to affect work, social interactions, etc. Duration: Minimum length of time needed to qualify as disorder (e.g. several weeks) to avoid misdiagnosis of transient difficulties Demographics: Some disorders are limited to certain age groups or genders (e.g. Premenstrual Dysphoric Disorder) --- Specifiers: Some disorders include considerations of presence – or absence – of certain symptoms, degrees of remissions, onsets of recovery and whether they are partial or full Subtype: e.g. PTSD in children younger than 6 years Severity: Varies by disorder but self explanatory…. E.g. Mild-moderate-severe (and profound, such as in intellectual disability) ----- Meeting Notes (9/10/15 16:06) ----- Specifier e.g.: Social Anxiety Disorder - performance only (e.g. fears public speaking or performing, but not other situations)
- Meta Analysis: Statistical technique for combining the findings from independents studies - often used to assess clinical effectiveness of healthcare interventions - this study was unique in that it 1) only included studies that compared 2 or more therapies, 2) did not classify Tx into categories, and 3) included only those treatments that were intended to be therapeutic --- PTSD Sx: Re-experiencing; avoidance of specifics or generalizations to Tx; hyperarounsal; hypervigilence --- “Bona fide”: Use of Wampold criteria – Main criteria: therapy was delivered by a trained therapist with established relationship with client; Tx was tailored to ct. needs --- Conclusion: Psychotherapy is effective (as compared to no Tx) & bona fide Txs provide same benefits for PTSD clients
- 6 domains: Cognition (understanding & communicating); mobility (getting around); self-care (hygiene); getting along (interacting with others); life activities (leisure, work); participation (in community activities)
- MSE: Structured assessment of patient’s behavioral and cognitive functioning.
- https://www.youtube.com/watch?v=6wRAVKZYDW4 Judicious self-disclosures: (Paul does jokingly state that he has trouble with email when Frances talks about difficulty working social media) - Paul’s insights derived from personal experiences (w/family) might be communicated through his acknowledging the difficulty of loving a rejecting child As a team: What are the most important reported symptoms, observed behaviors? What “family” of disorders (e.g. Depressive Disorders) would the symptoms likely “fit in”? (If more than one, please list in order of prominence) What are the three most important reported symptoms, background data, etc. What information, if any, needs to be gathered for a more educated diagnosis? Given the presented information, what diagnosis(es) seems most reasonable? If you are unsure, which “family” of disorders (e.g. Depressive Disorders) would the described symptoms likely “fit in”? What are your goals for next session?