Wednesday, September 30, 2009
Tonight we went over the six dimensions of assessment again and then we learned about levels of care. I am printing the information now. Encouraging us to collect and save this info, our teacher made the observation that although this is a short class, it is giving us more time to dive in and learn than we would on the job. She also said “counseling is an art” meaning the more we have a chance to use the assessment tools on the job, the easier it will be for us to work with clients and see what needs to be done to best help them.
Our teacher and other classmates have been able to enhance the class material with information gleaned from on-the-job experience. This has been pretty helpful to me, since I am new to this field.
I know this blog is to share my thoughts and opinions about the class but, as the "script" that is used while counseling is so helpful and vital to building a relationship I am going to just list a few of the jems that were shared tonight along with their importance.
- "In the past how long did you go without using?" (building confidence)
- "Do you feel emotional warmth when you enter your home" (change what you can)
- "It's OK to be here for awhile. We can take all the time you need! Everyone is different" (Stages of change)
- Decompression - When teens come home from treatment and realize that they are no longer in a safe environment. Now they have to deal with real people. So we try to get them in a program that matches as closely as possible their home environment.
- "Let me show you something, to see what you think." (Show them the stages of change and let them see if they can identify their stage)
- Great tip. List the services on the level of care cheat sheet where they fit in.
As always doing this blog is a great review that sets information in my brain. Let's just hope it sticks. I only wish I would have listened to the class with the perspective of documenting tools from a seasoned professional.
Levels of care (Cheat Sheet) provides very good explanation and criteria for placement. With interest I learned today, that the Levels of Care can be incorporated with recommended services for different programs. That piece definitely advanced my knowledge. I feel I have more screening tools now and equipped better. Seems to me ASAM-PPC2R , Levels of Care, Levels of Change are our "multiplication table" for Substance Abuse professionals.
I appreciate everyone's time and feedback on my presentation and look forward to hear rest of the class team on Monday.
“Learn from yesterday, live for today, hope for tomorrow. The important thing is not to stop questioning.” Albert Einstein quotes
Learning about the different treatment programs for our clients and families is also very helpful. There are times when I have to do referrals for clients or families, so knowing that there's different treatment centers available is a must. It would be nice to have a listing of all the treatment centers in Alaska.
Learning from each other in class and from Lara has helped me a great deal and I am so thankful for that. Another great learning experience in class, as usual. Thank you...
Reviewing the stages of change was nice. I had read them but listening to everyone else state examples and scenarios puts everything into prespective. This is a great tool that I will keep with me at work.
The levels of care is a very helpfull reference as well. I have often wondered how the levels of care are determined and this handout as well as the discussion helped me to better understand.
The review of the ASAM dimentions was something I really needed. I read through it, but as with the stages of change, it is always better for me to get others feedback and opinions. I feel confident that I will do well on my final with all of the handouts and worksheets provided.
Monday, September 28, 2009
The six ASAM Assessment dimensions are key to understanding a client’s condition and finding the best approach to helping a person with substance abuse issues. We learned that people with substance abuse problems often don’t seek help for other health problems, both emotional and physical. Sometimes they may not even realize they have other health issues. Part of the assessment is to note what other problems the person may have. We are going to treat the whole person.
I love the way our teacher has provided all of this information for us on the “bookshelf” of our virtual classroom. In this short class she has introduced us to some valuable stuff! I hope that we can talk some more about the assessment dimensions and stages of change in the next class.
ASAM dimensions underline comprehensive assesment and treatment plan and promote integration of knowledge about client's perspective.
1. Acute Intoxication and/or Withdrawal Potential
- Past history of serious, life-threatening withdrawal
- Currently having similar withdrawal symptoms
2. Biomedical conditions and complications
- Any current severe health problems
3. Emotional/Behavioral/Cognitive conditions and
- Imminent danger of harm to self/others
- Unable to function
4. Readiness to Change
- Ambivalent or feels treatment unnecessary
- Coerced, mandated, required assessment
5. Relapse/Continued Use/Continued Problem potential
- Currently under the influence
- Continued use/problems imminently dangerous
6. Recovery Environment
- Immediate threats to safety, well-being, sobriety
Supporting questions for each dimension of ASAM help to determine and clarify the placement criteria. I found that dimension questions can be quite practical. It was new material for me.
The American Society of Addiction Medicine's (ASAM) Patient Placement Criteria (ASAM PPC-2R) is guidelines for placement, continued care, recommendations and discharge of patients with alcohol and other drug problems.
Thinking about Substance Abuse professional field, it is life time dimension.
“There is nothing wrong with change, if it is in the right direction” Winston Churchill
Now having said that I want to reinforce how much the information that has been shared in this class has meant to me in terms of having gained some measure of confidence and a direction for more information in all the handouts that were posted. We certainly are not going to go into the workforce empty handed.
Sunday, September 27, 2009
The second movie seemed to be bits of a presentation from a very dynamic woman who not only shared facts that made me not want to use but brought up information that was new to me. I think the most dynamic part was that Marijuana can lead to cardiac arivula and that recepters covering the memory centers are all totally affected by Marijuana. I am so often faced with the "it's just pot" routine and just realized how unarmed I am to address it. She was very factual and short with her answers. They were like a gun going off. The other new piece of information was that the front brain is connected to the emotional brain but not until full maturity. Teens are not even equipted to put the information together with the caring emotional piece of themselves which has validated my gut feeling that I needed to protect my kids from association with drugs any way I can. And that is why they are homeschooling.
The third movie was not new information for me and I was dissapointed that there was not more on the reasons why women get addicted to alcohol easier. It was a movie perhaps more aimed at breaking down the denial of women as they might hear stories that they could relate to. I am not sure that it hit it's mark because I could even hear myself saying, "Oh that's not me", and I have 22 years clean and sober. Still there was one thing that was that women who started drinking younger had a greater chance of becomming addicted later in life. Again grist for our mill to protect our youth.
Thursday, September 24, 2009
The video on the Complexity of Drug Abuse was a good question and answer session. It was stated that Drugs are an everyday occurance and that people are being as responsible as possible, but due to the human behavior substance abuse happens. I strongly belive in these statements. Nobody wants to become an addict, it just happens. Learning the facts about drugs and the skills needed to either overcome or say no from the begining is very important!!
This brings me to the Teen discussion on drug abuse. I really enjoyed this video. I believe that prevention is the key when it comes to youth. I liked how the kids got involved and asked questions. I wish there was someone to teach prevention when I was in school, or at least give information about what the effects of drugs are, not just say "drugs are bad". I think that drug abuse awareness needs to be incorporated into every high school curriculum.
The women and alcohol video was very emotional. The thing that stood out the most for me was the fact "alcohol kills more teenagers than all other illegal drugs combined" I was shocked by this statistic.
It was nice to see a happy ending and all the women telling how long they have been sober for. This video gives hope for many!
Wednesday, September 23, 2009
Dr. Nora Volkow did a teen discussion on drug abuse, and these teens listened because Dr. Volkow was well known. She stated that when you are an adolescent, that is when you learn the most, because of your brain. She talked about internet addiction and cannaboid's, too. The teens gave good feed back on her discussion.
Alcohol, a women's health issue. Was a discussion based on seven women on their road to healing. After all, genetics plays a big role in rist factors. After you get older, you need more alcohol to get the same effect as when you first started. Alcohol abuse has caused them to miss functions, and to have their children taken away. Women feel vulunerable. This causes brain, liver, and heart damage, and also breast cancer. The younger a women drinks, the greater the chance of problems with alcohol later in life.
When a family member becomes addicted to drugs or alcohol, it affects the whole family unit. No one is sure what to do or how to react. This is a often a time to practice tough love. Family members must be firm with the addict in order not to be guilty of becoming enablers for his or her addiction. When the addict reaches rock bottom, he or she may realize that it is his or her responsibility to rebuild his or her life. Now it is up to him or her to claw his of her way out of the hole he or she has dug. His or her friends and family can either help or hinder his or her efforts.
Alcohol and drug use has become a sort of tradition in American culture. It’s a coming-of-age rite for teenagers and a social bonding ritual for men, women, and adolescents. Environment influences a person’s susceptibility to alcohol use and abuse. If everyone else is doing it, shouldn’t you do it too?
Nora Volkow in one of the Harlem's High School , NY discussed controversial topic on How Brain, Body and Behavior affected by drug use. Brain continues to be developed till age 25, so when adolescents start using drugs it affect memory, emotional state, abstract thinking, body organs. Most likely teens will exhibit risky behaviors (experimental, compulsive).
Alcohol abuse is a serious woman's health issue. Statistical data showing that 4 million women in United States abusively use alcohol or they are alcoholics. More than a half of population have family member involved in alcohol. Alcohol kills more teenagers than all illegal drugs combined. Alcoholism can happened regardless of age, culture, race, or environment. Genetics play contribution toward being risk factor. Women react to alcohol differently than man. More younger age women involved with alcohol more chance it will be a problem later in her life. Alcohol destroys families, relationship, self-esteem, body organs, taking away lives. Alcohol abuse and gender differences should be taken into account when treatment or prevention needed. Concentration on substance abuse education with prevention programs support are important focus for healthy generations.
The following excerpt is taking from the book Little Prince by A. Saint Exupery
The next planet was inhabited by a tippler.
This was a very short visit, but it plunged the little prince into deep dejection. "What are you doing there?" he said to the tippler, whom he found settled down in silence before a collection of empty bottles and also a collection of full bottles.
"I am drinking," replied the tippler, with a lugubrious air.
"Why are you drinking?" demanded the little prince.
"So that I may forget," replied the tippler. "Forget what?" inquired the little prince, who already was sorry for him.
"Forget that I am ashamed," the tippler confessed, hanging his head.
"Ashamed of what?" insisted the little prince, who wanted to help him.
"Ashamed of drinking!" The tippler brought his speech to an end, and shut himself up in an impregnable silence.
And the little prince went away, puzzled. "The grown-ups are certainly very, very odd," he said to himself, as he continued on his journey.
Monday, September 21, 2009
Explaining a bit about myself and the services I can offer to the client, and finding little ways to complement them, are two things I can do when meeting a client to create a more relaxed atmosphere. “What can I help you with?” sounds like a useful question to ask the client. Also they might be more willing to participate in an assessment honestly if I mention I would like to spend more time listening to them at the next appointment, for the assessment, when I am ready to make that appointment. I liked one student’s comment that she would want to tell this assessor everything – she said it was because of the accent or something, and I don’t have that but anyhow, I would like to have that quality of “I could tell you everything” in my work! The notion that counselors and substance abuse assessors pay attention to their gut feeling about a client is good also, because more often we are going to encounter lying and minimizing the truth.
At the end of the class we learned the “assessment dimensions” which are the main topics covered by all substance abuse assessments. I want to print out the information the instructor said she was putting on blackboard for us. I am thankful to be receiving so much information in this class.
I am slowly beginning to develop an outline for my oral presentation. I was glad to get some clarity on this assignment.
Today I have learn something new, that I can relate to my approach. I know I have an accent (sometimes it devalue my confidentiality), but never thought it will be not bad idea to ask my clients, if I have been understood well. So I appreciate for pointing this out. Counselors need to learn as much about themselves as about their clients and need be respectful of client's level of knowledge, experience and competency.
“As we grow as unique persons, we learn to respect the uniqueness of others.” Robert H. Schulle
This was a very intense class for me as it covered so many areas from how to relax a client or break down barriers to the six dimensions of an assessment. I am very happy to have the hands on experience as well as being able to listen in to others as they experience doing the screening. I also like that we are going through all the stages that a client may experience which lead up to the assessment. I had no idea that this process was so involved. I remember someone telling me that they had answered the 7 questions and from that knew that they were an alcoholic. Unfortunately there is much more involved and I would like to share some great suggestions that I hope to remember when a real life screening comes my way.
First of all, I liked that some housekeeping was done to relax the client. This may involve going over confidentiality, explaining what a screening is and that their right not to answer would be respected to please feel free to ask me to repeat myself if you do not understand. I also liked that while getting to know the person it is important to find out what the purpose of meeting with them is. When the scenario was presented that a person with 25 years recovery may come in, all the rules seemed to change. Now we have to dig a little deeper to see what their need may be as they already knew recovery. Something else may have been put on their plate that needed addressing which wasn’t there before. Some key words or questions I would like to remember were, “What’s not working this time? Does this person need to go to treatment? Is there anything in their past that may be coming up? Are the relationship issues, depression or dual diagnoses? Having thought through these questions I love that the professor pointed out that our questions lead us to the answer. The above questions signify that an assessment needs to be done and beyond that perhaps referrals for outside help.
Another great tidbit of the evening was what the teacher tells court referred clients. That is, “I want you to know that I’m only going to report your participation because you know I have to. You always have a choice whether to answer or not. Then after a brief on assessments I can see that we will just see the tip of the iceberg on these topics by the end of the class. So I am grateful for all the extra readings that are offered to stretch my knowledge.
I will watch the three videos on BLOG and write about it, before Wednesday's class.
I will also start working on my oral presentation. Maybe I will get an article from the newsminer or ADN.
I am finally able to log back into blackboard (thanks to UAF helpline), so now I can have access to everything that will be taught in class.
Today was a good day in class...thanks for reading my blog.
I felt a bit uncomfortable at first, just because it was something new and I could tell that my client was going to be a difficult one right from the get go.
I enjoyed the feedback from both the instructor and the students.
I tried to stay positive and get as much information as possible from the reluctant client.
I liked the suggestion about mentioning confidentiality in the very begining as an ice breaker. Some people may be reluctant to disclose personal information if they are not told it is confidential.
It is difficult to find things in common while doing the screening over the phone, but I think that after practice and carefull considerations of all the feedback, I may be able to do better next time around.
The second screener did a great job. She has a very soft voice and seems easy to talk to. I would feel comfortable talking with her. I like her comment " I admire your 25 years of sobriety" that is quite the ackomplishment and everyone deserves to be recognized for that.
Overall the class went great and I look forward to final presentations.
Wednesday, September 16, 2009
Having the opportunity to experience doing an assessment that felt so real was awesome. I missed the eye contact and offering of a cup of tea which relaxes me, but was very much reminded of the anger that is holding back the truth with this disease. Even while listening to the other classmate do her skit I knew that the personality portrayed was very real. I think It has prepared me for being ready to, “soften”. That is the word used by the professor which will be waiting in my mind like a mantra. While working with kids who have behavior (anger) issues I find that just waiting (softly) is often what they need and they join the circle on their own. I also like the comment that invited us to let their anger flow through us. That is kind of like being a ninja and using non resistance. Or maybe it is just showing them that we have safe space and they can too. I have my own fears and anger about this disease and without this awareness I may react which would not be helpful. There is a little rambling here but I am learning as I talk and I thank you all for listening.
- Active Listening
- Formulating questions (Miracle questions/ Open-Closed questions)
- Getting details
- Echoing client's words
- Non-verbal responses
- Complimenting, etc
are all can be effectively used during assessment.
The mission of counselors (consultants) is to empower clients with more knowledge and encourage to live life more productively. If counselors only focus on clients problems or disorders, clients may feel that they are victims of dysfunctional life. Helping clients to discover their own potential for recovery, find their own strength, motivating them to manage new life style skills and most important believing in and supporting in their progress will contribute to success of intervention outcome.
“Seeds of faith are always within us; sometimes it takes a crisis to nourish and encourage their growth.”Susan Taylor
The example later presented about the patient asking for anti-depressants and the follow up from the physician on researching the patient history was great! I know everyone in the medical field are very busy and want to provide the best care possible for the patients but I would really love to see more traditional, natural healing techniques being used. I understand that South Central has tribal doctors which is something I would like to learn more about.
The substance abuse screening scenarios were fun to listen to. The first one was excellent and really made me feel comfortable listening to it. The tone of both the client and the helpers voices really set the mood.
The second screening was tense and uncomfortable, a perfect example of the diversity you may encounter when working with substance abuse.
The feedback was great and the instructors tips helped. The main idea is to connect with the client and make them feel comfortable disclosing such sensitive information.
I esspessially like the idea of making sure and ask the client if you can see them again. I think this really makes the client feel that you care.
I was so nervous today in class because I haven't done a screening before. At first, my mind went scrambling for answers, which made me uncomfortable. And, the questions that I asked got my client irritated because my client didn't think she had a problem. And, this is not what I want to do in a real screening. I will continue to practice my techniques with coworkers or family members, to make me feel more comfortable. I will learn to listen more, I will learn to relax and not get so nervous, I will be as sweet as possible, and I will add a little humor to my screenings. I will do what it takes to make my client feel comfortable talking with me, and also to let them know that I'm there if they ever need me at any time.
Today was quite the experience for me, but I'm glad that I am here to help or assist people in need. Thank you for reading my blog.
Monday, September 14, 2009
One of the Jems of wisdom was, “Be kind to them. They will soften.” I can imagine myself in their shoes with a soft voiced woman like our professor offering me a cup of tea like she was inviting me into her living room. There is nothing better than feeling like someone likes me and would love for me to come back. Better yet if that like could be projected as unconditional acceptance. Now that is a skill that I would like to know more about. In a co-counseling course one of their tenants was that everyone is doing the best they can with what they have. I have processed this many times and find it to be true for me and we are all starting where we are. Another nugget was, “People will reflect back your feelings about them.” Boy isn’t that the truth.
I have three daughters in the hormonal puberty stage and if I am looking at them as cranky snarly teens they give it right back to me. If I am telling them about their strengths and gifts they are just that awesome. Today I made a commitment to do my best to put on my rose colored glasses which only reflect their value. And as I think about them I remembered another one liner that I heard tonight. That is, “Hurt feelings come out in anger”. And when anger is coming at me it probably has very little to do with me. So tomorrow I am going to try on the, “Be kind to them. They will soften.” All day. Thanks for a great class Professor H.
Another thing we were starting to talk about was being able to encourage people to change, letting them know you believe in their ability to get better. As helpers, we need to maintain a super positive attitude and be able to find the goodness in all kinds of people and situations.
One more thing to recognize prior to assessment is that bringing up this topic is bound to make people nervous. It may even cause some powerful feelings like anger, guilt, or embarrassment. Some people are going to try to hide their problem or play down how serious a problem is.
I am also interested in the final exam. I have never taken an exam over the phone or on Blackboard so I am looking forward to experiencing that.
Also, tonight in class we began talking about assessments and the "pre-assessment".
In order to get truthfull information which will benefit the assessment and the client in the long run, to individual needs to feel comfortable. This sometimes is not such an easy task.
I know how hard it is to walk through the doors of an agency for a substance abuse assessment, let alone divulge all of your personal information to either a complete stranger or to someone who isnt too fond of you because of the bad choices you have made in the past.
I have used the technique of finding something to comment them on to break the ice, and let them know that you arent here to critisize or judge.
In some cases you must remind the client that what happens inside these walls are completely confidential and you are a professional doing your job to try and assist the individual.
It is sometimes hard to get the respect you need as a professional when the whole town knows your history as well.
I am excited to be in this class. I was enjoying to read others posted responses. As of today learning I found quite interesting the concept of "cooking" in its implementation to counseling theory. In fact if we all would cook the same meal with the same receipt, still outcome will vary. Our counseling style, our life outlook, our beliefs, moral and values are all play the major contributing factors to what extend we can be supportive to clients. " I cited this from the previous post "People will reflect back your feelings about them" and also would like to add that clients will reflect back our own feelings about ourselves. I believe that it is essential not only see positive sides in client but to maintain professional competency and show own self respect and dignity.
Saturday, September 12, 2009
I chose to title my blogs with the date of the class I am blogging on. This will help me keep track of each blog.
It is always exciting to start a new class, meet new people and learn the teaching styles of a new instructor.
I am eager to begin learning the ins and outs of substance abuse assessment writing, as well as hearing all of the input from other students. One of the students and I have been in the same class in the past and I enjoy her spiritual take on all aspects of life.
I read the Guide to Substance Abuse Services for Primary Care Clinicians. After doing so, I spoke with my doctor who has been providing medical care for me since i was born. I asked her if she has ever been trained in any sort of substance abuse prevention and what sort of knowledge does she have on the subject.
Apparently, Medical school does not have a curriculum on substance abuse. This worries me...espessially with the Narcotic Abuse Epidemic which is currently underway.
I look forward to discussing this subject in class because it is a huge issue at the agency in which I work as well as my personal life.
Friday, September 11, 2009
I thought her discussion on "the politics of substance abuse counseling" was enlightening, and another thing that stood out for me in the class was when she briefly mentioned working with court appointed clients that don’t really want help. I know we are all going to encounter this type of person. It will be difficult for me to work with a person who can think only of themselves and denies the spiritual values. When a person thinks they are right and everyone else is wrong, they do not seem to be mature enough to achieve the growth required for personal change.
Wednesday, September 9, 2009
Twice in this class the word spiritual was used. Once when asked what an addiction was, one student answered, “A spiritual disease that someone can’t change”. The next was in a very neat picture of the four areas that addiction affects, one being spiritual and the others physical, emotional and mental. Here the attention was centered on the physical where the medical model suggests that addiction happens in the physical and affects all the others. And the sad part is the place of money in treatment focus and who gets help. Since treatment centers get funded because addiction is viewed as a disease and insurance companies are required to pay them, I suspect that they will be supporting the medical model more than the AA spiritual one. We also heard that acceptance into a treatment center is driven by funding from the government, which requires that over 80% of those entering treatment complete the program. I have been disillusioned but not discouraged. I have no doubt that there is a spiritual power within each of us that vitalizes, heals, and supports growth.
A friend of mine on his 50 plus birthday (he didn’t give up his age) said, “Aging is great. We just keep getting smarter. We can’t help it.” That is the spiritual element spontaneously happening in our lives. Still, as dual diagnosis was mentioned in the class I must say that our medical profession has made recovery possible for those who would not have a chance without a prescription. In the end I felt great relief to hear that our professor believed in a holistic model including, spiritual, mental, physical, and emotional healing. We could argue in which order these come in importance, but I prefer to agree with this holistic approach with the client steering what comes first for them.