2. 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

3. 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.

4. 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)

5. Unit 6 – Overview  Grief Advocacy  Mental Health  Family Role  Putting it together… Assessment Intake Family History

6. 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)

7. Types of Losses  Objects  Relationships  Temporary  Permanent

8. 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

9. 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 counseling To alleviate or address emotional/or behavioral problems associated with adjustment to divorce

10. 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.

11. 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 activity Sleep disturbance Appetite increases or decreases Isolating from family and friends Crying spells Feelings of hopelessness Neglect of personal hygiene

12. 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 worry Restlessness Irritability Disturbed sleep

13. 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.

14. 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 homicidal Clients 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

15. 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.

16. 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)

17. 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

18. Family Life Stressors  Vertical Stressors Historical Inherited  Horizontal Stressors In the Present Developmental OR Unexpected  Expected Life Stressors Developmental Situational  Unexpected Life Stressors Catch by surprise Non-events or altered time of developmental events

19. Research  Family Therapy At least as effective as individual work More durable results than individual work Increased chance of success with some issues Presence of both parents increases success rate Presence of both partners increases success rates Family counseling not offered to couples/families systematically may worsen problems (Pinsoff & Wynne, 1995, 2000)

20. 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.

21. 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 interviews Tests and inventories Behavioral observations Relevant information gathered from other sources

22. 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 skill Must be holistic – include family history, family behavior patterns, situational issues  LOTS of different assessment types and options – see Chapter 11

23. 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 goals 2. Obtaining a sense of the client’s interpersonal style, interpersonal skills, and personal history 3. Evaluating the client’s current life situation and functioning

24. 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 phases Applying a theory Considering 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

25. 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?”

26. 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 outcomes Objectives are statements of observable and measurable outcome targets Interventions 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.

27. 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