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Students will:

• Apply documentation skills to examine family therapy sessions *
• Develop diagnoses for clients receiving family psychotherapy *
• Analyze legal and ethical implications of counseling clients with psychiatric disorders *

* The Assignment related to this Learning Objective is introduced this week and submitted in Week 3.

Select two clients you observed or counseled this week during a family therapy session. Note: The two clients you select must have attended the same family session.

Then, address in your Practicum Journal the following:

• Using the Group Therapy Progress Note in this week’s Learning Resources, document the family session.
• Describe (without violating HIPAA regulations) each client, and identify any pertinent history or medical information, including prescribed medications.
• Using the Diagnostic and Statistical Manual of Mental Health Disorders, Fifth Edition (DSM-5), explain and justify your diagnosis for each client.
• Explain any legal and/or ethical implications related to counseling each client.
• Support your approach with evidence-based literature.

   Hello i need a Briefly, Good and Positive Comment for this post.Thank you.  I need at least two references.     

  

Alina 

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Practicum Experience: Addiction Issues and Depression

Treating substance and addiction disorders is an important step in helping the patient return to normal life. Fuentes & Hoffman (2016) explain that many patients may be suffering from growing addiction-related issues at younger ages than historically known. In my practicum experience, there have been patients that have comorbid symptoms including depression, anxiety, fatigue, and in extreme cases agoraphobia. When these patients present for the treatment they may not know the root cause of their condition nor all the comorbid symptoms. In some cases, the initial meeting establishes the scope of their condition as well as incumbent challenges they may not have identified earlier. This sets the parameters for a treatment approach that is relevant and specific to their needs. 

One patient that I met during practicum was a 43-year old caucasian male. He had lost his job during the early months of the year and was experiencing depression as a result of it. There are a lot of issues his family has faced resulting in him downsizing and moving in with his mother. The relationship between the two of them and the pressure to care for his ill father has added stress to the situation further. Aside from these problems he has developed an addiction to alcohol frequently having drinks several times throughout the day. 

These conditions and the patient’s perspective of hopelessness are some of the persisting circumstances in his life. These problems have continued for more than six months and have contributed to a sense of loss and a lack of self-worth. He used to be creative and make art projects with friends or coworkers. However, this has not been possible as he feels there is ‘no point to anything’. Instead, he has taken larger drinks more frequently over the past year. This was a remarkable example of his growing sense of despair that interferes with activities that may have been fun in the past. Davis et al. (2017) explain it is important to diagnose comorbid conditions early on to improve chances for patient improvement. According to DSM-V, the patient could have Major Depressive Disorder as well as Alcohol Use Disorder. With only three symptoms persisting for the specified amount of time the case would be mild. 

For this patient, two treatment options were suggested. Psychological therapy was offered on a weekly basis to help the patient rectify some of their underlying issues while addressing depression. In my experience, cognitive behavioral therapy is the most interesting because it offers a good solution for long-term symptom management. Acamprosate is a relatively new medication that makes the desire to drink lower for the patient. Choi et al. (2019) demonstrate the ability for this treatment to improve the chances of changing alcohol abuse over time. This is medication best regulated with small doses initially and increased based on how well the patient can handle it. At these early stages, the patient is willing to take the medication and will return for follow-up changes with treatment in the future. 

References 

Choi, B. Y., Lee, S. H., Choi, H. C., Lee, S. K., Yoon, H. S., Park, J. B., … & Suh, S. W. (2019). Alcohol dependence treating agent, acamprosate, prevents traumatic brain injury-induced neuron death through vesicular zinc depletion. Translational Research, 207, 1-18.

Davis, E. C., Rotheram-Borus, M. J., Weichle, T. W., Rezai, R., & Tomlinson, M. (2017). Patterns of alcohol abuse, depression, and intimate partner violence among township mothers in South Africa over 5 years. AIDS and Behavior, 21(2), 174-182.

Fuertes, J. N., & Hoffman, A. (2016). Alcohol consumption and abuse among college students: Alarming rates among the best and t

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Prior to beginning work on this discussion, review your textbook chapters and other required readings for this week: Implementing value-based payment reform: A conceptual framework and case examples, The Future of Capitation: The Physician Role in Managing Change in Practice (Links to an external site.), How to pay for health care: Bundled payments will finally unleash the competition that patients want, and The 8 Basic Payment Methods in Health Care. Be sure to also read the Insurance Model Quiz Show from your textbook in the Summary and Resources section.

There are four specific reimbursement methods in our health care system. For this discussion, you will write your initial post on one of the four methods as assigned (see the table below). Address the following in your initial post:

Explain why your method of reimbursement is the best method for the U.S. health care system.
Identify how this reimbursement model has evolved.
Determine how this reimbursement model has positively influenced cost, quality, and access of care.
Your original post should be at least 250 words using at least two scholarly sources supporting your viewpoint. For assistance, review the Understanding Insurance Models (Links to an external site.) game in the Chapter 3 Summary section of your textbook.

Reimbursement Method Last Name
Fee-for-service Student last name begins with A, E, H, O, V, Y
Capitation Student last name begins with B, I, L, N, P, W, Z
Pay-for-Performance Student last name begins with C, G, J, M, Q, S,
Value-Based Student last name begins with D, F, K, R, T, U, X
Guided Response: Respond to at least two of your classmates who have argued for two of the other methods. In your responses,

Debate with your peer why your method would benefit more in helping to control health care costs in the United States.
Rationalize, based on the pros and cons of your assigned method, why it is more beneficial than your peers’. Be sure to address its influence on cost, quality, and access to care.
Note: Your rebuttals should be at least 150 words.

Your quest to purchase a new car begins with an identification of the factors important to you. As you conduct a search of cars that rate high on those factors, you collect evidence and try to understand the extent of that evidence. A report that suggests a certain make and model of automobile has high mileage is encouraging. But who produced that report? How valid is it? How was the data collected, and what was the sample size?

In this Assignment, you will delve deeper into clinical inquiry by closely examining your PICO(T) question. You also begin to analyze the evidence you have collected.

To Prepare:

• Review the Resources and identify a clinical issue of interest that can form the basis of a clinical inquiry.
• Develop a PICO(T) question to address the clinical issue of interest you identified in Module 2 for the Assignment. This PICOT question will remain the same for the entire course.
• Use the key words from the PICO(T) question you developed and search at least four different databases in the Walden Library. Identify at least four relevant systematic reviews or other filtered high-level evidence, which includes meta-analyses, critically-appraised topics (evidence syntheses), critically-appraised individual articles (article synopses). The evidence will not necessarily address all the elements of your PICO(T) question, so select the most important concepts to search and find the best evidence available.
• Reflect on the process of creating a PICO(T) question and searching for peer-reviewed research.

The Assignment (Evidence-Based Project)

Part 2: Advanced Levels of Clinical Inquiry and Systematic Reviews

Create a 6- to 7-slide PowerPoint presentation in which you do the following:

• Identify and briefly describe your chosen clinical issue of interest.
• Describe how you developed a PICO(T) question focused on your chosen clinical issue of interest.
• Identify the four research databases that you used to conduct your search for the peer-reviewed articles you selected.
• Provide APA citations of the four relevant peer-reviewed articles at the systematic-reviews level related to your research question. If there are no systematic review level articles or meta-analysis on your topic, then use the highest level of evidence peer reviewed article.
• Describe the levels of evidence in each of the four peer-reviewed articles you selected, including an explanation of the strengths of using systematic reviews for clinical research. Be specific and provide examples.

  

Assignment:

Respond to at least two of your colleagues who were assigned a different disorder than you.

1. Compare the differential diagnostic features of the disorder you were assigned (Alcohol-Related Disorders) to the diagnostic features of the disorder your colleagues were assigned.

2. What are their similarities and differences? 

3. How might you differentiate the two diagnoses? 

4.  Support your responses with evidence-based literature with at least two references in each colleague’s response with proper citation in APA Format. 

Colleagues Response # 1

Diagnostic Criteria for Hallucinogen-Related Disorders

 Phencyclidine (PCP) use disorder is characterized by a pattern of use that leads to extreme dysfunction, occurs within 12 months and is manifested by at least two of the following: more PCP is taken or taken for longer than intended; continuous want or inability to control use; much time is spent obtaining, using or recovering from PCP; strong urge to use PCP; PCP use resulting in inability to carry out responsibilities at work, school or home; continuing to use PCP despite persistent dysfunctional social or interpersonal problems secondary to the effects of PCP; abandonment or decreased attendance of activities secondary to PCP use; continuous use despite it being unsafe; continued PCP use despite having a physical or psychological problem caused by PCP; tolerance as evidenced by need for more amount of PCP to reach desired effect and/or a decrease effect when using the same amount (American Psychiatric Association [APA], 2013).  Other Hallucinogen Use Disorder has the same diagnostic criteria as phencyclidine use disorder except the substance is a hallucinogenic other than phencyclidine (APA, 2013).   

Psychotherapy and Psychopharmacologic Treatment for Hallucinogen use disorder

 Hallucinogens can have acute and chronic adverse reactions.  An acute reaction that can occur is intoxication.  When intoxication occurs it causes perceptual and dysfunctional behavioral changes as well as physiological symptoms, such as palpitations, tremors, incoordination, sweating, tachycardia and blurred vision (Sadock, Sadock & Ruiz, 2014).  The initial treatment is called the “talk down” technique; it is when a provider offers reassurance in a calm and supportive tone telling the patient that the symptoms are drug induced and will be over soon (Gabbard, 2014).  If medications are needed in acute intoxication, benzodiazepines can be administered (Gabbard, 2014).  If the patient does not respond to the benzodiazepine, an antipsychotic can be administered (Sadock, Sadock & Ruiz, 2014).  Antipsychotics must be used with caution secondary to their ability to lower the seizure threshold (Gobbard, 2014).  

 A chronic adverse reaction can occur when psychosis or delirium continues from weeks to years after use (Gobbard, 2014).  The continuation of symptoms should alert providers to perform a psychiatric assessment.  Oftentimes, prolonged reactions occur as a result of psychiatric illness, continuous use of hallucinogens or poor premorbid adjustment (Gobbard, 2014).  The pharmacological treatment remains the same for long-term reaction as an acute reaction; antipsychotic drugs (Gobbard, 2014).  

Evidence based psychotherapeutic approach for hallucinogen use disorder is cognitive behavioral therapy (CBT) (McKay, 2020).  It is a widely used approach for many substance use disorders (SUDs).  CBT assists patients with SUDs by helping them change their cognitive beliefs and behaviors that make them susceptible to use (McKay, 2020).  It allows individuals with SUDs to gain more of an understanding of their triggers, behaviors and the reasons for them (McKay, 2020).  It also teaches them effective coping skills and motivates them to believe they have the ability to change (McKay, 2020).

Clinical Features Observed in a client with Hallucinogen use disorder

Expected observations in a client with hallucinogen use disorder include making excuses to use hallucinogens, such as a way to deal with stress; deciding to use hallucinogens instead of going to work or attending other obligations; continuing to use despite failing interpersonal relationships; feeling unwell when not using hallucinogens; an unkempt appearance; increased isolation from family and friends; continued use of hallucinogens despite palpitations and known tachycardia; feeling less effects of hallucinogens when using the same amount and becoming increasingly irritable. These clinical features align with the DSM-5 criteria mentioned above.  

Colleagues Response # 2

Opioid use disorder (OUD) is diagnosed in persons who misuse and abuse opiates to the point that they lose control and continue to use despite continuously incurring significant negative effects and other related problems.  Substance use disorders are complicated psychiatric conditions, and not a moral failing (Sadock, Sadock & Ruiz, 2014).  What turns voluntary use into the obsessive-compulsive use is a change in the structure and neurochemistry of the brain.   It is quite easy to become addicted to opiates as they are the drug of choice given by doctors worldwide for the relief of pain.

Cognitive Behavioral Therapy (CBT) is a psychosocial therapy that has been found to be very effective in treating Substance Use Disorder (SUD) relative to standard drug counseling in promoting abstinence from OUD (Barry et al., 2019).  Methadone is the pharmacological treatment of choice used for detoxing those who suffer with OUD.  Clonidine, Bentyl and Ibuprofen are also used as comfort medications.  Methadone along with Buprenorphine can also be used for maintenance therapy for those requiring medication-assisted therapy to continue with long-term sobriety.  Naloxone or Narcan is used in emergency cases of overdosing.  Naloxone is sprayed into the nostrils to knock the opiate off its receptors thus reversing the effects of the narcotics and restoring consciousness and respirations.

Physical manifestations of those with OUD include itching, dry mouth, facial flushing, and heaviness of extremities hence the nodding effect or the look that they are about to tip over.  Respiratory depression, pupillary constriction, and constipation are also associated with OUD.  Characteristics of those with the disorder involve impaired control, persistent drug-seeking behavior, social impairment, and recurrent substance use may result in a failure to fulfill major role obligations at work, school, or home (American Psychiatric Association, 2013).