Announcements Unit 6 project due by midnight on

Tuesday Another case study – similar questions

as on the previous projects Similar rules & requirements Make sure you read the project

description and grading rubrics carefully Incorporate my comments from previous

projects

Unit 6 – Special Populations In this unit, you will examine the needs

of special populations, including grief services, emotional and mental health services, and medical needs services.

Special populations have a unique set of issues to address and often need unique services. One such example is grief services for a child who has lost a loved one or is dealing with an impending loss because of a terminal illness.

Unit 6 – Special Populations Special populations may also need mental

health services. Some mental health issues are hereditary or familial, so the advocate may be dealing with multiple generations of mental health issues.

Special populations – often more than other populations – really need multidisciplinary interventions (collaboration with many resources)

Unit 6 – Overview Grief Advocacy Mental Health Family Role Putting it together…

AssessmentIntakeFamily History

Grief Advocacy Two articles posted in Doc Sharing about

working with grieving children How the grieving process may unfold for

a child depends on age, resiliency, and developmental level.

 Some children grieve immediately, while others grieve sporadically or delay acknowledging their feelings of loss

Grief isn’t always after death – could be after any kind of “loss” (divorce for example)

Types of Losses

Objects Relationships

Temporary Permanent

Grief process for children  Although not always in an exact sequential

process, children may experience the following emotions as a result of a loss.Denial that a loss occurred and project their anger

on someone or something else. Bargaining to reverse the loss (or possible loss).

For example, a child may internalize or vocalize that he/she will never again be mean to a younger sibling if Dad and Mom stay together.

Guilt and worry that they might have caused the loss.

Finally, sadness and depression must be constructively addressed before the child can accept the life change or before he/she can construct and reconstruct meaning of life

Children and Divorce

26% of children under the age of 18 live with a divorced parent.

39% of divorced women with children live in poverty

Civility among parents and assurance that both still love the children is helpful

Some need brief individual play therapy, others need family counselingTo alleviate or address emotional/or behavioral

problems associated with adjustment to divorce

Mental Health Services

Mental health and school counselors may work with clients on a variety of issues including depression, anxiety, eating disorders, Posttraumatic Stress Disorder, and clients with suicidal or homicidal thoughts.

Depression Depression is one of the most common client

issues a counselor encounters. Nearly 15 million, or approximately 7%, of adults in

the United States experience depression annually Depression is characterized by:

Persistent feelings of sadness or irritability Loss of interest in hobbies, work, and sexual activitySleep disturbance Appetite increases or decreases Isolating from family and friendsCrying spellsFeelings of hopelessnessNeglect of personal hygiene

Anxiety Anxiety is another commonly encountered

client issue. In the United States, 3% of the adult population

experiences Generalized Anxiety Disorder, 3% experiences Panic Disorder, and 7% experiences Social Phobia in their lifetime

Anxiety is characterized by:Excessive or constant worryRestlessnessIrritabilityDisturbed sleep

Eating Disorders Two common types of eating disorders

are Anorexia Nervosa and Bulimia Nervosa.

Anorexia Nervosa is characterized by a client’s refusal to maintain minimally normal body weight, a fear of gaining weight, and distorted perceptions of body size and shape.

Bulimia Nervosa involves binge eating and inappropriate compensatory measures to prevent or reduce weight gain.

Mental Health Treatment Settings

Inpatient or hospital-based treatment facilities provide 24-hour care to clients in acute crisis situations, such as:Clients who are suicidal or homicidalClients with mental illnesses such as

Schizophrenia or Bipolar Disorder who are dealing with psychosis or manic episodes

Clients who suffer from severe eating disorders and are at risk medically

Clients with substance dependence issues who need inpatient detoxification to reduce the medical risk associated with withdrawal symptoms

Mental Health Treatment Settings

Intensive outpatient treatment is appropriate for clients who are functioning at a high level but need more intensive treatment than outpatient therapy is able to provide.

Outpatient treatment typically consists of weekly or bi-weekly sessions with a professional counselor and the sessions usually are an hour in length.

What is a Family?

Persons biologically and/or psychologically related through historical, emotional, or economic bonds who perceive themselves to be part of a household.

(Gladding, 2007)

Different Types of Families & Their Issues Minority Ethnic

Families Dual-Career Families Single-Parent

Families Childless Families Remarried Families

Gay & Lesbian Families

Aging Families Multigenerational

Families Military Families

Family Life Stressors Vertical Stressors

HistoricalInherited

Horizontal StressorsIn the PresentDevelopmental ORUnexpected

Expected Life StressorsDevelopmental Situational

Unexpected Life StressorsCatch by surpriseNon-events or altered

time of developmental events

Research Family Therapy

At least as effective as individual workMore durable results than individual workIncreased chance of success with some issuesPresence of both parents increases success

ratePresence of both partners increases success

ratesFamily counseling not offered to

couples/families systematically may worsen problems

(Pinsoff & Wynne, 1995, 2000)

Bringing it Together… Assessment is a broad term that includes

many structured and unstructured processes for gathering information to understand the issues that bring people to counseling.

Case conceptualization refers to how professional advocates understand the nature of clients’ concerns, how and why the problems developed, and the types of interventions that might be helpful.

Assessment Assessment is the process of gathering

information in a systematic way to evaluate concerns or questions that a client brings to counseling.

Assessment includes:Intake interviewsTests and inventoriesBehavioral observationsRelevant information gathered from other sources

Assessment The assessment process informs

diagnostic formulation and counseling plans, and helps to identify resources that could help the client better cope with the presenting concern.Determining what information to gather is an

important assessment skillMust be holistic – include family history, family

behavior patterns, situational issues LOTS of different assessment types and

options – see Chapter 11

Intake Interviews While testing is one form of assessment, the

counseling interview is a hallmark of the counseling process.

The formality and the content of the intake interview will be determined by the context in which the interview occurs

The intake interview has three prime objectives:1. Identifying, evaluating and exploring the client’s chief

complaint and associated counseling goals2. Obtaining a sense of the client’s interpersonal style,

interpersonal skills, and personal history3. Evaluating the client’s current life situation and

functioning

Case Conceptualization Case conceptualization refers to the way that

professional counselors make meaning out of the information they have gathered.

Formulating a case conceptualization involves:Identifying patterns and themes associated with the

information gathered during the assessment phasesApplying a theoryConsidering how issues such as race, ethnicity, religious

beliefs, socioeconomic status, family structure, trauma and/or sexual and gender orientation impact a client’s presenting concerns

Assessing a client’s motivation for counseling

Treatment Planning A good treatment plan requires an

assessment appropriate to the client’s presenting concerns and a case conceptualization that includes an understanding of what the problem is, how it developed, and how to deal with the problem.

The formality of a treatment plan and the actual form that it takes varies from setting to setting.

An advocate should always be able to answer the question, “What are you trying to accomplish?”

Treatment Plans The format of a treatment plan will depend on the

setting in which you work. A three tiered system is a treatment plan that

outlines goals, objectives and interventions or strategies. Goals are broad statements of desired outcomesObjectives are statements of observable and

measurable outcome targetsInterventions are specific strategies designed to meet

the above objectives For each goal, objectives are identified that will help

the client reach the goal. For each objective, strategies are identified that will help the client reach the objective.

The bio-psycho-social model Interrelated, integrated roles of biology,

psychology, and social/cultural factors Biological components

Physical, biochemical, genetic factors

Psychological components Patterns of thinking, coping skills, perceptions, emotional

intelligence, temperament, personality characteristics

Social/cultural components Family relationships, support systems, work relationships,

broader cultural environment