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1 www.qprinstitute.com/joomla Sign up for an account using the special code given to you to access the materials. To access the course materials click “learning paths”

2 You get to this page by clicking “Learning Paths”

3 www.qprinstitute.com “QPR Instructor Resources”, password: “listen”

4 EMS Instructor Materials next slide www.qprinstitute.com “QPR Instructor Resources”, password: “listen”

5 EMS Instructor Materials

6 WELCOME COLORADO EMS SUICIDE PREVENTION SPECIALIST TRAINING

7 Before we get started I want you to c heck out the 3 people sitting nearest to you.

8 Introduction Depending on your relationship with those being trained, I would recommend a brief introduction of yourself. I like to answer the questions; “Who is the person standing up there training me?” “Why should I believe him/her?” “What does he/she have to teach me and where did they acquire this information?” Depending on your relationship with those being trained, I would recommend a brief introduction of yourself. I like to answer the questions; “Who is the person standing up there training me?” “Why should I believe him/her?” “What does he/she have to teach me and where did they acquire this information?”

9 Take Out Your Packets Just Like It’s Your Birthday!

10 Taking Care of Yourself. Suicide is personal Suicide is personal Many of you may be survivors Many of you may be survivors Some may be attempt survivors Some may be attempt survivors This training can be difficult This training can be difficult Take care of yourself during this training. Take care of yourself during this training.

11 Raise your hand if… Wait until all questions asked Have you ever thought about suicide? Have you ever thought about suicide? Do you know someone who has? Do you know someone who has? Do you know anyone who has made a suicide attempt? Do you know anyone who has made a suicide attempt? or even died by suicide? or even died by suicide? Are you worried, right now, that someone you know is thinking about suicide? Are you worried, right now, that someone you know is thinking about suicide?

12 Prerequisite online learning QPR Gatekeeper for Suicide Prevention Certificate QPR Gatekeeper for Suicide Prevention Certificate Understand suicide as a major public health problem Understand suicide as a major public health problem Name major suicide prevention organizations and access their web sites Name major suicide prevention organizations and access their web sites Recognize someone at risk of suicide Recognize someone at risk of suicide Recognize at least three suicide warning signs Recognize at least three suicide warning signs

13 Demonstrate increased knowledge, skill and self- efficacy in the application of QPR Demonstrate increased knowledge, skill and self- efficacy in the application of QPR Know how to engage and assist a suicidal colleague or co-worker Know how to engage and assist a suicidal colleague or co-worker Understand the common myths and facts surrounding suicidal behavior Understand the common myths and facts surrounding suicidal behavior Describe and name multiple local or state referral resources Describe and name multiple local or state referral resources Understand means restriction and how to immediately reduce risk Understand means restriction and how to immediately reduce risk

14 Recognize and identify at least three risk factors for suicide Recognize and identify at least three risk factors for suicide Recognize and identify at least three protective factors against suicide Recognize and identify at least three protective factors against suicide Understand the nature of suicide Understand the nature of suicide Engage in an interactive and helpful conversation with someone who has attempted suicide Engage in an interactive and helpful conversation with someone who has attempted suicide Engage in an interactive and helpful conversation with the loved ones or family members of someone who has died by suicide Engage in an interactive and helpful conversation with the loved ones or family members of someone who has died by suicide

15 Classroom learning goals Understand risk factors and warning signs associated with suicide Understand risk factors and warning signs associated with suicide Understand the nature of suicide Understand the nature of suicide Recognize risk factors associated with exposure to trauma Recognize risk factors associated with exposure to trauma Understand the need for and identify various strategies for self-care Understand the need for and identify various strategies for self-care

16 Respond to suicide attempt survivors Respond to suicide attempt survivors Help suicide survivors (family members left behind) Help suicide survivors (family members left behind) Help fellow EMS providers who may be having suicidal thoughts Help fellow EMS providers who may be having suicidal thoughts Identifying local and national suicide prevention resources Identifying local and national suicide prevention resources

17 Clump Up Why you are here Why you are here What has your experience taught you What has your experience taught you Share what you learned from the online material Share what you learned from the online material What do you still want to know What do you still want to know About suicide About suicide About teaching this material About teaching this material

18 Training others to be EMS Suicide Prevention Specialists (EMS SPS) The minimum training required to be awarded an EMS SPS certificate is five (5) hours The minimum training required to be awarded an EMS SPS certificate is five (5) hours The course can be taught entirely by the Instructor using the materials and audio visual aids, provided the EMS SPI is also a QPR Certified Gatekeeper Instructor. The course can be taught entirely by the Instructor using the materials and audio visual aids, provided the EMS SPI is also a QPR Certified Gatekeeper Instructor.

19 If not a QPR Certified Instructor, those earning a certificate as an EMS Suicide Prevention Specialist must complete Minimum of two (2) hours of online training Minimum of two (2) hours of online training Minimum of three (3) hours of classroom training Minimum of three (3) hours of classroom training Pass all online and classroom quizzes and exams as determined by the EMS SPI Pass all online and classroom quizzes and exams as determined by the EMS SPI Participate in role-plays and exercises Participate in role-plays and exercises See sample training schedule in packet See sample training schedule in packet

20 QPR Institute Training for Everyone To create safer communities means training at all levels: To create safer communities means training at all levels: - QPR Citizen Gatekeeper Training and Instructor Certification Course - QPR Suicide Triage Training and Instructor Training Course for 1st responders (e.g., QPR for EMS) - QPRT Suicide Risk Assessment training for health care professionals - QPRT for physicians and nurses

21 QPR Colorado EMS SPS Classroom Training

22 Classroom Material Schedule Introduction and overview Introduction and overview Brief review of QPR and online materials Brief review of QPR and online materials Suicide in Colorado Suicide in Colorado Understanding Suicide Understanding Suicide Local Resources Local Resources Role-plays Role-plays Self care Self care

23 Suicide in Colorado 34,598 suicide in United States in 2007 34,598 suicide in United States in 2007 Or 94.8 a day for a rate of 11.5 Or 94.8 a day for a rate of 11.5 940 suicides in Colorado in 2009 940 suicides in Colorado in 2009 Or 2.6 a day for a rate of 18.4 Or 2.6 a day for a rate of 18.4 Colorado ranked 6 th in 2007 Colorado ranked 6 th in 2007 Up from a ranking of 9 th in 2006 Up from a ranking of 9 th in 2006

24 In Colorado in 2009 940 people died by suicide 940 people died by suicide 190 people died by homicide; 8 by legal intervention 190 people died by homicide; 8 by legal intervention 15 children age 4 or younger were a victim of homicide 15 children age 4 or younger were a victim of homicide 7 people died of unintentional firearm injuries 7 people died of unintentional firearm injuries Suicide is the second leading cause of death and homicide is the third leading cause of death for young Coloradans ages 15-34. Suicide is the second leading cause of death and homicide is the third leading cause of death for young Coloradans ages 15-34. Health Statistics Section, Colorado Department of Public Health and Environment

25 Colorado Suicide 2005 - 2009 Health Statistics Section, Colorado Department of Public Health and Environment

26 UNDERSTANDING SUICIDE Provide a leading theory to better understand suicide Provide a leading theory to better understand suicide Teach the three necessary conditions for a suicide event to occur Teach the three necessary conditions for a suicide event to occur Demystify and de-stigmatize suicide by bringing the behavior into the range of understandable human behavior Demystify and de-stigmatize suicide by bringing the behavior into the range of understandable human behavior

27 Underlying Principles Suicide is not the great mystery that it has been made out to be. Suicide is not the great mystery that it has been made out to be. The basic components of suicide are knowable. The basic components of suicide are knowable. When we understand these components we can act with more confidence. When we understand these components we can act with more confidence. Informed interventions save lives. Informed interventions save lives.

28 Suicidal Behavior Means someone is in extreme pain and suffering Means someone is in extreme pain and suffering Means complex feelings and behavior Means complex feelings and behavior Involves many reasons and factors Involves many reasons and factors Means coming at it from many directions Means coming at it from many directions This training is just one those directions This training is just one those directions

29 Nature of suicide and Joiner’s new theory… Psychic suffering (Psyche-ache) Psychic suffering (Psyche-ache) Hopelessness Hopelessness Unbearable mental anguish Unbearable mental anguish Cognitive constriction Cognitive constriction Grossly impaired problem solving ability Grossly impaired problem solving ability Feeling a burden to others Feeling a burden to others Thwarted belongingness Thwarted belongingness Acquired capacity for self-injury and habituation to pain Acquired capacity for self-injury and habituation to pain T. Joiner, Why People Die by Suicide, 2006

30 Understanding Suicide Based on the work of Thomas Joiner, PhD and his book Why People Die by Suicide

31 Underlying Principles Suicide is not the great mystery that it has been made out to be Suicide is not the great mystery that it has been made out to be The basic components of suicide are knowable The basic components of suicide are knowable When we understand these components we can act with more confidence When we understand these components we can act with more confidence Informed interventions save lives Informed interventions save lives It’s what we don’t know that we don’t do, and what we don’t do costs us lives unnecessarily lost.

32 Basics of Suicide and Serious Attempts Two major components associated with suicide and serious attempts Two major components associated with suicide and serious attempts The desire to die and The desire to die and the capacity for self harm the capacity for self harm Two elements within the desire to die Two elements within the desire to die Perceived burdensomeness Perceived burdensomeness A sense of thwarted or low belongingness A sense of thwarted or low belongingness

33 Serious Attempt or Death by Suicide Those Who Desire Suicide Those Who Are Capable of Suicide Sketch of the Theory

34 Acquired Capacity for Suicide Suicidal behavior is not just about the desire to die Suicidal behavior is not just about the desire to die It requires the capacity to inflict self injury It requires the capacity to inflict self injury

35 The Acquired Capability to Enact Lethal Self-Injury This capacity is acquired over time This capacity is acquired over time Accrues with repeated and escalating experiences involving pain and provocation, such as Accrues with repeated and escalating experiences involving pain and provocation, such as Past suicidal behavior, but not only that… Past suicidal behavior, but not only that… Repeated injuries Repeated injuries Repeated witnessing of pain, violence, or injury (i.e.. physicians, EMS, ED nurses, and law enforcement personnel) Repeated witnessing of pain, violence, or injury (i.e.. physicians, EMS, ED nurses, and law enforcement personnel) Any repeated exposure to pain and provocation. Any repeated exposure to pain and provocation.

36 The Acquired Capability to Enact Lethal Self-Injury According to Joiner, with repeated exposure, one habituates – the “taboo” and prohibited quality of suicidal behavior diminishes, and so may the fear and pain associated with self- harm According to Joiner, with repeated exposure, one habituates – the “taboo” and prohibited quality of suicidal behavior diminishes, and so may the fear and pain associated with self- harm

37 What do tattoos mean?

38 Tattoos and Suicide In a case-controlled study comparing accidental deaths to suicides, people who died by suicide were more likely to have tattoos (Dhossche, Snell, & Larder, 2000). In a case-controlled study comparing accidental deaths to suicides, people who died by suicide were more likely to have tattoos (Dhossche, Snell, & Larder, 2000). Could it be that the eventual suicide victims obtained increased capacity for suicide partly via painful and provocative experiences, such as tattooing, piercing, etc.? Could it be that the eventual suicide victims obtained increased capacity for suicide partly via painful and provocative experiences, such as tattooing, piercing, etc.?

39

40 Deliberate self-harm and suicide Evidence: Evidence: - People who have experienced or witnessed violence or injury have higher rates of suicide – prostitutes, self-injecting drug abusers, people living in high-crime areas, physicians - People who have experienced or witnessed violence or injury have higher rates of suicide – prostitutes, self-injecting drug abusers, people living in high-crime areas, physicians - Those with a history of suicide attempt have higher pain tolerance than others

41 Components of the Desire for Death Perceived Burdensomeness Perceived Burdensomeness Thwarted Belongingness Thwarted Belongingness

42 Perceived Burdensomeness Feeling ineffective to the degree that others are burdened is among the strongest sources of all for the desire for suicide Feeling ineffective to the degree that others are burdened is among the strongest sources of all for the desire for suicide

43 Suicide lightens the load the rest of us carry…. Research: Brown, Comtois, & Linehan (2000) reported that genuine suicide attempts were often characterized by a desire to make others better off, whereas non-suicidal self-injury was often characterized by desires to express anger or punish oneself …

44 Thwarted or Low Belongingness The need to belong to valued groups or relationships is a powerful, fundamental, and extremely pervasive human motivation The need to belong to valued groups or relationships is a powerful, fundamental, and extremely pervasive human motivation When this need is thwarted, numerous negative effects on health, adjustment, and well-being have been documented When this need is thwarted, numerous negative effects on health, adjustment, and well-being have been documented

45 Thwarted Belongingness The need to belong is so powerful that, when satisfied, it can prevent suicide -- even when perceived burdensomeness and the acquired ability to enact lethal self-injury are present… The need to belong is so powerful that, when satisfied, it can prevent suicide -- even when perceived burdensomeness and the acquired ability to enact lethal self-injury are present… By the same token, when the need is thwarted, risk for suicide is increased By the same token, when the need is thwarted, risk for suicide is increased

46 Thwarted Belongingness: Empirical Evidence Hoyer and Lund (1993) studied nearly a million women in Norway; over the course of a 15-year follow-up, over 1,000 died by suicide Hoyer and Lund (1993) studied nearly a million women in Norway; over the course of a 15-year follow-up, over 1,000 died by suicide They reported that women with six or more children had one-fifth the risk of death by suicide as compared to other women They reported that women with six or more children had one-fifth the risk of death by suicide as compared to other women

47 Serious Attempt or Death by Suicide Those Who Desire Suicide Those Who Are Capable of Suicide Perceived Burdensomeness Thwarted Belongingness

48 Prevention/Treatment Implications The model’s logic is that prevention of “acquired ability” OR of “burdensomeness” OR of “thwarted belongingness” will prevent serious suicidality The model’s logic is that prevention of “acquired ability” OR of “burdensomeness” OR of “thwarted belongingness” will prevent serious suicidality Increasing belongingness may be the protective factor one can influence the most and quickest Increasing belongingness may be the protective factor one can influence the most and quickest Example PSA: “Keep your old friends and make new ones – it’s powerful medicine” Example PSA: “Keep your old friends and make new ones – it’s powerful medicine”

49 Questions and discussion?

50 RESPONDING TO SUICIDAL PEOPLE AND THEIR LOVED ONES The following structured interactive discussion session is intended to assist you by reviewing the training received online in this area. The following structured interactive discussion session is intended to assist you by reviewing the training received online in this area. Through role-plays you can practice and share strategies for dealing with those who have attempted suicide and the families and loved ones of both attempt survivors and those who complete suicide Through role-plays you can practice and share strategies for dealing with those who have attempted suicide and the families and loved ones of both attempt survivors and those who complete suicide

51 Finally this section is to minimize your experience of secondary trauma in responding to suicide events. Finally this section is to minimize your experience of secondary trauma in responding to suicide events.

52 Review Being emotionally present Being emotionally present Accurate empathy Accurate empathy Genuineness Genuineness Unconditional positive regard (NO Judgment!) Unconditional positive regard (NO Judgment!) Active listening Active listening Reflecting Reflecting Open ended questions Open ended questions Problem solving Problem solving Plan of Action Plan of Action

53 The definition of few terms Survivors of suicide: Committed suicide He took his own life She ended her own life She died by suicide

54 First responders may face any of the three following scenarios: A person who may be suicidal and have recognized warning signs A person who may be suicidal and have recognized warning signs A person who has just attempted suicide or attempted in recent past A person who has just attempted suicide or attempted in recent past Family, friends of someone who has attempted suicide or dies by suicide Family, friends of someone who has attempted suicide or dies by suicide

55 On the way to the ED Distressed person after a suicide attempt: “I just can’t take it anymore. My father is cold and distant and never listens to me when I’m upset. It’s like he can’t stand to be around me when I express my feelings.” Distressed person after a suicide attempt: “I just can’t take it anymore. My father is cold and distant and never listens to me when I’m upset. It’s like he can’t stand to be around me when I express my feelings.” You: “It sounds like your dad doesn’t listen to you when you say what you feel.” You: “It sounds like your dad doesn’t listen to you when you say what you feel.” Distressed person: “Right. You got that right!” Distressed person: “Right. You got that right!”

56 Distressed person: “Now that you how hard it is for me to ever talk to my dad, maybe you can see why we can’t spend any time together. If I get the least bit upset, he’s going to blow up.” Distressed person: “Now that you how hard it is for me to ever talk to my dad, maybe you can see why we can’t spend any time together. If I get the least bit upset, he’s going to blow up.” You: “So anytime you get upset, or show your feelings, your dad seems to withdraw or shut you down. Does he sometimes just leave the scene?” You: “So anytime you get upset, or show your feelings, your dad seems to withdraw or shut you down. Does he sometimes just leave the scene?”

57 What do you say to the family? Discuss Discuss Boot camp “In your experience” Boot camp “In your experience” Scenarios students have experienced? Scenarios students have experienced? Thoughts what would you add to what others have said? Thoughts what would you add to what others have said? Building consensus - we’re learning how to do this together Building consensus - we’re learning how to do this together

58 Suicidal Language Putting it in context Without understanding the context, it is difficult to understand the message…

59 Which of the following is a suicide warning sign? “I’m going to blow my brains out.” “I’m going to blow my brains out.” “I just can’t stand it anymore.” “I just can’t stand it anymore.” If either is a suicide warning sign, which statement requires immediate and urgent intervention? If either is a suicide warning sign, which statement requires immediate and urgent intervention?

60 Content vs. Context “I’m going to blow my brains out!” “I’m going to blow my brains out!” Is sitting in your office in a psychiatric hospital “I just can’t stand it anymore.” “I just can’t stand it anymore.” Is standing well out of arm’s reach on the edge of 10- story building Now… which person needed immediate and aggressive intervention?

61

62 Help reduce confusion… Risk Factor? Risk Factor? Protective Factor? Protective Factor? Warning sign? Warning sign? Clue? Clue? Threat? Threat? Suicidal Communication? Suicidal Communication? Clear statement, coded or hidden? Clear statement, coded or hidden?

63 What are these? “I’m going to kill myself!” “I’m going to kill myself!” Buying a gun. Buying a gun. Pointing a loaded gun at your head. Pointing a loaded gun at your head. Giving away prized possessions. Giving away prized possessions. Heavy drinking when you are clinically depressed. Heavy drinking when you are clinically depressed. Telling your friends what kind of music you want at your funeral when are apparently healthy. Telling your friends what kind of music you want at your funeral when are apparently healthy. Saying goodbye, a kiss and hug from a teenaged boy. Saying goodbye, a kiss and hug from a teenaged boy. “If a person kills himself, does he go to hell?” “If a person kills himself, does he go to hell?”

64 Steven Pinker – The Stuff of Thought The need for indirect speech – the speaker says something he/she doesn’t mean literally knowing the hearer will interpret what was intended and correctly interpret what was meant. The need for indirect speech – the speaker says something he/she doesn’t mean literally knowing the hearer will interpret what was intended and correctly interpret what was meant. All humans know how to “read between the lines” See, Politeness Theory (Politeness: Some Universals in Language Use – Brown & Levinson, 1987) All humans know how to “read between the lines” See, Politeness Theory (Politeness: Some Universals in Language Use – Brown & Levinson, 1987) Context is everything…. Context is everything….

65 We are all very nice… When lost and we need to ask a stranger for directions, “Excuse me…” When lost and we need to ask a stranger for directions, “Excuse me…” “Would you like to come and see my etchings? “Would you like to come and see my etchings? “Would you like to come up for coffee?” “Would you like to come up for coffee?” “Polite indirect speech can use any hint that cannot be pinned down as a request by its literal content, but that can lead an intelligent hearer to infer its intended meaning…” SP, 2006.

66 Our job? To make hearers of suicidal communications, polite requests for rescue, or for help from one’s community or significant others understood so that positive actions can follow. To make hearers of suicidal communications, polite requests for rescue, or for help from one’s community or significant others understood so that positive actions can follow. Plausible deniability: Plausible deniability: “Can you pass the salt?” vs. “The chowder is pretty bland.” Or, “They never have enough salt in this restaurant.”

67 Forms of communications: Off record requests in context… Hints “Lions could hide in the lawn.” Hints “Lions could hide in the lawn.” Understatements “You got a real nice store here. It would be too bad if something happened to it.” Understatements “You got a real nice store here. It would be too bad if something happened to it.” Idle generalizations “It’s too dark to read in here.” Idle generalizations “It’s too dark to read in here.” Rhetorical questions “It looks like someone has had too much to drink?” Rhetorical questions “It looks like someone has had too much to drink?”

68 Examples from real cases… Parishioner to Pastor, “Do people who kill themselves go to hell?” Parishioner to Pastor, “Do people who kill themselves go to hell?” Catholic woman to best friend, “It’ll be fine, I’ve seen the virgin.” Catholic woman to best friend, “It’ll be fine, I’ve seen the virgin.” Patient to pharmacist, “Are you sure this is enough medicine to cause death?” Patient to pharmacist, “Are you sure this is enough medicine to cause death?” Patient to doctor, “You’ve been a wonderful doctor. Thanks for everything.” Patient to doctor, “You’ve been a wonderful doctor. Thanks for everything.”

69 Last words from real cases Depressed farmer to inpatient nurse on discharge, “Don’t worry about me, I’ll be six feet under by Friday.” Depressed farmer to inpatient nurse on discharge, “Don’t worry about me, I’ll be six feet under by Friday.” Depressed boy to mother, “Do you think God has a place in heaven for a boy like me?” Depressed boy to mother, “Do you think God has a place in heaven for a boy like me?” Father to son, “I’m going home soon.” Father to son, “I’m going home soon.” WWII vet to social worker, “Don’t worry, when the going gets tough the tough know what to do.” WWII vet to social worker, “Don’t worry, when the going gets tough the tough know what to do.”

70 Suicidal Communications - If you were suicidal, who would you tell? - How would you tell them? - How many times would you tell them? - What would you do if people did not respond? - How would you change your message if ignored?

71 QPR ROLE PLAY PRACTICE SESSION AND Q&A

72 QUESTIONS FOR THOSE WHO WERE “SUICIDAL” “What did you become aware of during the course of this exercise? “What did you become aware of during the course of this exercise?

73 QUESTIONS FOR THOSE WHO PRACTICED QPR “What did it feel like for you ask about suicide risk?” “What did it feel like for you ask about suicide risk?” “How comfortable were you?” “How comfortable were you?”

74 FIRST RESPONDER SELF CARE Provide a structured interactive discussion session in which students can recognize and discuss the stressful nature of their jobs Provide a structured interactive discussion session in which students can recognize and discuss the stressful nature of their jobs In small group discussion, review their personal coping skills and stress management strategies and brainstorm additional ones In small group discussion, review their personal coping skills and stress management strategies and brainstorm additional ones Help students identify where they can go to gain additional skills Help students identify where they can go to gain additional skills

75 What your peers said

76 It works if you work it Having someone to talk too about the stress and the feelings that build up inside so they don’t just one day explode Having someone to talk too about the stress and the feelings that build up inside so they don’t just one day explode Being around friends and family and just hanging out Being around friends and family and just hanging out Sitting by the fire with a few friends, telling stories, watching for the first star of the night and poking the fire with a stick Sitting by the fire with a few friends, telling stories, watching for the first star of the night and poking the fire with a stick

77 Taking walks, playing ball or other forms of exercise to clear out the tension Taking walks, playing ball or other forms of exercise to clear out the tension Going fishing, panning for gold, or other activities in order to spend some valuable time with yourself and clear your head Going fishing, panning for gold, or other activities in order to spend some valuable time with yourself and clear your head Meditation, prayer, yoga, and other spiritual or religious practices that can help provide a sense of peace and perhaps some perspective Meditation, prayer, yoga, and other spiritual or religious practices that can help provide a sense of peace and perhaps some perspective

78 Positive Coping Methods Number 1 at 35% Number 1 at 35% Peer and family support talking it out Peer and family support talking it out Number 2 at 30% Number 2 at 30% Physical activities, hunting, fishing, outdoors, exercise Physical activities, hunting, fishing, outdoors, exercise Other methods included Other methods included Faith/prayer/reflection Faith/prayer/reflection

79 Some not so positive coping 7% just walk away/move on to next call 7% just walk away/move on to next call 5% drugs and alcohol 5% drugs and alcohol Other comments included Other comments included Detach emotionally Detach emotionally Inadequate Inadequate Internalization Internalization Irrelevant Irrelevant

80 Getting help for yourself questions How do I know if help is warranted? How do I know if help is warranted? How bad do I have to feel before I ask for help? How bad do I have to feel before I ask for help? Isn't it better to "tough it out" with emotional problems? Isn't it better to "tough it out" with emotional problems? How do I pick a professional? Which kind? How do I pick a professional? Which kind?

81 More questions What's the difference between a social worker, psychologist, psychiatrist, and counselor? Whets a CD counselor? What's the difference between a social worker, psychologist, psychiatrist, and counselor? Whets a CD counselor? If I did make an appointment, what questions should I ask? If I did make an appointment, what questions should I ask? Will my insurance pay for the help I may need? Will my insurance pay for the help I may need?

82 Once in the office questions: What will happen on my first visit? What will happen on my first visit? Are things I should ask to get off to a good start? Are things I should ask to get off to a good start? Is it OK to get a second opinion if I don't like what I hear? Is it OK to get a second opinion if I don't like what I hear? How will I know what I need? How will I know what I need?

83 More questions Do I have to like the professional, and what if I don't? Do I have to like the professional, and what if I don't? What should I do if I'm disappointed? What should I do if I'm disappointed? Should I ask about the risks and benefits of the treatment proposed? Should I ask about the risks and benefits of the treatment proposed?

84 Last to recognize it How far do you push a friend, family How far do you push a friend, family Who can you go to, to protect confidentiality Who can you go to, to protect confidentiality Particularly in small towns Particularly in small towns

85 THANKS!


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